DRG Mapping Policy

We updated the description within the policy and added the following statement. Note:  For inpatient admissions with a discharge status of ‘deceased,’ payment shall be the lower of the calculated DRG rate or the actual billed charges." For additional information related to this policy, please click here. 

Preventive Policy for Commercial and Medicare

CPT Code 0064U (Syphilis Screening) was added as a preventive service effective 1 de abril, 2025 for both Medicare and Commercial Products 

We added “once per Calendar year" to reflect the term “annually" in the Preventative for Medicare policy. 

G0567 Annual Behavioral re-assessment for all lines of business has been added as a new code. 

Preventive Services for Commercial Members Policy 

Preventive Services for Medicare Members Policy

Non-Reimbursable Health Service Code

The following new codes effective 1 de abril, 2025 will be considered not separately reimbursed: A2030, A2031, A2032, A2033, A2034, A2035, A6515, A6516, A6517, A6518, A6519, A6611, A9300, A9611, E0201, G0567, J1245, L0720, L1933, L1952, L6028, L6029, L6030, L6031, L6032, L6033, L6037, L7406, Q4354-Q4367, S4024

The following codes have been deleted effective 1 de abril, 2025: L8010 and S4988

For additional information related to this policy, please click here. 

COVID-19 Monoclonal Antibody Treatment and Antiviral IV Medications

The following codes have been deleted effective 1 de abril, 2025: M0220, M0221, M0222, M0223, M0240, M0241, M0243, M0244, M0245, M0246, M0247, Q0220, Q0221, Q0222, Q0240, Q0243, Q0244, Q0245, Q0247.

For additional information related to this policy, please click here. 

Radiopharmaceuticals

The following new codes were added to the policy effective 1 de abril, 2025: A9611 and C9300.

For additional information related to this policy, please click here.