Empire BlueCross BlueShield Professional Reimbursement Policy
|
|
- Amberlynn Hall
- 5 years ago
- Views:
Transcription
1 Subject: Frequency Editing NY Policy: 0016 Effective: 05/01/ /16/2015 Coverage is subject to the terms, conditions, and limitations of an individual member s programs or products and policy criteria listed below. DESCRIPTION The Health Plan uses claims processing logic based on ClaimsXten rationale to determine when the use of multiple units is appropriate. The Health Plan also uses, among other factors, the nomenclature for a particular Current Procedural Terminology (CPT ) or Healthcare Common Procedure Coding System (HCPCS Level II) code or the ability to clinically perform or report a particular service more than one time on a single date of service or within a particular date span per member per provider in making these determinations. POLICY 1. All or any of the following factors identify when a procedure will be limited in units, or number of times a code is eligible for reimbursement on a single date of service. a. The description of a procedure code includes the word(s) bilateral or unilateral or bilateral b. A procedure code description specifies unilateral and there is another CPT code for the bilateral service or another add-on code for additional services (the unilateral CPT code cannot be submitted more than once on a single date of service) c. The description of a procedure code includes a specified time frame (e.g. per 30 day period) d. The description of a procedure code implies multiplicity (e.g. evaluation(s); muscle(s); injection(s); area(s); material(s); etc.) e. The total number of times it is clinically possible or clinically reasonable to perform a given procedure on a single date of service is limited In some circumstances a RT/LT or site specific modifier ( e.g. F5, T3; etc.) will allow a code to process when used more than once, since these modifiers will identify the specific side or digit when more than one site is being treated or evaluated. f. A procedure code is reported more than one time, but typically is not performed more than once on a single date of service. 2. When a procedure code is submitted with multiple units, and only a single unit is acceptable, reimbursement will be based on only one unit. 3. The Health Plan will apply all unit/frequency edits pre-adjudication, using both the unit field and multiple submissions of line items. NY 0016 Page 1 of [7]
2 4. The Health Plan will apply a frequency edit, when applicable, to a base code which has a related addon code listed in CPT Appendix D. Since the related add-on code(s) describes a phrase such as each additional or list separately in addition to the primary procedure, the base code is eligible for reimbursement only once per date of service (e.g., only one of the following initial vaccine administration codes or is allowed per date of service.) 5. The Health Plan will apply some frequency edits across dates of service. 6. For Durable Medical Equipment (DME), the Health Plan will apply frequency maximums per day and/or per date span (usually based on the Centers for Medicare & Medicaid Services (CMS s) Medically Unlikely Edits (MUEs), industry standards, and/or HCPCS description). (See also our Durable Medical Equipment reimbursement policy.) 7. The Health Plan will apply some frequency maximums per day and/or per date span when procedures are within the same service grouping (e.g., unattended sleep studies and/or home sleep studies reported on the same date of service and/or within a seven day period will only be allowed one time during the seven day period; routine blood collection on the same date of service will be allowed once per date of service). The Health Plan has customized ClaimsXten unit/frequency logic for some procedure codes. Please see the table in the Coding Section for these customizations. CODING The following occurrence restrictions are examples of some frequency edits added to certain codes that do not fit into one of the categories identified in the policy section above, or the description of the code includes a designated time frame. Services billed in excess of these restrictions are not eligible for reimbursement even when billed with an override modifier (e.g., modifier 59 or modifier 91). The inclusion or exclusion of a specific code does not indicate eligibility for coverage under all circumstances Collection of venous blood by venipuncture ** limit includes 36415, 36416, and S Collection of capillary blood specimen (eg, finger, heel, ear stick) ** NY 0016 Page 2 of [7]
