COVID-19 Updates

Blue Cross and Blue Shield of Kansas City (Blue KC) is grateful to all the healthcare providers who have been working tirelessly to take care of our community while being on the frontlines fighting the COVID-19 outbreak these last two and a half years

For the latest updated information on COVID-19 policies, over-the-counter testing guidelines, coding and billing, see the “COVID-19 Information” section on the home page of Providers.BlueKC.com.

Telehealth Update

Effective January 1, 2022, the Centers for Medicare and Medicaid Services (CMS) revised the description of existing place of service (POS) code 02 and created new POS code 10 to meet the overall insurance industry needs. Effective April 1, 2022, Blue KC modified its claims system to reflect this change.

Telehealth services billed by a provider with a POS code 02 is based on the Medicare fee schedule for telehealth services provided in a facility. The Medicare fee schedule for telehealth services provided in a facility is reimbursed at a lower amount than telehealth services provided in the patient’s home (POS code 10).

It is important providers use the correct coding guidelines published by CMS: POS code 02 is for telehealth provided other than in the patient’s home, while POS code 10 is for telehealth

provided in the patient’s home. When filing claims with POS code 02 or POS code 10 for telehealth, please remember to follow the correct coding guidelines.

For more details on Telehealth, visit the COVID-19 Information section on the home page of Providers.BlueKC.com.

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Community Investment

Blue KC is pitching in to help KC Current Goalkeeper AD Franch give back to the KC community by “Playing for Trees”.

During September’s “Hunger Action Month”, Blue KC, a founding partner of the KC Current and the National Women’s Soccer League team’s official health insurance partner, is proud to announce we are donating $100 each time AD records a save in support of Franch’s “Playing for Trees” campaign, which partners with The Giving Grove to bring more orchards to neighborhoods in Kansas City.

Blue KC’s donations kicked off with the Current’s match on August 28 and will continue through the remainder of the 2022 season, including any postseason games. The donations are going directly to The Giving Grove, a Kansas City-based nonprofit that supports neighborhood volunteers in planting and caring for fruit trees, nut trees and berry brambles that improve the urban environment, increase tree canopy and provide a sustainable source of free, organically-grown food for neighborhoods facing high rates of food insecurity.

The Giving Grove is one of Blue KC’s Well Stocked partners. Founded in 2018, Blue KC’s Well Stocked initiative aims to increase food access and reduce food insecurity in Kansas City.

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Behavioral Health

Blue KC partnered with the Kansas City Royals, Carl’s Cause, Zero Reasons Why and other behavioral health and suicide prevention organizations to raise awareness for the 988 crisis number during the July 23 Royals game at Kauffman Stadium. One week earlier, the National Suicide Prevention Lifeline rolled out the new 988 crisis number, which is available for suicide prevention and mental health crisis.

This promotion was part of the Shut Out the Stigma initiative, Blue KC’s partnership with the Royals, to elevate the understanding in our community about the importance of behavioral health. Check out this powerful video about the 988 event with the Royals.

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How to Check HMO Member’s PCP on ID Card

Like putting on your white laboratory coat or scrubs, we want the claims process to be one of the easiest things you do all day! To help avoid a claim denial, please make sure our HMO members are seeing the correct Primary Care Provider listed on their ID card. Here’s how to identify the correct PCP on our HMO ID cards:

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Office of Inspector General Telemedicine Fraud Alert

Blue KC recently received the Office of Inspector General (OIG) Special Fraud Alert for Practitioners to exercise caution when entering into arrangements with Telemedicine Companies. Below are a few main takeaways that may be helpful to providers. Clickhere to access the direct link for the Alert:

Key Takeaways:

