Reimbursement Policy Updates

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Reimbursement Policy Updates

09/15/2022

Starting Jan. 1, 2023, we are introducing a new reimbursement policy, Foot Care Services and Nail Debridement (Commercial, Medicare, and Medicaid), for both EmblemHealth and ConnectiCare.

Starting Jan. 1, 2023, the EmblemHealth and ConnectiCare Modifier Reference Policy will align with CMS’ 10% payment reduction for claims submitted with modifiers FX (use of traditional x-ray film rather than digital radiography) and FY (x-rays taken using computed radiography technology/cassette-based imaging).

Our COVID-19 Vaccine and Monoclonal Antibody Infusions Policy has been updated with the new codes shown in the Revision History.

Our Provider’s Guides to Preventive Health Services (Medicare) for EmblemHealth and ConnectiCare have been updated to align with CMS as shown in the Revision History.

ConnectiCare’s Commercial Preventive Services List has been updated with State of Connecticut’s new breast/ovarian cancer mandate criteria effective Jan. 1, 2023.

Reminder: The Evaluation & Management Services (E&M) Policy (EmblemHealth and ConnectiCare) will replace our Supplemental E&M Policy. In addition, as of Sept. 1, 2022, EmblemHealth no longer reimburses consultation codes 99241-99255 for our GHI PPO City of New York Plans. Non-consultative E&M codes may be utilized based on the code that best describes the service performed.

Provider Update