3 limit includes 36415, 36416, and S Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injections, localization device), imaging supervision and interpretation Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid) Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation Magnetic resonance guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per IMRT plan 77600, Hyperthermia, externally generated; superficial (i.e., heating to a depth of 4 cm or less) or deep (i.e., heating to depths greater than 4 cm) Unlisted molecular pathology procedure Level IV - Surgical pathology, gross and microscopic examination needle biopsy prostate Respiratory syncytial virus, monoclonal antibody, recombinant, for intramuscular use, 50 mg, each Fundus photography with interpretation and report 93268, 93270, Wearable patient activated EKG event recording 93271, , 93294, 93295, per 30 day period of time Transtelephonic rhythm strip pacemaker evaluation(s) system up to 90 days 9 units per date of service when reported for specimens related to needle biopsy of the prostrate 4 per date of service 1 per 30 days 1 per 90 days of service NY 0016 Page 3 of [7]
4 93297, 93298, Implantable cardiovascular monitor system, 1 per 30 days interrogation device evaluation(s) up to 30 days Doppler echocardiography color flow velocity 2 per date of service mapping 94014, 94015, Patient-initiated spirometric recording per 30 1 per 30 days day period of time 94774, 94775, Pediatric home apnea monitoring event 1 per 30 days 94776, recording per 30 day period of time Professional services for the supervision of 120 doses per 365 days preparation and provision of antigens for allergen immunotherapy; single or multiple antigens (specify number of doses) 95250, Continuous glucose monitoring 1 per 30 days of service Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (e.g., by airflow or peripheral arterial tone), and sleep time Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (e.g., by airflow or peripheral arterial tone) Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (eg, thoracoabdominal movement) Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities), per hour of the psychologist's or physician's time, both face-toface time with the patient and time interpreting test results and preparing the report 5 per 365 days NY 0016 Page 4 of [7]
5 96150, 96151, Health and behavior assessment/intervention; 8 per date of service 96152, 96153, each 15 minutes Additional sequential infusion, up to 1 hour 6 per date of service Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic Initiation of prolonged IV Chemotherapy administration (more than 8 hours) requiring the use of a portable or implantable pump 97012,97014, Physical medicine modalities 97016, 97018, 97022,97024, 97026, Physician attendance and supervision of hyperbaric oxygen therapy, per session for the administration of drugs such as omalizumab (Xolair ) 3 per date of service 99363, Anticoagulant management 1 per 90 days of service A4210 Needle-free injection device, each 2 per 365 days A4230 Infusion set for external insulin pump, non 60 per 90 days needle cannula type A4231 Infusion set for external insulin pump, needle 60 per 90 days type A4232 Syringe with needle for external insulin pump, 60 per 90 days sterile, 3CC A4244 Alcohol or peroxide, per pint 12 per 90 days A4245 Alcohol wipes, per box 24 per 90 days A4250 Urine test or reagent strips or tablets (100 tablets 4 per 90 days or strips) A4253 Blood glucose test or reagent strips for home 11 per 90 days blood glucose monitor, per 50 strips A4257 Replacement lens shield cartridge for use with 1 per 30 days laser skin piercing device, each A4258 Spring powered device for lancet, each 2 per 365 days A4259 Lancets, per box of per 90 days NY 0016 Page 5 of [7]
6 A4556 Electrodes (EG, Apnea Monitor), per pair 2 pair per 30 days A4557 Lead wires (EG, Apnea Monitor), per pair 4 pair per 365 days A4595 Electrical stimulator supplies, 2 lead, per month, 2 per 30 days (e.g., TENS, NMES) A6530 Compression stockings 8 per 365 days A6549 E0441, E0442, Oxygen one month s supply 1 per 30 days E0443, E0444 E1812 Dynamic knee, extension/flexion device, include 1 per 30 days soft interface material G0249 Provision of test materials and equipment for home INR monitoring includes: provision of materials for use in the home and reporting of test results to physician; testing not occurring more frequently than once a week; testing materials, billing units of service include 4 tests 3 per 90 days of service G0398 G0399 G0400 Home sleep study test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation Home sleep test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation] Home sleep test (HST) with type IV portable monitor, unattended; minimum of 3 channels J1560 Gamma globulin injection codes J7321, J7323, Hyaluronan or derivative for intra-articular 2 per date of service J7324, J7326 injection, per dose J9355 Injection, trastuzumab, 10 mg (Herceptin ) 95 units per date of service Q4101 Apligraf, per sq cm 44 per date of service NY 0016 Page 6 of [7]
