Get Policy Bulletin #11-86-ope - Onlineresources Wnylc

ing to CMS policy, 3D rendering with interpretation and reporting of CT, MRI, US, or other tomographic modality (76376, 76377), requires an approved secondary diagnosis. A qualifying procedure for the 3D rendering should also be included on the same date of service, or in the previous three days.

We may ask you to submit clinical records before we pay a claim if the claim includes: A code appended with Modifier 22 (unusual procedural service). For example, we may request an operative report for surgical procedures or office notes for non• surgical procedures.

Clinical policy bulletins are used by Medicare Advantage plans and commercial payers to describe the services and procedures they cover and under what circumstances, says Denise Wilson, vice president of clinical audit and appeal services at AppealMasters in Towson, Maryland.

Medical Clinical Policy Bulletins (CPBs) detail the services and procedures we consider medically necessary, cosmetic, or experimental and unproven. They help us decide what we will and will not cover.

Consistent with Centers for Medicare & Medicaid Services (CMS) policy and Patient Protection and Affordable Care Act (PPACA) requirements, Aetna covers medically necessary routine patient care costs in clinical trials (in the same way that it reimburses routine care for members not in clinical trials) ing to the ...

Bilateral surgical and nonsurgical procedures are reported as a single code billed (1) with modifier 50, (2) twice on the same day with RT and LT modifiers, or (3) with 2 units. For Medicare plans, Aetna pays 150% of the fee schedule amount for a bilateral surgical procedure.