This policy update becomes effective 04/15/2020. The policy update reaffirms the Company's continuing position on Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus. However, the following five consultation codes will be removed from Attachment A because they will not be eligible for reimbursement at all effective 04/15/2020: 99241, 99242, 99243, 99244, and 99245.
In products where members are able to self-refer to providers for care and services, members are advised to use participating providers in order to receive the highest level of benefits.When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.
For more information on how Claim Payment Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.
The following CPT codes have been added to the policy: 92273, 92274
This policy has been identified and updated for the CPT code update effective 01/01/2019.
The following CPT code has been termed from the policy: 92275
The following CPT narratives have been revised in this policy: 93924, 93927, 93928
This policy has been identified and updated for the HCPCS code update effective 01/01/2019.
The following HCPCS code has been added to the policy: G2011