Billing News Jan 2023
UHC – Updated: Evaluation and Management (E/M) Policy, Professional
Effective with date of service 1/1/23, the reimbursement policy will be revised to align with the Evaluation and Management(E/M) CPT coding and guidelines changes from the American Medical Association (AMA) and the Centers for Medicare and Medicaid Services (CMS).
UHC Preventative Care Services 1/1/2023 updated
Hepatitis B Virus Infection Screening Updated service description; added Jul. 2022 Bright Futures guideline to indicate Bright Futures recommends screening between the ages 0-21 years [perform risk assessment for hepatitis B virus (HBV) infection] Updated lists of applicable codes; added: o CPT code 87467 o ICD-10 diagnosis codes Z00.121 and...
BCBS Michigan - Won’t be bundling testing codes for sexually transmitted infections at this time
In an article in the October Record, we wrote that we planned to bundle STI testing codes in the near future. However, after additional consideration, we’ve decided not to move forward with this initiative at this time.
BCBS Michigan – Basic Benefit and Medical Policy – Noninvasive Techniques for Patients with Chronic Liver Disease
The policy has been updated to cover procedure codes *0002M and *0003M when criteria are met, effective Sept. 1, 2022. The use of FibroSURE™ multianalyte assays (HCV FibroSURE, ASH FibroSURE, NASH FibroSURE) in chronic liver disease has been established. It may be considered a useful diagnostic option when indicated
Anthem - Notification regarding reimbursement changes to COVID-19 laboratory services codes (MAC)
Commercial and Medicare Advantage plans from Anthem Blue Cross and Blue Shield (Anthem) Beginning with dates of service on or after April 1, 2023, or the end of the public health emergency (PHE), whichever is later, reimbursement for COVID-19 laboratory service codes may be reduced for participating providers contracted with Anthem. New...
Pennsylvania’s Data Breach Notification Law Is Changing: What Does It Mean for Entities Doing Business in the Keystone State?
Pennsylvania’s updated breach notification law has an expanded definition of “personal information.” Previously, the definition of “personal information” under Pennsylvania law only included an individual’s first name or first initial and last name in combination with a Social Security number, driver’s license number, or a state identification...
Year-End Legislative Package Includes Freeze on PAMA Cuts, Excludes the VALID Act
Congress released the text of a sweeping year-end legislative package. The Consolidated Appropriations Act for Fiscal Year 2023 funds the federal government for the remainder of the fiscal year and enacts or extends several health provisions. The bill includes a one-year freeze to laboratory reimbursement cuts and data reporting associated...
CMS amends CY 2023 fee guidance for independent dispute resolution process; Agencies issue initial report for April-September
The Center for Medicare & Medicaid Services has amended its 2023 fee guidance for the federal independent dispute resolution process, the agency announced last week. Under the amended guidance, administrative fees due from each party for participating in independent dispute resolutions will increase to $350 per party. Additionally,...
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