Frequency Editing for Aug. 2015 (Empire BCBS)

Effective January 1, 2015, CPT published new codes for Definitive Drug Testing. Beginning with claims processed on or after May 18, 2015, Empire BCBS 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, 80366, 80367, 80368, 80371, 80372, 80373, 80374, 83992. Definitive Drug Testing codes within the same drug classes reported more than once per date of service are considered mutually exclusive and not eligible for separate reimbursement. Therefore, beginning with claims processed on or after August 17, 2015, modifiers will not override the mutually exclusive edits. 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 with prior, current, and subsequent dates of service to accumulate and apply this frequency limit to claims for dates of service on or after 11/16/2015.

 

Source: https://www.empireblue.com/provider/noapplication/f5/s1/t2/pw_e236111.pdf?refer=ehpprovider