Provider eNews - April 2017 edition

Provider coding and reimbursement changes and reminders cont.

Anesthesia
We remind anesthesia providers to report applicable modifiers identified in the BWC Professional Provider Fee Schedule. In 2015, BWC adopted the industry standard modifiers (–AA, -QS, -QY and –QZ) for anesthesia services. We also remind providers to discontinue reporting the previous BWC custom modifiers (-30 and -95) that expired Dec. 31, 2014.

Telemedicine
For dates of service on or after Jan. 1, 2017, BWC adopted new CPT modifier -95 for telemedicine services. This modifier pays the appended service at 100 percent of the fee schedule. BWC will no longer recognize modifiers –GT (interactive telecommunication) and –GQ (telehealth store and forward) for telemedicine services, effective for dates of service on or after May 1, 2017. Therefore, BWC will deny services reported with these modifiers.

Radiology/Imaging
For dates of service on or after May 1, 2017, providers should report modifiers –CT (computed tomography services furnished using equipment that does not meet each of the attributes of the National Electrical Manufacturers Association XR-29-2013 standard) and –FX (X-rays taken using film). Both apply when a provider is using equipment that is no longer standard.

For hospital outpatient services, modifier –CT will result in a 15-percent payment reduction and modifier –FX will result in a 20-percent payment reduction. While they're also currently required for professional provider billing, BWC will not apply payment reductions at this time.

Off-campus provider-based billing
BWC will not adopt the financial reduction associated with off-campus provider-based billing provision of the 2017 CMS OPPS Final Rule. The rule defined regulations related to provider based outpatient department reimbursement. This section of the final rule is referred to as Section 603. Under Section 603, effective for CMS on Jan. 1, 2017, most hospital off-campus provider-based departments that began furnishing services on or after Nov. 2, 2015, (date of enactment of Section 603) are no longer eligible to be paid under OPPS.

Detailed policies related to the Section 603 were not available during BWC's outpatient rule-making process. Therefore, BWC opted to postpone implementation for at least a year to study the CMS changes and determine potential impacts to the workers' compensation environment.

Although we postponed the reimbursement reduction associated with the Section 603 provision, BWC will require providers to report the applicable modifier –PO and the newly added modifier -PN on hospital outpatient bills to effectively study and forecast future impacts.
-PN: Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital
-PO: Excepted service provided at an off-campus, outpatient, provider-based department of a hospital.