Payment Policy Updates

October 2022

November 3, 2022

The following policies received an annual review with no changes:

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

In the cross-reference section, Modifier 22 payment policy was added. In the modifier section, a paragraph to indicate Modifier 22 is not appropriate to append to anesthesia codes for increased anesthesia service was added. In the moderate/conscious sedation section, clarified the descriptions of moderate sedation to be more reflective of the actual code descriptions.

In the cross-reference section, payment policy Modifier 22 was added. At the end of the policy section, a paragraph to indicate that appending Modifier 22 is not appropriate to indicate increased anesthesia services was added.

Added codes 0051U and 0328U to the definitive/quantitative drug class sections of the policy.

Removed the prior opening paragraph of the policy since the date was over a year old.

Clarified the policy statement to make it more understandable.

Added an introductory paragraph to the policy statement. Moved the confirmatory visit section to the beginning of the policy. In the global obstetric (OB) package section, some minor revisions to descriptions of services included in the global OB package were made. In the antepartum care only section, a reference that prenatal visits rendered prior to an unexpected pregnancy termination can be billed was added. In the delivery only section, indicated that the date of delivery should be used for the date of service. Also made minor revisions to the descriptions of services included in the delivery only codes. In the delivery including postpartum section, indicated that the date of delivery should be used for the date of service. Clarified that if the postpartum care 6-8 weeks post-delivery is not also rendered by the delivering provider, then only the delivery only codes can be billed. In the postpartum section, clarified that the post-delivery visits include both in-office and home visits. Added a new section for maternity complications services.

Added clarification to the “Plan of Care Modifiers” section of the policy and a link to the list of applicable codes. Also noted that as stated in the June payment policy updates, effective with claims processed on and after August 15, 2022, a “plan of care modifier” (GN, GO, GP) must be appended to applicable therapy services by any provider and any specialty that bills these therapy codes. A link to the applicable therapy codes was added to the policy.