Claims Corner

claimscontactCenCal HEALTH’s Claims Department posts updates to billing and benefit information for our Providers in our Claims Corner. These articles offer important and timely information that may affect how your claim is adjudicated.

Some of these updates may be changes to CenCal Health processes only, and some may be updates published by the State of California that apply to CenCal Health as well.

We recommend all of our Providers access these articles often. Any questions related to any of these articles may be directed to our Claims Department at (805) 562-1083.

Recent Billing/Policy Update Articles


Attention Articles Posting Date
Physicians, Outpatient Hospitals, Clinics, and Laboratories
New Benefit: PIK3CA Gene Analysis July 2020
Physicians, Outpatient Hospitals, and Clinics
New Benefit: Online Assessment and Management Services July 2020

DME New Benefit: Multi-function Ventilator July 2020

DME Policy Update: Respiratory Suction Pumps July 2020

DME Policy Update: High Frequency Chest Wall Oscillation Devices

July 2020

Physicians, Outpatient Hospitals, and Clinics
Policy Update: Eculizumab

July 2020

Physicians, Outpatient Hospitals, and Clinics
Policy Update: School District Provider Reimbursable Vaccines

July 2020

Physicians, Outpatient Hospitals, and Clinics
Billing Update: Immune Globulins and Adalimumab Injection July 2020

Medical Transportation Billing Update: Specialty Care Transport for Non-Emergency Patient Transfers July 2020

Physicians, Outpatient Hospitals, Clinics, and Laboratories
New Benefit: COVID-19 Specimen Collection June 2020
Physicians, Outpatient Hospitals, and Clinics
New Benefit: Outpatient Treatment of Opioid Use Disorder June 2020
Physicians, Outpatient Hospitals, and Clinics
New Benefit: Triamcinolone Acetonide June 2020

Physicians, Outpatient Hospitals, and Clinics
New Benefit: Andexanet Alfa (Andexxa) June 2020

Physicians, Outpatient Hospitals, Clinics, and Laboratories
Rate Update: COVID-19 Specimen Collection June 2020

Physicians, Outpatient Hospitals, and Clinics
Rate Update: Split-Billed Radiology June 2020
Physicians, Outpatient Hospitals, and Clinics
Policy Update: Depression Screening June 2020

Physicians, Outpatient Hospitals, and Clinics
Policy Update: Supplemental Payments for Family Planning Services June 2020

Physicians, Outpatient Hospitals, Clinics, and DME Policy Update: Incontinence Creams and Washes June 2020

Physicians, Outpatient Hospitals, and Clinics
Policy Update: Immunization Codes June 2020

Physicians, Outpatient Hospitals, Clinics, and Laboratories
Policy Update: Cystic Fibrosis June 2020

Physicians, Outpatient Hospitals, Clinics, and Laboratories
Billing Update: COVID-19 Diagnostic Testing June 2020

Physicians, Outpatient Hospitals, and Clinics
Billing Update: Modifier CS June 2020
 
ALL PROVIDERS STILL USING PAPER TO SUBMIT CLAIMS? January 2018
February 2018
February 2018
March 2018
March 2018
March 2018
Policy Update:  Diclofenac Sodium Injection
Policy Update: Copper Intrauterine Devices (IUDs)
Policy Update: Dental Conscious and Deep Sedation
Policy Update: Dental Conscious and Deep Sedation
September 2018 
October 2018
October 2018
October 2018
November 2018
November 2018
November 2018
December 2018
January 2020
January 2020
January 2020
 February 2020
 February 2020
Physicians, Outpatient Hospitals, and Clinics

April 2020
April 2020
April 2020
April 2020
April 2020
April 2020
April 2020
April 2020

May 2020
May 2020
Policy Update: 

July 2020

Upcoming New Benefits

The following notifications have been identified as upcoming "New Benefits" CenCal Health recently became aware of and plans to adopt. These notices are informative only and will not be implemented until an effective date of service has been established; therefore, provider billing changes are not required at this time.

To ensure proper billing and avoid unnecessary denials, please be sure to check the "Recent Billing/Policy Updates" section monthly for articles posting the effective date and specific billing/policy details related to the "New Benefits" notifications below.


Attention Notifications Posting Date
ALL PROVIDERS CenCal Health is not currently aware of any upcoming New Benefits at this time. Please check back frequently for future updates.

May 2019

Upcoming Policy and Rate Changes

The following notifications have been identified as upcoming "Policy and/or Rate Changes" CenCal Health recently became aware of and plans to adopt. These notices are informative only and will not be implemented until an effective date of service has been established; therefore, provider billing changes are not required at this time.

To ensure proper billing and avoid unnecessary denials, please be sure to check the "Recent Billing/Policy Updates" section monthly for articles posting the effective date and specific billing/policy details related to the "Policy and/or Rate Changes" notifications below.


