2014 MARFS

Updates & Corrections

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Updates

Payment policy updates
Payment policy updates
Posting date Policy Area Description
November 24, 2014   1069M is being end dated 12/31/14. All Activity Prescription Forms will be billed with 1073M. The new rules for billing 1073M are:
  • A claim may have up to 6 APFs submitted within the first 60 days of the initial date of treatment and then up to 5 times per 60 days thereafter.
  • Any APF falling outside the limits above will suspend. It will then be up to the CM to review the bill and appropriately allow or deny it.
October 1, 2014 Interpretive Services Beginning November 1, 2014, video interpretive services are covered when requested by health care providers and vocational counselors through L&I’s video based interpreter contract. Only vendors listed in the L&I contract may provide and be paid for video interpretive services.
May2013UpdatesPayment policy: Video interpretive services
September 22, 2014   Because of a reduction in the relative value units and maximum fees for CPT® code 77012, CT guidance for needle placement, the department or self-insurer will pay for both the guidance and the injection when CT guidance is used. This policy is retroactive to July 1, 2014
June 23, 2014   Cardiac Nuclear Imaging:
The following imaging procedures will require utilization review effective 7/1/2014.
78451, 78452, 78453, 78454, 78459, 78469, 78491, 78492, 78494, 78496
June 23, 2014   Catheter Ablation Procedures for Supraventricular Tachyarrhythmias:
The following procedures will require utilization review effective 7/1/2014.
93650, 93653, 93654, 93655, 93656, 93657
June 23, 2014   Cochlear Implants:
The following changes to procedure codes related to cochlear implants will become effective 7/1/2014.
69930 - This procedure will require utilization review effective 7/1/2014.
L8614 - The cochlear implant is bundled with the facility payment for 69930.

The following items require prior authorization.
L8615, L8616, L8617, L8618, L8619, L8621, L8622, L8623, L8624, L8627, L8628, L8629

Fee schedules updates
Fee schedule updates
Posting date Description Updated version
December 15, 2014

2014 ASC Fee Schedule Updates
Includes:

  • New ASC codes for 2014, and
  • Deleted ASC codes effective December 31, 2014
May2013UpdatesNew ASC Fee Schedule Updates
December 11, 2014 DELETED Procedure Codes - Invalid after December 31, 2014 May2013UpdatesDeleted Procedure Codes, effective December 31, 2014
December 11, 2014 New CPT, HCPCS, effective January 1, 2015.

May2013UpdatesNew CPT, HCPCS, effective January 1, 2015

May2013UpdatesNew CPT, HCPCS, effective January 1, 2015

October 8, 2014

Effective October 1, 2014 procedure code 25999 will be reimbursed as “By Report” on the ASC Fee Schedule.

 
August 25, 2015 Effective October 1, 2014, the following codes will be covered and require prior authorization.
90867, 90868, 90869 - The payment for these codes is By Report.
See Coverage decision.
August 13, 2014 New HCPCS Codes effective October 1, 2014. May2013UpdatesNew HCPCS codes, effective October 1, 2014
August 6, 2014 The Office of the Attorney General decided to update its fee schedule for other healthcare providers and vocational providers. May2013UpdatesFee schedule for testimony and related fees, effective July 1, 2014
July 31, 2014

The following codes were previously listed incorrectly in the Prosthetics & Orthotics fee schedule and have been updated.

L3901

$1,864.20

$1,864.20

L3904

$3,032.12

$3,032.12

L3905

$996.85

$996.85

L3906

$429.10

$429.10

L3908

$82.72

$82.72

L3912

$130.92

$130.92

L3913

$272.24

$272.24

 

 
June 12, 2014 New codes added for July 2014. May2013UpdatesNew CPT, HCPCS, effective July 1, 2014

Corrections

Payment policies corrections
Payment policy corrections
Posting date Policy Area Description
September 8, 2014 Hospitals (Chapter 35) In chapter 35 (page 6) section of the Medical Aid Rules and Fee Schedules (MARFS) the APR-DRGs that are assigned to certain Per Diem rates were stated incorrectly. Correction - APR DRG per diem rates, effective July 1, 2014.
August 5, 2014 Pathology & Laboratory Services (Chapter 17)

The following codes listed in the Bloodborne Pathogen section of Chapter 17, Pathology and Laboratory Services, have been end dated and are no longer valid. 83890, 83894, 83896, 83898, 83902, and 83912.


Fee schedule corrections
Fee schedules corrections
Posting date Description Updated version
December 10, 2014 G0463 was erroneously listed as Not Covered in the January 2014 Fee Schedule Updates. This code is covered for hospitals effective January 1, 2014. Any bills that were denied because of this error should be adjusted and paid appropriately.  

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