Bariatric Surgery and Procedures: A very common question that I receive, from surgeons-Is hiatal hernia repair, if done with another Bariatric surgery procedure or major esophagogastric procedure, paid separately? I always remind the surgeons that even if the code exists it does not mean that it is reimbursed separately. Below, please see the the CIGNA updated policy.
Below please find the summary of Preventive Care Services Billing updates for Cigna 2021. Some of these changes were announced in December 2020, however do not take affect until Feb 1/2021.
Below are the changes that are affective on Jan 1,2021
Source: Cigna First Quarter Provider Policy Updates
This policy applies to services performed in a facility: HCPCS and CPT codes
Aetna Better Health of Louisiana would like to remind providers that its Behavioral Health Reimbursement policy is aligned with the Louisiana Department of Health’s Medicaid Services. Providers need to check the Provider Manual regarding the proper billing practices for Behavioral Health Services. If the manual requires additional guidance for appropriate reimbursement, the details will be outlined by ABHLA in a supporting reimbursement policy.
To check the compliance with billing practices of the Louisiana Department of Health’s Medicaid Services, Aetna Better Health of Louisiana conducted an internal audit. ABHL found that many of the claims did not have the INDIVIDUAL PROVIDER as RENDERING provider but instead a FACILITY was listed as a rendering provider.
In order to comply with the proper billing and coding for these services, done in a facility setting, please put an INDIVIDUAL RENDERING PROVIDER NPI in the box 24J on the HCFA 1500.
Below are just some codes that might have been paid previously (with a facility NPI):
Claims with the Facility NPI listed as the rendering provider will be denied and paid claims may be recovered by the health plan. Should you receive denials for this reason, you may rebill your denied claim(s) as a corrected claim with the Individual Provider NPI listed as rendering for ABHLA to reprocess and pay the claim(s).
Please note that providers may see reimbursement impacted if not aligned to the Louisiana Department of Health’s Medicaid services manual within 30 days of the date of this notification.
Below is just a partial list of the Louisiana Department of Health’s Medicaid Services: Behavioral Health Services Fee Schedule:
KR2 Medical Billing 