Insurance Updates:  February 24, 2021

By Policy and Advocacy Brief posted 02-24-2021 15:02

  

Insurance Updates:  February 24, 2021

Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes the release of COVID-19 and telehealth/telemedicine specific newsletters and policy updates. Blue Cross Blue Shield (BCBS) Kansas City Missouri reviewed its Erectile Dysfunction, Prostate Biopsies and Urinary Tumor Markers for Bladder Cancer Policies.

COVID-19 Updates:

CareFirst BCBS

CareFirst BCBS published its Coronavirus Resource Center for Healthcare Providers News & Announcements provider bulletin, announcing:

  • It is waiving cost sharing for in-network or out-of-network visits to a provider’s office for treatments related to COVID-19 for Medicare Advantage members.
  • Information regarding billing and submitting claims for coronavirus treatment for Medicare Advantage members.
  • Information regarding claims submissions for office visits, urgent care, or ER visits associated with the diagnoses or testing of COVID-19 for Medicare Advantage members.
  • Information regarding billing and submitting claims for coronavirus treatment, office visits, urgent care, ER visits, home births during the COVID-19 pandemic, and coronavirus testing to specify commercial members.

Read the update.

Cigna

Cigna published its COVID 19 News (Employers and Brokers) News & Announcements provider bulletin, updating information regarding that customer cost-sharing and co-pays for diagnostic testing and related office visits for commercial, insured, IFP, and Medicare members will be waived until April 20.

Read the update.

CMS

CMS published its MLN Connects News & Announcements newsletter covering COVID-19: Revised Clinician Codes Accepted with CS Modifier.

Read the update.

 

National Insurance Carriers/MACs Updates:

BCBS Kansas City Missouri

BCBS Kansas City Missouri reviewed its Erectile Dysfunction Policy with the following changes to criteria:

  • Changed “meet coverage criteria” to “is considered medically necessary”.
  • Changed “meet coverage” criteria to “is considered experimental and investigational”.

Read the update.

BCBS Kansas City Missouri reviewed its Prostate Biopsies Policy revising policy statements to replace coverage eligibility language with medical necessity language.

Read the update.

BCBS Kansas City Missouri reviewed its Urinary Tumor Markers for Bladder Cancer Policy revising policy statements to replace coverage eligibility language with medical necessity language.

Read the update.

CGS Administrators

CGS Administrators reviewed its Bladder/Urothelial Tumor Markers (J15) (A56471) Local Coverage Article (LCA) updating ICD-10 coding information and adding billing instructions for the following codes, in order to specify instructions for UroVysion that are differentiated from other services:

  • 88120 – Cytopathology, in situ hybridization (e.g., fish), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; manual
  • 88121 – Cytopathology, in situ hybridization (e.g., fish), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; using computer-assisted technology

Read the update.

Cigna

Cigna reviewed its Sacral Nerve and Tibial Nerve Stimulation for Urinary Voiding Dysfunction, Fecal Incontinence and Constipation Policy adding the following HCPCS code:

  • C1820 – Generator, neurostimulator (implantable), with rechargeable battery and charging system

Read the update.

CMS

CMS reviewed its Prostate Specific Antigen (190.31) National Coverage Determination (NCD) updating the revision history, adding a link to January 2021 ICD-10 covered code list, and adding January, April, and October 2020 editions of changes to Lab NCD Edit Software.

Read the update.

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