Payment Policy Updates

View payment policy updates archive

April 3, 2025

The following policies received their annual review with no changes:

• Consultation code Services
• Modifier 23
• Modifier 57
• Modifier 63
• Modifier 66
• Modifier 76
• Modifier 77
• Multiple Deliveries/Births
• Modifier TH
• Multiple Endoscopy Procedure Reductions

The following policies received their annual review with the changes noted below:

• Multiple Diagnostic Imaging Reductions
  • From the policy section: Revised the Multiple Procedures Rendered During the Same Session statement; removing the combined claims process and advising these services should be billed on the same claim
• Modifier CQ and CO
  • From the policy section removed “This 10 percent standard is also known as the "de minimis" standard as established by the Center for Medicare and Medicaid Services (CMS) CY 2022 final rule.” As the 10% rule was replaced by the standard “mid-point” rule for timed codes and added “the mid-point of the service (e.g., at least 8 minutes of a 15 minute service).”