BILLING NEWS

Update to claims processing edits and reimbursement policies

On June 1, 2017,  BCBSGA will be updating the following new and/or revised reimbursement policies. Effective January 1, 2017, BCBSGA is documenting their current edit that denies 82570 (urine creatinine) or 83986 (urine pH) when reported with 80305-80307 (presumptive drug testing) and G0659 (definitive drug testing). In addition, for claims processed on or after May 20, 2017, modifiers 59 and modifiers (X) EPSU will not override the edits. Their current edit denies 82542 (column chromatography) when reported with presumptive or definitive drug testing services. They are updating their policies for claims processed on or after May 20, 2017 to include the new CPT codes 80305-80307 and HCPCS code G0659 plus existing HCPCS codes G0480-G0483 (drug test(s), definitive... qualitative or quantitative, all sources, includes specimen validity testing, per day) to this edit. Modifiers will not override the edits. When similar or identical procedures are performed, but are qualified by an increased level of complexity, only the most comprehensive service performed should be reported. Based on this logic, BCBSGA  is  documenting in their policies dated May 20, 2017 that their current edit denies G0480-G0483 when reported with G0659. Modifiers will not override this edit.


INDUSTRY NEWS TAGS: BCBS Georgia


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