Notification of Reimbursement Policy Revisions Effective September 18, 2023 (Posted July 18, 2023)
| Medical Drug Policy Name | Revised 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 Surgery | 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 | 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. |
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