Tag: Billing
CoVid-19 News from UHC
Beginning Jan. 15, 2022, UnitedHealthcare is covering the cost of Food and Drug Administration (FDA)-authorized or approved over-the-counter (OTC) at-home COVID-19 diagnostic tests for Individual and Family Plan and Individual and Group Market health plan members.
- The national public health emergency has been extended from Jan. 15, 2022 to April 15, 2022. See how that extension affects temporary provisions for COVID-19 testing and testing-related visits:
- Currently there are 2 monoclonal antibody and 3 antiviral treatment options authorized or approved for use.
- Reminder: CMS Billing change effective 1/1/2022.
- Health care professionals who administer the COVID-19 vaccine serum or monoclonal antibody treatment to Medicare Advantage members should submit medical claims through the UnitedHealthcare standard claims process.
- For services rendered through Dec. 31, 2021, claims should be billed to the applicable Centers for Medicare & Medicaid Services (CMS) Medicare Administrative Contractor (MAC), as previously established for reimbursement of these claims
UnitedHealthCare Network News
Effective Feb. 4, 2022, UHC will no longer print and mail paper provider remittance advice (PRAs) for medical claims to network health care professionals.
UHC has updated their codes for the Outpatient Procedure Grouper (OPG) mapping. They have deleted 30 old codes and added 31 new codes. For more information follow this link.
Regarding New Telehealth Code
NOT ALL HEALTH PLANS ARE RECOGNIZING THE NEW TELEHEALTH CODE
TMA staff recommend you check with health plans directly to find out if they recognize the following:
- POS 10, a new Centers for Medicare & Medicaid Services code that corresponds to telehealth provided to patients at home, set to take effect on April 4.
- Modifier 93, an American Medical Association CPT code modifier now in effect that corresponds with a real-time medical service delivered by telephone or another audio-only technology.
Also not yet recognized by all health plans are the following Healthcare Common Procedure Coding System modifiers:
- Modifier FQ (furnished using audio-only communication technology);
- Modifier FR (supervising practitioner was present through two-way communication technology with both audio and video); and
- Modifier FT (unrelated evaluation and management during a postoperative period, or on the same day as a procedure or another evaluation and management visit).
TMA reimbursement specialists are keeping watch on insurers’ recognition of codes and modifiers. TMA’s Health Plan News page will post new developments as they emerge; for example, as noted on the Health Plan News page, Humana is recognizing modifier FQ.
Continue to read Texas Medicine Today for updates.
CPT copyright American Medical Association. All rights reserved.
Last Updated On January 20, 2022
ICD-10 Adds Z Codes
Starting April 1, 2022
You will have new ICD-10-CM Z codes to report if you find the patient you are treating is partially vaccinated or unvaccinated for COVID-19.
- New subcategory Z28.31 (Underimmunization for COVID-19 status), and under it, two new patient status codes:
- Z28.310 (Unvaccinated for COVID-19).
- Z28.311 (Partially vaccinated for COVID-19).
- Z29.39 (Other underimmunization status).
Medicare FFS Claims: 2% Payment Adjustment (Sequestration) Changes
- No payment adjustment through March 31, 2022
- 1% payment adjustment April 1 – June 30, 2022
- 2% payment adjustment beginning July 1, 2022
Aetna, No Longer Paying Office Consult
*ALERT*
Starting March 1, 2022, Aetna will no longer pay office consultation codes 99241 – 99245
*ALERT*
Coding and Billing Compliantly for APPs, MGMA
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CoVid-19 news from UHC
Temporary cost share waivers extended; additional billing guidance issued
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