The following claims edits will go into effect June 26, 2018:
| Policy | Description | What plans are affected? |
|---|---|---|
| Care management services | Care management CPT codes 99487, 99489-99490 are payable only when billed with a primary and a secondary diagnosis. Reference: AMA CPT code full descriptions |
Commercial and Medicare Advantage |
| Routine foot care frequency | Routine Foot Care CPT codes 11055-11057, 11719-11721 or G0127 will not be payable if billed more than once within a two-month period. Reference: NGS Medicare LCD L33636 |
Commercial and Medicare Advantage |
| Corneal pachymetry | CPT 76514 (Ophthalmic ultrasound, diagnostic; corneal pachymetry) will not be payable when billed more than once in a patient's lifetime with a diagnosis of glaucoma or ocular hypertension (OHT). Reference: NGS Medicare LCD L33630 |
Medicare Advantage only |
