New and Updated Reimbursement Policies

RECENTLY UPDATED

October 9

RP-064 Government Supplied Vaccinations and Antibody Treatments
Policy was updated with new and deleted vaccine codes.

October 16

RP-007 Multiple Procedure Payment Reduction for Certain Diagnostic Imaging Procedures
Policy was updated with new and deleted imaging codes.

October 23

RP-049 Merit-based Incentive Payment System (MIPS) for Out of Network Providers
This policy was reviewed as part of our standard review process. No changes in direction were made.

RP-055 Nominal Charges
This policy was made applicable to professional (1500) claims.

RP-060 Genetic Testing Ordering Requirements
This policy was reviewed as part of our standard review process. No changes in direction were made.

RP-069 DME Maintenance, Repair and Replacement
This policy was reviewed as part of our standard review process. No changes in direction were made.

RP-071 Incremental Nursing
This policy was reviewed as part of our standard review process. No changes in direction were made.

October 30

RP-026 Portable Radiography and ECG Services – Modifiers UN, UP, UQ, UR, US
This policy will be made applicable to Medicare Advantage. Additional direction will be added for modifiers UN, UP, UQ, UR, and US when submitted with code R0075 (a transportation service code). These modifiers are also required to be included on all related claims, and the Commercial section will be updated with direction to reflect this requirement.

UPCOMING

November 13

RP-064 Government Supplied Vaccinations and Antibody Treatments
Policy will be updated to delete vaccine codes.

January 15, 2024

RP-037 Emergency Evaluation and Management Coding Guidelines
Outpatient surgery will be removed from the exclusion criteria.