Billing News Feb 2023
CMS Halts IDR Process After Texas Court Ruling
On February 10, 2023 CMS instructed Independent Dispute Resolution (IDR) entities to hold all payment determinations in out-of-network disputes until CMS could issue additional guidance. The CMS announcement comes after the February 6 Texas District court ruling backing the Texas Medical Association’s claim the IDR process as described in the...
UHC - Molecular Oncology Testing for Cancer Diagnosis, Prognosis, and Treatment Decisions Update eff. 1/1/2023
Documentation Requirements: Updated list of CPT codes with associated documentation requirements; added 0332U and 81449* (*annual edit) Applicable Codes: Updated list of applicable CPT codes to reflect annual edits: o Added 0356U, 0362U, 0363U, 81449, 81451, and 81456 o Revised description for 81445, 81450, and 81455
Blue Cross highlights medical, benefit policy changes
NEW PAYABLE PROCEDURES Molecular markers in fine needle aspirates of the thyroid Procedure code *0245U is payable when criteria are met, effective June 1, 2022. Inclusions: ThyroSeq® ThyraMIR microRNA®/ThyGeNEXT® Afirma BRAF® after Afirma Genomic Sequencing Classifier Afirma MTC® after Afirma Genomic Sequencing Classifier
Blue Cross highlights medical, benefit policy changes
NEW PAYABLE PROCEDURES Early detection of prostate cancer: Biomarkers For the purpose of early detection of prostate cancer, testing of genetic and protein biomarkers prior to an initial or repeat biopsy is considered established when criteria are met. Procedure codes *0005U and *0113U were added as payable for all groups, effective July 1,...
Anthem - AIM Specialty Health will transition to Carelon Medical Benefits Management Inc.
Anthem - AIM Specialty Health will transition to Carelon Medical Benefits Management Inc. Synopsis: Commercial and Medicare Advantage plans from Anthem Blue Cross in California. In March 2023, AIM Specialty Health®* will transition to Carelon Medical Benefits Management Inc. This transition is a name change only, and there will be no...
Regence BCBS – Commercial Policy Updates
Changes effective February 1, 2023 Genetic Testing • Evaluating the Utility of Genetic Panels (#64) • Genetic Testing for Familial Hypercholesterolemia (#11) • Targeted Genetic Testing for Selection of Therapy for Non-Small Cell Lung Cancer (NSCLC) (#56) Laboratory • Circulating Tumor DNA and Circulating Tumor Cells for Management (Liquid...
A New Consumer Data Protection Bill in Oregon: A Summary of SB 619
Earlier this month, the Oregon state legislature introduced Senate Bill (SB) 619, “relating to protections for the personal data of consumers.” The bill has since been referred to the Senate Committee on Judiciary and the Joint Committee on Ways and Means. Structurally, SB 619 generally follows the Virginia Consumer Data...
A New Consumer Data Protection Bill in Oregon: A Summary of SB 619
Earlier this month, the Oregon state legislature introduced Senate Bill (SB) 619, “relating to protections for the personal data of consumers.” The bill has since been referred to the Senate Committee on Judiciary and the Joint Committee on Ways and Means. Structurally, SB 619 generally follows the Virginia Consumer Data...
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