Attention Notifications Posting Date
ALL PROVIDERS CenCal Health is not currently aware of any upcoming Policy and/or Rate Changes. Please check back frequently for future updates.
May 2019

Upcoming Diagnosis Restriction Changes

The following notifications have been identified as upcoming changes related to "Diagnosis Restrictions" CenCal Health recently became aware of and plans to adopt. These notices are informative only and will not be implemented until an effective date of service has been established; therefore, provider billing changes are not required at this time.

To ensure proper billing and avoid unnecessary denials, please be sure to check the "Recent Billing/Policy Updates" section monthly for articles posting the effective date and specific billing/policy details related to the "Diagnosis Restrictions" notifications below.


Attention Notifications Posting Date
ALL PROVIDERS   CenCal Health is not currently aware of any upcoming Diagnosis Updates at this time.  Please check back frequently for future updates.
May 2019 

Upcoming Code Conversions

The following notifications have been identified as upcoming HIPAA-compliant "Code Conversions" CenCal Health recently became aware of and plans to adopt. These notices are informative only and will not be implemented until an effective date of service has been established; therefore, provider billing changes are not required at this time.

To ensure proper billing and avoid unnecessary denials, please be sure to check the "Recent Billing/Policy Updates" section monthly for articles posting the effective date and specific billing/policy details related to the "Code Conversion" notifications below.


Attention Notifications Posting Date
LTC Providers  COMING SOON -- Effective for dates of service TBD -- LTC local codes (01-98) will be terminated.  Providers should bill using the appropriate HIPAA-compliant Revenue Codes.  Please refer to the HIPAA section of our website for the latest conversion details.  July 2018
Outpatient Hospitals COMING SOON -- Effective for dates of service TBD -- local codes for Hospital Outpatient Services (Z7500-Z7514, Z7610-Z7614) will be terminated.  Providers should bill using the appropriate HIPAA compliant, nationally recognized revenue codes, CPT-4 codes and/or HCPCS codes that best represents the service provided. Please refer to the HIPAA section of our website for the latest conversion information.   July 2018
 ALL PROVIDERS Effective for dates of service on or after July 1, 2017  -- CenCal Health will terminate ALL the local codes (X-codes & Z-codes).   Providers should bill using the appropriate national CPT-4/HCPCS code, including the appropriate Revenue Code where applicable, that best represents the service provided.  Please refer to the HIPAA section of our website for the latest conversion details.                                   
 June 2017

ARCHIVE - 2020 Recent Billing/Policy Update Articles

Here you will find previously posted 2020 articles from the "Recent Billing/Policy Updates" section


Attention Articles Posting Date
Physicians, Outpatient Hospitals, Clinics, and Laboratories 

New Benefit: COVID-19

May 2020
Physicians, Outpatient Hospitals, Clinics, and Laboratories
New Benefit: 2020 HCPCS Quarterly Update May 2020

Physicians, Outpatient Hospitals, Clinics, and Laboratories 
New Benefit: Meningococcal Conjugate Vaccine May 2020

Physicians, Outpatient Hospitals, and Clinics
Policy Update: Developmental Screening Policy May 2020

Physicians, Outpatient Hospitals, and Clinics
Policy Update: Automatic External Defibrillator
May 2020

Physicians, Outpatient Hospitals, Clinics, and Laboratories
Policy Update: Hepatitis C Screening
May 2020

Physicians, Outpatient Hospitals, and Clinics
Policy Update: Koate DVI

May 2020

Physicians, Outpatient Hospitals, and Clinics
Policy Update: NCCI Quarterly Update
May 2020
DME Policy Update: Non-Wheelchair Accessories and Supplies

May 2020

DME Policy Update: Back-up Ventilators

May 2020
DME Policy Update: Oxygen Modifier May 2020
Physicians, Outpatient Hospitals, Clinics, and Laboratories 
Billing Update: COVID-19 Anti-body Testing

May 2020

Physicians, Outpatient Hospitals, and Clinics
Billing Update: COVID-19 Diagnosis May 2020

Physicians, Outpatient Hospitals, Clinics, and Laboratories 
New Benefit: Presumptive Eligibility for COVID-19 Testing April 2020
Physicians, Outpatient Hospitals, Clinics, and Laboratories 
New Benefit: COVID-19 Lab Tests April 2020
Physicians, Outpatient Hospitals, and Clinics
New Benefit: Oncology Codes April 2020
Physicians, Outpatient Hospitals, Clinics, and Laboratories
New Benefit: Genomic Sequence Analysis April 2020
Physicians, Outpatient Hospitals, and Clinics
Policy Update: CCS and GHPP Drug/Nutritional Product Exceptions April 2020
Physicians, Outpatient Hospitals, and Clinics
Policy Update: CCS Service Code Groupings April 2020
Physicians, Outpatient Hospitals, and Clinics
Policy Update: Fetal Aneuploidy Codes April 2020 
Physicians, Outpatient Hospitals, and Clinics
Policy Update: Evaluation and Management (E&M) April 2020
Physicians, Outpatient Hospitals, and Clinics
Policy Update: Acyclovir April 2020
Physicians, Outpatient Hospitals, and Clinics
Policy Update: NCCI Quarterly Update April 2020
Physicians, Outpatient Hospitals, and Clinics
Billing Update: Ophthalmoscopy April 2020
DME Billing Update: Incontinence Medical Supplies April 2020
Physicians, Outpatient Hospitals, and Clinics
Update: CPT-4 2020 Pathology Codes April 2020
Physicians, Outpatient Hospitals, and Clinics
Reminder: Dental Services April 2020
All Providers New Benefit:  Childhood Developmental Screening March 2020
Physicians, Outpatient Hospitals, and Clinics
New Benefit:  Screening for Adverse Childhood Experiences March 2020

