Payment Policy Updates

December 2023

January 4, 2024

The following policies received their annual review with no changes:

The following policies received their annual review with the following updates:

Add-On Codes

Corrected the link to the CMS file of Add-On codes

Evaluation and Management (E&M) Visit Billed with Preventive Medicine Examination

In the Policy section, in the third paragraph, added the last sentence indicating that the diagnosis for the separate and distinct E&M service must reflect the separate and distinct nature of the E&M from the preventive medicine exam service; in the fourth paragraph, added a phrase indicating that BOTH the E&M service and the Preventive Medicine Exam service should be billed on the same claim. In the Codes/Coding Guideline section, updated code descriptions for New and Established procedure codes.

Group Psychotherapy Services (90853)

In the Policy section, identified the source of the one-unit limit for procedure code 90853.

Modifier 22 – Increased Procedural Services

In the Policy section, revised the second paragraph to identify which codes are valid with modifier 22; revised the fourth paragraph to indicate that medical records are required in order for the claim to be processed correctly;  revised the sixth paragraph to indicate that if chart notes/medical records do not support the increased work, no increased reimbursement will be allowed and if documentation is not received at all, the appended procedure will not be reimbursed.  Added a new section on the billing of maternity services which may be appended with modifier 22.

Modifier 25 – Significant, Separately Identifiable Evaluation &Management (E&M) Service on Same Day of Procedure or Other Service

In the Policy section, minor revisions to identify global days for minor and major surgical procedures

Place of Service Codes

In the Codes/Coding Guidelines section, Place of Service code 10 was changed from “F” (facility RVUs) to “NF” (non-facility RVUs) effective January 1, 2024

Screening Services with Evaluation and Management (E&M) Services

In the third bullet in each of the sections of the Policy, changed the word “will” to “may” be allowed with modifier 25.

Teledentistry Services

In the Policy section, added a full description to the codes D9995 and D9996.

Telehealth/Telemedicine Services

In the “Telehealth Real-time Communications (audio and video)” section:

  • Revised wording of the first paragraph,
  • Expanded the second paragraph to identify sources for audio and video services
  • Expanded the third paragraph to add a referral notation to the modifier and place of services sections of the policy

In the “Telephone Assessment and Management (Audio only) section:  Added the last two paragraphs to identify sources for the audio only services and  added a referral to the modifier and place of service sections of the policy.

In the “Online Digital Services” section: Added the last paragraph to refer to the Online Digital Services section in the “Codes and Coding Guidelines” section of the policy for additional information.

In the “Originating Site” section of the policy, revised the wording of the first and third paragraphs.

In the “Distant Site” section of the policy:  Revised the wording of the first paragraph and  added the last two paragraphs of the section.

In the “Audio Only Services Modifiers”, added the fourth bullet.

In the “Codes and Coding Guidelines” section:

  • In the “Telemedicine Real-Time Communications (Audio AND Video required)” section, expanded bullet three to indicate that services in the AMA CPT Codebook Appendix T may be rendered via audio and video if the code is also marked with a “star” symbol in the code lists within the codebook
  • In the “Telephone Assessment and Management (Audio Only)” section, added the last paragraph indicating where in the policy these procedure codes can be found.