Policy Updates July 2015

The information outlines updates to policies that are effective this month. To view the updated policy in its entirety, select the policy name.

Policy Name Affected Physicians Updates effective July 13, 2015
Modifier 25 (M25)* Primary care physicians The CMS Medically Unlikely Edit (MUE) for codes 99212, 99213, and 99214 will be eliminated, as it conflicts with our reimbursement policy indicating that we only pay one E&M service per health care professional per single date of service.
Multiple Procedure Reduction – Radiology (R01) * Health care professionals who own radiology equipment or employ radiology staff who perform imaging services This update will consolidate the 11 contiguous body families into one combined list. As a result, multiple imaging procedures, regardless of body area, may be subject to a reduction.
Additionally, this policy will apply to all places of service except the inpatient hospital setting.

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The appearance of an item or procedure in this update indicates only that we have recently adopted or revised a policy. It does not imply that we provide coverage for the items or procedures listed. In the event of an inconsistency or conflict between the information provided below and the posted policy, the provisions of the posted policy will prevail.