New HCPCS Modifiers Effective from Jan 1, 2020

New HCPCS Modifiers Effective from Jan 1, 2020

HCPCS Modifiers List 2020: MA Ordering professional is not required to consult a clinical decision support mechanism due to service being rendered to a patient with a suspected or confirmed emergency medical conditionMB Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of insufficient internet accessMC Ordering professional is…

UHC – Reimbursement Update to Vaccines for CPT 90461

UHC – Reimbursement Update to Vaccines for CPT 90461

As part of the Patient Protection and Affordable Care Act (PPACA) regulations, CPT 90461 code is not reimbursable for vaccines administered to Medicaid members through the Vaccines for Children (VFC) program in Florida. Beginning Aug. 15, 2019, any claim line billed for this code will be denied Source: https://www.uhcprovider.com/content/provider/en/viewer.html?file=%2Fcontent%2Fdam%2Fprovider%2Fdocs%2Fpublic%2Fresources%2Fnews%2F2019%2Fnetwork-bulletin%2FSeptember-2019-Network-Bulletin.pdf

Horizon BCBSNJ Reimbursement Guidelines Changes in Outpatient Laboratory Claims

Horizon BCBSNJ Reimbursement Guidelines Changes in Outpatient Laboratory Claims

Outpatient Laboratory Claims: Referring Practitioner Required In accordance with Centers for Medicare and Medicaid Services (CMS) guidelines, Horizon BCBSNJ requires that claims for clinical laboratory services report the referring practitioner on the claim submission. This applies to participating and non-participating providers. Effective November 15, 2019 Horizon BCBSNJ will change the way consider and reimburse certain clinical…

Screening and Diagnostic Mammography — Retired Part A and Part B LCD

Screening and Diagnostic Mammography — Retired Part A and Part B LCD

LCD ID number: L36342 (Florida/Puerto Rico/U.S. Virgin Islands) After review of the local coverage determination (LCD) for screening and diagnostic mammography, it was determined to retire the LCD based on national coverage determination (NCD) 220.4.  Therefore, the related coding guideline article is also being retired. Effective date: The retirement of this LCD and related coding…

2020 ICD-10 CM New Codes Effective from October 1, 2019

2020 ICD-10 CM New Codes Effective from October 1, 2019

New Codes: D75.A Glucose-6-phosphatedehydrogenase(G6PD)deficiencywithoutanemia D81.30 Adenosinedeaminasedeficiency,unspecified D81.31 Severecombinedimmunodeficiencyduetoadenosinedeaminasedeficiency D81.32 Adenosinedeaminase2deficiency D81.39 Otheradenosinedeaminasedeficiency I26.93 Singlesubsegmentalpulmonaryembolismwithoutacutecorpulmonale I26.94 Multiplesubsegmentalpulmonaryemboliwithoutacutecorpulmonale I48.11 Longstandingpersistentatrialfibrillation I48.19 Otherpersistentatrialfibrillation I48.20 Chronicatrialfibrillation,unspecified I48.21 Permanentatrialfibrillation I80.24 Phlebitisandthrombophlebitisofperonealvein I80.241 Phlebitisandthrombophlebitisofrightperonealvein I80.242 Phlebitisandthrombophlebitisofleftperonealvein I80.243 Phlebitisandthrombophlebitisofperonealvein,bilateral I80.249 Phlebitisandthrombophlebitisofunspecifiedperonealvein I80.25 Phlebitisandthrombophlebitisofcalfmuscularvein I80.251 Phlebitisandthrombophlebitisofrightcalfmuscularvein I80.252 Phlebitisandthrombophlebitisofleftcalfmuscularvein I80.253 Phlebitisandthrombophlebitisofcalfmuscularvein,bilateral I80.259 Phlebitisandthrombophlebitisofunspecifiedcalfmuscularvein I82.45 Acuteembolismandthrombosisofperonealvein I82.451 Acuteembolismandthrombosisofrightperonealvein I82.452 Acuteembolismandthrombosisofleftperonealvein I82.453 Acuteembolismandthrombosisofperonealvein,bilateral I82.459 Acuteembolismandthrombosisofunspecifiedperonealvein I82.46…

Stop Hepatitis B via HBsAg Screening in Pregnant Women

Stop Hepatitis B via HBsAg Screening in Pregnant Women

Screening for Hepatitis B (HBV) infection in pregnant women provides substantial benefit, reaffirms the U.S. Preventive Services Task Force (USPSTF) in their recommendation statement released last month. This determination follows their review of new evidence on the benefits and risks of screening for hepatitis B surface antigen (HBsAg). Serologic testing accurately identifies HBV infection and,…

United Healthcare Commercial Reimbursement Policy Updates effective from Sep 1st, 2019

United Healthcare Commercial Reimbursement Policy Updates effective from Sep 1st, 2019

Looking for the United healthcare physical therapy billing guidelines? The modifier “GN, GO or GP” will be required on Always for “Therapy codes” to align with the Centers for Medicare & Medicaid Services (CMS). According to CMS, certain codes are “Always Therapy” services regardless of who performs them, and always require a therapy modifier —…