UHC issuing recoupments on 88305 prostate biopsies for Medicare Advantage members
We’ve recently seen many commercial payers move to only paying prostate biopsies coded G0416 instead of 88305 (for instance, Cigna will institute this rule effective Aug. 18). It’s not exactly a major surprise to see them adopting CMS guidelines on this...
CMS clarifies monetary penalties for failing to report COVID-19 results
As part of a new interim rule issued to clarify COVID-19 data reporting requirements, CMS also outlined the monetary penalties entities that fail to do so may face. As part of the Interim Final Rule published Aug. 24, CMS stated that any healthcare facility (including...
Understanding UHC’s lab test registry
Beginning Oct. 1, United Healthcare (UHC) will require labs to provide unique test codes on claims for in-scope services. In order to comply, lab providers must register their lab tests BEFORE Sept. 1, 2020. Lab test codes must be on claims for in-scope lab test...
Cigna to cease payment for 88305 prostate biopsies
In a recent letter to providers, Cigna announced it will no longer reimburse prostate needle biopsies billed with CPT 88305 beginning Aug. 18. Instead, claims on or after that date must be submitted with HCPCS code G0416, one unit, to be eligible for payment. This...