Physicians, Outpatient Hospitals, and Clinics
Rate Update:  Split-Billed Radiology Services March 2020

Physicians, Outpatient Hospitals, Clinics, and Laboratories 
Rate Update:  Fetal Aneuploidy March 2020

Physicians, Outpatient Hospitals, and Clinics
Policy Update:  Molecular Pathology Procedures March 2020

Physicians, Outpatient Hospitals, and Clinics
Policy Update:  Place of Service Code 25 March 2020
Physicians, Outpatient Hospitals, and Clinics
Policy Update:  Contraceptive Ring and Patch March 2020

Physicians, Outpatient Hospitals, and Clinics
Policy Update: List of Contracted Sterile Needles
March 2020
DME Policy Update:  Contracted Incontinence Absorbent Products March 2020

DME Policy Update:  List of Enteral Nutrition Procedures March 2020

DME Policy Update:  HCPCS Codes A4335 and A6250 March 2020

All Providers Update:  List of Contracted Drugs March 2020

All Providers Correction:  2020 HCPCS Policy Updates February 2020
Physicians, Outpatient Hospitals, Pharmacies, and Clinics
New Benefit:  Durolane February 2020


Physicians, Outpatient Hospitals, and Clinics

New Benefit:  Biovance February 2020
Long Term Care Rate Update:  Intermediate Care Facility Rates February 2020
Physicians, Outpatient Hospitals, Pharmacies, and Clinics
Policy Update:  Initial Antepartum Office Visits February 2020
DME and Pharmacies Policy Update:  Incontinence Creams and Washes February 2020
DME and Pharmacies
Policy Update:  Wound Care Advanced Dressings February 2020
DME Billing Update:  Medical Supply Billing Codes February 2020
Physicians, Outpatient Hospitals, Long Term Care, and Clinics 
New Benefit:  Evaluation and Management January 2020
Physicians, Outpatient Hospitals, Long Term Care, and Clinics 
New Benefit:  CYP2C19 Gene Analysis January 2020
Physicians, Outpatient Hospitals, Long Term Care, and Clinics
New Benefit:  Ambulatory Blood Pressure Monitoring January 2020
Physicians, Outpatient Hospitals, and Clinics
Policy Update:  List of Contracted Incontinence Medical Supplies January 2020
Physicians, Outpatient Hospitals, and Clinics
Policy Update:  Naltrexone and Buprenorphine Injections January 2020
Physicians, Outpatient Hospitals, and Clinics
Policy Update:  Ophthalmological Services January 2020

Physicians, Outpatient Hospitals, and Clinics
Policy Update:  SMN1 Gene Analysis January 2020

Physicians, Outpatient Hospitals, and Clinics
Policy Update:  Genetic Testing of Tuberous Sclerosis Complex January 2020

Physicians, Outpatient Hospitals, and Clinics
Policy Update:  List of Contracted Waterproof Sheeting January 2020

Physicians, Outpatient Hospitals, and Clinics
Policy Update:  Incontinence Creams and Washes January 2020

DME Policy Update:  Wheelchair Accessories January 2020

All Providers Billing Update:  2020 HCPCS Annual Update January 2020

All Providers Update:  Provider Manual Updates January 2020

ALL PROVIDERS STILL USING PAPER TO SUBMIT CLAIMS? January 2018
February 2018
February 2018
March 2018
March 2018
March 2018
Policy Update:  Diclofenac Sodium Injection
Policy Update: Copper Intrauterine Devices (IUDs)
Policy Update: Dental Conscious and Deep Sedation
Policy Update: Dental Conscious and Deep Sedation
September 2018 
October 2018
October 2018
October 2018
November 2018
November 2018
November 2018
December 2018
January 2020
January 2020
January 2020
 February 2020
 February 2020
Physicians, Outpatient Hospitals, and Clinics

April 2020
April 2020
April 2020
April 2020
April 2020
April 2020
April 2020
April 2020

ARCHIVE - 2019 Recent Billing/Policy Update Articles

Here you will find previously posted 2019 articles from the "Recent Billing/Policy Updates" section


Attention ARCHIVED 2019 Recent Billing/Policy Update Articles Original Posting Date
All Providers Update: Time-Limited Supplemental Payment for Family Planning Services December 2019
All Providers
New Benefit: Optician Services Restored December 2019
Physicians, Outpatient Hospitals, and Clinics
New Benefit: Screening for Adverse Childhood Experiences December 2019

