April 7, 2022
The following payment policies received their annual review with no changes:
Add On Codes
Inpatient Acute Transfers
from DRG Hospitals
Modifier JW– Drug Amount
Discarded/Not Administered to Any Patient
Multiple Diagnostic Cardiovascular
Services Reductions
Multiple Diagnostic
Imaging Reductions
The following payment policies received their annual review and changes/updates made are as follows:
Ambulatory
Surgery Center (ASC) Facility Services
Clarified the correct use of the place of service code 24 and the modifier SG.
New Policy: COVID-19 Testing for
Occupational, Vocational, School, Travel Or Public Health Purposes
New payment policy on diagnostic testing, surveillance testing and over-the-counter (OTC) home test kit testing.
Durable
Medical Equipment/Home Medical Equipment
Clarified that the "rental to purchase equipment" classification includes "purchase or rental to purchase equipment." Updated the list of codes in the link in the policy to reflect the 2022 DME CMS fee
schedule.
Organ Acquisition Costs (Medicare Advantage
Benefits Policy Only)
Added exception that acquisition costs of kidneys are excluded from reimbursement.
Serious Adverse
Events – Inpatient Facility Services
In the hospital acquired condition section of the policy, clarified that the plan will not reimburse diagnosis codes on the CMS hospital-acquired conditions list or a never event diagnosis code. In the "present
on admission" section of the policy, identified where to find the coding guidelines for present on admission indicators. In the codes/coding guidelines section of the policy, minor revisions to the present on admission indicator code descriptions.