7 S9529 Routine venipuncture for collection of specimen(s), single homebound, nursing home, or skilled nursing facility patient ** limit includes 36415, 36416, and S CPT is a registered trademark of the American Medical Association Use of Reimbursement Policy: This policy is subject to federal and state laws, to the extent applicable, as well as the terms, conditions, and limitations of a member s benefits. Reimbursement Policy is constantly evolving and we reserve the right to review and update these policies periodically. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, or otherwise, without permission from the health plan Empire BlueCross BlueShield NY 0016 Page 7 of [7]
Empire BlueCross BlueShield Professional Commercial Reimbursement Policy
Subject: Frequency Editing NY Policy: 0016 Effective: 03/01/2016 04/30/2016 Coverage is subject to the terms, conditions, and limitations of an individual member s programs or products and policy criteria
More informationEmpire BlueCross BlueShield Professional Commercial Reimbursement Policy
Subject: Frequency Editing NY Policy: 0016 Effective: 01/01/2017 02/28/2017 Coverage is subject to the terms, conditions, and limitations of an individual member s programs or products and policy criteria
More informationEmpire BlueCross BlueShield Professional Commercial Reimbursement Policy
Subject: Frequency Editing NY Policy: 0016 Effective: 03/01/2017 04/30/2017 Coverage is subject to the terms, conditions, and limitations of an individual member s programs or products and policy criteria
More informationEmpire BlueCross BlueShield Professional Commercial Reimbursement Policy
Subject: Frequency Editing NY Policy: 0016 Effective: 05/01/2017 05/19/2017 Coverage is subject to the terms, conditions, and limitations of an individual member s programs or products and policy criteria
More informationAnthem Blue Cross and Blue Shield Commercial Professional Reimbursement Policy
Subject: Frequency Editing CT Policy: 0016 Effective: 03/01/2017 03/31/2017 Coverage is subject to the terms, conditions, and limitations of an individual member s programs or products and policy criteria
More informationAnthem Blue Cross and Blue Shield Commercial Professional Reimbursement Policy
Subject: Laboratory and Venipuncture Services ME Policy: 0029 Effective: 08/22/2016 03/31/2017 Coverage is subject to the terms, conditions, and limitations of an individual member s programs or products
More informationUniCare Professional Reimbursement Policy
UniCare Professional Reimbursement Policy Subject: Laboratory and Venipuncture Services Policy #: UniCare 0029 Adopted: 02/02/2010 Effective: 08/31/2017 Coverage is subject to the terms, conditions, and
More informationSleep Management Program Changes: Frequently Asked Questions for Providers
Sleep Management Program Changes: Frequently Asked s for Providers New Sleep Studies Program Managed by NIA General What is changing? Harvard Pilgrim is updating our authorization program for both attended
More informationAnthem Central Region Clinical Claims Edit
Please compare the claim's date of adjudication to the range of the edit in question. Prior versions, if any, can be found below. Subject: Different Services with Anesthesia Services Edit #785 Effective
More informationEmpire BlueCross BlueShield Professional Commercial Reimbursement Policy
Subject: Documentation Guidelines for Central Nervous System Assessments and Tests NY Policy: 0046 Effective: 12/01/2014 11/30/2015 Coverage is subject to the terms, conditions, and limitations of an individual
More informationUltrasound Reimbursement Guide 2015: BioJet Fusion
Ultrasound Reimbursement Guide 2015: BioJet Fusion Diagnosis codes explain the rationale for a given service and are a key factor in a payer s evaluation of medical necessity and coverage determination
More informationMAGNETIC RESONANCE IMAGING (MRI) AND COMPUTED TOMOGRAPHY (CT) SCAN SITE OF CARE
UnitedHealthcare Commercial Utilization Review Guideline MAGNETIC RESONANCE IMAGING (MRI) AND COMPUTED TOMOGRAPHY (CT) SCAN SITE OF CARE Guideline Number: URG-13.01 Effective Date: February 1, 2019 Table
More informationRoutine Venipuncture and/or Collection of Specimens
Manual: Policy Title: Reimbursement Policy Routine Venipuncture and/or Collection of Specimens Section: Laboratory & Pathology Subsection: None Date of Origin: 1/1/2000 Policy Number: RPM012 Last Updated:
More informationSympathetic Electrical Stimulation Therapy for Chronic Pain
Sympathetic Electrical Stimulation Therapy for Chronic Pain Policy Number: 015M0076A Effective Date: April 01, 015 RETIRED 5/11/017 Table of Contents: Page: Cross Reference Policy: POLICY DESCRIPTION COVERAGE
More informationMedicare CPAP/BIPAP Coverage Criteria
Medicare CPAP/BIPAP Coverage Criteria For any item to be covered by Medicare, it must 1) be eligible for a defined Medicare benefit category, 2) be reasonable and necessary for the diagnosis or treatment
More informationCoding Companion for Podiatry. A comprehensive illustrated guide to coding and reimbursement
Coding Companion for Podiatry comprehensive illustrated guide to coding and reimbursement 2016 Contents Contents Foot and Toes 28043-28045 [28039, 28041] 28043 28039 28045 28041 Excision, tumor, soft tissue
More informationFY16 BCCS Reimbursement Rates and Billing Guidelines Appendix B 2
FY16 BCCS Reimbursement Rates and Billing Guidelines Appendix B 2 77053 Mammary ductogram or galactogram, single duct, Global Fee $59.05 May be billed with 77055, G0206, 77056, G0204, 76641, 76642 Billable
More informationCODING SHEETS CHRONIC INTRACTABLE PAIN MANAGEMENT. Effective January 1, 2009 CODMAN 3000 NEUROMODULATION AND ONCOLOGY REIMBURSEMENT HOTLINE
CODING SHEETS CHRONIC INTRACTABLE PAIN MANAGEMENT Effective January 1, 2009 CODMAN 3000 NEUROMODULATION AND ONCOLOGY REIMBURSEMENT HOTLINE Phone: 800-609-1108 Email: codmanpump@aol.com Fax: 303-703-1572
More informationReimbursement Information for Diagnostic Ultrasound and Ultrasound-guided Procedures 1 Performed by Emergency Medicine Physicians
GE Healthcare Reimbursement Information for Diagnostic Ultrasound and Ultrasound-guided Procedures 1 Performed by Emergency Medicine Physicians January, 2013 www.gehealthcare.com/reimbursement This overview
More informationSleep 101. Kathleen Feeney RPSGT, RST, CSE Business Development Specialist
Sleep 101 Kathleen Feeney RPSGT, RST, CSE Business Development Specialist 2016 Why is Sleep Important More than one-third of the population has trouble sleeping (Gallup) Obstructive Sleep Apnea Untreated
More informationLumify. Lumify reimbursement guide {D DOCX / 1
Lumify Lumify reimbursement guide {D0672917.DOCX / 1 {D0672917.DOCX / 1 } Contents Overview 4 How claims are paid 4 Documentation requirements 5 Billing codes for ultrasound: Non-hospital setting 6 Billing
More informationDME NO AUTHORIZATION REQUIRED LIST October 1st, 2012 Revision. ALL PROVIDERS (Vendors, Home Health, Offices)
DME NO AUTHORIZATION REQUIRED LIST October 1st, 2012 Revision For members who have Medicare Part B fee-for-service, no authorization is needed for any Part B covered service! Contracted vendors must be
More informationReimbursement Information for Diagnostic Ultrasound and Ultrasound-guided Vascular Procedures 1
GE Healthcare Reimbursement Information for Diagnostic Ultrasound and Ultrasound-guided Vascular Procedures 1 January, 2013 www.gehealthcare.com/reimbursement This overview addresses coding, coverage,
More informationUltrasound Reimbursement Information for Anesthesiology 1
GE Healthcare Ultrasound Reimbursement Information for Anesthesiology 1 January, 2009 www.gehealthcare.com/reimbursement This overview addresses coding, coverage, and for ultrasound guidance with continuous
More information2019 ABBOTT REIMBURSEMENT GUIDE CMS Physician Fee Schedule
ABBOTT REIMBURSEMENT GUIDE CMS Physician Fee Schedule This document and the information contained herein is for general information purposes only and is not intended and does not constitute legal, reimbursement,
More informationDiabetes Management, Equipment and Supplies
Coverage Summary Diabetes Management, Equipment and Supplies Policy Number: D-001 Products: UnitedHealthcare Medicare Advantage Plans Original Approval Date: 11/01/2006 Approved by: UnitedHeatlhcare Medicare
More informationCERT PAP Errors: The DME CERT Outreach and Education Task Force Responds
CERT PAP Errors: The DME CERT Outreach and Education Task Force Responds DME CERT Outreach and Education Task Force National PAP Webinar, December 17, 2014 PAP CERT Errors Medical Records: Face-to-Face
More information2017 NBCCEDP Allowable Procedures and Relevant CPT Codes
2017 NBCCEDP Allowable Procedures and Relevant CPT Codes Listed below are allowable procedures and the corresponding suggested Current Procedural Terminology (CPT) codes for use in the National Breast
More informationClinical Breast Examination N/A Yes Screening Mammogram $ TC $ 43.56
For the Period 07/01/2015 through 06/30/2016 Revised: 10/09/2015 Breast Procedures (1) Screening Clinical Breast Examination N/A Screening Mammogram 77057 $ 78.38 77057-TC $ 43.56 77057-26 $ 34.82 Follow-Up
More informationCHAP 11.doc Version 15.3
CHAP 11.doc CHAPTER XI MEDICINE EVALUATION AND MANAGEMENT SERVICES CPT CODES 90000-99999 FOR NATIONAL CORRECT CODING INITIATIVE POLICY MANUAL FOR MEDICARE SERVICES Current Procedural Terminology 2008 American
More informationINDIANA HEALTH COVERAGE PROGRAMS
INDIANA HEALTH COVERAGE PROGRAMS PROVIDER CODE TABLES Note: Due to possible changes in Indiana Health Coverage Programs (IHCP) policy or national coding updates, inclusion of a code on the code tables
More informationFoundational funding sources allow BCCHP to screen and diagnose women outside of the CDC guidelines under specific circumstances in Washington State.
