Claims Corner

Recent Billing/Policy Update Articles

Attention	Articles	Posting Date
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	STILL USING PAPER TO SUBMIT CLAIMS?	January 2018

February 2018

March 2018

Policy Update: Diclofenac Sodium Injection

Policy Update: Copper Intrauterine Devices (IUDs)

Policy Update: Dental Conscious and Deep Sedation

September 2018

October 2018

November 2018

December 2018

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.

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.

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.

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 - 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	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

AcceptReject

ARCHIVE - 2017 Recent Billing/Policy Update Articles

Here you will find previously posted 2017 articles from the "Recent Billing/Policy Updates" section

Attention	ARCHIVED 2017 Recent Billing/Policy Update Articles	Original Posting Date
Physicians, Outpatient Hospitals, and Clinics	New Benefit: Cuvitru for Primary Humoral Immunodeficiency (billable under HCPCS code J3590)	December 2017
Physicians, Outpatient Hospitals, and Clinics	Billing Update: Modifier ZA (when billing Zorxio with HCPCS Code Q5101)	December 2017
Physicians, Outpatient Hospitals, and Clinics	Policy Update: Bevacizumab 10 mg Injection (HCPCS Code J9035)	December 2017
DME, Orthotics & Prosthetics, and Physical Therapy	Policy Update: HCPCS code L3000 (Orthotic Foot Insert)	December 2017
Physicians, DME, Orthotics & Prosthetics, and Physical Therapy	Policy Update: Lower Extremity, Thoracic Control (HCPCS Codes L2670 and L2680)	December 2017
Physicians, Outpatient Hospitals, and Clinics	Policy Update: Cystourethroscopy Services (CPT-4 Codes 52441 and 52442)	December 2017
Physicians, Outpatient Hospitals, and Clinics	New Benefit: Nusinersen 0.1mg injection (C9489), Bezlotoxumab 10mg injection (C9490) and Ustekinumab, for intravenous injection, 1mg (Q9989)	November 2017
Physicians, Outpatient Hospitals, and Clinics	Billing Update: Modifier ZB (when billing Inflectra with HCPCS Code Q5102)	November 2017
Physicians, Outpatient Hospitals, and Clinics	Billing Update: Modifier ZC (when billing Renflexis with HCPCS Code Q5102)	November 2017
Physicians, Outpatient Hospitals, Clinics, and Laboratories	Policy Update for Breast Cancer Gene Analysis (CPT-4 Codes 81211, 81213 and 81162)	November 2017
Physicians, Outpatient Hospitals, Clinics, and Laboratories	Policy Update for Hereditary Colon Cancer Disorder (CPT-4 Codes 81435 and 81436)	November 2017
Physicians, Outpatient Hospitals, and Clinics, DME	Policy Update: DME Wheelchair and Wheelchair Accessory Guidelines	November 2017
Physicians, Outpatient Hospitals, and Clinics, DME and Obstetricians	Policy Clarification: Rental/Purchase of Breast Pumps	November 2017
Physicians, Outpatient Hospitals, Clinics, Vision Providers, and Ophthalmologists	Diagnosis Update for Professional Vision and Ophthalmology Services	November 2017
Physicians, Outpatient Hospitals, Clinics and Obstetricians	Annual 2017 CPT4/HCPCS Code Update Revisions	October 2017
Physicians, Outpatient Hospitals, and Clinics	Immunization and Vaccines FAQs	October 2017
Physicians, Outpatient Hospitals, Clinics and Obstetricians	New Benefit: Pathogen(s) Test for Platelets HCPCS Code Q9987	October 2017
Physicians, Outpatient Hospitals, and Clinics	Rate Update for Skin Lesion Surgery CPT-4 Codes 17110 and 17111	October 2017
Physicians, Outpatient Hospitals, Clinics, Obstetricians and Laboratories	Policy Update for HIV Screening and Infectious Agent Detection HCPCS Code G0475 and CPT-4 Code 87801	October 2017
ALL PROVIDERS	Annual Update 2017 CPT-4/HCPCS Codes- Additional Information	September 2017
Physicians, Outpatient Hospitals, and Clinics	New Benefit: Siltuximab 10 mg Injection	September 2017
