February 2, 2023
The following payment policies received their annual review with no changes:
- Modifier 25 – Significant, Separately Identifiable Evaluation & Management (E&M) Service on Same Day of Procedure or Other Service
- Modifier 58 – Staged or Related Procedure or Service by Same Physician or Other Qualified Healthcare Professional during Postoperative Period
- Modifier 91 – Repeat Clinical Diagnostic Laboratory Test
- Robotic Surgical System and Computer Assisted Navigation Codes (S2900, 20985, 0054T and 0055T)
- Teledentistry Services
The following payment policies received their annual review with the changes noted below:
- Evaluation and Management (E&M) Visit Billed with Preventive Medicine Examination
Added third paragraph to indicate that the appending of modifier 25 is not a guarantee of payment. In the Codes/Coding Guidelines section of the policy, updated the code descriptions in the sections Home Services (new and established) and Preventive Medicine Services (effective January 1, 2023). - Group Psychotherapy Services (90853)
Correction: One unit will be applied to code 90853 effective with “dates of service” December 7, 2022, on and after rather than process dates. - Modifier 22 – Increased Procedural Services
Clarified modifier 22 should not be appended to services rendered to neonates and infants with a body weight of less than 4 kg. - Modifier 54, 55, 56 – Surgical Care Only/Postoperative Management Only/Preoperative Management Only
Inserted the phrase “or other qualified healthcare professional” as a potential provider of services. Added the second bullet under Modifier 54. - Screening Services with Evaluation and Management (E&M) Services
Added the last paragraph in the policy to indicate appending modifier 25 to the E&M must be documented in the notes as a separate and distinct E&M service. - Site Specifying Modifiers
Created a new section in the policy for laterality. - Telehealth/Telemedicine Services
Removed effective dates on modifiers that were over a year old.