• Fraud Scheme: Telemedicine Companies intentionally paid physicians and nonphysician practitioners kickbacks to generate orders or prescriptions for medically unnecessary durable medical equipment, genetic testing, wound care items or prescription medications, resulting in submissions of fraudulent claims to Medicare, Medicaid and other Federal healthcare programs.
• Concerns: These schemes raise concern because of the potential for considerable harm to Federal healthcare programs and their beneficiaries, which may include: (1) an inappropriate increase in costs to Federal healthcare programs for medically unnecessary items and services and, in some instances, items and services a beneficiary never receives; (2) potential to harm beneficiaries by, for example, providing medically unnecessary care, items that could harm a patient, or improperly delaying needed care; and (3) corruption of medical decision-making.
• Federal Laws Implicated: When a party knowingly and willfully pays remuneration to induce or reward referrals of items or services payable by a Federal healthcare program, the Federal anti-kickback statute is violated. By its terms, the statute ascribes liability to parties on both sides of an impermissible kickback transaction. Other laws implicated may include the OIG’s exclusion authority related to kickbacks, the Civil Monetary Penalties Law provision for kickbacks, the criminal healthcare fraud statute and the False Claims Act.
• Suspect Characteristics:
  • The Practitioner does not have sufficient contact with or information from the purported patient to meaningfully assess the medical necessity of the items or services ordered or prescribed.
  • The Telemedicine Company compensates the Practitioner based on the volume of items or services ordered or prescribed, which may be characterized to the Practitioner as compensation based on the number of purported medical records that the Practitioner reviewed.
  • The Telemedicine Company only furnishes one product or a single class of products (e.g., durable medical equipment, genetic testing, diabetic supplies, or various prescription creams), potentially restricting a Practitioner’s treating options to a predetermined course of treatment.
    **See Alert for full list of Suspect Characteristics
• Recommendation: The OIG encourages Practitioners to use heightened scrutiny, exercise caution and consider the above list of suspect criteria prior to entering into arrangements with Telemedicine Companies.

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Blue Medicare Advantage Information

Transitions of Care – Receipt of Discharge Information Quality Measure

According to a 2007 Journal of Hospital Medicine report, about half of all adults discharged from a hospital experience a medical error and approximately one in five of these suffer an adverse event.

The National Committee for Quality Assurance (NCQA) targets hospitals, medical health plans and providers for transitions of care measures to build the structures that safely coordinate patient care between in-patient and out-patient settings because these transitions are placing patients at risk for errors (Wheeler, 2022).

Completing follow-up education, confirming follow-up appointments and completing medication reconciliations post discharge all require physician offices to receive information about a hospital admission.

In 2022, Blue Medicare Advantage incentivized the Transitions of Care – Receipt of Discharge Information quality measure to align with the Centers for Medicare and Medicaid Services (CMS). The goal is to collaborate and improve the networks that enable primary care physicians (PCP) offices to obtain hospitalization documentation, so they can act on it.

Closing the Quality Gap

Discharge information should be received within two calendar days of hospital discharge and may be included in a discharge summary, a summary of care record or in structured fields in an electronic medical record.

At a minimum, the discharge information content must include ALL of the following: Name of practitioner responsible for the member’s care during the inpatient stay Procedures or treatment provided Diagnosis at discharge Current medication list Test results, or documentation of pending test or no test pending Instructions to the PCP or ongoing care provider for patient care Received date if not available in shared electronic medical record (EMR) *This can include the date of receipt of a fax or upload if outside a shared EMR.

While there is ongoing education about this new measure, we know there may be lingering questions or clarity required to confirm what documentation is going to close the measure. Feel free to reach out to your provider engagement team to work with Blue KC on the process.

Consider working to provide documentation about hospitalizations in your existing networks and shared EMRs first. Next, consider how to expand the networks between existing networks and those outside facilities to augment supporting all patients’ safety through transitions of care.

(References: Kripalani, S., Jackson, A. T., Schnipper, J. L., & Coleman, E. A. (2007). Promoting effective transitions of care at hospital discharge: a review of key issues for hospitalists. Journal of hospital medicine: an official

publication of the Society of Hospital Medicine, 2(5), 314-323. https://doi.org/10.1002/jhm.228; O'Neill, A. (2022, June 13). Transitions of care. NCQA. Retrieved August 31, 2022, from https://www.ncqa.org/hedis/measures/transitions-of-care/.

