Payment Policy Updates

March 2022

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.