Claims Corner

Recent Billing/Policy Update Articles

Attention	Articles	Posting Date
Physicians, Outpatient Hospitals, and Clinics	New Benefit: Cinacalcet Tablets	November 2020
Physicians, Outpatient Hospitals, Clinics and Laboratories	Rate Update: Fetal Gene Analysis	November 2020
Physicians, Outpatient Hospitals, Clinics and Laboratories	Rate Update: COVID 19 Reimbursement Rates	November 2020
Physicians, Outpatient Hospitals, and Clinics	Rate Update: CPT-4 Code 86413	November 2020
Physicians, Outpatient Hospitals, and Clinics	Rate Update: FQHC/RHC Annual Rate	November 2020
Physicians, Outpatient Hospitals, and Clinics	Policy Update: National Correct Coding Initiative	November 2020
Physicians, Outpatient Hospitals, and Clinics	Policy Update: List of Medical Supplies Billing Codes, Units and Quantity Limits	November 2020
DME	Policy Update: Cough Stimulating Device and Replacement Components	November 2020
Physicians, Outpatient Hospitals, and Clinics	Billing Update: Pen Needles	November 2020
Vision	Update: PIA Optical Laboratory Services Eligibility	November 2020
Physicians, Outpatient Hospitals, Clinics, and Laboratories	New Benefit: COVID-19 Quantitative Antibody Test	October 2020
Physicians, Outpatient Hospitals, Clinics, and Laboratories	New Benefit: Magnetoencephalography and Magnetic Source Imaging	October 2020
Physicians, Outpatient Hospitals, and Clinics	Rate Update: Electroencephalography Procedure	October 2020
LTC	Rate Update: FS/PSA Facilities	October 2020
LTC	Rate Update: DP/PSA Facilities	October 2020
LTC	Rate Update: FS/NF-B Rates	October 2020
LTC	Rate Update: FSSA/NF-B Rates	October 2020
Physicians, Outpatient Hospitals, and Clinics	Policy Update: CCS and GHPP Service Code Groupings	October 2020
Physicians, Outpatient Hospitals, and Clinics	Policy Update: Injection Codes	October 2020
Physicians, Outpatient Hospitals, and Clinics	Policy Update: Sinuva Sinus Implant	October 2020
Physicians, Outpatient Hospitals, Clinics, and Laboratories	Billing Update: HCPCS Quarterly Update	October 2020
Physicians, Outpatient Hospitals, Clinics, and Laboratories	Billing Update: Immune Globulins	October 2020
DME	Correction: DME Manual	October 2020
DME	Correction: Multi-Function Ventilator	October 2020
Physicians, Outpatient Hospitals, Clinics, and Pharmacies	News: Medi-Cal Rx Portal Registration	October 2020
Physicians, Outpatient Hospitals, Clinics, and Laboratories	New Benefit: Genomic Sequence Analysis	September 2020
Physicians, Outpatient Hospitals, and Clinics	New Benefit: CPT-4 Codes 86408 and 86409	September 2020
Physicians, Outpatient Hospitals, and Clinics	New Benefit: Brachytherapy Codes	September 2020
Physicians, Outpatient Hospitals, Clinics, and Laboratories	Rate Update: Clinical Laboratory Rates	September 2020
Physicians, Outpatient Hospitals, and Clinics	Rate Update: Pharmacy Fee-For-Service	September 2020
Physicians, Outpatient Hospitals, Clinics, and Laboratories	Policy Update: CPT Code for COVID19 Testing	September 2020
Physicians, Outpatient Hospitals, and Clinics	Policy Update: Depression Screenings	September 2020
Physicians, Outpatient Hospitals, and Clinics	Policy Update: CPT Code 81404	September 2020
Physicians, Outpatient Hospitals, and Clinics	Policy Update: Remdesivir to Treat COVID19	September 2020
Physicians, Outpatient Hospitals, and Clinics	Update: Correction for Echocardiography in Provider Manual	September 2020
Physicians, Outpatient Hospitals, Clinics, and Laboratories	New Benefit: COVID-19 Testing	August 2020
Physicians, Outpatient Hospitals, and Clinics	New Benefit: Provisional Postpartum Care	August 2020
Physicians, Outpatient Hospitals, and Clinics	New Benefit: Family Therapy	August 2020
Physicians, Outpatient Hospitals, and Clinics	Policy Update: CCS Service Code Groupings	August 2020
Physicians, Outpatient Hospitals, and Clinics	Billing Update: HCPCS Quarterly Update	August 2020
Physicians, Outpatient Hospitals, and Clinics	Update: Abortion Services Due To COVID-19	August 2020
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

January 2020

February 2020

Physicians, Outpatient Hospitals, and Clinics

April 2020

May 2020

Policy Update:

July 2020

Policy Update:

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 - 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: 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
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

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

January 2020

February 2020

Physicians, Outpatient Hospitals, and Clinics

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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