Updating and Certifying Provider Data in CMS’ National Plan & Provider Enumeration System

Blue KC wants to remind you to review your National Provider Identifier (NPI) data in the National Plan & Provider Enumeration System (NPPES) as soon as possible to ensure accurate provider data is displayed. As you may know, providers are legally required to keep their NPPES data current.

CMS is also encouraging Medicare Advantage Organizations to use NPPES as a resource for our online provider directories. By using NPPES, we can decrease the frequency by which we contact you for updated directory information and provide more reliable information to Medicare beneficiaries.

If the NPPES database is kept up to date by providers, our organization can rely on it as a primary data resource for our provider directories, instead of calling your office for this information. With updated information, we can download the NPPES database and compare the provider data to the information in our existing provider directory to verify its accuracy.

When reviewing your provider data in NPPES, please update any inaccurate information in modifiable fields, including provider name, mailing address, telephone and fax numbers and specialty to name a few. You should also make sure to include all addresses where you practice and actively see patients and where a patient can call and make an appointment. Do not include addresses where you could see a patient but do not actively practice.

Please remove any practice locations that are no longer in use. Once you update your information, you will need to confirm it is accurate by certifying it in NPPES. Remember, NPPES has no bearing on billing Medicare Fee-For-Service.

If you have questions pertaining to NPPES, you may reference NPPES help by clicking here.

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Advance Care Planning Vendor Update

Effective Advance Care Planning (ACP) is a valuable part of patient care and, as you know, it can be very time consuming. To support your team and give our members an opportunity to complete comprehensive ACP, Blue KC began partnering last year with Iris Healthcare, a specially trained ACP healthcare organization.

We want to update you that enrollment has closed for our Commercial and Medicare Advantage members whom we have identified would benefit from this FREE service. Iris Healthcare will work with these enrolled members for two years, with the option for these members to opt out at any time.

As a reminder, the Iris Healthcare ACP experts facilitate the discussions and generate Advance Directive documents with the member. Once completed, the documents can be shared with providers and facilities with the permission of the member. Clinicians may utilize completed documents from Iris for ACP consultation with our members, and submit the following ACP CPT codes for your time and service reviewing the signed Advance Directives:

CPT 99497 (base code) – $86	Time-based code for initial 30-minutes of ACP discussions during a face-to-face encounter with patient and/or family member(s) / surrogate
CPT 99498 (add on) – $75	Time-based code for each additional 30-minutes of APC discussions during a face-to-face encounter with patient and/or family member(s) / surrogate

What Iris Healthcare Does:

• Completes ACP conversations on behalf of care teams.
• Defers all specific treatment detail and patient questions to you.
• Coordinates family discussions and resolves family conflict or care disagreements.
• Meets quality measures and helps improve patient experience.
• Distributes ACP documents to you for your input and/or signature where appropriate, such as medical order for life-sustaining treatments.

What Iris Healthcare Does Not Do:

• Provide medical or nursing care.
• Suggest or advise a patient or family on care choices.
• Submit CPT codes or invoice the patient.

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Prior Authorization Updates

Codes for Interventional Pain Management Procedures Will Move to eviCore

To streamline the clinical review process for Interventional Pain Management Procedures, Blue KC will be transitioning prior authorization over to eviCore, effective January 1, 2023.

Currently, eviCore administers prior authorization reviews for High-Tech Imaging and Cardiology for all lines of business. The additional codes that will now go to eviCore can be found in the table below. These codes will be the same for all lines of business (Commercial, Blue Medicare Advantage, ACA QHP and Small Group ACA). Some of these codes did not previously require a prior authorization, so providers are encouraged to become familiar with this change.

Note: Any procedures already authorized for dates of service prior to January 1, 2023 by Blue KC will remain in effect and will not need to be resubmitted to eviCore. Procedures that were not on the prior authorization list prior to January 1, 2023 WILL REQUIRE a prior authorization to be in place if the service will be performed on or after January 1, 2023.