All Providers Policy Update: HCPCS Quarterly Update

December 2019

All Providers Policy Update: National Correct Coding Initiative Quarterly Update December 2019

All Providers Policy Update: Childhood Development Screening December 2019
Physicians, Outpatient Hospitals, Long Term Care, Clinics and DME
Policy Update: Incontinence Creams and Washes December 2019

Physicians, Outpatient Hospitals, Clinics and DME
Policy Update: Pediatric Incontinence Products December 2019

Physicians, Outpatient Hospitals, and Clinics
Policy Update: Fulvestrant Injection December 2019

Physicians, Outpatient Hospitals, and Clinics
Policy Update: Contracted Waterproof Sheeting December 2019

Physicians, Outpatient Hospitals, and Clinics
Policy Update: Contracted Diabetic Test Strips and Lancets December 2019

Physicians, Outpatient Hospitals, Inpatient, and Clinics
Policy Update: ICD-10 Procedure Code Policy December 2019
All Providers Billing Update: 2020 CPT-4 Annual Update December 2019

Physicians, Outpatient Hospitals, and Clinics
Billing Update: Incontinence Medical Supplies December 2019

All Providers Update:  Prop 56 Supplemental Payment

November 2019
Physicians, Outpatient Hospitals, and Clinics
Policy Update:  Acyclovir Injection November 2019
Physicians, Outpatient Hospitals, and Clinics
Policy Update:  Buprenorphine November 2019

Physicians, Outpatient Hospitals, and Clinics
Policy Update:  Spinal Canal Ultrasound November 2019

Physicians, Outpatient Hospitals, and Clinics
Policy Update:  Internal (Female) Condoms November 2019

Physicians, Outpatient Hospitals, and Clinics
Policy Update:  Intrauterine Devices and Contraceptive Implant November 2019

DME
Policy Update:  Frequency Updates for DME Codes November 2019

Physicians, Outpatient Hospitals, Long Term Care, Clinics and DME
Billing Update:  List of Contracted Intermittent Urinary Catheters

November 2019
DME Billing Update:  DME Supply Codes November 2019

DME  Billing Update:  Wound Care Advance Dressing November 2019

Physicians, Outpatient Hospitals, and Clinics
New Benefit: Evocative and Suppression Panel Tests October 2019
Physicians, Outpatient Hospitals, and Clinics
New Benefit: Scleral Contact Lens October 2019

Physicians, Outpatient Hospitals, and Clinics
Rate Update: Skin Substitute Products October 2019

All Providers Policy Update: Onasemnogene Abeparvovec-xioi October 2019

Physicians, Outpatient Hospitals, Pharmacy and Clinics
Policy Update: End of Life Option Act Services October 2019

Physicians, Outpatient Hospitals, and Clinics
Policy Update: Induce Abortion October 2019

Physicians, Outpatient Hospitals, and Clinics
Policy Update: BRAF Gene Analysis  October 2019
Physicians, Outpatient Hospitals, and Clinics
Policy Update: Gene Analysis October 2019
Physicians, Outpatient Hospitals, and Clinics
Policy Update: Microbiology October 2019

Physicians, Outpatient Hospitals, and Clinics
Policy Update: Cough Stimulating Device October 2019
All Providers Update: Provider Manual Revisions October 2019

Physicians, Outpatient Hospitals, and Clinics
Policy Update:  Postpartum Office Visits September 2019
DME Policy Update:  CPAP and Bi-PAP Providers September 2019
All Providers Billing Update:  2020 ICD-10/PCS Code Annual Update September 2019
All Providers New Benefit: Fractional Exhaled Nitrous Oxide August 2019
All Providers Benefit Removed: BCG Vaccine August 2019
All Providers Benefit Removed: HCPCS Code J0604 August 2019
DME Rate Update: Allied Health and Other Programs  August 2019
All Providers  Policy Update: Family PACT Programs August 2019
Physicians, Outpatient Hospitals, and Clinics
Policy Update: Radium Ra-223 Dichloride  August 2019
Physicians, Outpatient Hospitals, and Clinics
Policy Update: Abatacept Injection August 2019
Physicians, Outpatient Hospitals, and Clinics
Policy Update: Avelumab Injection August 2019
Physicians, Outpatient Hospitals, and Clinics
Policy Update: Bendamustine HCI August 2019
Physicians, Outpatient Hospitals, and Clinics
Policy Update: Ovarian Oncology Biochemical Assays August 2019
Physicians, Outpatient Hospitals, and Clinics
Policy Update: Iron Sucrose Injection August 2019
Physicians, Outpatient Hospitals, and Clinics
Policy Update: Ipilimumab August 2019
Physicians, Outpatient Hospitals, and Clinics
Policy Update: Infliximab Injection August 2019
Physicians, Outpatient Hospitals, and Clinics
Billing Update: Evaluation Management Codes August 2019
All Providers News: Crossover Claims August 2019
Physicians, Outpatient Hospitals, and Clinics
New Benefit: Counseling to prevent Perinatal Depression July 2019
Physicians, Outpatient Hospitals, and Clinics
New Benefit: July 2019 HCPCS Quarterly Update
July 2019
Physicians, Outpatient Hospitals, and Clinics
Rate Update: Radiology Services
July 2019
DME
Rate Update: Allied Health and Other Programs July 2019
All Providers Policy Update: Early and Periodic Screening, Diagnostic and Treatment (EPSDT) July 2019
Physicians, Outpatient Hospitals, and Clinics
Policy Update: Omalizumab Injection  July 2019
Physicians, Outpatient Hospitals, and Clinics
Policy Update: Nusinersen Injection  July 2019
Physicians, Outpatient Hospitals, and Clinics
Policy Update: Nivolumab Injection  July 2019
DME Policy Update: Underwear Incontinence Supply  July 2019
Physicians, Outpatient Hospitals, and Clinics
Billing Update: Diabetes Prevention Program (DPP) July 2019
All Providers

