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2021 E / M (Evaluation and Management) Updates

2021 E&M Guideline Changes

March 30, 2021

E&M changes in 2021 overview

Having questions about the 2021 E&M guideline changes for office visits?

January 5, 2021

Question: Since history and physical exam are no longer required to level the visit, should I still document these elements? Answer:  Yes. Although history and physical exam are no longer required to level the vi…

Understanding the Complexities of Each Defined Condition & How to Document

December 22, 2020

Self-limited or minor problem: A problem that runs a definite and prescribed course, is transient in nature, and is not likely to permanently alter health status. Stable, chronic illness: A problem with an expected dur…

Insurance Updates

CDPHP Fee Schedule Changes-Effective 7/1/2021

May 4, 2021

Recently, based on the recommendation of the physician compensation committee, the CDPHP board of directors approved the 2021 fee schedule for all lines of business, including CDPHP Universal Benefits Inc. and CDPHP. …

COVID-19: FDA Revoked the EUA for Bamlanivimab When Administered Alone

April 27, 2021

On April 16, the FDA revoked the Emergency Use Authorization (EUA) for bamlanivimab, when administered alone, due to a sustained increase in COVID-19 viral variants in the U.S. that are resistant to this antibody th…

Workers Comp Electronic Claims Submission Required as of July 1, 2021

April 16, 2021

In an effort to increase health care provider participation in the workers' compensation system, improve injured workers' access to timely, quality medical care, and reduce the administrative burden for providers…

The OIG workplans plans to conduct a series of telehealth audits for Medicare Part B services

April 13, 2021

The scope of the audits Phase one will focus on making an early assessment of whether services like evaluation and management, opioid use order, end-stage renal disease and psychotherapy meet Medicare requirements. …

Health Care Providers-The Board will require XML submissions of Form CMS-1500 beginning July 1 2021

April 2, 2021

In order to increase health care provider participation in the workers' compensation system and improve injured workers' access to timely, quality medical care, the Workers' Compensation Board (Board) made a …

MVP Medical Policy Updates Effective April 1 2021

March 16, 2021

MVP Health Care has updated a number of policies found on the site for provider review. Changes include New policies, Updated policies, Reviewed without changes as well as archived as no longer active.

MVP COVID19 Testing Update

February 25, 2021

MVP Health Care® (MVP) covers the cost of COVID-19 testing that has been deemed medically necessary at no cost share to the members.   MVP does not, however, reimburse for COVID-19 tests performed on an…

MVP Prior Authorization for Musculoskeletal Surgery Updates

February 25, 2021

Effective January 1, 2021, MVP Health Care® (MVP) is updating the Magellan Healthcare™ Utilization Review Matrix for Musculoskeletal Surgery of the Spine, Hip, Knee, Shoulder, and Interventional Pain Mana…

MVP COVID19 Vaccine Reimbursement and Coding

February 25, 2021

COVID-19 Vaccine Reimbursement and Coding MVP Health Care® (MVP) is covering approved COVID-19 vaccines at no cost-share to Members in all plans. Please follow the guidance below when submitting for reimbursement …

Excellus New Group Membership Notice

February 25, 2021

Effective January 1, 2021, several groups transtioned from Lifetime Benefit Solutions to Excellus BCBS. Please reivew all Member Cards for eligibility and benefits at each visit.

Administrative Policy AP-26 COVID-19 Viral and Antibody Testing and Supplies – Diagnosis Code B97.29

February 25, 2021

For claims billed on or after February 1, 2021, to remove interim diagnosis code B97.29 (Coronavirus as the cause of diseases classified elsewhere).  This update applies to all lines of business and is in line with …

Excellus Physical, Occupational, and Speech Therapy Preauthorization Process Change

February 25, 2021

Effective March 1st: UnitedHealthcare Community Plan of NY has a new requirement for Primary Care Provider Referral to Specialist

February 23, 2021

Please read the attached FAQ from UnitedHealthcare Community Plan of NY regarding their new referral process for members in need of services from a specialist provider. All in-network providers and UnitedHealthcare Commu…

Excellus BlueCross BlueShield Reinstating Reimbursement for Preventive Health Visits for Children and Adults via Telehealth During the Public Health Emergency

December 31, 2020

Excellus stresses that this is an option, not a requirement, and they strongly encourage in-person visits whenever possible, consistent with recent recommendations from the Centers for Medicare & Medicaid Services …

Notification to Providers Regarding Changes to Compliance Certification Requirements Pursuant to New York State Social Services Law (SOS) §363-d

December 30, 2020

UnitedHealthcare Temporary Prior Authorization Program Changes-- COVID-19

December 22, 2020

SNF prior authorization: UnitedHealthcare is suspending prior authorization requirements for admission to in-network SNFs. Transfer prior authorizations: UnitedHealthcare suspending prior authorizationrequirements w…

Coding Updates

Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service

April 13, 2021

Why is modifier 25 important? Modifier 25 used to indicate a significant, separately identifiable E/M service was performed by the same physician or other qualified health care professional on the day of procedure. …

Modifier 59- Distinct procedural Service

April 13, 2021

What is Modifier 59? Modifier 59 is used to identify a procedure that is distinct or independent from other non–E/M services that the provider performs on the same day.

G2212 and 99417, Do You Know the Difference?

April 2, 2021

2021 Brought in a new year and new guidelines. We learned about the 2021 office visit E&M guidelines and what those changes meant, as well as the addition of codes to accommodate prolonged services when time-based co…

Telehealth Grid

December 3, 2020

Documentation: Patient initiated and consent (written or verbal) Same as any face-to-face patient encounter, with the addition of the following: A statement indicating the service was provided via telehealth: P…

ICD-10 Codes- COVID-19

September 21, 2021

As a result of the ongoing COVID-19 public health emergency, the Centers for Disease Control and Prevention’s National Center for Health Statistics (CDC/NCHS) is implementing additional codes into the International…