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Regulatory Updates
NETWORK NATIONAL LABORATORY SERVICES CARE PROVIDERS FOR 2019

In 2019, Quest Diagnostics will join UnitedHealthcare’s national network of participating laboratory providers to better support members and the care providers who order laboratory services.

LabCorp offers nearly 5,000 frequently requested and specialty tests, including a wide range of clinical, anatomic pathology, genetic and genomic tests, delivered through LabCorp’s broad patient access points, including a growing retail presence.

Quest, which is an in-network lab for a limited number of UnitedHealthcare plans in some markets today, has 6,000 patient access points and will be in-network nationwide for all plan participants beginning Jan. 1, 2019.

Read more details.

Regulatory Updates
TELEHEALTH AND TELEMEDICINE
POLICY UPDATE

Oxford will consider for reimbursement Telehealth services which are recognized by The Centers for Medicare and Medicaid Services (CMS) and appended with modifiers GT or GQ, as well as services recognized by the AMA included in Appendix P of CPT and appended with modifier 95.

In addition, Oxford recognizes certain additional services which can be effectively performed via Interactive Audio and Video Telecommunications systems; these codes will be considered for reimbursement when reported with modifier GT:

  • Medical genetics and genetic counseling services (CPT code 96040
  • Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum (CPT codes 98960-98962
  • Alcohol and/or substance abuse screening and brief intervention services (CPT codes 99408-99409
  • Remote real-time interactive video-conferenced critical care (CPT codes 0188T and 0189T, reimbursable with or without modifier GT since their description indicates a Telehealth service and the technology used

Refer to the policy for:

  • 2018 Codes Recognized with Modifiers GT or GQ
  • 2018 Codes Recognized with Modifier 95 Oxford requires one of the following modifiers to be reported when performing a service via Telehealth to indicate the type of technology used and to identify the service as Telehealth

Read more details here.

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Insights
November 2018