| Procedure |
Effective Date |
Change |
| 95165 – Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens |
6/1/2012 |
95165 will be allowed 30 times per date of service. |
|
D9610 – Therapeutic parenteral drug, single administration
|
6/1/2012 |
D9610 will be denied as incidental when billed with codes D9220, D9221, D9241 or D9242. Modifier 59 will override the edit. |
| J9055 – Injection, cetuximab, 10 mg |
6/1/2012 |
Effective 6/1/2012, cetuximab (Erbitux) will be considered experimental and investigational for the treatment of glioma and vaginal cancer. Refer to Clinical Policy Bulletin #0684for more information. |
| Qualitative drug screen codes G0431& G0434 |
6/1/2012 |
Starting 6/1/2012, the use of either G0431 or G0434 will be required for the billing of qualitative drug screens. One unit of either code will be reimbursed per patient encounter, when qualitative testing methods are used. Any billing of CPT codes 80100, 80101 or 80104 will be adjudicated according to this policy with appropriate mapping to one unit of G0431 or G0434 per patient encounter. |
| Inappropriate billing or coding |
Annual Reminder |
Code adjustments will be made for inappropriate billing or coding. Examples of these adjustments include rebundling of services that are considered part of, incidental to, or inclusive to the primary procedure as well as adjustments for mutually exclusive procedures. |
| 93224 – 93227 – External electrocardiographic recording up to 48 hours by continuous rhythm recoding and storage |
Reminder |
93224 – 93227 are used to report external electrocardiographic recording services of up to 48 hours. These procedure codes should be reported once within a 48 hour time period. |