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Reimbursement Policy Update for January 1, 2023
Medicare Reimbursement PolicyReason for Update

Add-On Codes

Routine Policy Review. Minor revisions only.
Anesthesia, Professional and FacilityRoutine Policy Review. Minor revisions only.
Bundling GuidelinesRoutine Policy Review. Removed Care Management Section.  
Co-Surgeon, Assistant Surgeon, and Assistant-at-Surgery GuidelinesRoutine Policy Review. Minor revisions only.
Consistency GuidelinesRoutine Policy Review. Minor revisions only.
Diagnosis Validity & Code GuidelinesRoutine Policy Review. Minor revisions only.
Evaluation and Management ServicesRoutine policy review. Minor revisions only.
Facility Billing GuidelinesRoutine Policy Review. Minor revisions only.
Global SurgeryRoutine Policy Review. Minor revisions only.
Immunization GuidelinesRoutine Policy Review. Minor revisions only.

Inpatient Readmission

Routine Policy Review. Minor revisions only.
Maximum Units of ServiceRoutine Policy Review. Minor revisions only.
Modifier GuidelinesRoutine Policy Review. Minor revisions only.
Multiple Procedure Payment Reduction GuidelinesRoutine Policy Review. Minor revisions only.
NCCI EditingRoutine Policy Review. Minor revisions only.
NDCRoutine Policy Review. Minor revisions only.
ObservationRoutine Policy Review. Minor revisions only.
Once in a LifetimeRoutine Policy Review. Minor revisions only.
Outpatient Code Editor (OCE) EditsRoutine Policy Review. Minor revisions only.
Partial Hospitalization and Intensive Outpatient ProgramsRoutine Policy Review. Minor revisions only.
Place of ServiceLanguage added to clarify DME billing requirement for POS. Medical Director approved.
Preadmission and Preoperative ServicesRoutine Policy Review. Minor revisions only.
Pricing and Adjudication PrinciplesRoutine Policy Review. Minor revisions only.
Revenue Codes Requiring Procedure Codes, FacilityRoutine Policy Review. Minor revisions only.
Split Surgical PackageRoutine Policy Review. Minor revisions only.
Status CodesRoutine Policy Review. Minor revisions only.
Supply and Equipment ReimbursementRoutine Policy Review. Minor revisions only.

Telehealth

New policy developed. Medical Director approved.

Unplanned Return to Surgery

New policy developed. Blue Cross NC will reduce reimbursement for services filed with modifier 78.