Payment Policy Updates

July 2024

August 1, 2024

The following policies received their annual review with no changes:

The following policies received their annual review with the changes noted:

Telehealth/Telemedicine Services

In the section “Telephone Assessment and Management (Audio only)”:

  • Added the fifth paragraph with two sub-bullets which identify the new definition for an “established relationship” for audio only services received by all members from Washington providers only
  • In the sixth and seventh paragraphs, added a termination date for the definitions of “established relationship” for Washington providers only

(NEW POLICY) Critical Care in Emergency Department when Patient is Discharged to Home (Facility)

Effective with claims dates of service on and after October 30, 2024, if an Emergency Department facility claim is submitted with a discharge status code of 01-Discharged Home and includes critical care procedure codes 99291 and 99292, then the critical care procedure codes 99291 and 99292 may be reviewed and denied reimbursement by the plan if the critical care services do not meet the requirements/guidelines for critical care services.