December 5, 2024
The following payment policies received their annual review with no changes:
- Modifier 73-Discontinued Outpatient Hospital/Ambulatory Surgery Center (ASC) Procedure Prior to Administration of Anesthesia
- Modifier 74-Discontinued Outpatient Hospital/Ambulatory Surgery Center (ASC) Procedure after Administration of Anesthesia
- Physical Medicine and Rehabilitation Services
The following payment policies received their annual review with the following changes:
In the Exception section of the policy, identified that effective November 24, 2024, procedure code 01996 does not require an anesthesia modifier.
In the Exception section of the policy, identified that effective November 24, 2024, procedure code 01996 does not require an anesthesia modifier.
COVID-19 Testing: Diagnostic, Surveillance and Over the Counter
IN the Policy section, removed all references to COVID tests, COVID procedure codes, COVID diagnoses which all terminated at the end of the public health emergency, May 12, 2023.
Durable Medical Equipment (DME) / Home Medical Equipment (HME)
Updates to the code list in the embedded link include the following:
- CORRECTION: Code A4608 was not changed to “Oxygen Rental only (RR)” in the prior policy update; it has been corrected to now reflect “Oxygen Rental only (RR)”
- New codes added effective with dates of service on and after April 1, 2024: E0736, E0738, E0737
- New codes added effective with dates of service on and after October 1, 2024: A7021, E0469, E0683, E0743, E2513
In the Policy section:
- Added a statement in the first paragraph regarding excessive volume amounts.
- In the section Modifier JW-Drug Amount discarded/not administered to any patient, added a statement in the sixth paragraph which states: “When a larger dose (vial) is used, excessive volumes of waste will not be reimbursed, Reimbursement for waste will be reduced to match the dose of the smallest vial available.”
Personal Protective Equipment (PPE)
- Removed from the Policy section references to the public health emergency requirements to cover PPE billed with code 99072
- Removed from the Exceptions section reference to procedure code 99072 reimbursement after the end of the public health emergency. The code reverts to being a Status B code.