Category: Updates

Posted in #aetna, #Medicare, #Medicareadvantage, Payer Updates, Payers and CPT reinbursement, Training, Updates

Aetna Reimbursement Policy: A9275

Posted on by KR2Medical Billing

According to the Aetna October Provider Updates: Aetna will NO LONGER REIMBURSE for code A9275- Home glucose disposable monitor, includes strips. This DME is considered statutory non-covered by Medicare.

Effective Date: 1/1/2024

This reimbursement policy change applies to commercial and Medicare lines of business (plan types).

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Posted in NY Providers, Payer Updates, Updates

EmblemHealth updated timely filling date (claims) for self funded plans!

Posted on by KR2Medical Billing

According to EmblemHealth-for self funded plans: Local 389 Health and Welfare fund- for the DOS 9/1/23 and thereafter have a new timely filling date for submitting claims. The new date is 90 days after the services were rendered.

This new time frame applies to In network and Out of Network providers.

Types of claims: professional, facility and other provider types

Please note that this change DOES NOT APPLY to the other ASOs (Administrative Service Organizations).

The following is still in affect:

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UHC Medicaid: Idaho: diabetic DME coverage change-benefit

Starting for DOS 4/1/26 and thereafter the following codes will be covered through the patient pharmacy benefit and no longer will be covered under patient medical benefit. For DOS 1/1/26 through 3/1/26- providers can still bill either through medical benefit or pharmacy benefit. Find this type of content useful? Follow my blog!

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Anthem BCBS: 32BJ fund new TPA and cards

As the new year starts so do the change of theember ID changes and or group numbers. Is your provider office aware of these changes? Please note that for any 32BJ members there is a new TPA, group#, member ID, and cards. Please note the new ID: Effective Jan 1,2026- new members ID prefix BJVBJ.…

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Are you leaving revenue on the table?

Aetna update! Is your practice compliant? Are you appending proper modifiers to radiology, diagnostic services and surgery services- when billed with the following ICD-10 codes: Z53.01, Z53.09, Z53.1, Z53.20, Z53.21, Z53.29, Z53.8, Z53.9? As per Aetna- if the following modifiers are not billed on the claims for the above services with above named ICD-10 codes-…

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Posted in NY Providers, Payer Updates, Payers and CPT reinbursement, Training, Updates

MVP Health Plans: reimbursement of sick E&M codes billed w/preventative codes -05/01/23

Posted on by KR2Medical Billing

According to the latest announcement MVP Health Plan will change the reimbursement of sick E/M codes when they are billed on the same day as a preventative codes.

This policy applies to Primary Care Physicians.

According to the new reimbursement policy the sick E&M codes will be reimbursed at 50% of allowable amount if the codes are billed on the same date of service as the preventative codes.

The reimbursement will be applied with or without the modifier 25 present.

Policy applies to the following codes:

Preventive medicine services are represented in evaluation and management (E/M) codes 99381–99429. These E/M codes may be reported by any qualified physician or other qualified healthcare professional.

Preventative cpt codes 99381–99397 for comprehensive preventive evaluations are age-specific, beginning with infancy and ranging through patients age 65 and over for both new and established office patients.

E&M codes may include: 99202-99205, 99212-99215

For more information please refer to MVP Evaluation and Management (E&M) policy.

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