News: Diabetes Prevention Program (DPP) June 2019
All Providers
News: Diabetes Prevention Providers New to Medi-Cal June 2019
Physicians, Outpatient Hospitals, and Clinics
New Benefit: Hepatitis B Vaccine June 2019
DME New Benefit: Oral Appliance for Obstructive Sleep Apnea June 2019
Physicians, Outpatient Hospitals, and Clinics
Policy Update: Mepolizumab HCPCS code J2182 June 2019
Physicians, Outpatient Hospitals, and Clinics
Policy Update: Buprenorphine Implant June 2019
Physicians, Outpatient Hospitals, and Clinics
Policy Update: KIR (killer cell immunoglobulin-like receptor) June 2019
Physicians, Outpatient Hospitals, and Clinics
Policy Update: Ipilimumab HCPCS Code J9928 June 2019
Physicians, Outpatient Hospitals, and Clinics
Policy Update: Hydroxyprogesterone Caproate June 2019
Physicians and Clinics
Policy Update: Dental Services Updated for FQHC, RHC and IHS-MOA Clinic
Providers
June 2019
DME Policy Update: Brest Pump Supplies June 2019
All Providers Billing Update: NICU/PICU Services Code Conversion June 2019
All Providers Billing Update: EPSDT Psychology, Mental & Behavioral Health June 2019
Physicians, Outpatient Hospitals, and Clinics
New Benefit: April 2019 HCPCS Quarterly Update May 2019
Physicians, Outpatient Hospitals, and Clinics
Policy Update: Breast Cancer Gene Analysis May 2019
Physicians, Outpatient Hospitals, and Clinics
Policy Update: SMN1 Gene Analysis May 2019
All Providers Policy Update: Reslizumab Injection  May 2019
Physicians, Outpatient Hospitals, and Clinics
Billing Update: EPSDT Psychology, Mental Health & Behavioral Health Code Conversion
May 2019
All Providers Billing Update: NICU/PICU Services Code Conversion May 2019
All Providers Billing Update: CCS Service Code Groupings  May 2019
Physicians, Outpatient Hospitals, and Clinics
New Benefit: Physician Administered Drugs April 2019 
Physicians, Outpatient Hospitals, and Clinics
Billing Update: NICU/PICU Services Code Conversion April 2019
Physicians, Outpatient Hospitals, and Clinics
Billing Update: Audiology/EPSDT Audiology/Speech Theraphy Code Conversion April 2019
Physicians, Outpatient Hospitals, and Clinics
Billing Update: EPSDT Psychology, Mental Health & Behavioral Health Code Conversion April 2019
Physicians, Outpatient Hospitals, and Clinics
Policy Update: NICU/PICU Sevices Codes Conversion SAR/eSAR Requirements  April 2019
Physicians, Outpatient Hospitals, and Clinics
Policy Update: Requirements for Tocilizumab  April 2019
Physicians, Outpatient Hospitals, Clinics, and Laboratories
New Benefit: Targeted Genomic Sequence Analysis March 2019
Physicians, Outpatient Hospitals, and Clinics
New Benefit: Epoetin Beta ERSD Therapy March 2019
Physicians, Outpatient Hospitals, and Clinics
Rate Update: Modifier UA and UB Rates March 2019
Physicians, Outpatient Hospitals, and Clinics
Policy Update: Unlisted Multianalyte Assays March 2019
Physicians, Outpatient Hospitals, and Clinics
Policy Update: Intravitreal Implants March 2019
Physicians, Outpatient Hospitals, and Clinics
Policy Update: Modifiers Override Medical Justification Requirement March 2019
Physicians, Outpatient Hospitals, and Clinics
Policy Update: Alcohol Misuse Screenings March 2019
DME Policy Update: Tumor Treating Field Devices March 2019
Physicians, Outpatient Hospitals, and Clinics
Billing Update: Blood Factor Rebinyn March 2019
Physicians, Outpatient Hospitals, and Clinics
Proposition 56 Supplemental Payment February 2019
Physicians, Outpatient Hospitals, Clinics, and Laboratories
News: Diabetes Prevention Program (DPP) February 2019
Physicians, Outpatient Hospitals, Clinics, and Laboratories
Billing Update: NICU/PICU Services February 2019

