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Payers updating policies for ASC procedures

Four payers have updated their policy for ASC procedures since May 24:

1. Cigna is delaying the implementation of its modifier 25 policy. The reimbursement policy requires the submission of medical records with all evaluation and management claims with CPT 99212-99215 and modifier 25 when a minor procedure is billed. 

2. Aetna will no longer require prior authorization for cataract surgery or video electroencephalography procedures. For spinal fusion and cervical artificial disc surgeries, Aetna will no longer require precertification for the site of service. The surgeries still need to be precertified.

3. Optum Ventures, CVS Ventures, Anthem and HLM Venture Partners announced they are investing in CareBridge, a value-based care company for patients receiving home and community-based services. CareBridge has closed a $140 million financing round to begin expanding to more than a dozen states. Over the last year, the company has grown from serving about 1,100 full-risk patients last June to 19,000 to date and is now valued at over $1 billion.

4. Blue Cross Blue Shield changed its colonoscopy policy after a patient in Greensboro, N.C., complained about lack of coverage. 

5. Aetna has dropped its policy to not cover cardiac PET/CT scans following a joint letter from the American Society of Nuclear Cardiology and the Society of Nuclear Medicine and Molecular Imaging.

 

 

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