Updated Payment Policies
Date: 01/25/21
Heritage Health (Medicaid):
Nebraska Total Care continually reviews and updates our payment and utilization policies to ensure that they are designed to comply with industry standards while delivering the best patient experience to our members. As a part of that review, the below policies have been revised or changed. Nebraska Total Care will be implementing effective April 1, 2021.
For more detailed information about these policies, please refer to the Clinical and Payment Policies on our website.
| Number | Policy Name | Policy Revisions/Changes | Line of Business |
|---|---|---|---|
| CP.MP.100 | Allergy Testing and Therapy (PDF) | Add the following CPT codes as non-payable: 86160, 86161, 86162, 86332, 86343, 86485, 86628, 0165U, 0178U. Add the following ICD-10-CM codes as payable when billed with CPT codes 86003, 86005, 86008, 95004, 95017, 95018, 95024, 95027, 95028, 95076, and 95079: Z91.010 | Medicaid |
| CP.MP.134 | Evoked Potential Testing (PDF) | Add the following procedure codes as payable when billed with the following ICD-10 codes. This edit only applies to members age 6 years and older: CPT: 92585 95925 95926 95927 95928 95929 HCPCS: G0453 ICD-10 codes to add: E08.40 E08.41 E08.42 E08.43 E08.44 E08.49 E71.520 E71.521 E71.522 E71.528 E71.529 G31.89 G31.9 G90.8 G90.9 H46.00 H46.01 H46.02 H46.03 H46.10 H46.11 H46.12 H46.13 H46.2 H46.3 H46.8 H46.9 H54.3 H54.60 H54.61 H54.62 A39.82 H35.54 R44.1 R48.3 G11.10 G11.11 G11.19 G96.89 Remove the following procedure codes as payable when billed with the following ICD-10 codes. This edit only applies to members age 6 years and older: CPT: 92585 95925 95926 95927 95928 95929 HCPCS: G0453 ICD-10 codes to remove: G93.6 G93.82 H54.7 R40.2 R40.3 R42 R47.01 | Medicaid |
| CP.MP.97 | Testing for Select Genitourinary Conditions (PDF) | Policy being revised and becoming more restrictive by adding the following ICD-10 CM codes to the list of codes that deny payment for CPT code 87798. O09.521 | Medicaid |
| Medicaid |