{"id":8660,"date":"2025-03-07T14:06:52","date_gmt":"2025-03-07T14:06:52","guid":{"rendered":"http:\/\/hnetalk.com\/provider\/?p=8660"},"modified":"2025-03-07T14:06:52","modified_gmt":"2025-03-07T14:06:52","slug":"medical-policy-update-march-2025","status":"publish","type":"post","link":"http:\/\/hnetalk.com\/provider\/medical-policy-update-march-2025\/","title":{"rendered":"Medical Policy Update (March 2025)"},"content":{"rendered":"

Please read the following update related to various Health New England programs and changes that may have an impact on your patients and\/or your practice.<\/p>\n

If you have any questions about the information in this notice, please contact Health New England Provider Experience at (800) 842-4464, extension 5000. A representative is available Monday through Friday between the hours of 8:00 a.m. and 5:00 p.m.<\/p>\n\n\n\n\n\n\n
Updates<\/strong><\/td>\nNotes<\/strong><\/td>\n<\/tr>\n<\/thead>\n
Medical Policy<\/strong><\/td>\nPeripherally Implanted Nerve Stimulation (PNS), Peripheral Subcutaneous Field Stimulation (PSFS) – Medical Policy<\/strong><\/p>\n
    \n
  • This policy will remain in effect at this time (will not be retired).<\/li>\n
  • CPT codes 64555, 64596, and 64598 will continue to be covered with prior authorization.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Payment Policies<\/strong><\/p>\n

\u00a0<\/strong><\/td>\n

Drug Testing<\/strong><\/p>\n
    \n
  • Effective 05\/2025<\/li>\n
  • Added new drug codes for denial (G0481-G0483)<\/li>\n
  • Commercial LOB only<\/li>\n<\/ul>\n

     <\/p>\n

    Telehealth Services<\/strong><\/p>\n

      \n
    • Effective 05\/2025<\/li>\n
    • Added a denial edit for E&M with modifier 93\/95<\/li>\n
    • Commercial LOB only<\/li>\n<\/ul>\n

       <\/p>\n

      Outpatient Rehab<\/strong><\/p>\n

        \n
      • Effective 05\/2025<\/li>\n
      • Added the requirement for all OT\/PT\/ST services to bill an appropriate modifier, otherwise these charges will be denied.<\/li>\n<\/ul>\n

         <\/p>\n

        Amended Policies<\/strong><\/p>\n

          \n
        • Revised 1\/25<\/li>\n
        • ACO Home Care Partnership (Handbook)<\/li>\n
        • Authorization Requirements<\/li>\n
        • Universal Health Plan\/Home Health Authorization Form requirements Initial requests – Sect vii:\n
            \n
          • Daily medication administration visits for a 60-day certification period should include one (1) skilled nursing visit every 60 days,<\/strong> based on supporting documentation.<\/li>\n<\/ul>\n<\/li>\n
          • Continuation of Services – Sect v:\n
              \n
            • Daily medication administration visits for a 60-day certification period should include one (1) skilled nursing visit every 60 days,<\/strong> based on supporting documentation.<\/li>\n<\/ul>\n<\/li>\n
            • Services<\/li>\n
            • Medication Administration Visits:\n
                \n
              • Members receiving approved medication administration visits will be allowed, at a minimum, one skilled nursing visit every 60 days<\/strong> to assess the plan of care and the member\u2019s ongoing need for medication administration visits.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n","protected":false},"excerpt":{"rendered":"

                Please read the following update related to various Health New England programs and changes that may have an impact on your patients and\/or your practice. If you have any questions about the information in this notice, please contact Health New England Provider Experience at (800) 842-4464, extension 5000. A representative is available Monday through Friday […]<\/p>\n","protected":false},"author":11,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[92],"tags":[],"class_list":["post-8660","post","type-post","status-publish","format-standard","hentry","category-provider-newsletter"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p6ZZHB-2fG","_links":{"self":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8660","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/users\/11"}],"replies":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/comments?post=8660"}],"version-history":[{"count":3,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8660\/revisions"}],"predecessor-version":[{"id":8663,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8660\/revisions\/8663"}],"wp:attachment":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media?parent=8660"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/categories?post=8660"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/tags?post=8660"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}