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

Medical Drug Policy NameRevised Criteria
Diagnosis Validity 

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 

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 SurgeryNon-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 GuidelinesAdded 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.