Latest Notices and Updates


PacificSource allows “incident to” billing for caregivers who are not eligible to be credentialed by PacificSource or a delegated credentialing entity.  This provides practices the opportunity to fully utilize their staff appropriately.  PacificSource does NOT allow incident to billing for practitioners who are eligible for credentialing. 

Effective June 1, 2018, in order for a service to be considered for payment under the “incident to” billing policy, the modifier SA must be appen
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Prolotherapy - Please be reminded that claims  billed for trigger point injections, CPT 20552-20553, billed without the appropriate  J-Code will be denied.

 

Nail Debridement - Please note that claims submitted for nail debridement must follow the LCD from Noridian Medicare.


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Prior Authorization Grid Updates
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Please join us for a webinar that will help answer questions for the upcoming 2018 HEDIS audit.
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Change Request (CR) 10152 eliminates the requirement to use the GT modifier (via interactive
audio and video telecommunications systems) on professional claims for telehealth services.
Use of the telehealth Place of Service (POS) Code 02 certifies that the service meets the
telehealth requirements.


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Anesthesia services furnished in conjunction with and in support of a screening colonoscopy are reported with CPT code 00812.  
Effective for claims with dates of service on or after January 1, 2018, Medicare will pay claim lines with new CPT code 00812 and

waive the deductible and coinsurance.
 


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For claims with Dates of Services January 1 2018, prolong preventive services will be payable by Medicare when billed with an add-on to an applicable preventive services that is payable from the MPFS and cost share will be waived.  G0513 and G0514 for prolonged preventive services will be added as part of this update and cost-share will be waived.


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Effective for claims with dates of service on or after January 1, 2018, the following HCPCS
codes are being replaced: 
 

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New Provider Course: Exercise Therapy as an Alternative to Opioids for Chronic Mechanical Low Back Pain


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Care Coordination Services and Payment for Rural Health Clinics (RHCs) and Federally-Qualified Health Centers (FQHCs)
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