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2013 MARFS

Updates & Corrections

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Updates

Payment policy updates
Payment policy updates
Posting date Policy Area Description
January 15, 2014 Impairment Rating Services Effective January 31, 2014, L&I will end date local code 1190M, Impairment rating by attending physician, limited, 1 body area or organ system. We are taking this action to make billing for impairment ratings for attending providers consistent with consultant and IME ratings.

As of February 1, 2014, the description for 1191M, Impairment rating by attending physician, standard, 2-3 body areas or organ systems, will change to reflect 1-3 body areas or organ systems. Providers must bill 1191M instead of 1190M for impairment ratings for 1 body system.

Fee schedules updates
Fee schedule updates
Posting date Description Updated version
March 13, 2014 New HCPCS codes effective April 1, 2014 May2013UpdatesNew HCPCS, effective April 1, 2014
January 20, 2014 Effective January 1, 2014, the department will cover code L6880 with prior authorization, and when appropriate conditions are met. N/A
January 14, 2014 Effective January 1, 2014, the department and self-insurers will pay for electronic medical records (CDs) with HCPCS code S9981. The fee for this code is $25.00 N/A
December 16, 2013 DELETED Procedure Codes - Invalid after December 31, 2013 May2013UpdatesDeleted Procedure Codes, effective December 31, 2013
December 16, 2013 New CPT, HCPCS, effective January 1, 2014.

May2013UpdatesNew CPT, HCPCS, effective January 1, 2014

May2013UpdatesNew CPT, HCPCS, effective January 1, 2014

December 16, 2013

2014 ASC Fee Schedule Updates
Includes:

  • New ASC codes for 2014, and
  • Deleted ASC codes effective December 31, 2013
May2013UpdatesNew ASC Fee Schedule Updates
September 23, 2013 New HCPCS codes effective October 1, 2013 May2013UpdatesNew HCPCS Codes effective October 1, 2013
May 28, 2013 New CPT, HCPCS, Local Codes effective July 1, 2013. May2013UpdatesNew CPT, HCPCS, Local Codes effective July 1, 2013
May 28, 2013 Local codes 1057M and 1064M are end dated effective 6/30/13.  

Corrections

Payment policies corrections
Payment policy corrections
Posting date Policy Area Description
   

None at this time...


Fee schedule corrections
Fee schedules corrections
Posting date Description Updated version
April 22, 2014 G0463 was inadvertently listed as denied in the January updates. This code is valid and covered in the hospital outpatient setting effective January 1, 2014. This code is to be billed by hospitals in lieu of the outpatient E&M codes. Self-insurers should pay for this service by the percent of allowed charges methodology.  
October 24, 2013 Wound Therapy devices (E2402) are rented per day. 1 unit of service = 1 day. Negative Pressure Wound Therapy (NPWT) is covered with conditions, when the wound is related to an injury or illness allowed on the claim. The daily rental for this code is $83.30. Equipment limits for E2402: Patients are allowed one NPWT pump per episode (a pump may be used for more than one wound at the same time). Supplies should be limited to 15 dressing kits (A6550) per wound per month, and 10 canister sets (A7000) per month.  
October 23, 2013 Nursing Home Billing Code payment amounts listed incorrectly. May2013UpdatesFee Schedule Corrections October 23, 2013
July 18, 2013

The following codes were inadvertently listed as not covered in the July fee schedule. They are covered when guidelines are met and require prior authorization.

Code

Description

Non-Facility Fee

Facility Fee

L5856

Elec knee-shin swing/stance

$27,398.87

$27,398.87

L5857

Elec knee-shin swing only

$9,722.18

$9,722.18

L5858

Stance phase only

$21,212.05

$21,212.05

 

See Fee Schedule lookup

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