Policy Updates Reimbursement PoliciesCommercialJuly 31, 2019

Reimbursement Policy Updates

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

Bundled Services - Professional

Beginning with dates of service on or after November 1, 2019, new Interprofessional CPT codes 99451 and 99452 are not eligible for reimbursement when they are reported with another service or reported as a stand-alone service. These codes have been added to policy section 1 of the Bundled Services and Supplies reimbursement policy.

 

Frequency Editing - Professional

Our Frequency Editing policy applies frequency maximums per day and/or per date span within the same grouping which may be based on the CMS’s MUEs, industry standards, and/or code description.  Beginning with dates of service November 1, 2019, maximum units per day may be based on claims data analysis.

PUBLICATIONS: August 2019 Empire Provider News