New and updated billing policies are now available

We’ve posted several new and updated billing policies, which align to industry standards, to the Provider Manual.

Policies going into effect Dec. 23, 2024

The following policies and policy updates will go into effect on Dec. 23, 2024. Below are links and a high-level overview of each policy. Please see each policy for specific billing, coding and reimbursement details.

Hearing aid and cochlear implant replacement parts and accessories (added to Miscellaneous DME policy)

We’ll apply limits to hearing aid and cochlear implant replacement parts and accessories for commercial plans, mirroring the limits already in place for Medicaid plans and established by MDHHS. Note: Limits for cochlear implants may be subject to a member’s Hearing Rider language – some items are considered not covered.

Trigger point injections

Trigger point injections (TPI) are given to relieve muscle pain for patients. In alignment with CMS, we’ll apply limits to commercial plans for CPT 20552 and 20553, limiting to four injections per rolling year.

Policy going into effect Jan. 1, 2025

The following policy will go into effect on Jan. 1, 2025:

Durable Medical Equipment (DME) place of service (POS)

We’ll require DME claims for commercial plans to be coded with the POS where the member will primarily use the DME item. This aligns with the DME POS requirement already in place for Medicare plans and established by CMS.

Additional policy updates

Additionally, the following policies were recently posted to or updated in this Provider Manual's billing / coding policies page. They put our current policies and requirements into writing for transparency. Please see the individual policies for details: