Category: Training

Posted in #reimbursement, EmblemHealth NY, Payer Updates, Prior Authorization Insurance Carrier Updates, Training

Emblem Health to add more DME codes to prior auth list.

Posted on by KR2Medical Billing

Are you a a DME provider or a physician that prescribes DME for Emblem Health members? Then this blog post is for you!

Starting on for any DOS 13,2026 and thereafter the following DME codes will be added to the prior authorization list.

Image via Emblem Health
Images via Emblem Health website

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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 HEDIS Measures, Training

HEDIS ADD measure requirenments.

Posted on by KR2Medical Billing

HEDIS ADD measure requirenments:

This measure tracks patients that are between 6-12 years old and had had at least 3 f/u visits within 10 months of the first ADHD medication prescription being dispensed.

  1. F/U visit with the prescribing provider within the 30 days of the medication being dispensed
  2. Two more follow up visit within the next 9 month

In addition to providers explaining the medication options and side effects, they should also schedule mo they visits, if needed, to make sure a good routine is in place and then every 3 months, for the first year.

Behavioral therapy, psychotherapy, family therapy, social skills therapy, etc should also be discussed with the patient and the parent.

In addition there should be collaboration with other providers and the school.

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