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Commercial Reimbursement Policy Updates for September 18, 2023

Reimbursement Policy

Revision

Diagnosis Validity (PDF)

Added “CMS instruction” to correct diagnostic coding in Reimbursement Guidelines. 

 

Drug and Biologicals (PDF)

 

Modifier JZ added to Billing and Coding.  Instruction for drugs with multiple administration routes added to Reimbursement Guidelines.  

 

Global Surgery (PDF)

Non-physician practitioners reimbursement of a Major Procedure (90 day) language added to Reimbursement Guidelines.  Medical Director approved. 

 

Modifier Guidelines (PDF)

Added Erythropoiesis stimulating agent (ESA) modifiers, deceased modifiers, Modifier PI, and X-Ray Transportation.