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, other providers and non-hospital facilities. It applies to laboratory and radiology services from hospitals.
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 (95120-95134).
- 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., 94760 96904).
- 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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