Frequency Editing for Aug. 2015 (BCBS, BCBS Georgia)
August 31, 2015Effective January 1, 2015, CPT published new codes for definitive drug testing. Beginning with claims processed on or after May 18, 2015, BCBSGA implemented a frequency limit of 1 per date of service for the following codes: 80321-80322, 80324-80337, 80339-80344, 80346-80347, 80350-80352, 80361-80364, 80369-80370, and 80375-80377. For claims processed on or after August 17, 2015, they will also implement a frequency limit of 1 per date of service for the following definitive drug testing codes based on CPT nomenclature: 80320, 80323, 80338, 80345, 80348, 80349, 80353-80360, 80365, 83992, 80366-80368 and 80371-80374. For dates of service on or after November 16, 2015, they will apply a frequency limit of 18 units within a 365 day period to definitive drug testing codes 80320-80377 and 83992. This edit will use claim lines processed in history that have previous, current, and subsequent dates of service to accumulate and apply this frequency limit.