July 2021 – Page 3 – KR2 Medical Billing

UHC Commercial: Genetic testing in NICU-catch underlying genetic conditions.

Posted on July 13, 2021July 13, 2021 by KR2Medical Billing

This policy applies to commercial plans for patients that are in the Neonatal Intensive Care Unit (NICU) and who were born at 32 weeks’ gestation or older, and where a genetic condition is suspected, are eligible for select rapid tests through a new genetics program.

Below are some important information regarding this new program.

What is the effective date for this program?

July 1,2021

Who is Eligible for this new program?

Patients that were born at 32 weeks gestation or above where a genetic condition is suspected by the provider are eligible for select rapid test. Please refer to the clinical indicator document for suggestions on when an underlying genetic condition may be suspected.

What genetic tests are included in the NICU Genetic Testing program?

Test options will continue to be evaluated and updated. At this time, rapid whole exome sequencing (rWES), available through XomeDxXpress® , analyzes the exome, which is the part of the genome that is thought to include most mutations that impact health.

Will the facility get reimbursed for the NICU Genetic Testing?

NO. The reimbursement will be only given to the participating laboratories directly.

How does this impact the facility’s current inpatient contract with UnitedHealthcare?
There is no impact to a facility’s current contract. The NICU Genetic Testing program is a new program, effective July 1, 2021, where tests pre-selected for inclusion in the program may be submitted directly to the approved laboratory for reimbursement. When a program approved test is utilized with the code UHC NICU, the laboratory will know to seek reimbursement from UnitedHealthcare directly and not the hospital.

Where to get more information?

• Laboratory Support: GeneDx has professionals, including genetic counselors, geneticists and clinicians, available to answer questions at no cost. For assistance, please contact GeneDx at Xpress@genedx.com, 888-729-1206.
• Genetic Counseling Services: InformedDNA, an in-network virtual genetic counseling practice, is available to provide pre-test and/or post-test genetic counseling and informed consent for genetic testing to the parents of your patients via telephone. To refer a patient, go to informeddna.com or call 800-975-4819. InformedDNA is in-network with most
UnitedHealthcare commercials plans.

What is RAPID (EXPEDITED) WHOLE EXOME SEQUENCING – TRIO (WES)?

Laboratory Proper Billing and coding:

81415 Exome (e.g., unexplained constitutional or heritable disorder or syndrome); sequence analysis

81416 Exome (e.g., unexplained constitutional or heritable disorder or syndrome); sequence analysis, each comparator exome (e.g., parents, siblings) (List separately in addition to code for primary procedure)

Partial Whole Exome and Whole Genome Sequencing medical policy:

Need to contact UHC ?

For more questions on NICU genetic testing, please contact United_Genetics@uhc.com.

To read the full Whole Exome and Whole Genome Sequencing, please click here.

#unitedhealthcare, Training, Updates

UHC: Genetic testing for hereditary cancer-11 codes that are not covered

Posted on July 13, 2021 by KR2Medical Billing

Ordering Genetic Testing for your patients? Avoid the costly and unnecessary denials with the most up to date medical coding and medical billing guideline information. Below please find the updated information regarding UHC Genetic testing for hereditary cancer information.

There are 11 codes that were added to the list of non-covered, experimental/investigational list.

These codes will be denied, no matter the prior authorization status, as the Genetic Testing for Hereditary Cancer medical policy states, “genetic testing for BRCA1 and BRCA2 or Multi-Gene hereditary panels with RNA testing is unproven.”

The changes are applied to both Commercial and Medicaid Plans.

**UHC Commercial Medical Policy. To visit the full policy please click here.**

**UHC Community Health (Medicaid)Medical Policy. For the full medical policy, please click here.**

Partial List of non covered codes:

**For the full list of noncovered codes please click here.**

This change does not affect other BRCA1 testing, BRCA2 testing or multi-gene hereditary cancer panels, which will continue to require prior authorization.

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Aetna Louisiana Better Health: new reimbursement policy for portable x-ray

Posted on July 7, 2021 by KR2Medical Billing

This policy applies to Aetna Medicaid members and for the portable x-ray services done on 08/01/2021 and thereafter.

Aetna Better Health of Louisiana (ABHLA) is aligned with the Louisiana Department of Health’s Medicaid Services Manual, and would like to remind providers to refer to these manuals when submitting claims.

portable x-ray machine (image via southwestxray.com)

Reimbursement:

ABHLA will reimburse payment of medically necessary diagnostic x-ray services to Medicaid eligible recipients who are unable to travel to a physician’s office or outpatient hospital’s radiology facility.

Specific diagnostic radiology services for an eligible recipient may be provided in the recipient’s place of residence by an enrolled portable x-ray provider. These services are only considered for payment when they are medically necessary and ordered by the recipient’s physician.

Portable X-ray machine (image via medgadget)

The Portable X-Ray reimbursement policy includes the following:

• Transportation of portable x-ray equipment is reimbursable only when the equipment used is actually transported to the location where x-ray services are provided.

• A single transportation payment per trip to a facility or location for a single date of service is reimbursed.

Medical Coding and Billing Corner:

Proper documentation needed: Physician’s order for portable x-ray services must include the suspected diagnosis or reason the x-ray is required, area of the body to be exposed, number of radiographs ordered, and the precise views needed.

Proper Place of Service: Portable x-ray units transported to a recipient’s residence are to be billed with the Place of Service (POS) as the location where the service has been rendered, rather than using POS 15 (Mobile Unit). The recipient’s place of residence should be billed with the appropriate POS on the CMS-1500

Need more information, please contact Aetna Louisiana Better Health: via email- LAProvider@AETNA.com or call 1-855-242-0802 and follow the prompts.

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