March 3, 2022
Evaluation
and Management Services Visit Billed With Preventive Medicine Examination
Added clarification to the second paragraph in the policy section addressing the correct use of modifier 25 on an office visit code billed on the same date of service
as a preventive medicine examination. Removed code 99201 which was deleted effective January 1, 2022.
Modifier
22-Increased Procedural Services
Clarified the correct way to code for additional work required for anesthesia services is to bill with additional time units or physical status modifiers rather than appending modifier 22 to the anesthesia service.
Modifier
25 – Significant Separately Identifiable E&M Service on Same Day of
Procedure or Other Service
Added clarification on the correct use of modifier 25 on evaluation and management (E&M) services indicating that appending modifier 25 does not result in automatic reimbursement unless supported by the documentation
in the member's medical record as a separately identifiable service.
Modifier
58 – Staged Procedure
Annual review; no changes.
Modifier
91 – Repeat Clinical Diagnostic Laboratory Test
Minor clarification added to the end of the first paragraph in the policy statement.
Robotic
Surgical Systems and Computer Assisted Navigation Codes
Deleted the paragraph indicating the policy applies to facility claims as that is stated in the purpose section of the policy.
Screening
Services with Evaluation and Management Services
Clarified in the policy statement that the documentation must support the need for a separately identifiable E&M office visit when billed in conjunction with the screening test.
Site
Specifying Modifiers
Clarified that left and right modifiers must match the laterality of the ICD-10 CM diagnosis code and that the left and right modifiers are appended only when the procedure pertains to one anatomic side but not both.
Teledentistry
Services
Added clarification in second paragraph of the policy section that code D0190 can be performed via an audio-only telecommunications system. Added the last bullet in the documentation section of the policy.
Telehealth/Telemedicine
Services
Updated the modifier section of the policy to include new telehealth modifiers effective January 1, 2022: modifiers 93, FQ and FR.