New and Updated Reimbursement Policies

RECENTLY UPDATED

April 3

RP-047 Venipuncture and Lab Services
This policy was reviewed as part of our standard review process. No changes were made.

RP-072 Injection and Infusion Services
Codes Q5127 and Q5130 were added to this policy.

April 10

RP-064 Government Supplied Vaccinations and Antibody Treatments
Code 0174A was added to this policy.

April 24

RP-009 Modifiers 25, 59, XE, XP, XS XU, and FT
This policy was reviewed as part of our standard review process. No changes were made.

RP-012 Rigid Immobilization
This policy was reviewed as part of our standard review process. No changes were made.

RP-013 Electrocardiogram and Medical Imaging Interpretation
This policy was reviewed as part of our standard review process. No changes were made.

UPCOMING

IMPORTANT: With the public health emergency (PHE) coming to an end, the following reimbursement policies (RPs) will have Telehealth and Virtual Health components changed or removed, or will otherwise return to pre-PHE direction, effective July 6, 2023:

RP-010 Incident To Billing Services and Advanced Practice Provider Reductions
The supervising physician must be physically present. Virtual supervision will no longer be allowed.

RP-015 Professional and Technical Components for Applicable Services
Exceptions for procedure codes 99000 and 99001 as diagnostic services are being eliminated.

RP-016 Physician Laboratory and Pathology Services
Exceptions for procedure codes 99000 and 99001 as clinical pathology tests are being eliminated.

RP-027 Hemodialysis and Peritoneal Dialysis
Procedure codes 99401, 99402, 99403, 99404, 99411, and 99412, will no longer be eligible to be performed as telemedicine. Similarly, procedure codes, 99221, 99222 and 99223, will no longer be eligible to be performed as telemedicine.

RP-041 Services Not Separately Reimbursed
The following procedure codes 90887, 99024, 99374, 99377, 99378, 99379, 99380 and 99483 will no longer be eligible to be performed as telemedicine.

New York will no longer reimburse for code U0005.

RP-046 Telemedicine and Telehealth Services
The provision that — Eligible Providers performing and billing telehealth services must be eligible to independently perform and bill the equivalent face-to-face service — is being reinstated.

NOTE: Additional COVID-19-related language will be removed effective May 29, 2023.

RP-054 Ambulance Services
Destination requirements for ground transports that were waived during the PHE are being reinstated.

For more information about changes following the end of the PHE, go to the COVID-19 (Coronavirus) Information page on the PRC.