Physicians, Outpatient Hospitals, and Clinics
Billing Update: Sign Language Interpreter Services February 2019
 
Physicians, Outpatient Hospitals, and Clinics
Billing Update: Advance Care Planning February 2019

Physicians, Outpatient Hospitals, and Clinics
Billing Update: Audiology, EPSDT Audiology and Speech Therapy February 2019

Physicians, Outpatient Hospitals, and Clinics
Billing Update: Transportation Services February 2019
 
Physicians, Outpatient Hospitals, Clinics, and Laboratories
Policy Update: Molecular Pathology Procedures February 2019

Physicians, Outpatient Hospitals, Clinics, and Laboratories
Policy Update: Thyroid Gene Expression Analysis February 2019

Physicians, Outpatient Hospitals, Clinics, and Laboratories
Policy Update: CPT-4 Code 81329 February 2019

Physicians, Outpatient Hospitals, Clinics, and Laboratories
Policy Update: Bright Futures/AAP Preventative Screening February 2019

Physicians, Outpatient Hospitals, Clinics, and Laboratories
Policy Update: Laboratory Services February 2019

Physicians, Outpatient Hospitals, and Clinics
New Benefit:  Cladribine (HCPCS Code J9065) January 2019
Physicians, Outpatient Hospitals, Clinics, and Laboratories
Billing Update:  2019 HCPCS Annual Update January 2019
Physicians, Outpatient Hospitals, Clinics, and Laboratories
Billing Update:  Correction to 2019 CPT Annual Update January 2019
Physicians, Outpatient Hospitals, and Clinics
Policy Update:  USPSTF and ACIP Preventative Services January 2019

ARCHIVE - 2018 Recent Billing/Policy Update Articles

Here you will find previously posted 2018 articles from the "Recent Billing/Policy Updates" section


Attention ARCHIVED 2018 Recent Billing/Policy Update Articles Original Posting Date
Physicians, Outpatient Hospitals, Clinics, and Laboratories
New Benefit:  Diabetes Prevention Program December 2018
Physicians, Outpatient Hospitals, Clinics
New Benefit:  Chronic Care Management Services December 2018
Physicians, Outpatient Hospitals, Clinics
New Benefit:  EContra Emergency Contraceptive Services December 2018
Physicians, Outpatient Hospitals, Clinics, and Laboratories
Billing Update:  2019 CPT Annual Update December 2018
Physicians, Outpatient Hospitals, Clinics, and Laboratories
Billing Update:  October 2018 HCPCS Quarterly Update December 2018
Physicians, Outpatient Hospitals, Clinics
Billing Update:  EPSDT Home Health Services December 2018
Physicians, Outpatient Hospitals, Clinics
Billing Update:  Revenue Codes for Outpatient Services December 2018
Physicians, Outpatient Hospitals, Clinics
Billing Update:  Sign Language Interpreter Services December 2018
Physicians, Outpatient Hospitals, Clinics
Billing Update:  Maternal Care Services and CPSP December 2018
Physicians, Outpatient Hospitals, Clinics, and Laboratories
Billing Update:  NICU/PICU Services
December 2018
Physicians, Outpatient Hospitals, Clinics, and Laboratories
Policy Updates:  EPSDT Psychology, Mental & Behavioral Health December 2018
Physicians, Outpatient Hospitals, Clinics, and Laboratories
New Benefit:  Depression Screenings November 2018
Physicians, Outpatient Hospitals, Clinics, and Laboratories
New Benefit:  Diabetes Prevention Program November 2018
Physicians, Outpatient Hospitals, Clinics
Rate Updates:  Corrected Rates for Select HCPCS Codes November 2018 
Physicians, Outpatient Hospitals, Clinics, and Laboratories
Policy Updates:  Cervical Cancer Screenings and HPV Testing November 2018 
DME Providers

Policy Updates:  Insulin Pumps November 2018 

DME Providers

Policy Updates:  CPAP and Bi-PAP Equipment November 2018 

DME Providers

Policy Updates:  Breast Pumps and Supplies November 2018 

DME Providers
Billing Update:  Disposable Insulin Delivery System November 2018 

Physicians, Outpatient Hospitals, Clinics, and Laboratories
New Benefit: TPMT Gene Analysis October 2018
Physicians, Outpatient Hospitals, Clinics, and Laboratories
Billing Update: 2018 ICD-10-PCS Annual Update October 2018
Physicians, Outpatient Hospitals, Clinics
Billing Update: EPSDT Psychology, Mental Health and Behavioral Health October 2018
Physicians, Outpatient Hospitals, Clinics
Billing Update: Audiology, EPSDT Audiology and Speech Therapy October 2018
Physicians, Outpatient Hospitals, Clinics
Billing Update: Sign Language Interpreter Services October 2018
Physicians, Outpatient Hospitals, Clinics, and Laboratories
Rate Update: Newborn Screening Rate October 2018
Physicians, Outpatient Hospitals, Clinics, and Laboratories
Rate Update: Pathology Service Codes October 2018
Physicians, Outpatient Hospitals, Clinics, and Laboratories
New Benefit: Fetal Non-Stress Testing September 2018 
Physicians, Outpatient Hospitals, Clinics
New Benefit: April HCPCS Quarterly Update
September 2018 

