Billing News May 2021



Regence – Commercial: Genetic Testing

  • May 10, 2021

Genetic Testing: effective May 1, 2021 Genetic Testing for Hereditary Breast and Ovarian Cancer and LiFraumeni Syndrome (#02) Added medical necessity criterion for germline BRCA1/2 testing if tumor testing indicates that a variant is present in the tumor tissue Assays of Genetic Expression in Tumor Tissue as a Technique to Determine...

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Aetna - National Correct Coding Initiative (NCCI)

  • May 10, 2021

The NCCI is a collection of bundling edits created and sponsored by the Centers for Medicare & Medicaid Services (CMS). CCI edits are for services performed by the same provider on the same date of service only. Aetna is updating and adding effective August 1, 2021 based on the NCCI policy.

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Regence - Medicare Advantage: Laboratory

  • May 10, 2021

Laboratory: effective May 1, 2021 COVID-19 Testing (Medicare #74) Added clarification to the policy regarding physician order requirements for antibody testing; the Centers for Medicare & Medicaid Services (CMS) considers antibody testing subject to the same physician order requirements applied to diagnostic COVID-19 viral testing

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UHC - COVID-19 Testing, Treatment, Coding & Reimbursement - Update

  • May 10, 2021

Last update: April 19, 2021 Testing, coding and reimbursement protocols and guidelines are established based on guidance from the Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), state and federal governments and other health agencies. We’re closely monitoring COVID-19-related updates from...

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UHC - Training for the Genetic and Molecular Lab Testing Program Process

  • May 10, 2021

Starting June 1, 2021, we will begin managing prior authorizations for genetic and molecular tests. This change will impact the process for requesting prior authorization and registering lab tests. Here is where ordering providers and laboratories can find more information:  Training and information for requesting prior...

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COVID-19 Immunity from Liability Provisions, Adopted in Emergency, Now Repealed in New York State

  • May 10, 2021

On April 6, Governor Cuomo signed into law Chapter 96 of the Laws of 2021, which completely repeals the health care facility and provider COVID-19 immunity from liability provisions adopted in April 2020 as part of the Emergency or Disaster Treatment Protection Act (Public Health Law §§ 3080-82). As a result, health care facilities, their...

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Billing for Hospice COVID-19 Testing

  • May 10, 2021

NGS - COVID-19 Testing as it Relates to the Terminal Illness NGS position is that the COVID-19 testing is related to the terminal illness and the GW modifier is not appropriate. Hospices should, therefore, provide payment to the lab. The rationale is that the hospice is responsible for the management and palliation of the terminal illness and...

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Summary of Private Payor Rate-Based Medicare Clinical Laboratory Fee Schedule-Updated

  • May 10, 2021

A laboratory, including an independent laboratory, a physician office laboratory, or hospital outreach laboratory that meets the definition of an applicable laboratory under the Clinical Laboratory Fee Schedule (CLFS), must report information, including laboratory test HCPCS codes, associated private payor rates, and volume data. CMS recently...

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