Skip to content

Industry News: Utah

Monday, January 16, 2012

Beginning January 1, 2012, Utah Medicaid will provide coverage and reimbursement information for HCPCS and CPT codes through a new web-based lookup tool. The tool will allow providers to search for coverage and reimbursement information by procedure code, date of service, and provider type.

Monday, January 16, 2012

The 2012 Coding Updates provides information on the new codes as well as the new Molecular Pathology Procedure codes. The update details what codes are covered and non-covered. Manual review is required prior to testing for some codes. Submit supportive medical record documentation for manual review prior to testing.

Monday, January 16, 2012

The mutation test (T315I) is covered as medically necessary when required in determining salvage therapy and the decision for bone marrow transplant. Direct sequencing includes the following molecular diagnostic tests: 83902x1, 83898 x4, 83896 x3 and 83913 x1.

Thursday, December 29, 2011

The NMP22 Bladder Check Test is used in the diagnosis and monitoring of bladder cancer. NAS will allow coverage and payment for this test when used to monitor bladder cancer between cystourethroscopy intervals.

Effective for dates of service on or after January 1, 2012, use the following codes:

• 86386 - Nuclear Matrix Protein 22(NMP22), qualitative and V10.51 - Personal history of malignant neoplasm of bladder

Thursday, December 29, 2011

This article is to remind providers who bill Medicare Part A services that effective for dates of service beginning January 1, 2012, a brief hold will be placed on all claims. The hold will take place during the first 15 days of January 2012.

Due to updated pricing files installed into the Fiscal Intermediary Shared System (FISS), claims need to be verified for correct pricing to ensure proper payment. All claims held during this time will be released no later than January 15, 2012.

Tuesday, November 01, 2011

The NMP22 Bladder Check Test® is used in the diagnosis and monitoring of bladder cancer. NAS will allow coverage and payment for this test when used to monitor bladder cancer between cystourethroscopy intervals, effective for dates of service on or after September 19, 2011.

For claim payment, use the following codes:
• 88299 - Unlisted cytogenetic study, adding the description "NMP22" in Item 19 of the CMS-1500 form or the electronic equivalent. For Part A claims, add this notation to the remarks screen….and

Tuesday, November 01, 2011

Noridian Administrative Services (NAS) will administer the Medicare Part A and Part B contract for the new jurisdiction which consists of the following states: Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, and Wyoming.

A MAC JF implementation page has been posted to the NAS website. The page will be the web source for Part A and Part B providers as NAS implements the new CMS JF contract. Providers should begin to refer to the site for developing information during the implementation process.

Thursday, September 01, 2011

The use of the Advance Beneficiary Notice of Noncoverage (ABN) allows the appropriate liability to be transferred to the patient in the event that the services do not meet reimbursement criteria. In ABN reviews performed by the CERT and other review contractors, the most common error seen involves the "Notifier(s)" section (A) of the form. Entities who issue ABNs are collectively known as Notifiers. These entities can include physicians, non physician practitioners, providers (including laboratories), and suppliers.

Thursday, September 01, 2011

Noridian Administrative Services has noticed an increase in physician and physician office coding errors for Complete Blood Count (CBC), with and without differential, and other laboratory test billing.

The most common billing errors identified:

Monday, June 27, 2011

Noridian hosted a CERT and Laboratory Services Ask the Contractor Teleconference (ACT) on May 17, 2011. The following are some issues identified during the CERT audit.

• Incorrect coding a urinalysis with microscopy based on protocol. There must be a physician order for the test, Medicare does not accept protocols.
• Complete drug screening tests performed without the specific type of drug mentioned. For example is the drug screen specifically for opiates or barbiturates.

Monday, June 27, 2011

End Stage Renal Disease (ESRD) facilities may begin to see some of their claims being adjusted to correct various issues that have been found after the implementation of the new ESRD Prospective Payment System (PPS).

Monday, June 27, 2011

On December 20, 2010, the Division of Medicaid and Health Financing implemented a prepayment cost-saving editing solution to enhance the current editing within the Medicaid Management Information System (MMIS). The program incorporates correct coding principles, and industry accepted standards and guidelines to identify appropriate coding for provider billing and reimbursement.

In the near future, Medicaid will be adding additional modules to the existing prepayment editing tool. The new edits may affect claims and payment in the following areas:

• Unlisted procedure codes

Tuesday, March 29, 2011

Noridian Administrative Services: Carrier/FI for Arizona, Alaska, Idaho, Oregon, Montana, North Dakota, South Dakota, Utah, Washington, Wyoming and Minnesota.
When billing for a service or procedure, select the CPT, HCPCS or drug code that accurately identifies the service or procedure performed. If no such procedure or service exists, then report the service or procedure using the appropriate unlisted procedure or service code. NAS will not correctly code unlisted codes when a valid code is available.
Correct Coding Guidelines:

Tuesday, March 01, 2011

NAS is providing the following clarification on the use of “standing orders” for laboratory tests. While Medicare generally requires that lab tests be individually ordered by the treating physician, in some circumstances, recurring orders for a lab test that are specific to the needs of an individual patient may be reimbursable.

Tuesday, March 01, 2011

Based on a recent clarification of federal Medicaid policy, Utah Medicaid is no longer able to receive federal funds for claims received after the one year timely filing period. Therefore, effective immediately, all claims and adjustments for services must be received by Medicaid within twelve months from the date of service.

Tuesday, March 01, 2011

Utah Medicaid currently sends providers notification of prior authorization decisions (both approvals and denials) via both facsimile and standard mail.

Beginning January 1, 2011, Utah Medicaid is discontinuing the practice of sending approval and denial notices to providers through standard mail. Providers will continue to receive these notifications via facsimile.

Tuesday, March 01, 2011

CPT codes 80100 or 80101, used for drug screen testing, should be ordered to reflect only those drugs likely to be present based on the patient’s medical history or current clinical presentation. Urine and serum tests which are for the same class are considered duplicative, and therefore, not covered. Medicaid considers drug screening for medico-legal purposes or employment purposes as not medically necessary. The medical necessity of completing additional tests beyond those of abuse must be well documented by the diagnoses submitted.

Tuesday, March 01, 2011

The following CPT code has been removed from requiring manual review:
87800 Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; direct probe(s) technique

Tuesday, March 01, 2011

Non-Covered Codes
87797 Infectious agent detection, NOS, direct probe technique 96360 Intravenous infusion, hydration; initial 31 minutes to one hour

Tuesday, March 01, 2011

Covered Codes:
82930 Gastric acid analysis, includes Ph if performed each specimen
85598 Phospholipid neutralization; hexagonal phospholipid
88177 Cytopathology, evaluation of fine needle aspirate; immediately cytohistologic study to determine adequacy for diagnosis, each separate additional evaluation episode, same site

Non-Covered Codes:

80104 Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure
83861 Microfluidic analysis utilizing an integrated collection and analysis device, tear osmolarity