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Notification of Reimbursement Policy Revisions Effective September 18, 2023 (Posted July 18, 2023)

Reimbursement PolicyRevision
Diagnosis Validity (PDF)

Added “CMS instruction” to correct diagnostic coding in Reimbursement Guidelines.  Medical Director Approved.  Notification on 7/18/2023 for effective date 9/18/2023.

Drug and Biologicals (PDF)

Modifier JZ added to Billing and Coding. Instruction for drugs with multiple administration routes added to Reimbursement Guidelines.  Medical Director approved.  Notification on 7/18/2023 for effective date 9/18/2023

Global Surgery (PDF)

Non-physician practitioners reimbursement of a Major Procedure (90 day) language added to Reimbursement Guidelines.  Medical Director approved.  Notification on 7/18/2023 for effective date 9/18/2023

Modifier Guidelines (PDF)

Added Erythropoiesis stimulating agent (ESA) modifiers, deceased modifiers, Modifier PI, and X-Ray Transportation.  Medical Director Approved.  Notification on 7/18/2023 for effective date 9/18/2023.