The following policies are effective Jan. 1, 2021:
- Payment Policy: Prolonged Services (Commercial & Medicare): This is a new policy effective Jan. 1, 2021, when the Centers for Medicare & Medicaid Services (CMS) finalized HCPCS code G2212 for prolonged office/outpatient evaluation and management (E&M) visits. ConnectiCare is following CMS minimum time guidelines and allowing G2212 to be used with 99205 or 99215. Do not use 99358, 99359 or 99417 with code 99202-99215.
- Evaluation & Management (E&M) Codes Supplemental Policy: ConnectiCare will be updating the reimbursement policy to follow the revised 2021 Evaluation and Management (E&M) CPT® coding and guideline changes from the American Medical Association (AMA) and CMS.
- Payment Policy: ASC Grouper 2021 (Commercial): ConnectiCare has updated the ASC Grouper Policy to include new codes effective Jan. 1, 2021. Ambulatory surgical groupers will be paid according to surgical contracted rates when billed with revenue codes 360 or 490. If surgical services are billed with revenue codes other than 360 or 490 and the claims contain charges for anesthesia and/or recovery room, claims will be paid according to the surgical contracted rates unless otherwise negotiated.
- Medical Necessity Guidelines: Experimental, Investigational or Unproven Services (Commercial & Medicare): ConnectiCare has updated the Experimental, Investigational or Unproven Services Policy to include new codes effective Jan. 1, 2021. ConnectiCare defines the terms “investigational” or “experimental” as the use of a service, procedure or supply that is not recognized by the health plan as standard medical care for the condition, disease, illness or injury being treated. A service, procedure or supply includes, but is not limited to the diagnostic service, treatment, facility, equipment, drug or device.
CPT® is a registered trademark of the American Medical Association.