00640	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	ANESTHESIA
01935	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	ANESTHESIA
01936	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	ANESTHESIA
01991	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	ANESTHESIA
01992	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	ANESTHESIA
0213T	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	FACET JOINT
0214T	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	FACET JOINT
0215T	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	FACET JOINT
0216T	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	FACET JOINT
0217T	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	FACET JOINT
0218T	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	FACET JOINT
0228T	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	EPIDURAL STEROID
0229T	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	EPIDURAL STEROID
0230T	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	EPIDURAL STEROID
0231T	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	EPIDURAL STEROID
0274T	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	THERMAL INTRADISCAL
0275T	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	THERMAL INTRADISCAL
20550	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	EPIDURAL STEROID
20552	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	TRIGGER POINT INJECTION
20553	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	TRIGGER POINT INJECTION
22526	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	THERMAL INTRADISCAL
22527	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	THERMAL INTRADISCAL
23350	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	EPIDURAL STEROID
27096	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	SI JOINT
61790	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	STEREOTACTIC PROCEDURE
61791	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	STEREOTACTIC PROCEDURE
62263	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	ADHESIOLYSIS
62264	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	ADHESIOLYSIS
62280	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	ADHESIOLYSIS
62281	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	ADHESIOLYSIS
62282	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	ADHESIOLYSIS
62287	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	DECOMPRESSION PROCEDURE
62290	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	DISCOGRAPHY
62291	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	DISCOGRAPHY
62292	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	CHEMONUCLEOLYSIS
62310	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	EPIDURAL STEROID
62311	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	EPIDURAL STEROID
62318	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	EPIDURAL STEROID
62319	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	EPIDURAL STEROID
62320	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	EPIDURAL STEROID
62321	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	EPIDURAL STEROID
62322	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	EPIDURAL STEROID
62323	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	EPIDURAL STEROID
62324	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	EPIDURAL STEROID
62325	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	EPIDURAL STEROID
62326	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	EPIDURAL STEROID
62327	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	EPIDURAL STEROID
62350	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	DRUG PUMP
62351	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	DRUG PUMP
62355	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	REMOVAL
62360	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	DRUG PUMP
62361	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	DRUG PUMP
62362	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	DRUG PUMP
62365	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	REMOVAL
62367	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	ANALYSIS
62368	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	ANALYSIS
62369	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	ANALYSIS
62370	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	ANALYSIS
63650	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	NEUROSTIMULATOR IMPLANT
63655	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	NEUROSTIMULATOR IMPLANT
63661	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	REMOVAL
63662	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	REMOVAL
63663	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	NEUROSTIMULATOR IMPLANT
63664	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	NEUROSTIMULATOR IMPLANT
63685	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	NEUROSTIMULATOR IMPLANT
63688	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	REMOVAL
64405	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	NERVE BLOCK
64445	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	NERVE BLOCK
64451	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	SI JOINT
64472	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	FACET JOINT
64479	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	EPIDURAL STEROID
64480	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	EPIDURAL STEROID
64483	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	EPIDURAL STEROID
64484	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	EPIDURAL STEROID
64490	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	FACET JOINT
64491	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	FACET JOINT
64492	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	FACET JOINT
64493	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	FACET JOINT
64494	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	FACET JOINT
64495	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	FACET JOINT
64510	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	REGIONAL SYMPATHETIC BLOCK
64520	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	REGIONAL SYMPATHETIC BLOCK
64581	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	NEUROSTIMULATOR IMPLANT
64620	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	NERVE BLOCK
64622	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	SPINAL DENERVATION RFA
64625	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	SI JOINT
64626	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	SPINAL DENERVATION RFA
64633	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	SPINAL DENERVATION RFA
64634	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	SPINAL DENERVATION RFA
64635	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	SPINAL DENERVATION RFA
64636	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	SPINAL DENERVATION RFA
64999	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	SPINAL DENERVATION RFA
95970	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	ANALYSIS
95971	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	ANALYSIS
95972	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	ANALYSIS
95973	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	ANALYSIS
95974	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	ANALYSIS
95975	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	ANALYSIS
95978	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	ANALYSIS
95979	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	ANALYSIS
95980	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	ANALYSIS
95981	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	ANALYSIS
95982	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	ANALYSIS
95990	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	REFILL
95991	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	REFILL
C1767	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	NEUROSTIMULATOR IMPLANT
C1778	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	NEUROSTIMULATOR IMPLANT
C1787	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	NEUROSTIMULATOR IMPLANT
C1816	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	NEUROSTIMULATOR IMPLANT
C1820	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	NEUROSTIMULATOR IMPLANT
C1883	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	NEUROSTIMULATOR IMPLANT
C1897	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	NEUROSTIMULATOR IMPLANT
E0783	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	DRUG PUMP
E0785	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	DRUG PUMP
E0786	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	DRUG PUMP
G0259	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	SI JOINT
G0260	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	SI JOINT
J1040	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	STEROID INJECTATE
L8680	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	NEUROSTIMULATOR IMPLANT
L8681	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	NEUROSTIMULATOR IMPLANT
L8682	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	NEUROSTIMULATOR IMPLANT
L8683	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	NEUROSTIMULATOR IMPLANT
L8685	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	NEUROSTIMULATOR IMPLANT
L8686	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	NEUROSTIMULATOR IMPLANT
L8687	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	NEUROSTIMULATOR IMPLANT
L8688	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	NEUROSTIMULATOR IMPLANT
L8689	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	NEUROSTIMULATOR IMPLANT
L8695	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	SPINAL IMPLANT	NEUROSTIMULATOR IMPLANT
M0076	CPT/HCPCS	MSK	INTERVENTIONAL PAIN	INJECTIONS	PROLOTHERAPY

