• Coding and Billing Guidelines | Provider | Premera Blue Cross

    discarded (i.e., drug wastage), the appropriate drug or biological code along with the JW modifier can be reported and is eligible for reimbursement. The JW modifier (“drug amount discarded/not administered to any patient”) should be reported on a separate line. The charge reported with the JW modifier should be combined and processed with the drug or biological code. Telemedicine and Telehealth Services. Telemedicine and Telehealth medical services – and procedures – are covered under some Blue Cross and Blue Shield of Texas (BCBSTX) PPO and HMO health care plans. If your health plan covers these services, you may get medical care from an in-network doctor or provider by mobile app, online video or phone. Reminder: payment for discarded drugs only applies to use vials. Modifier –JW identifies unused/wasted drug for dose vials. Effective Jan. 1, mandatory use of modifier -JW for Medicare Part B claims units wasted. Effective Jan. 1, , a JW modif ier (Drug amount discarded/not administered to any patient) will be required to bill any unused drugs or biologicals from SDVs or packages. (ASP) minus percent for certain separately payable drugs or biologicals (hereafter the appropriate B modifier is required on each line of a B-acquired drug. A B modifier is not required on claim lines of a non Please refer to the JW modifier FAQ document for . Attention B covered entities with Anthem Blue Cross and Blue Shield: Effective April 1, , Anthem requires that a “JG,” “TB,” or another relevant modifier be added to claims B eligible outpatient drugs under the Medicare Outpatient Prospective Payment System (OPPS). This decision by Anthem resembles the January 1, decision by the Centers for. The Blue Cross and Blue Shield Association does not have to member information. We regulate the brand and licenses to all 36 Blue Cross and Blue Shield local companies. To specific information about your coverage, EOBs, prescriptions, a bill, or any other questions related to your individual or group health insurance. Blue Cross will not allow professional P charges for therapeutic, prophylactic and diagnostic injections when rendered in certain places of service. Professional services (P) submitted with a facility place of service (such as 21, 22 or 23), will deny as provider liability. Documentation Submission. When claims for drugs and biologicals BCBSRI requires providers to use to JW modifier to identify the unused drug or biologicals from use vials/packages that are appropriately discarded. The JW modifier should be billed on a separate line and will provide payment for the amount of discarded drug or biological. For example, a use vial that is labeled to contain units of a .

    As a general matter, not-for-profits cannot use donor-restricted funds for other expenses. Local coverage determination policies can be found at www. If you are eligible for the Blue Cross Blue Shield Global Core program, enter the first three letters or numbers of your member ID here to access your international claim form and instructions. Separate encounter, a service that is distinct because it occurred during a separate encounter. CPCP v. Blood draw. CPT Codes provide a uniform language that accurately designates medical, surgical, and diagnostic services-enabling reliable nationwide communication among physicians, patients, and third parties. Applications are available at the AMA website. Effective Jan. The amount ordered, administered, and the amount discarded must be documented in the medical record. Simply select Get a Quote and you can view and compare our plans and pricing.

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