This version of the policy will become effective 9/1/2021. This policy is being issued to communicate a change in the Company's reimbursement position for Multiple Payment Procedure Reductions (MPPR) on certain diagnostic services (Attachment A), to include Outpatient Facility providers. The adoptable source for this policy is CMS.
The following procedure codes have been added to attachment A of this policy:
Group A: 93050, 93260, 93261, 93702, 93895, 93985, 93986
Group B: 0506T, 0507T, 0509T, 92145, 92242
Group C: 74712, 76391, 76978, 76981, 76982, 77048, 77049
The following codes have been removed from Attachment A of this policy:
Group A: 75791, 93965
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This policy has been identified and updated for the CPT/HCPCS code update effective 07/01/2021.
Procedure code 0508T has been added to the policy
The Following CPT codes have been removed from the policy:
93241, 93242, 93243, 93245, 93246, 93247, 93985, 93986, and 92229
Not following proper guidelines may result in claim underpayments or claim overpayments, which may result in subsequent retractions. In these situations, it is the professional provider's responsibility to resubmit appropriately.
FACILITY PROVIDERS
Not following proper guidelines may result in claim underpayments or claim overpayments, which may result in subsequent retractions. In these situations, it is the facility provider's responsibility to resubmit appropriately.
This version of the policy will become effective 10/09/2023. The intent of the policy remains unchanged. The policy has been updated to rename Group A, B, and C with the multiple procedure indicators 6, 7, and 4 from Medicare Physician Fee Schedule Database (MPFSDB) for the Company's Multiple Procedure Payment Reduction (MPPR) guidelines.
The policy has been formatted in a numerical order. The policy Attachment A with a list of procedure codes has been archived; therefore, the providers should refer to the link for the Physician Fee Schedule from CMS in the Coding Table for reference.
This policy has been identified and updated for the CPT/HCPCS code update effective 01/01/2022.
The following Procedure codes have been added to the policy
This policy has been identified and updated for the CPT/HCPCS code update effective 10/01/2021.
The Following CPT code has been removed from the policy:
0508T
This version of the policy will become effective 9/1/2021. This policy is being issued to communicate a change in the Company's reimbursement position for Multiple Payment Procedure Reductions (MPPR) on certain diagnostic services (Attachment A), to include Outpatient Facility providers.
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Procedure code 0508T has been added to the policy
The following CPT codes have been added to the policy:
77046, 77047, 92273, 92274
This policy has been identified and updated for the CPT code update effective 01/01/2019.
The following CPT codes have been termed from the policy:
77058, 77059, 92275,
The following CPT narratives have been revised in this policy:
93279, 93285, 93286, 93288, 93290, 93291