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Moda Health Plan Medical Policy Updates – December 2022
Click here to view the Moda Health Plan Medical Policy Updates »
December 2022 Moda Health Plan Medical Policy Updates:
- 2021 & 2023 Updates to Evaluation and Management (E/M) Visits and Prolonged Services
- 340B Drug Discount Program-Acquired Drugs and Biologicals (Modifiers JG & TB)
- Additional Practice Expense Items During a Public Health Emergency (PHE) – CPT 99072
- Add-on Codes
- After Hours and Other Special Circumstances
- Aliqopa™ (copanlisib)
- Amvuttra (vutrisiran)
- Behavioral Health Case Management & Care Coordination
- Besponsa ™(inotuzumab ozogamicin)
- Bevacizumab: Avastin®; Mvasi®; Zirabev™; Alymsys®; Vegzelma™
- Breyanzi® (lisocabtagene maraleucel)
- Cardiac Defibrillators External
- Clinic Services In the Hospital Outpatient Setting
- Colorectal Cancer Screening And Related Ancillary Services
- Cryoablation of Breast Fibroadenomas
- DRG Payment With Patient Transfers
- Drugs and Biologicals, Wastage and/or Discarded Amounts (Modifier JW)
- E0485, E0486 Oral Sleep Apnea Device/Appliance Documentation
- Emergency Department Visit Leveling
- Epoetin alfa: Epogen®; Procrit®; Retacrit® (Subcutaneous/Intravenous)
- Facility DRG Validation & Outlier Review
- Facility Guidelines, General Overview
- Feraheme® (ferumoxytol)
- Global Surgery Package for Professional Claims
- Gynecologic or Annual Women’s Exam Visit & Use of Q0091 (Pap, Pelvic, & Breast Visit)
- Hearing Assistive Technology
- Intra-joint and Surgical Site Postoperative Pain Relief Drug Delivery System (Pain Pump)
- Kymriah® (tisagenlecleucel)
- Level of Care Review
- Lumoxiti™ (moxetumomab pasudotox-tdfk)
- Medical Records Documentation Standards
- Medical, Surgical, and Routine Supplies (including but not limited to 99070)
- Moda Health Reimbursement Policy Overview
- Moderate (Conscious) Sedation
- Modifier 22 – Increased Procedural Services
- Modifier 50 – Bilateral Procedure
- Modifier 51 – Multiple Procedure Fee Reductions
- Modifier 52 – Reduced Services
- Modifier SL – State Supplied Vaccine
- Modifiers XE, XS, XP, XU, and 59 – Distinct Procedural Service
- Modifiers 58, 78, and 79 – Staged, Related, and Unrelated Procedures
- Modifiers 73 & 74 – Discontinued Procedures For Facilities
- Modifiers 80, 81, 82, and AS – Assistant At Surgery
- Modifiers QK, QX, QY, QZ – Supervised Anesthesia
- Monjuvi® (tafasitamab-cxix)
- Monoferric™ (ferric derisomaltose)
- Mylotarg ™(gemtuzumab ozogamicin)
- Never Events, Adverse Events, Hospital-Acquired Conditions (HAC), and Serious Reportable Events (SRE)
- Operating Microscope (CPT Code 69990)
- Pedmark® (sodium thiosulfate)
- Poteligeo® (mogamulizumab-kpkc)
- Radiology Reductions for Technology Type – Modifiers FX & XY
- Readmissions
- Reference (Outside) Laboratory — Modifier 90
- Robotic Assisted Surgery
- Routine Venipuncture and/or Collection of Specimens
- Rylaze™ (asparaginase Erwinia chrysanthemi (recombinant)-rywn)
- Skyrizi® (risankizumab-rzaa)
- Tecartus® (brexucabtagene autoleucel)
- Telehealth And Telemedicine
- Telehealth and Telemedicine Expanded Services for Covid-19
- Therapy Assistant Modifiers CO & CQ
- Transportation of Portable X-ray Equipment, Multiple Portable X-rays – Modifiers UN, UP, UQ, UR, US
- Trogarzo ™(ibalizumab-uiyk)
- Valid Modifier to Procedure Code Combinations
- Velcade® (bortezomib)
- Yescarta® (axicabtagene ciloleucel)
Click here to view the Moda Health Plan Medical Policy Updates »
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