Program Description The Breast, Cervical and Colon Health Program (BCCHP) screens qualifying clients for breast cancer. The program is funded through a grant from the Centers for Disease Control and Prevention
More informationReimbursement Information for Ultrasound-guided Procedures Performed by Anesthesiologists 1
GE Healthcare Information for Ultrasound-guided Procedures Performed by Anesthesiologists 1 January, 2013 www.gehealthcare.com/reimbursement This overview addresses coding, coverage, and payment for ultrasound
More informationCardiac Rhythm Management Coder 2017
Cardiac Rhythm Management Coder 2017 An easy-to-use tool for coding and reimbursement compliance Prepared and Published By: MedLearn Publishing, A Division of Panacea Healthcare Solutions, Inc. 287 East
More information2018 Cerebrovascular Reimbursement Coding Fact Sheet
The information contained in this document is provided for informational purposes only and represents no statement, promise, or guarantee by Cordis Corporation concerning levels of reimbursement, payment,
More informationMedical and claim payment policy activity
Medical and claim payment policy activity Commercial business The following pages list the policy activity for commercial business that we have posted to our Medical Policy Portal from. For the most up-to-date
More informationCigna - Prior Authorization Procedure List: Radiology & Cardiology
Cigna - Prior Authorization Procedure List: Radiology & Cardiology Category CPT Code CPT Code Description 93451 Right heart catheterization 93452 Left heart catheterization 93453 Combined right and left
More informationMedical and claim payment policy activity
Medical and claim payment policy activity Commercial business The following pages list the policy activity for commercial business that we have posted to our Medical Policy Portal from January 24 February
More informationCoding for Preventive Services A Guide for HIV Providers
Coding for Preventive Services A Guide for HIV Providers Jessie Murphy, MPH and Michelle Cataldo, LCSW, April 2016 Implementation of the Patient Protection and Affordable Care Act and other regulatory
More informationCoding for Sleep Disorders Jennifer Rose V. Molano, MD
Practice Coding for Sleep Disorders Jennifer Rose V. Molano, MD Accurate coding is an important function of neurologic practice. This section of is part of an ongoing series that presents helpful coding
More informationICD-9-CM Diagnosis Code options
ICD-9-CM Diagnosis Code options Diagnosis codes are used by both physicians and facilities to document the indication for the procedure. Intrathecal drug delivery is directed at managing chronic, intractable
More informationContinuous Glucose Monitoring Devices Pharmacy Policy
Line of Business: All Line of Business Effective date: August 16, 2017 Revision date: August 16, 2017 Continuous Glucose Monitoring Devices Pharmacy Policy This policy has been developed through review
More informationCardiac Rhythm Management Coder 2018
Cardiac Rhythm Management Coder 2018 An easy-to-use tool for coding and reimbursement compliance Prepared and Published By: MedLearn Publishing, A Division of MedLearn Media, Inc. 445 Minnesota Street,
More information2012 CPT Changes Affecting Radiology REVISIONS
2012 CPT Changes Affecting Radiology REVISIONS 22520 Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection; thoracic 22521 lumbar 22522
More informationReimbursement Information for Diagnostic Musculoskeletal Ultrasound and Ultrasound-guided Procedures 1
GE Healthcare Reimbursement Information for Diagnostic Musculoskeletal Ultrasound and Ultrasound-guided Procedures 1 January, 2013 www.gehealthcare.com/reimbursement This overview addresses coding, coverage,
More informationCigna - Prior Authorization Procedure List Cardiology
Cigna - Prior Authorization Procedure List Cardiology Category CPT Code CPT Code Description 33206 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial 33207 Insertion
More informationPhysical Medicine & Rehabilitation: Maximum Combined Frequency per Day Policy
Policy Number Physical Medicine & Rehabilitation: Maximum Combined Frequency per Day Policy 2017R0101E Annual Approval Date 7/13/2016 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT
More informationBCCCNP Service CPT Code FY 2019 Rate Oct 1, 2018 Dec 31, 2018
1 Screening Mammogram (Bilateral); including CAD Service CPT Code 77067 77067-TC 77067-26 $111.40 $81.32 $30.08 $131.51 $93.70 $37.82 * Note: Breast tomosynthesis, unilateral (77061) and bilateral (77062)
