Billing News Feb 2021



Assays of Genetic Expression in Tumor Tissue as a Technique to Determine Prognosis in Patients with Breast Cancer

  • February 8, 2021

Effective 1-15-2021 Updated Description Section Updated Medical Policy Section Removed Item A: The use of Oncotype DX, EndoPredict, the Breast Cancer Index, MammaPrint, and Prosigna to determine recurrence risk for deciding whether to undergo adjuvant chemotherapy may be considered medically necessary in individuals with primary, invasive...

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Medi-Cal Proprietary Laboratory Analyses (PLA) Codes Now Implemented

  • February 8, 2021

A previously published News article announced the progress of the implementation for Proprietary Laboratory Analyses (PLA) codes on January 20, 2020. Implementation of PLA codes was completed on January 25, 2021, and providers may start billing for PLA codes. Updated provider manual sections with additional billing...

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HRSA COVID-19 Uninsured Program - Information on U0005

  • February 8, 2021

FAQs for COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment and Vaccine Administration - Beginning, January 1, 2021, Medicare will reimburse independent laboratories $75 per claim (HCPCS codes U0003 and U0004) with a potential add-on reimbursement of $25 (HCPCS code U0005) if the laboratory returned...

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UnitedHealth Group's Optum to Buy Change Healthcare for $13B

  • February 8, 2021

UnitedHealth Group's Optum unit has agreed to buy Change Healthcare for $7.84 billion in cash plus about $5 billion in debt, the companies said on Wednesday. The acquisition will strengthen the insurer's portfolio of healthcare technology services and capabilities. Change Healthcare will join with OptumInsight to provide software and data...

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HHS Expands COVID-19 Public Health Emergency until April, Preserving Key Telehealth Flexibilities

  • February 8, 2021

The Department of Health and Human Services (HHS) has extended the public health emergency surrounding the COVID-19 pandemic until April, extending key waivers for regulations on a variety of topics such as telehealth. The public health emergency declaration was originally scheduled to expire Jan. 21. HHS Secretary Alex Azar extended the...

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Massachusetts Health Care Bill Makes Several Significant Changes

  • February 8, 2021

The Act’s balance billing-related requirements differ somewhat from the recent similar federal legislation on the topic, the No Surprises Act. Again, the Massachusetts law applies only to non-emergency services; the federal law addresses non-emergency, emergency, and air ambulance services. Yet the Massachusetts Act is also somewhat broader than...

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Circulating Tumor DNA Management of Non-Small Cell Lung Cancer (Liquid Biopsy)

  • February 8, 2021

Effective 1-15-2021 Updated Description Section Updated Medical Policy Section Revised Item I.A., with the following changes: (Content that is underlined was added, content with a strikethrough was removed.) “At diagnosis, Except as noted below, analysis of 2 types of somatic sensitizing variants within the epidermal growth factor receptor...

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UHC – Update: Claim Coding, Submissions and Reimbursement

  • February 8, 2021

On or after Jan. 1, 2021 — HCPCS U0005: • This code should be used when billing for add-on payment to laboratories for a COVID-19 diagnostic test run on high throughput technology if the laboratory a) completes the test in 2 calendar days or less, and b) completes the majority of their COVID-19 diagnostic tests that use high throughput...

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