SNF Waiver Extension of Prior Authorization

Blue KC wants to remind you the in-network Skilled Nursing Facilities’ (SNF) waiver of prior authorization for Commercial, Small Group ACA and Blue Medicare Advantage members will remain in place through the end of the public health emergency, which currently runs through October 13, 2022.

The waiver only applies to in-network SNF admissions from acute hospitals. Please check the Recent News Updates section on the home page of Providers.BlueKC.com for more details, as we continue to evaluate the success of this program and consider extending the waiver outside of the public health emergency period.

Code Updates

The codes below have been added to our prior authorization list, effective November 1, 2022, and continue to apply

Code	Description	Effective date	Line of Business
43497	Incision of muscle of lower esophagus using an endoscope	11/1/2022	ACA and Commercial
15877	Suction Assisted removal of fat of body	11/1/2022	Commercial
0398T	Destruction of tissue of brain using MRI guidance	11/1/2022	Commercial
19328	Removal of intact breast implant	11/1/2022	Commercial

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Payment Policy Updates

Observation Care: POL-PP-126

Blue KC will have an updated payment policy for Observation Care that will impact all lines of business. Effective January 1, 2023, Blue KC will not reimburse for Observation Care that exceeds 72 hours.

For more details about this current payment policy, go to the log-in page at Providers.BlueKC.com and click on the Go to Payment Policies blue button. Scroll down and look under the heading, All Provider Payment and Coding Policies. The updated payment policy will be available to view on the Provider Portal beginning January 1, 2023.

JW Modifier Reminder

Effective September 1, 2022, Blue KC has a new payment policy POL-PP-234 for JW Modifier. This policy will allow us to be consistent across all lines of business, as the policy is already in place for Blue Medicare Advantage.

When the total volume of a single use/dose vial (SDV) of a drug or biological cannot be administered to a patient and unused quantity is appropriately discarded (i.e., drug wastage), the appropriate drug or biological code, along with the JW modifier, can be reported and is eligible for reimbursement, in addition to the amount of the drug administered up to the amount of the drug or biological as indicated on the SDV or package label.

Additional details include:

The drug amount discarded/not administered to any patient	Should be reported on a separate claim line with the inclusion of the JW modifier.
The Medical Record	Must clearly document the exact dosage administered and the exact amount of the discarded portion of the drug or biological.
Providers are expected to use the drug or biological in a responsible way to avoid drug wastage	If a patient needs 45 mg of a drug and the product comes in 50 mg and 100 mg single use vials, the 50 mg vial should be used to minimize wastage.
When submitting a claim for a single use vial, packaged and dispensed for use on a single patient	The unused portion of the single use vial may not be used on or billed for a different member.
When submitting a claim for a multi-dose vial	The provider may not bill for the unused portion of the multi-dose vial.
The units billed	Must correspond with the smallest dose (vial) available according to national compendia that could provide the appropriate dose for the patient. The JW modifier only applies to drugs designated as single-use or single dose on the FDA-Approved label or package insert. Please refer to the FDA website for more information.
Providers shall not charge, bill or collect a fee for drug wastage (modifier JW)	When the units billed do not correspond with the smallest dose (vial) available, according to national compendia, to provide the proper dose for the patient.