More informationNew Billing Guidelines for Home Infusion, Enteral and Parenteral Therapies Home Infusion Fee Schedule Effective July 1, 2009
STAT Bulletin PO Box 80 Buffalo, New York 14240-0080 May 12, 2009 Volume 15:Issue 18 To: All Home Health Care and Home Infusion Therapy Providers Contracts Effected: All Lines of Business New Billing Guidelines
More informationModifier SL - State Supplied Vaccine
Manual: Policy Title: Reimbursement Policy Modifier SL - State Supplied Vaccine Section: Modifiers Subsection: None Date of Origin: 6/26/2007 Policy Number: RPM024 Last Updated: 8/7/2017 Last Reviewed:
More informationCertification Review. Module 28. Medical Coding. Radiology
Module 28 is the study of x-rays, using radiant energy and other imaging techniques, such as resonance imaging or ultrasound, to diagnose illnesses and diseases. Vocabulary Barium enema (BE): lower gastrointestinal
More information2018 HEMODIALYSIS CATHETERS CODING AND REIMBURSEMENT GUIDE
2018 HEMODIALYSIS CATHETERS CODING AND REIMBURSEMENT GUIDE Contents Overview of Central Venous Access s for Hemodialysis 2 Procedures Using Hemodialysis s 2 Physician Reimbursement for Hemodialysis s 3
More informationUltrasound and Fluoroscopic Paravertebral Facet Joint Injections
Policy Number FAC06222011RP Ultrasound and Fluoroscopic Approved By UnitedHealthcare Medicare Committee Current Approval Date 06/25/2014 IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable
More informationPhysical Therapy and Occupational Therapy Initial Evaluation and Reevaluation Reimbursement Policy. Approved By
Policy Number Physical Therapy and Occupational Therapy Initial Evaluation and Reevaluation Reimbursement Policy 0044 Annual Approval Date 4/2017 Approved By Optum Reimbursement Committee Optum Quality
More informationMEDICAL POLICY No R10 INFUSION SERVICES & EQUIPMENT
INFUSION SERVICES & EQUIPMENT Effective Date: August 1, 2017 Review Dates: 10/95, 12/99, 12/01, 11/02, 11/03, 11/04, 10/05, 10/06, 10/07, 10/08, 10/09, 4/10, 4/11, 4/12, 4/13, 5/14, 5/15, 2/16, 2/17, 5/17
More informationVascular Plug Procedures 2014 CODING AND PAYMENT REFERENCE GUIDE ST. JUDE MEDICAL - CARDIOVASCULAR DIVISION
Vascular Plug Procedures 2014 CODING AND PAYMENT REFERENCE GUIDE ST. JUDE MEDICAL - CARDIOVASCULAR DIVISION IMPORTANT: St. Jude Medical provides this reference guide for general information purposes only
More informationDiagnostic and interventional venous procedures (lower extremity)
2017 Coding and Medicare payment guide Diagnostic and interventional venous procedures (lower extremity) All coding, coverage, billing and payment information provided herein by Philips Volcano is gathered
More informationAAHAM Western Region December 11, 2014
Chargemaster Changes for 2015 AAHAM Western Region December 11, 2014 Presented by: Terrance Wong Terrance Wong & Associates Healthcare Financial Consultants 350 Augusta Drive Palm Desert, CA 92211 (760)
More informationPREFACE TO THE IMAGING GUIDELINES Version 17.0; Effective
evicore healthcare Clinical Decision Support Tool Diagnostic Strategies: This tool addresses common symptoms and symptom complexes. Imaging requests for patients with atypical symptoms or clinical presentations
More informationContractor Name: Novitas Solutions, Inc. Contractor Number: Contractor Type: MAC B. LCD ID Number: L34834 Status: A-Approved
LCD for Blood Glucose Monitoring in a Skilled Nursing Facility (SNF) (L34834) Contractor Name: Novitas Solutions, Inc. Contractor Number: 12502 Contractor Type: MAC B LCD ID Number: L34834 Status: A-Approved
More informationModifier 62 - Co-surgery (Two Surgeons)
Manual: Policy Title: Reimbursement Policy Modifier 62 - Co-surgery (Two Surgeons) Section: Modifiers Subsection: None Date of Origin: 1/1/2000 Policy Number: RPM035 Last Updated: 7/5/2017 Last Reviewed:
More informationTimed Therapeutic Procedures
Timed Therapeutic Procedures Policy Number: 10.01.526 Last Review: 4/2014 Origination: 4/2009 Next Review: 4/2015 Policy Documentation to support the reporting of timed procedure codes is required. The
More informationAnesthesia Processing Guidelines
Anesthesia Processing Guidelines Policy Number: 10.01.511 Last Review: 5/2018 Origination: 10/1988 Next Review: 5/2019 Policy The following guidelines are utilized in processing anesthesia claims: 1) Anesthesia
More informationSANOFI PASTEUR INFLUENZA VACCINE PRESENTATIONS CODING AND BILLING CHECKLIST
SANOFI PASTEUR INFLUENZA VACCINE PRESENTATIONS 08-09 CODING AND BILLING CHECKLIST Are you ready? Are you sure that your systems are fully updated? Are you aware of important influenza vaccination payment
