Correction to reimbursement policy: Place of Service - Facility

Notice of Material Amendment/Change to Contract (MAC)

In the July edition of Provider News, we announced a Place of Service — Facility reimbursement policy indicating that evaluation & management (E/M) services and other professional services must be billed on a CMS-1500 claim form and are not reimbursable when billed on a UB-04 claim form (excluding E/M services rendered in an emergency room and billed with ER revenue codes).

 

It has come to our attention that some of the preventive counseling CPT^® codes mentioned in the July article were listed incorrectly. The correct preventive counseling CPT codes are 99401–99404, 99411, and 99412, and are not reimbursable when billed in an outpatient setting of a facility effective with dates of service on or after February 1, 2023.

Please note, however, that the revenue codes 960-983 and the E/M services noted in the July edition were listed correctly in the Place of Service — Facility reimbursement policy effective with dates of service on or after October 1, 2022.

 

For specific policy details, visit the reimbursement policy page on our provider website.

 

OHBCBS-CM-009521-22-CPN9003