March 2, 2023
The following payment policies received their annual review with no changes made:
- Inpatient Acute Transfers from DRG Hospitals
- Modifier JW – Drug amount discarded/not administered to any patient
- Multiple Diagnostic Cardiovascular Services Reductions
- Multiple Diagnostic Imaging Reductions
- Serious Adverse Events – Inpatient Facility Services
The following payment policies received their annual review with the changes noted:
- Rewrote the last paragraph in the policy statement so that it’s easier to read.
Modifier SG – Ambulatory Surgery Center (ASC) Facility Services
- Changed the title of the policy from “Ambulatory Surgery Center (ASC) Facility Services – Modifier SG and Place of Service Code 24” to “Modifier SG – Ambulatory Surgery Center (ASC) Facility Services”.
- Moved the bullet for Modifier SG to the top and then a bullet for place of service code 24.
Durable Medical Equipment (DME)/Home Medical Equipment (HME)
- In the cross-reference section, added payment policies for Modifier XE, XS, XP, XU, site specifying modifiers, and Modifier 59.
- In the definitions section and the policy statement, expanded the definition of purchased only services.
- In the modifiers section of the policy statement, added additional modifiers that should also be appended when applicable.
- The final paragraph in the policy section was updated to indicate the presence of the code on the list is not a guarantee of payment but is dependent upon the member’s benefits.
- The embedded link to the code list subject to this policy was updated with the following codes:
- Code additions effective with dates of service January 1, 2023:
- E0183 – Rental only
- E2102 – Purchase or Rental to Purchase
- E2103 – Purchase or Rental to Purchase
- K1002 – K1033 – Rental Only
- Code terminations effective with dates of service January 1, 2023:
- K0554.
- Code additions effective with dates of service January 1, 2023:
- In the references section, added the new references for Medicare and Medicaid National Correct Coding (NCCI) edits.