View payment policy updates archive
February 6, 2025
The following policies received their annual review with the following changes:
Durable Medical Equipment (DME/Home Medical Equipment (HME)
CORRECTION to 11/12/24 entry: Code E0737 should actually be code E0739 effective 04/01/2024
New Codes added to the embedded code list effective January 1, 2025:
- A4594 – Purchase only (NU)
- E1803, E1804, E1807, E1808, E1813, E1814, E1822, E1823, E1826, E1827, E1828, E1829 – Capped Rentals (RR) or Outright Purchase (NU)
Medicare Indicator Status B, Status P and Status T Services Reimbursement
In the Definitions section of the policy, added a new definition for “Status Indicator” and revised the definitions for Status Indicator B, P and T codes.
In the Codes/Coding Guideline section of the policy:
- Moved codes 96040 and 99072 into the Exceptions section of the policy
- Removed the information related to the Public Health Emergency (PHE) on payment for procedure code 99072-Personal Protective Equipment (see Version History for details)
In the Exceptions section of the policy:
- Added code 96040 which terminated effective December 31, 2024
- Added new code 96041 which became effective January 1, 2025, and added coding guidelines from the CPT Codebook
- Added code 99072 which returned to Status B status effective with dates of service on and after July 8, 2023
- Revised the paragraph on DME Agencies and Suppliers
Modifier 53 – Discontinued Procedure
- In the Cross Reference section, removed Modifier SG reference since it is not mentioned in the Policy
- In the Policy section, the fourth paragraph revised to bullet out the two modifiers that can be appended to discontinued ASC and Outpatient facility services
- Removed the statement from the Exceptions section: ”Oregon providers: Reimbursement will be 100% of the provider’s applicable Fee Schedule allowed amount.”
National Drug Code (NDC) Billing Guidelines – Professional Claims
- In the Cross Reference Section, added the policy “Drugs Administered in a Physician Office”
- In the Policy section, created a new sub-section titled “Billing Compounded Drugs” and included the paragraphs already in the policy under this sub-section
- In the Reference section, included additional references pulled from the policy “Drugs Administered in a Physician Office.”
National Drug Code (NDC) Billing Guidelines – Outpatient Facility Claims
- Added a new section “Codes/Coding Guidelines” and listed two mandates for Washington providers and their respective billing guidelines
- In the Laws, Regulations and Standards section, listed the two Washington Senate bills references in the Codes/Coding Guidelines section of the policy
- In the Laterality sub-section, a paragraph was deleted that duplicated paragraphs two and three.
Unlisted, Non-Specific and Miscellaneous Procedure Codes
- Moved the table of Unlisted Codes and documentation requirements into the Codes/Coding Guideline section of the policy.
- Revised and clarified the Policy statement
Telehealth/Telemedicine Services
In the Policy section, moved the following sections into the Codes/Coding Guideline section:
- Telehealth Modifiers
- Telehealth Place of Service (POS) Codes
In the Codes/Coding Guidelines section:
- Added new CPT codes, effective January 1, 2025, to the following sections:
- Audio and video communications: Codes 98000-98007
- Audio only communications: Codes 98008-98016
- Updated the CPT Codebook guidelines in the following sections:
- Audio and video communications
- Audio only communications
- Online digital communications
- The following Audio only codes terminated effective December 31, 2024: 99441-99443 and G2012
Removed the following from the Exceptions section:
- Two Telehealth visits (synchronous/asynchronous, telephone assessment and management or online internet communications) that occur on the same day will only be reimbursed when different providers perform the services, or the visits are for different diagnoses.
- For the duration of the Public Health Emergency (PHE), Telephone assessment codes (99441-99443, 98966-98968) and Online Digital services codes (99421- 99423, 98970-98972 and G2061-G2063) can be billed for NEW PATIENT encounters even though the actual code descriptions identify the codes are to be billed for “established patients”. (terminated May 12, 2023)