Preventive Services for Medicare Advantage Plans   

Annual Well Visits are now allowed up to two times per calendar year. This change is intended to increase flexibility and support timely preventive care for our members. We have updated the language in this policy to reflect this change. While a second visit is now permissible, we strongly encourage providers to schedule the first Annual Well Visit as early in the calendar year as possible. Completing an early year visit helps ensure that preventive screenings, risk assessments, and care planning are addressed promptly, supporting better health outcomes throughout the year. For additional details related to this policy, please click here. 

Telemedicine/Telephone Services for Commercial and Medicare Advantage Plans

Coding and Payment Guidelines and Modifiers

Modifier 93 has been added to both the Telemedicine policy and the Coding and Payment Guidelines and Modifiers Policy. Modifier 93 was created within the CPT coding framework to describe synchronous (sink-crow-ness) telemedicine services rendered via real-time audio-only communication. While modifiers FQ and 93 are similar being for audio only, modifier 93 aligns with CPT/professional coding, whereas modifier FQ aligns with institutional reporting/UB billing, for example when services are rendered in Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) and/or outpatient hospital facilities. When used appropriately, both modifiers accurately communicate that the encounter met telehealth criteria but was conducted using audio-only technology.  Both modifiers are informational only.

For additional details related to these policies, please click the policy name below:

Telemedicine/Telephone Services for Commercial and Medicare Advantage Plans

Coding and Payment Guidelines and Modifiers

Sexually Transmitted Infections Testing Professional

This policy was updated to allow 87801 to process when two or more of the STI tests CPT codes are billed on the same date of service. For additional details related to this policy, please click here.