More informationPOSITRON EMISSION TOMOGRAPHY (PET)
Status Active Medical and Behavioral Health Policy Section: Radiology Policy Number: V-27 Effective Date: 08/27/2014 Blue Cross and Blue Shield of Minnesota medical policies do not imply that members should
More informationReimbursement Guidelines for Pain Management Procedures 1
GE Healthcare Reimbursement Guidelines for Pain Management Procedures 1 April 2015 www.gehealthcare.com/reimbursement This overview addresses coding, coverage, and payment for pain management procedures
More information2009 Pain Coding Update and Pain Industry Business Trends
2009 Pain Coding Update and Pain Industry Business Trends Linda Van Horn, MBA June 13, 2009 2009 Pain Coding Update and Pain Industry Trends Agenda 2009 CPT Coding Updates Pay For Incentives ICD-10 American
More informationSaturation Biopsy for Diagnosis and Staging and Management of Prostate Cancer
Saturation Biopsy for Diagnosis and Staging and Management of Prostate Cancer Policy Number: 7.01.121 Last Review: 2/2018 Origination: 8/2006 Next Review: 8/2018 Policy Blue Cross and Blue Shield of Kansas
More informationClinical Policy: Digital Breast Tomosynthesis Reference Number: CP.MP.90
Clinical Policy: Reference Number: CP.MP.90 Effective Date: 01/18 Last Review Date: 12/17 Coding Implications Revision Log See Important Reminder at the end of this policy for important regulatory and
More informationClinical Policy: Digital EEG Spike Analysis
Clinical Policy: Reference Number: CP.MP.105 Last Review Date: 01/18 Coding Implications Revision Log See Important Reminder at the end of this policy for important regulatory and legal information. Description
More informationSix Major Section Of The Cpt Manual
Six Major Section Of The Cpt Manual What section of the CPT manual would you find the code for a superficial abscess of the skin of the penis? What are the major sections of the CPT manual? 1. A discussion
More information2019 MITRACLIP CODING AND PAYMENT GUIDE
CLAIM 2019 MITRACLIP AND PAYMENT GUIDE MitraClip Transcatheter Mitral Valve Repair Hospital Rates: Effective October 1, 2018 Physician Rates: Effective January 1, 2019 References and Brief Summary 1 CLAIM
More information2011 CPT Code Update. Diagnostic Radiology. Computed Tomography (CT), Abdomen and Pelvis. Deletion of Xeroradiography and Subtraction Codes
2011 CPT Code Update [The Health Insurance Portability and Accountability Act [HIPAA] transaction and code set rules require the use of the medical code set that is valid at the time a service is provided.
More informationPayment Policy. Chiropractic Care. Policy Specific Section: September 10, 2012 November 10, 2012
Payment Policy Chiropractic Care Type: Payment Policy Policy Specific Section: Payment Original Policy Date: Effective Date: September 10, 2012 November 10, 2012 Description Chiropractic is a branch of
More informationPolicy Specific Section:
Payment Policy Anesthesia Services Type: Payment Policy Policy Specific Section: Payment Original Policy Date: Effective Date: October 1, 2010 06-16-2014 Description Anesthesia services consist of the
More informationSaturation Biopsy for Diagnosis and Staging and Management of Prostate Cancer
Saturation Biopsy for Diagnosis and Staging and Management of Prostate Cancer Policy Number: 7.01.121 Last Review: 2/2019 Origination: 8/2006 Next Review: 8/2019 Policy Blue Cross and Blue Shield of Kansas
More informationReimbursement Information for Diagnostic Ultrasound and Ultrasound-guided Procedures Commonly Performed by Otolaryngologists
GE Healthcare Reimbursement Information for Diagnostic Ultrasound and Ultrasound-guided Procedures Commonly Performed by Otolaryngologists 1 January, 2013 www.gehealthcare.com/reimbursement imagination
More informationSmartMonitor Helpful for Filing
Apnea Monitor HCPCS E0618 or E0619 Overview The following information describes coverage and payment information regarding the use of the Circadiance SmartMonitor: Coding, coverage, payment, and documentation
More information2017 Blue Cross and Blue Shield of Louisiana
Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively referred to as the Company ), unless otherwise provided
More informationInspire Medical Systems. Physician Billing Guide
Inspire Medical Systems Physician Billing Guide 2019 Inspire Medical Systems Physician Billing Guide This Physician Billing Guide was developed to help providers correctly bill for Inspire Upper Airway
More informationThe revision date appears in the footer of the document. Links within the document are updated as changes occur throughout the year.
