2012 MARFS

Updates & Corrections

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Payment policy updates
Payment policy updates
Posting date Policy Area Description
March 25, 2013  

Effective March 25, 2013 the department is placing restrictions on who may bill for non-CLIA waived testing.

Non-CLIA Waived Testing

  • Requirements for billing
    Complex or moderately comlex clinical pathology procedures that are not waived under the Clinical Laboratory Improvement Act (CLIA) must be performed in laboratories that are accredited or have a categorized staus under the State Department of Health or equivalent accrediting body.
  • Payment limits
    Payment for complex and moderately complex clinical pathology procedures will not be paid to any provider that only has a CLIA certificate of waiver or the Provider Performed Microscopic Procedure certificate.
November 8, 2012 Drugs Effective 09/01/2012, the department will not pay for repackaged drugs.
November 7, 2012 Hospitals Effective immediately - Veterans Administration Hospital Swing Bed Use
October 29, 2012 Medical Testimony Payment for medical testimony for an independent medical examination at the out-of-state rate will only be made if the examination was conducted out of state. Payment is not based on the physical address of the examiner
September 25, 2012  

The following codes will require utilization review effective 10/1/2012.








September 10, 2012 Hospitals

New APR-DRG weights, high and low outlier thresholds and average lengths of stay effective for dates of service beginning October 1, 2012.
DRG Per Diem Rates and DRG Base Rates are not changing.

Oct2010UpdatesAPRDRG Assignment effective October 1, 2012.
Oct2010UpdatesAPRDRG Assignment Field Key effective October 1, 2012.
Oct2010UpdatesAPRDRG Assignment effective October 1, 2012.


September 4, 2012   The following spinal injection codes require utilization review after September1, 2012.
Codes Injection Type Therapuetic Diagnostic

62310  64483
62311  64484
62318  0228T
62319  0229T
64479  0230T
64480  0231T

Epidural Injections

Cervical, Thoracic or Lumbar
Covered, with conditions and utilization review Covered, with conditions and utilization review


Sacroiliac Joint Injections Covered, with conditions and utilization review Not covered

64490  0213T
64491  0214T
64492  0215T
64493  0216T
64494  0217T
64495  0218T

Facet Injections

Medial Branch Blocks

Not covered

Not covered
Covered with conditions; Candidates for facet neurotomy


Intradiscal Not covered Not covered



Fee schedules updates
Fee schedule updates
Posting date Description Updated version
April 12, 2013

Effective February 27th, 2013, providers can bill for interest on medical bills for self-insured claims only. While the effective date to start billing self-insured providers for interest is 2/27/13; providers may bill interest on proper medical bills on self-insured claims for dates of service occurring before 2/27/13.
Providers use both of the following to bill interest:

March 27, 2013

Effective 1/1/2013, CPT code 90863, Management of prescriptions and review of medication, when performed with psychotherapy, is not covered. Psychiatrists and psychiatric ARNPs should bill an appropriate E/M procedure code for this service.

March 19, 2013 New HCPCS Codes effective April 1, 2013. Oct2010UpdatesNew HCPCS codes effective April 1, 2013
March 12, 2013 There was an error in the fee schedule for J9031. The correct fee should be $152.14.  
January 23, 2013 The department will cover 90785, interactive complexity, effective 1/1/2013. The non-facility and facility fee is $7.75  
January 2, 2013 Effective 1/1/2013, the ASC payment amount for procedure code 27899 is $98.97  
December 20, 2012 Effective 1/1/2013, the mileage rates for vehicles will be $.57 per mile.  
December 7, 2012

Procedure Code 64555 will be "Not Covered" by the department effective January 1, 2013.

December 6, 2012 New and end dated billing codes for 2013 Oct2010UpdatesAdditional CPT & HCPCS and Med/Surg codes effective January 1, 2013
Oct2010UpdatesComma Delimited file of Additional CPT & HCPCS codes effective January 1, 2013
Oct2010UpdatesCPT and HCPCS codes invalid after December 31, 2012
December 6, 2012 January 2013 ASC Fee Schedule updates - additions and deletions Oct2010UpdatesJanuary 2013 ASC Fee Schedule updates
September 6, 2012 Additional HCPCS codes effective October 1, 2012 Oct2010UpdatesUpdates effective October 1, 2012.
July 11, 2012 Updates to vocational fee caps effective July 1, 2012. Oct2010UpdatesVocational fee cap updates.
July 30, 2012 The following fees for enteral and parental supplies is effective September 1, 2012. Oct2010UpdatesUpdates effective September 1, 2012.


Payment policies corrections
Payment policy corrections
Posting date Policy Area Description
July 9, 2012 Surgery - microsurgery section

Correction to codes in the microsurgery section. Oct2010UpdatesThese CPT® codes aren't allowed with CPT® 69990.

Fee schedule corrections
Fee schedules corrections
Posting date Description Updated version

None at this time...


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