April 2022
Maintaining current and accurate payment polices is a priority for Neighborhood. We know our provider network relies on policies to inform doing business with Neighborhood.
The following document was recently removed from the Billing Guidelines and Payment Policies webpage and is now published on Neighborhood’s Archive webpage for Billing Guidelines and Payment Policies:
- Psychological Assessment Services; Billing guidance included in Physicians Services Payment Policy.
Please see below for a list of payment policy activity from January through early April 2022:
Non-Covered Services Payment Policy
Action: Effective January 12, 2022
Summary of changes:
- Updated to include new CPTS and HCPCS;
- A summary of changes for the January 12, 2022 update is published on Neighborhood’s Billing Guidelines and Payment Policies webpage.
Impacted lines of business: All
Acupuncture Services Payment Policy
Action: Effective February 1, 2022
Summary of changes:
- Newly created payment policy for Commercial members, however, not a new benefit.
Impacted lines of business: Commercial
Vision Care Services Payment Policy
Action: Effective March 1, 2022
Summary of changes:
- Combines guidance that was formerly documented in Neighborhood’s Vision Care Services Billing Guidelines and Ophthalmology Billing Guidelines.
- As of March 1, 2022 vision providers are required to bill the S codes in accordance with the revised payment policy. The reimbursement rate for the S codes is scheduled to align with the rate for the 9 codes. Claims that paid the S code at the S code rate will be reprocessed to pay the 9 code rate.
- Refraction services (92015) are not separately reimbursable when billed with a routine or medical eye exam or an evaluation and management service.
- If the refraction services are rendered outside of a routine or medical eye exam or an evaluation and management service, refraction services will be reimbursable.
- Fitting of eyeglasses is not reimbursable (92340, 92341, and 92342), unless billed with new frames and/or lenses. Fitting fees are reimbursable when eyeglasses are purchased, either a full pair or just lenses.
- Repair and refitting of eyeglasses is not separately reimbursable (92370).
Note: Providers should not bill their members for any of these services as they are included in the payment for other services billed during the same visit. Under no circumstance should a vision care provider pass the cost of an eyeglass adjustment or any component of an eye exam to a member.
Impacted lines of business: All
Multiple Procedures Payment Policy
Action: Effective March 12, 2022
Summary of changes:
- The former payment policy identified reimbursement guidelines for ambulatory surgery center (ASC) services and non-ASC surgical and radiology services. The new payment policy clarifies and categorizes services by ASC and non-ASC services.
Impacted lines of business: All
Temporary COVID-19 Telemedicine/Telephone-only Services
Action: Effective April 1, 2022; Policy updated April 8, 2022. Former policy saved on Neighborhood’s Billing Guidelines and Payment Policies Archive webpage, Temporary COVID-19 Telemedicine/Telephone-only Services – Archive 9.
Summary of changes:
- Updated “Claim Submission” section to include a new place of service (POS) code – POS 10 – to be used to indicate that the service was delivered via telemedicine/telephone only. The following POS codes should be used to indicate that the service was delivered via telemedicine/telephone only:
- POS 02 – when patient is not located in their home, or
- POS 10 (effective 4/01/22) – when the patient is located in their home.
Impacted lines of business: All
Physical and Occupational Rehabilitation Services Payment Policy
Action: Effective April 1, 2022
Summary of changes:
- Updated “Prerequisites” section to include the following clarification regarding ordering/referring providers for outpatient therapy services:
- Members must receive an order for outpatient therapy services from their primary care provider (PCP) or treating physician that is separate and distinct from the practice providing therapy. The ordering/referring provider must be documented in the member’s medical record, as well as, noted in Box 17 (referring provider) on the claim.
Impacted lines of business: All
Speech Therapy Services Payment Policy
Action: Effective May 1, 2022
Summary of changes:
- Updated “Prerequisites” section to include the following clarification regarding ordering/referring providers for outpatient therapy services:
- Members must receive an order for outpatient therapy services from their primary care provider (PCP) or treating physician that is separate and distinct from the practice providing therapy. The ordering/referring provider must be documented in the member’s medical record, as well as, noted in Box 17 (referring provider) on the claim.
Impacted lines of business: All
Last updated: April 11, 2022 @ 3:12 pm