This payment policy will be available to view on September 1, 2022. Go to the log-in page at Providers.BlueKC.com and click on Go To Payment Policies.

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Medical Policy Updates

As announced in our August Provider Bulletin, Blue KC’s updated medical policies for elective total hip and total knee replacements will go into effect on October 3, 2022. To view these policies, visit Providers.BlueKC.com. After logging in, go to the Medical Policies section and select “Review Our Medical Policy”. Once you choose “I agree”, you’ll find the two policies under “Future Policy Updates”.

Key changes in these policies include:

More specific definitions around what is required for conservative treatments prior to the surgery

Additional specific requirements for x-ray interpretations submitted

Clarifications around a maximal BMI permitted to gain approval for joint replacement

Please also remember requests for an inpatient admission are reviewed separately after the initial review for the surgery. Elective joint replacements do not meet criteria for expedited status, so please provide sufficient time for review and decisions before scheduling these surgeries to avoid having to cancel and reschedule.

Finally, our new guidelines will require submitting orthopedic practices to obtain and submit all the pertinent records to prove requirements have been met. Statements saying “all requirements have been met” will no longer be accepted.

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Pharmacy Policy Updates

Here are new Blue KC pharmacy polices that will require prior authorization and apply October 1, 2022:

New Pharmacy Policies
Policy Number	Policy Name	Summary
5.01.794	Vonjo (pacritinib)	FDA Approved for myelofibrosis; Oral; Specialty pharmacy benefit
5.02.625	Korsuva (difelikefalin)	FDA approved for Chronic kidney disease associated pruritus, moderate to severe; IV; Medical-Rx benefit
5.02.626	Opdualag (nivolumab and relatlimab-rmbw)	FDA approved for Melanoma, unresectable or metastatic; IV; Medical-Rx benefit

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Partnering with You to Reduce ER Rates

Blue KC monitors aspects of continuity and coordination of medical care between care settings and initiates actions as needed to improve continuity. It is important to provide quality care and empathy towards each member. As the first contact in a member’s healthcare journey, communication and care coordination increase the overall healthcare outcome for the member.

ER rates have gone up and continue to remain high, even post-COVID, due to scheduling restraints with PCP and Specialists. The goals are to help reduce those ER rates by encouraging flexible scheduling and clinical triage to help improve the chances for a member to get an appointment in a timely manner.

When same day appointments are not available, offering alternative care through urgent care, telehealth or other outreach clinics eases the member’s concerns when dealing with illnesses, such as flu or coughs and colds.

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Portal Power

Blue KC’s powerful digital tool for providers can be accessed 24/7 with a click of a button! Experience our Provider Portal at Providers.BlueKC.com	Provider Portal Features Include: Search and review claims Submit and view electronic prior authorizations Look up member eligibility Access Medical and Payment Policies See provider remittances View Provider Reference Guides Check out recent news updates Find provider forms And so much more!
NOT REGISTERED FOR THE PROVIDER PORTAL? CLICK ON "REGISTER NOW" ON THE LOG-IN PAGE!

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Contact Us

Your comments are welcome and can be sent to BlueSpeak@BlueKC.com. We would love to hear from you!

Please join the BlueSpeak email distribution list by signing into the Provider Portal and then selecting “Register for BlueSpeak eNewsletter” under “Provider Service Quick Links” on the home page.

If you have questions about any of these updates, please call the Blue KC Provider Hotline at 816-395-3929 for Commercial line of business, 866-508-7140 for Blue Medicare Advantage line of business or 866-859-3822 for the ACA Provider Hotline. We value and appreciate you as our partner in providing quality care.

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