Payment Policy Updates

November 2023

December 7, 2023

The following Policies received their annual review with no changes:

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

  • Blood Draw/Venipuncture – 36415
    • Added a Cross Reference to the Laboratory and Pathology Billing Guidelines Payment Policy.  Revised the Policy statement to be more explanatory on coding for venipuncture. Added References.
  • Claim Editing
    • Policy title changed; Revised the Purpose statement, Definition, Policy statement  and Exception sections of the policy to provide more details and clarity on claim editing.
  • Home Birth Kit Supplies – S8415
    • Added the last bullet in the list of supplies considered included in the birth kit
  • Modifier 79 – Unrelated Procedure/Service by Same Provider during Postoperative Period
    • In the Policy section, added further clarification on correct coding for modifier 79 in the first, second and last paragraphs.
  • Modifier 80, 81, 82 – Assistant Surgeons (Physician)
    • In the Policy section, added the last sentence to the third paragraph which indicates that only one surgical assistant is allowed per applicable surgical procedure.  Also added the sixth paragraph indicating that the assistant surgeon only reports the procedure codes for which they assisted the primary surgeon and only those procedure codes eligible for an assistant surgeon will be reimbursed.
  • Modifier AS – Physician Assistant, Nurse Practitioner or Clinical Nurse Specialist Services for Assistant at Surgery (Non-Physician)
    • In the Policy section, added the fourth paragraph indicating that the assistant surgeon only reports the procedure codes for which they assisted the primary surgeon and only those procedure codes eligible for an assistant surgeon will be reimbursed. Added the last sentence to the seventh paragraph which indicates that only one surgical assistant is allowed per applicable surgical procedure
  • Modifier SG - Ambulatory Surgery Center (ASC) facility services
    • Minor clarification to the opening paragraph.  Added the last two paragraphs in the Policy to identify how to enter the ASC’s NPI provider identification number on the claim record.
  • Modifier SL – State Supplied Vaccine
    • Revised Policy statement.  Added an Exception.  Included a link to the Alaska State Immunization Program Formulary grid
  • New and Established Patient Guidelines
    • In the Policy section, in the fourth paragraph, added clarification on how covering providers will affect the status of the patient; in the sixth paragraph, added clarification that if a provider sees a patient in the prior three years in any location, that patient is considered an established patient in all locations and added the seventh paragraph indicating if no face to face patient encounter is rendered, only reading/interpreting of tests, the patient is NOT considereda new patient.
  • Prolonged Services for Labor Management
    • Minor clarifications to the Policy statement and code descriptions.