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Notification of Reimbursement Policy Revisions Effective January 1, 2024 (Posted November 1, 2023)

Reimbursement PolicyRevision
Add-On Codes MA NotificationLabor epidural language added. Medical Director approved. Notification on 11/1/2023 for effective date 1/1/2024.
Drug and Biologicals MA NotificationAdded coding guidance to Reimbursement Guidelines for reimbursement of administration fees.  Medical Director approved. Notification on 11/1/2023 for effective date 1/1/2024.
Evaluation and Management MA NotificationRemoved language regarding codes 99381 – 99397.  Medical Director approved.  Notification on 11/1/2023 for effective date 1/1/2024.
Nonpayment for Serious Adverse Events MA NotificationNew policy developed.  Medical Director approved.  Notification on 11/1/2023 for effective date 1/1/2024.
Opioid Treatment Program Reimbursement MA NotificationNew policy developed.  Medical Director approved.  Notification on 11/1/2023 for effective date 1/1/2024.
Pricing and Adjudication Principles MA NotificationBullets added for CMS rationale for reimbursement and reimbursement for denied or non-covered codes. Medical Director Approved. Notification on 11/1/2023 for effective date 1/1/2024.
Reduced and Discontinued Services MA NotificationNew policy developed.  Medical Director approved.  Notification on 11/1/2023 for effective date 1/1/2024.
Telehealth MA NotificationRemoved language regarding codes 99381-99397.  Medical Director approved.  Notification on 11/1/2023 for effective date 1/1/2024.

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