Policy Updates Reimbursement PoliciesCommercialAugust 31, 2020

Frequency Editing (Professional)

Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem.

Beginning with dates of service on or after December 1, 2020, Empire BlueCross BlueShield will apply a frequency limit to CPT codes 90791 (Psychiatric diagnostic evaluation) and 90792 (Psychiatric diagnostic evaluation with medical services) with the following limitations:
  • 1 per 365 days, per member, per provider NPI for members over 21
  • 2 per 365 days, per member, per provider NPI for members under age 21

 

For more information about this policy, visit the Reimbursement Policy page at empireblue.com/provider.

 

633-0920-PN-NY

 

PUBLICATIONS: September 2020 Empire Provider News