Effective July 1, 2010
New Commercial Coding Edits for Facilities

The following changes, effective for facility claims adjudicated on or after July 1, 2010, apply to commercial facility providers:

E&M Services

• Tufts Health Plan will not reimburse Evaluation and Management (E&M) services when billed with physician services for outpatient cardiac rehabilitation (93797-93798), as reimbursement for the E&M service is included in the physician services for outpatient cardiac rehabilitation. Tufts Health Plan will consider reimbursement if the appropriate modifier is appended to the E&M procedure code.
  
  This change is documented in the Cardiac and Pulmonary Rehabilitation Facility Payment Policy.
  
  
• Tufts Health Plan will not reimburse E&M services when billed with a stress test, as reimbursement for the E&M service is included in the stress test. Tufts Health Plan will consider reimbursement if the appropriate modifier is appended to the E&M procedure code.
  
  This change is documented in the Outpatient Payment Policy.

Therapeutic Port Films
Tufts Health Plan will reimburse CPT procedure code 77417 (Therapeutic port film[s]) once in a seven-day period. This change is documented in the Radiation Oncology Payment Policy.

May 1, 2010
Note: The information in this article was correct as of the date of posting and may not reflect subsequent policy changes.