Physicians, Outpatient Hospitals, Clinics
New Benefit: July HCPCS Quarterly Update

September 2018
Physicians, Outpatient Hospitals, Clinics, and Laboratories
Billing Update: Whole-Child Model Program September 2018
Physicians, Outpatient Hospitals, Clinics, and Laboratories
Billing Update: 2018 ICD-10-CM Diagnosis Code Annual Update  September 2018 
Physicians, Outpatient Hospitals, Clinics, and Laboratories
Billing Update: 2019 ICD-10-CM/PCS Diagnosis Code Annual Update 
September 2018
Physicians, Outpatient Hospitals, Clinics, and Laboratories
Billing Update: Chemical Pathology September 2018 

Physicians, Outpatient Hospitals, Clinics, and Laboratories
Policy Update: Automated Hemogram and RSV Laboratory Tests

September 2018 
Physicians, Outpatient Hospitals, and Clinics
Policy Update: TAR Update for Skin Substitute September 2018 

Anesthesiologist

Policy Update: Dental Conscious and Deep Sedation

September 2018
Physicians, Outpatient Hospitals, Clinics, and Laboratories
Billing Update: Molecular Pathology Codes August 2018
Physicians, Outpatient Hospitals, Clinics
Billing Update: EPSDT Home Health Code Conversion August 2018
Physicians, Outpatient Hospitals, Clinics
Policy Update: Self-Administered Hormonal Contraceptives August 2018
Physicians, Outpatient Hospitals, Clinics, and Laboratories
Policy Update: Infectious Agent Detection Laboratory Codes August 2018
Transportation Providers

Policy Update: Non-Emergency Medical Transportation August 2018
Physicians, Outpatient Hospitals, Clinics
New Benefit: Skin Substitutes (HCPCS codes Q4159 & Q4160) July 2018
Physicians, Outpatient Hospitals, Clinics, and Laboratories 
New Benefit: Molecular Pathology (CPT-4 code 81310) July 2018
Physicians, Outpatient Hospitals, Clinics, and Laboratories 
Policy Update: Clinic Dispensing for Miscellaneous Drugs July 2018
Physicians, Outpatient Hospitals, Clinics, and Laboratories   Policy Update: HCPCS code G0433 Added to CIA-Waived List

July 2018
Physicians, Outpatient Hospitals, Clinics
Policy Updates: Breast Pump Supplies  July 2018
Physicians, Outpatient Hospitals, Clinics
Policy Update: Copper Intrauterine Devices (IUDs) July 2018
Transportation Providers New Benefit: Non-Medical Transportation  June 2018
Orthotics and Prosthetics Providers Policy Update: Cranial Remolding Orthosis (HCPCS code S1040) June 2018
Outpatient Hospitals
Policy Update: Revenue Code Update for Outpatient Services
June 2018
Physicians, Outpatient Hospitals, Clinics, and Laboratories 
Policy Update: Molecular Pathology Codes  June 2018
Physicians, Outpatient Hospitals, Clinics, and Laboratories 
Policy Update: Lynch Syndrome Testing (CPT-4 code 81403)
June 2018
Physicians, Outpatient Hospitals, Clinics, and Laboratories 
Policy Update: Brest Oncology Profiled via RT-PCR (CPT-4 code 81519) June 2018
Physicians, Outpatient Hospitals, Clinics, and Laboratories 
Policy Update: Clinical Laboratory Services June 2018
Physicians, Outpatient Hospitals, and Clinics
Policy Update: CPT-4 Codes Annual Update Correction June 2018
DME Providers Policy Update: DME for Disabled Parents to Assist with Child Care June 2018
DME Providers Policy Update: Power Wheelchair Nonstandard Set Frames (HCPCS codes E2340 - E2343) June 2018
DME Providers Policy Update: Power Seat Elevators June 2018
DME Providers Policy Update: Seating and Positioning Component Coverage  June 2018
DME Providers Policy Update: Select Blood Pressure Equipment (HCPCS codes A4660 & A4663) June 2018
Transportation Providers Policy Update: Medical Transportation (Dry Runs) June 2018
Transportation Providers Policy Updates: Emergency Air and Ground Transportation June 2018
Physicians, Outpatient Hospitals, and Clinics
Rate Update: Newborn Screening (HCPCS code S3620) June 2018
Physicians, Outpatient Hospitals, and Clinics
Rate Update: Skin Substitute Products (HCPCS codes Q4131, Q4132 and Q4133) June 2018
Physicians, Outpatient Hospitals, and Clinics
Rate Update: Specified Apheresis Procedures  June 2018
Primary Care Providers Rate Update: Preventative Medicine Evaluation and Management (CPT-4 codes 99385 & 99395) June 2018

