MLN Matters Number: MM12381 - New Waived Tests Effective Date: October 1, 2021

  • Sep 14, 2021

Listed below are the latest tests the FDA approved as waived tests under CLIA. The CPT codes for the following new tests must have the modifier QW to be recognized as a waived test. CPT Code Effective Date Description 80305QW October 9, 2021 American Screening LLC Discover Panel Dip Card Tests MOR2000 80305QW October 9, 2021 American Screening LLC...

Read


New CPT Codes for Immunizations

  • Sep 14, 2021

Aug. 16, 2021: Accepted addition of one administration code 0013A to report Moderna third dose. Appendix Q has been updated to reflect this addition. This code was published on Aug. 16, 2021 and this code (0013A) is effective for Emergency Use Authorization as of Aug. 12, 2021. July 30, 2021: Accepted addition of one administration code 0003A to report Pfizer-BioNTech third dose...

Read


AMA Adds CPT Code for Third Dose of Pfizer’s COVID-19 Vaccine

  • Sep 14, 2021

The American Medical Association on July 30 published a Current Procedural Terminology code for the potential administration of a third dose of Pfizer's COVID-19 vaccine. The third dose's code is 0003A. The code will be used only if the third dose is cleared by the FDA, but the AMA published the update to ensure electronic systems are prepared should the booster shot receive approval...

Read


California Issues New Health Facility Breach Reporting Requirements

  • Sep 14, 2021

On July 1, 2021, the California Department of Public Health (“CDPH”) issued new regulations[1] (the “Regulations”) effective immediately that more narrowly limit the circumstances under which instances of unauthorized access to medical information have to be reported to CDPH. The new regulations also give CDPH more discretion to adjust penalties for violations. The Regulations complement...

Read


Connecticut Governor Signs Bill Limiting Hospital Billing and Collection Efforts and Revising Connecticut’s Facility Fee Laws

  • Sep 14, 2021

On July 7, 2021, Connecticut Governor Ned Lamont signed into law Public Act 21-129 entitled “An Act Concerning Hospital Billing and Collection Efforts By Hospitals And Collection Agencies” (“the Act”). The Act expands the types of entities to which billing and collection restrictions apply, places further limitations on collection efforts by such entities, and makes several changes to...

Read


UHC Commercial Policy - Hepatitis Screening Update

  • Sep 14, 2021

Effective 10/1/2021 Updated: Applicable Codes Revised description for CPT code 87350 Updated list of ICD-10 diagnosis codes:  Added: B00.81, O35.7XX0, O35.7XX1, O35.7XX2, O35.7XX3, O35.7XX4, O35.7XX5, O35.7XX9, O36.8210, O36.8211, O36.8212, O36.8213, O36.8214, O36.8215, O36.8219, O36.8220, O36.8221, O36.8222, O36.8223, O36.8224, O36.8225, O36.8229, O36.8230, O36.8231, O36.8232, O36....

Read


BCBS Commercial - Covid Testing Coding

  • Sep 14, 2021

Use correct diagnosis codes for COVID-19 testing. Reminder and clarification on which diagnosis codes to use for COVID-19 testing for commercial members: Blue Cross Blue Shield of Michigan and Blue Care Network continue to cover COVID-19 testing that is considered medically necessary by an attending health care provider. For commercial members, when an attending health care provider...

Read


BCBS - Claim Editing Update for Modifier 59 Coming Later This Year to Medicare Plus Blue Claims

  • Sep 14, 2021

As communicated in an August Record article, BCBS will begin editing claim lines when modifier 59 is appended on Medicare Plus Blue℠ claims.  Example of billing scenario: If you bill modifier 59 and receive a claim line denial, following are some examples of circumstances when it would be appropriate to appeal the denial by submitting medical records that demonstrate the services...

Read