Physicians, Outpatient Hospitals, Clinics and Obstetricians	New Benefit: Surgical and Preventative Preterm Birth HCPCS Codes (C9745-C9747 and Q9985-Q9986)	September 2017
Physicians, Outpatient Hospitals, Clinics, Obstetricians and Gynecologists	Policy Update for Sterilization CPT-4 Codes 58661 (Laparoscopy) and 58700 (Salpingectomy)	September 2017
Physicians, Outpatient Hospitals, and Clinics	Policy Update for Allergen Specific IgE Testing (CPT-4 Code 86003)	September 2017
DME, Orthotics & Prosthetics, and Physical Therapy	Policy Update for Several DME HCPCS Codes	September 2017
Physicians, Outpatient Hospitals, and Clinics	Billing Update: Cardiac Magnetic Imaging Resonance for Morphology (CPT-4 Code 75561)	September 2017
Audiology, DME, Orthotics & Prosthetics, and Physical & Occupational Therapy	Billing Update to Specific Orthotics & Prosthetics HCPCS Codes	September 2017
Physicians, Outpatient Hospitals, Clinics and FQHCs/RHCs/IHS-MOAs	Billing Update: End of Life Option Services	September 2017
FQHCs/RHCs/IHS-MOAs	Billing Update for Service Authorization Requests (SARs)	September 2017
Clinical Laboratories	Rate Update for Clinical Laboratory Services	September 2017
Physicians, Outpatient Hospitals, Clinics and Laboratories	Billing Update: Drug Testing HCPCS Codes G0477-G0479 to be Discontinued	August 2017
ALL PROVIDERS	Annual Update for 2017 CPT-4/HCPCS Codes	August 2017
Physicians, Outpatient Hospitals, Clinics and Ophthalmologists	Policy Update for Eye and Ocular Adnexa Surgery (CPT-4 Codes 65778, 65779, 66820, 66821)	August 2017
DME Providers	Policy Update for Sterile Needles (HCPCS Code A4125)	August 2017
FQHC, RHC and IHS-MOA Providers	Additional Information for HIPAA Conversion Update	August 2017
Physicians, Outpatient Hospitals, and Clinics	New Benefit: Cardiac Magnetic Resonance Imaging (CPT-4 Code 75561)	July 2017
Physicians, Outpatient Hospitals, and Clinics	New Benefits under Physicians Administered Drugs (HCPCS Codes C9484-C9488)	July 2017
Physicians, Outpatient Hospitals, and Clinics	Policy Update for Modifier KX	July 2017
Physicians, Outpatient Hospitals, and Clinics	Policy Update for Lanreotide 1 mg Injection (HCPCS Code J1930)	July 2017
Physicians, Outpatient Hospitals, and Clinics	Rate Update for Pulmonary Valve Implantation (CPT-4 Code 33477)	July 2017
FQHC, RHC and IHS-MOA Providers	Billing Update: HIPAA Code Conversion Coming Soon	July 2017
Physicians, Outpatient Hospitals, Clinics and Family Planning Providers	New Benefit: Contraceptive Cervical Cap and Diaphragm (HCPCS Codes A4261 and A4266)	June 2017
Physicians, Outpatient Hospitals, Clinics and Family Planning Providers	New Benefit: Levonorgestrel-releasing Intrauterine System, 19.5 mg (HCPCS Code S4989)	June 2017
Physicians, Outpatient Hospitals, and Clinics	New Benefit: Procalcitonin Assay (CPT-4 code 84145)	June 2017
ALL PROVIDERS	New Benefit: Modifier 95	June 2017
Indian Health Services Providers	Policy update for Acupuncture Services	June 2017
Inpatient Hospitals	Policy Update for Emergency Room Reimbursement Policy	June 2017
Physicians, Outpatient Hospitals, Clinics and DME Providers	Policy Update for DME Prescriptions	June 2017
Physicians, Outpatient Hospitals, Clinics and DME Providers	Policy Update for Medical/Incontinence Supplies and Enteral Nutrition Prescriptions	June 2017
Physicians, Outpatient Hospitals, and Clinics	Policy Update for ECMO/ECLS Services	June 2017
Physicians, Outpatient Hospitals, Clinics and Obstetricians	Policy Update for Pregnancy Services	June 2017
Physicians, Outpatient Hospitals, Clinics and Obstetricians	Policy Update for Select Ultrasound Services (CPT-4 Codes 76514, 76830, 76856 and 76857)	June 2017
Physicians, Outpatient Hospitals, and Clinics	Policy Update for Zoster Vaccine (CPT-4 codes 90736)	June 2017
Physicians, Outpatient Hospitals, and Clinics	Policy Update for Allergen Immunotherapy Injections (CPT-4 Codes 95115 and 95117)	June 2017
