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Claims edits that go into effect Nov. 27, 2018


Please refer to the table below for claims edits that will go into effect on Nov. 27, 2018:

Policy Description Affected plans
Low dose CT scan for lung cancer screening We will deny G0297 (Low dose CT scan (LDCT) for lung cancer screening) when billed by any provider more frequently than once per year.
Guidance: Centers for Medicare & Medicaid Services
Medicare only
Valstar® code J9357 Valrubicin (intravesical) should be reported with an appropriate bladder instillation procedure code CPT 50391 or 51720.
Guidance: FDA–approved package insert in prescribing information and the pharmaceutical compendium.
Commercial and Medicare
Iluvien® code J7313 When fluocinolone acetonide intravitreal implant (J7313) is injected into the eye (vitreous), it should be reported on the same claim with the appropriate injection procedure code CPT 67028.
Guidance: Drug Manufacturer
Commercial and Medicare