Billing News Mar 2021



BCBS Michigan - Procedure Codes *71271 and *33208 Don’t Require Authorization for Most Members

  • March 10, 2021

Services associated with radiology CPT code *71271 and cardiology CPT code *33208 don’t require authorization for these members: Blue Care Network commercial BCN Advantage℠ Medicare Plus Blue℠ We’ve removed these procedure codes from the document, Procedures that require prior authorization by AIM Specialty Health®: Cardiology,...

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Biden Administration Will Provide $1.6B to Improve COVID-19 Testing and Sequencing

  • March 10, 2021

The White House COVID-19 Response Team announced on Feb. 17, 2021 that the Biden administration will provide $1.6 billion to expand and improve COVID-19 testing and genomic sequencing. The US Department of Health and Human Services and the US Department of Defense will spend $650 million to expand testing opportunities for schools kindergarten...

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ACMG Lobbying State Legislatures on Genetic Counselors' Scope of Practice Draws Criticism

  • March 10, 2021

The American College of Medical Genetics and Genomics is lobbying state legislatures to add language to genetic counseling licensure bills that would restrict genetic counselors from independently ordering certain types of genetic tests and conveying the clinical implications of the results to patients. The disagreement over genetic counselors'...

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Cigna Ends Prior Authorization for Some CT Exams

  • March 10, 2021

Cigna will no longer require prior authorization for some CT scans of the heart, according to an updated precertification list. The change is effective Feb. 1. Cigna will end prior authorizations for CT angiogram of the heart, coronary arteries and bypass grafts with contrast material, according to a news release from the Society of...

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Blue Cross Network - Clinical Editing Updates Coming in June to Outpatient Claims

  • March 10, 2021

Starting in June, Blue Care Network and BCN AdvantageSM will be updating clinical edits applied to outpatient claims. We’re expanding the edits to continue promoting correct coding to outpatient claims and maintain alignment with national coding guidelines. BCN Advantage medical and payment policies will continue to comply with: • National...

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UHC Commercial - Reimbursement Policy Update Bulletin: March 2021

  • March 10, 2021

Laboratory Services Respiratory Viral Panel Testing Policy, Facility -  Eff. June 1, 2021 The new Laboratory Services Respiratory Viral Panel Testing Policy, Facility, will be effective for dates of service on or after 6/1/2021 Consistent with guidelines included in CMS Local Coverage Determinations, the policy will deny certain multiplex...

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Medicaid Colorado - Incorrect Member Billing for COVID-19 Tests and Co-Pay Amounts

  • March 10, 2021

Providers are reminded that members cannot be billed for the covered COVID-19 tests, including rapid tests. Visit the COVID-19 Information for Health First Colorado and CHP+ Providers and Case Managers web page for the covered codes listed in the COVID-19 Coding Information section. Providers are instructed to not collect co-pay amounts from any...

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Medicaid Rhode Island - Hospital Outpatient Rate Increase

  • March 10, 2021

The APC and outpatient laboratory rates are increasing by 2.6% above their current level, effective 7/1/2020. Previously paid outpatient claims with dates of service on and after 7/1/2020 will be adjusted and reprocessed at the new rate. The adjustment is scheduled for 3/20/2021 to be reflected in the 3/26/2021 remittance advice. The updated rates...

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