Date Issued: 10/8/2015
As noted in the Provider Manual, EmblemHealth uses multiple types of commercially available claims review software to support the correct coding of claims that result in fair, widely recognized and transparent payment policies.* One of these policies bundles CPT code 81002 and CPT code 81003 (Urinalysis, by dip stick or tablet reagent) when reported with an Evaluation and Management service (e.g., CPT codes 99201-99205, 99211-99215 and 99381-99397). CPT codes 81002 and 81003 will not be separately reimbursed unless Modifier 25 is appended to the E/M service indicating that a diagnostic, non-screening, urinalysis was performed.
*Policy sources include, but are not limited to, AMA and CMS policy regarding reimbursement of E/M services submitted with Modifier 25, as well as EmblemHealth’s plan-specific requirements (refer to the Claims Review Software section of the Claims chapter of the EmblemHealth Provider Manual for additional information about claims review software used by EmblemHealth).