Anesthesiologist

Rate Update: Certain Anesthesia Services June 2018
Hospice Providers Rate Update: Hospice Care Providers June 2018
Physicians, Outpatient Hospitals, Clinics, and Laboratories 
Billing Update:  PL and PS Modifier on Pathology Codes May 2018
Physicians, Outpatient Hospitals, Clinics, and Laboratories 
Billing Update: Revenue Codes for Outpatient Services May 2018
Physicians, DME, Orthotics & Prosthetics, and Physical Therapy  Billing Update:  Updated Modifiers for Oxygen Codes May 2018
Physicians, DME, Orthotics & Prosthetics, and Physical Therapy
Billing Update: Updated Diagnosis Codes for Removable Foot Inserts May 2018
Physicians, Outpatient Hospitals, Clinics, and Laboratories 
Policy Update:  Clinical Criteria for DNA Sequence Analysis May 2018
Physicians, Outpatient Hospitals, Clinics, and Laboratories   Policy Update:  Clinical Criteria for Familial Hyperinsulinism Gene Analysis

May 2018
Physicians, DME, Orthotics & Prosthetics, and Physical Therapy
Policy Update:  Frequency limitation for Orthotic Codes May 2018
Physicians, Outpatient Hospitals, Clinics, and Laboratories 
New Benefit: FLT3 Gene Analysis  (81245 and 81246) April 2018
Physicians, Outpatient Hospitals, and Clinics
Billing Update:  Alcohol Misuse (G0442 and G0443) April 2018

Physicians, Outpatient Hospitals, and Clinics, Transportation
Billing Update:  Non-Emergency Medical Transportation  April 2018

Hospice Providers
Billing Update:  Hospice Routine Home Care (0650, 0659 and 0552) April 2018

Physicians, Outpatient Hospitals, Clinics, and Laboratories 
Billing Update:  HPV Testing and Co-Testing (87624 and 87625) April 2018

Physicians, Outpatient Hospitals, Clinics, and Laboratories   Policy Update:  Breast Cancer Gene Analysis (81162, 81211 and 81213) April 2018

Physicians, Outpatient Hospitals, and Clinics
Billing Update:  Vitamin B-12 Injections (J3420) April 2018
 
Physicians, Outpatient Hospitals, and Clinics
Policy Update:  Diclofenac Sodium Injection (J1130)

April 2018

Physicians, Outpatient Hospitals, Clinics, and Laboratories 
Policy Update:  Newborn Metabolic Screening Panel

April 2018

Physicians, Outpatient Hospitals, and Clinics
Rate Update:  Family Planning Drugs (J3490) April 2018

Physicians, Outpatient Hospitals, and Clinics
Proposition 56 Supplemental Payments April 2018
Physicians, Outpatient Hospitals, Clinics, and Laboratories 
New Benefit: Additional Gene Tests Billable under Molecular Pathology CPT-4 codes (81406,81404 and 81405) March 2018
Physicians, Outpatient Hospitals, Clinics, and Laboratories 
New Benefit:  Surgical Pathology (88365) March 2018

Physicians, Outpatient Hospitals, and Clinics
Policy Update: Nerve Pedicle Transfer (64905) March 2018
Physicians, Outpatient Hospitals, and Clinics, Transportation
Policy Update:  Medical Transportation Dry Runs (A0225) March 2018
Physicians, Outpatient Hospitals, and Clinics, Home Health Agencies
Policy Update:  Face to Face Encounters for Home Health Services March 2018
Physicians, DME, Orthotics & Prosthetics, and Physical Therapy
Rate Update:  Knee Orthosis Codes (L1851 and L1852)

March 2018
ALL PROVIDERS

2017 and 2018 CPT-4/HCPCS Update February 2018
Physicians, Outpatient Hospitals, Clinics, and Laboratories 
Policy Update: Microsatellite Instability Analysis (81301) February 2018

Physicians, DME, Orthotics & Prosthetics, and Physical Therapy
Policy Update: Wheelchair and Scooter Repair and Maintenance February 2018

ALL PROVIDERS

Annual 2018 CPT-4/HCPCS Code Update January 2018
Physicians, Outpatient Hospitals, and Clinics
New Benefit: Pulmonary Rehabilitation (G0424) January 2018
Physicians, Outpatient Hospitals, and Clinics
Upcoming Benefit: Diabetes Prevention Program January 2018
Physicians, Outpatient Hospitals, and Clinics
Policy Update: Mammography Codes 77065 and 77066 January 2018
Physicians, Outpatient Hospitals, Clinics, and Laboratories 
Policy Update: Neuropsychological Testing January 2018
Physicians, Outpatient Hospitals, and Clinics
Billing Update: Place of Service Code Update on Sleep Study and Polysomnography Codes January 2018
Physicians, Outpatient Hospitals, Clinics, Vision Providers, and Ophthalmologists
Billing Update: Ophthalmic Biometry (92136) January 2018
Physicians, Outpatient Hospitals, Clinics, and Laboratories
Billing Update:  KIT Gene Analysis (81272) January 2018
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