DME Providers	Policy Update for Blood Pressure Monitor (HCPCS Code A4670)	June 2017
DME Providers	Policy Update for DME Oxygen and Respiratory Equipment	June 2017
Physicians, Outpatient Hospitals, and Clinics	Rate Update for Ureter and Urethra Surgery Services (CPT-4 Codes 52441, 52442, 53850 and 53852	June 2017
Physicians, Outpatient Hospitals, and Clinics	Rate Update for Application of Topical Fluoride Varnish (CPT-4 Code 99188)	June 2017
Physicians, Outpatient Hospitals, Clinics and Laboratories	New Benefit: SMN1/SMN2 Gene Test (CPT-4 Code 81401)	May 2017
Physicians, Outpatient Hospitals and Clinics	Diagnosis Restrictions Update for Bevacizumab 10 Mg Injection (HCPCS code J9035)	May 2017
DME Providers	Policy Update for Medical Supply Invoices	May 2017
Physicians, Outpatient Hospitals, Clinics and Laboratories	Medi-Cal Rate Update for CPT-4 codes 88112 (Cytopathology, Selective Cellular Enhancement Technique) and 88333 (Pathology Consultation during Surgery)	May 2017
Physicians, Outpatient Hospitals and Clinics	Medi-Cal Rate Update for CPT-4 code 11042 (debridement, subcutaneous tissue)	May 2017
Physicians, Outpatient Hospitals, Clinics and Laboratories	Policy Clarification for SMN1 Gene Tests (CPT-4 Codes 81400, 81403 & 81405)	May 2017
Physicians, Outpatient Hospitals and Clinics	UPDATE: HIPAA Conversion of Intravenous Solutions (Local Codes X7700 & X7702)	April 2017
Physicians, Outpatient Hospitals and Clinics	New Benefit: Carbidopa and Levodopa Enteral Suspension (HCPCS Code J7340)	April 2017
Physicians, Outpatient Hospitals, Clinics, Family Planning Providers	Policy Update for Clinic Dispensing of Contraceptive Supplies (HCPCS Codes J7303 and J7304)	April 2017
DME Providers	Policy Update for Obstructive Sleep Apnea (OSA)	April 2017
Medical Transportation Providers	Policy Update for Medical Transportation related to Emergency Statements, Round Trips, Night Calls and Non-Emergency Transports	April 2017
Physicians, Outpatient Hospitals, Clinics and Radiologists	New Benefit: Abdominal Ultrasound Services (HCPCS Code C9744)	March 2017
Physicians, Hospitals and Clinics	Policy Update for ECMO and ECLS Services	March 2017
Physicians, Outpatient Hospitals, and Clinics	HIPAA Conversion for Inhalation Solutions (Local Codes X7700 and X7702)	March 2017
Physicians, Outpatient Hospitals, and Clinics	Policy Update for Central Nervous System Assessments/Tests	February 2017
DME Providers	Pricing Policy Update for Wheelchair Accessory	February 2017
DME and Prosthetics & Orthotics Providers	Policy Update for HCPCS L1902 (Prefabricated Ankle Orthosis)	February 2017
ALL PROVIDERS	Policy Update for Revenue Codes	January 2017
Physicians, Outpatient Hospitals, Clinics and Laboratories	New Benefit: EndoPredict (CPT-4 Code 81599)	January 2017
Physicians, Outpatient Hospitals, and Clinics	New Flu Vaccine: Flucelvax (CPT-4 Code 90674)	January 2017
Physicians, Outpatient Hospitals, and Clinics	New Injection Codes: Atezolizumab (HCPCS Code C9483), Reslizumab (HCPCS Code C9481) and Sotalol (HCPCS Code C9482)	January 2017
Physicians, Outpatient Hospitals, Clinics and Allergy Providers	Policy Update for Allergy Desensitization Services (CPT-4 Codes 95115 and 95117)	January 2017
Physicians, Outpatient Hospitals, Clinics and Laboratories	Policy Update for Colorectal Cancer Screening (CPT-4 codes 81528)	January 2017
Podiatrists	Policy Clarification for Podiatry Services	January 2017

About Us

Our Leadership

Need Health Coverage?

Our Members Are Important to Us

Plans & Nurse Advice Lines

Benefits, Privacy, Testimonials

Questions, Forms, Mission Statement

We Build Strong Relationships with Our Providers

Provider Needs & Information

Pharmacy, Claims, Portal info

Forms Manuals & Policies

We Are Proud to Participate in Our Community

Serving Our Community

Community Resources:

Community Resources (continued):