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October and November 2022 Billing and Coding and Medical Policy Article Updates
Billing and Coding: Complex Drug Administration Coding (A58620)
Billing and Coding: Molecular Pathology Procedures (A56199)
CPT code 81313 has been removed from Group 1- Tier 1 Covered codes section (Please refer to L37733 Biomarkers for Prostate Cancer Diagnosis)
CPT code 81551 has been removed from Group 3 Tier 1 Non-covered codes section (Please refer to L37733 Biomarkers for Prostate Cancer Diagnosis)
Duplicative language currently in L35000 regarding medical necessity (Abstract and Indications of Coverage by CPT Code) have been removed from A56199. (Please refer to L35000)
Billing and Coding: Osteopathic Manipulative Treatment (A56954)
Removed statement about NCCI edits that listed specific E/M codes.
Billing and Coding: Transthoracic Echocardiography (TTE) (A56781)
ICD-10-CM codes I71.02 and I71.03 were added to Group 1 diagnoses after being omitted from the previous article version.
Self-Administered Drug Exclusion List: Medical Policy Article (A53021/A53022)
The article has been updated to add: “All insulin products” in the “Descriptor Brand Name” column for HCPCS codes C9399, J1815, J1817, J3490 and J3590 effective 11/19/2022. A duplicate row for C9399 Insulin Glargine (Lantas Solostar®) has been end-dated. Tirepatide (Mounjaro™) (C9399, J3490, J3590) has been added effective for dates of service on or after 11/19/2022.