An Independent Licensee of the Blue Cross Blue Shield Association. APPENDIX C HOME INFUSION THERAPY MANUAL This appendix to the Business Procedure Manual briefly describes home infusion therapy benefits
More informationSample page. For the Physical Therapist An essential coding, billing and reimbursement resource for the physical therapist CODING & PAYMENT GUIDE
CODING & PAYMENT GUIDE 2019 For the Physical Therapist An essential coding, billing and reimbursement resource for the physical therapist Power up your coding optum360coding.com Contents Getting Started
More informationPEDIATRIC SKILLED NURSING POLICY AND PROCEDURE MANUAL. Sample Home Health Agency
2019 PEDIATRIC SKILLED NURSING POLICY AND PROCEDURE MANUAL Sample Home Health Agency Pediatric Nursing is a nursing specialty that is provided to children in their places of residence. Because of this
More informationOutpatient Infusion Coding & Documentation: Take Your Skills to a Higher Level
Outpatient Infusion Coding & Documentation: Take Your Skills to a Higher Level Presented by Robin Zweifel, BS, MT(ASCP) Marta Kramer, MBA, CCS-P.. June 27, 2014 Disclaimer MedLearn Publishing has prepared
More informationHIGHMARK RADIATION THERAPY AUTHORIZATION PROGRAM
HIGHMARK RADIATION THERAPY AUTHORIZATION PROGRAM ADMINISTRATIVE GUIDE Program effective with service dates beginning January 1, 2012 2011-2016 Highmark Inc. All rights reserved. TABLE OF CONTENTS IN THIS
More informationHigh Tech Imaging Quick Reference Guide
High Tech Imaging Quick Reference Guide 1 High Tech Imaging Authorizations may now be requested through our secure provider portal, BlueAccess. Getting Started Step 1: Log into BlueAccess from www.bcbst.com
More informationConnectiCare Commercial & Exchange Members Utilization Review Matrix 2018 Spine Surgery, Implantable Infusion Pump Insertion & Other Spine Procedures
ConnectiCare Commercial & Exchange Members Utilization Review Matrix 2018 Spine Surgery, Implantable Infusion Pump Insertion & Other Spine Procedures The matrix below contains all of the CPT-4 codes for
More informationMEDICAL MANAGEMENT POLICY
PAGE: 1of 8 This Medical policy is not a guarantee of benefits or coverage, nor should it be deemed as medical advice. In the event of any conflict concerning benefit coverage, the employer/member summary
More informationMP.090.MH Nerve Block, Paravertebral, Facet Joint, and SI Injections
MedStar Health, Inc. POLICY AND PROCEDURE MANUAL MP.090.MH Nerve Block, Paravertebral, Facet Joint, and SI This policy applies to the following lines of business: MedStar Employee (Select) MedStar MA DSNP
More informationName of Policy: Sympathetic Therapy and Bioelectrical Nerve Block or Electroanalgesic Nerve Block for the Treatment of Pain
Name of Policy: Sympathetic Therapy and Bioelectrical Nerve Block or Electroanalgesic Nerve Block for the Treatment of Pain Policy #: 015 Latest Review Date: February 2010 Category: Therapy Policy Grade:
More informationFAQ CODING & REIMBURSEMENT. WatchPAT TM Home Sleep Test
FAQ CODING & REIMBURSEMENT WatchPAT TM Home Sleep Test TABLE OF CONTENTS PATIENT SELECTION CRITERIA 3 CODING & MODIFIERS 4-6 PLACE OF SERVICE 6 FREQUENCY 7 ACCREDITATION 7 SLEEP MEDICINE GLOSSARY AND ACRONYMS
More informationAnthem Midwest Clinical Claims Edit
Please compare the claim's date of adjudication to the range of the edit in question. Prior versions, if any, can be found below. Subject: Noninvasive Ear or Pulse Oximetry with Evaluation and Management
More informationClinical Policy: Essure Removal Reference Number: CP.MP.131
Clinical Policy: Reference Number: CP.MP.131 Effective Date: 11/16 Last Review Date: 11/17 Coding Implications Revision Log See Important Reminder at the end of this policy for important regulatory and
More informationESSURE A RESOURCE FOR CODING
ESSURE REIMBURSEMENT GUIDE A RESOURCE FOR CODING INDICATION Essure is indicated for women who desire permanent birth control (female sterilization) by bilateral occlusion of fallopian tubes. IMPORTANT
More informationClinical Policy: Cochlear Implant Replacements Reference Number: CP.MP.14
Clinical Policy: Reference Number: CP.MP.14 Effective Date: 02/09 Last Review Date: 09/17 Revision Log Coding Implications See Important Reminder at the end of this policy for important regulatory and
More informationCPT Code Details
CPT Code 93572 Details Code Descriptor Intravascular Doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically
More informationDetailed Summary of the Proposed Rule for the Hospital Outpatient Prospective Payment System
Detailed Summary of the Proposed Rule for the Hospital Outpatient Prospective Payment System The Centers for Medicare and Medicaid Services (CMS) released its proposed rule for calendar year (CY) 2017
More informationCandidates sitting for the examination for licensure purposes in California should study and be familiar with the following test plan:
Candidates sitting for the examination for licensure purposes in California should study and be familiar with the following test plan: NHA Certified Phlebotomy Technician (CPT) CA-Specific Detailed Test
More informationMEDICAL POLICY Cardiac Event Monitors/ Cardiac Event Detection
POLICY: PG0039 ORIGINAL EFFECTIVE: 10/01/11 LAST REVIEW: 12/12/17 MEDICAL POLICY Cardiac Event Monitors/ Cardiac Event Detection GUIDELINES This policy does not certify benefits or authorization of benefits,
More information