Medical Policy Updates

Reimbursement Policy Update Posted November 30, 2021

Medical Guidelines Reason for Update
Bundling Guidelines Added statement to Balloon Sinuplasty section “Modifiers 58, 59, 78 and 79 (or XE, XS, XP, XU) will not allow additional payment when appended to these codes.”
Nonpayment for Serious Adverse Events Clarifying statements added to Reimbursement Guidelines section “All providers, including, but not limited to inpatient psychiatric hospitals, critical access hospitals, or other facilities granted CMS exemption status, are subject to POA, HAC, and Never Event editing.” and “Blue Cross Blue Shield North Carolina (Blue Cross NC) will not reimburse claim lines containing diagnoses or procedures with “N” or “U” POA indicators. The presence of “N” or “U” indicate a condition was hospital acquired and therefore not eligible for reimbursement.“ POA indicators added to Billing and Coding section.
Radiation Therapy Services Policy renamed from “Intensity Modulated Radiation Therapy“ to “Radiation Therapy Services“. Policy expanded from IMRT to include SRT.