| Invalid
Services
| Topic: Invalid
Services |
Date
of Origin: December 2009 |
| Section: Administrative |
Policy
No: 107 |
| Last Reviewed Date:
April 2010 |
Last Revised Date:
March 2011 |
This policy applies to all physicians and other health care professionals. This policy does not apply to facilities (hospitals, surgery centers, kidney centers, etc…)
Definitions
Invalid services are those that are not eligible for reimbursement.
Policy Statement
Providers will not be reimbursed nor allowed to retain
reimbursement for Invalid services. Invalid services
are denied provider write-off.
The following are examples of services that Regence
considers to be Invalid. This is not an all inclusive
list.
- Allergen provision plus administration combined
codes. Services must be broken out and
reported using separate codes representing each service
(95120-92134)
- Codes identified as not payable to professional
providers (e.g., S9083)
- Codes used in specific Regence Programs when the
provider is not contracted with or the member not
enrolled in that Program (e.g. S0281)
- CPT category
II supplemental tracking codes (0001F-7025F)
- HCPCS National ‘T’ codes established
for state Medicaid agencies (T1000-T5999)
- Medicare clinical trial codes (G0293-G0294)
- Medicare demonstration project codes (G9001-G9140)
- Medicare only codes (e.g., G0175, G0180)
- Medicare status ‘B’ codes (e.g., 36416,
90885)
- Physician quality reporting indicator HCPCS codes
(PQRI) (G8006-G8544)
- Services that are included in the facility reimbursement
and not separately payable to professional providers
(e.g., 99026, 99190)
- Services that are not direct face-to-face patient
care (e.g. 98966, 99375)
- Services which Regence does not contract for (S0270-S0274)
- Services which Regence considers part of another
service and therefore not separately reimbursable
(e.g. 96904, 94760)
- State Medicaid alcohol and drug abuse treatment
services (e.g., H0001, H2013)
- Surgical techniques requiring use of robotic surgical
system (S2900 - list separately in addition to code
for primary procedure)
- Tests, procedures
or medical drugs that are considered obsolete in nature (e.g., 92560,
P2028, 90645)
Please refer to the Coding
Toolkit on the Provider
Web site for codes Regence denies as Invalid.
References
None
Cross References
None
Your use of this Reimbursement Policy constitutes your agreement to be bound
by and comply with the terms and conditions of the Reimbursement
Policy Disclaimer.
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