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Attention providers
What is changing?
HCA made the following changes to the Physician-related services/health care professional services billing guide:
Retroactive to dates of service on and after May 1, 2023, in the Noninvasive cardiac imaging section of the document:
- Under Service procedure codes, HCA separated out the procedure codes that HCA requires prior authorization for, indicating that the medical necessity review will be conducted by Comagine Health
- Under Medical necessity criteria, for Stress echocardiography and Coronary Computed Tomographic Angiography (CCTA), HCA changed the age limitation from “younger than 19 years of age” to “(18 years of age or older)”
- Under Documentation requirements, HCA removed “No policy-specific documentation requirements” and added “Providers must document the medical necessity criteria and any other tried and failed procedures/ imaging in the client’s medical record”
Retroactive to dates of service on and after January 1, 2023:
- For the Labor management section, HCA replaced CPT® codes 99356 and 99357 with CPT® code 99418, limited to 1 hour per client, per pregnancy, and rewrote the entire section.
- In the Labor management coverage table, HCA revised the affected language to reflect that CPT® codes 99356 and 99357 have been replaced by CPT® code 99418.
- In the Obstetric care and delivery section and the EPA criteria table, HCA deleted CPT® code 99251 and added CPT® code 99252, as appropriate.
For more details, refer to the What has changed table inside the updated guide, which is located on HCA’s Provider billing guides and fee schedules webpage.
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