Billing News Mar 2021



UHC - Designated Diagnostic Provider

  • March 10, 2021

“Designated Diagnostic Providers are designed to support our members in choosing cost-effective and high-value care providers. Effective July 1, 2021, and subject to state regulatory approval, outpatient diagnostic lab services will only be covered for members with UnitedHealthcare Designated Diagnostic Provider benefit designs if delivered...

Read



BCBS - Comprehensive Genomic Profiling for Selecting Targeted Cancer Therapies

  • March 10, 2021

As of March 5, 202, here is the updated description in the policy section: Deleted: “expanded cancer molecular panels” Added: “comprehensive genomic profiling” Updated Rationale section In Coding section: Deleted: CPT/ HPCS: 81161; 81162; 81200; 81201; 81202; 81203; 81205; 81206; 81207; 81208; 81209; 81210; 81212; 81215; 81216; 81217...

Read



AHA Decries UnitedHealthcare’s Diagnostic, Drug Coverage Policies

  • March 10, 2021

The American Hospital Association (AHA) is seeking immediate relief from UnitedHealthcare’s new benefit design program that would restrict in-network diagnostic providers. The hospital group called on CMS to exercise its oversight authority over Medicare Advantage, Medicaid managed care, Children’s Health Insurance Program and Health...

Read



Effective March 3, 2021 - BCBS Policy Genotype-Guided Warfarin Dosing Updated

  • March 10, 2021

As of March 3, 20201 Description section updated. Title changed from Genetic Testing for Warfarin Dose to Genetic Testing for Warfarin Dose In Policy section: • Added “P450 4F2 (CYP42)” • Removed “international normalized ratio” • Removed Policy Guidelines Rationale section In Coding section: • Added code: 0030U

Read



COVID-19 Testing and Testing-Related Services Update February 19, 2021

  • March 10, 2021

UnitedHealthcare will cover medically appropriate COVID-19 testing at no cost share during the national public health emergency period (currently scheduled to end April 20, 2021) when ordered by a physician or appropriately licensed health care professional for purposes of the diagnosis or treatment of an individual member. Scope-of practice...

Read



BCBS Medical Policy Update

  • March 10, 2021

Published February 26, 2021. Assays of Genetic Expression in Tumor Tissue as a Technique to Determine Prognosis in Patients with Breast Cancer Circulating Tumor DNA Management of Non-Small Cell Lung Cancer (Liquid Biopsy) Endoscopic Radiofrequency Ablation or Cryoablation for Barrett Esophagus Genetic Testing for Cardiac Ion Channelopathies...

Read



Anthem - Claims Editing Update for ICD-10-CM Excludes 1 Notes

  • March 10, 2021

March 1, 2021 Policy Updates / Reimbursement Policies Beginning with dates of service on or after February 1, 2021 Anthem has implemented revised claims editing logic tied to Excludes 1 notes from ICD-10-CM 2020 coding guidelines.  To help ensure the accurate processing of claims, use ICD-10-CM Coding Guidelines when selecting the...

Read



HIPAA Privacy Rule and Security Rule Developments to Note Early in 2021

  • March 10, 2021

In the regulatory arena, the Department of Health and Human Services (HHS) Office for Civil Rights (OCR) released proposed changes to the HIPAA Privacy Rule in late January 2021. The proposed regulations include several modifications to HIPAA requirements, including changes that enhance individuals’ access to their own health information and...

Read