Updated 2020 payment policies


We have updated some of our payment policies for 2020. Please refer to the policies for details:

  1. Payment Policy: ASC Grouper 2020 (Commercial), effective Jan. 1, 2020: 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.
  2. Payment Policy: Unlisted/Unspecified Procedure Codes (Commercial and Medicare), effective May 1, 2020: We have updated our reimbursement policy for Unlisted Procedure Codes. As of May 1, 2020, clinical documentation review will be required for claims submitted with unlisted procedure/service codes. Claims submitted with unlisted procedure codes must be submitted with supporting clinical documentation or they will be denied. Please review the complete policy guidelines, which includes the required “Unlisted Procedure or Service Code Special Report Claim Form.”

Also, here’s our Payment Policy: Anesthesia Reimbursement (Commercial and Medicare) that went into effect on Oct. 1, 2019.