Category: Payer Updates

Posted in #reimbursement, BCBS Empire NY, NY Providers, Payer Updates, Prior Authorization Insurance Carrier Updates

Anthem BCBS NY: New PET tracer UM policy

Posted on by KR2Medical Billing

The following information will apply to any DOS on 12/1/25 and thereafter.

Starting 12/1/25 the PET tracer will require an auth in addition to PET services.

Please submit both PET and radiotracer codes- for prior authorization. The UM criteria for PET will not be affected. However both codes will be either approved or denied. Please note that the radiotracer must coorespond to the requested PET code.

The following codes will be affected:

Image via Anthem BCBS
Image via Anthem BCBS
Image via Anthem BCBS

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Posted in #aetna, #reimbursement, NY Providers, Payer Updates, Training

PrEP proper billing and coding

Posted on by KR2Medical Billing

Proper Medical coding and billing is important to the financial health of your practice!

Medication codes:

Image via Google

Administration code

Please avoid using the regular 96372 administration code. Instead use the following administration code: G0012

This code is used when the provider physically administers the PrEP medication.

Supply Code

For the oral PrEP pharmacies should bill: Q0251

Image via Google

ICD-10 codes:

F19.10, F19.20, Z11.3, Z11.4, Z20.2, Z20.6, Z29.81, Z72.51- Z72.53, Z72.89, Z79.899

These services are classified as preventative medicine.

Based on which insurance payers your office accepts, there can be some variations of coverage to the additional services that may be related to PrEP. Please make sure you check with the insurance payers before performing any services for additional coverage information.

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Posted in #reimbursement, EmblemHealth NY, NY Providers, Payer Updates, Training, Updates

EmblemHealth/Connecticare/Molina Health update

Posted on by KR2Medical Billing

Are you a provider in CT or NY that serves EmblemHealth/Connecticare members-this blog post is for you!!!

Back in July of 2024, EmblemHealth announced and entered into an agreement with MolinaHealth to sell ConnectiCare (a company part of EmblemHealth).

In a Feb 2025, the sale was finalized.

So what does this mean to you as a provider?

EmblemHealth put together a reference table that the providers can utilize to check the plan/network information and which area that plan/network covers, plus description of the plans; ex deductible, copay, OON benefits, etc.

Image via EmblemHealth website.

Please visit here to view the PDF version of the whole document.

Molina also created a FAQs section that you can access from the same EmblemHealth website.

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