Currentpriority healthPolicy N/A
Category III CPT Codes (T codes) - Documentation, Coding and Billing Guidance
This policy governs the use, documentation, coding, and billing expectations for CPT Category III (temporary 'T') codes for Priority Health members and providers, and describes authorization and modifier guidance that may affect reimbursement.
Policy Summary
Payerpriority health
PolicyCategory III CPT Codes (T codes) - Documentation, Coding and Billing Guidance
Policy CodePolicy N/A
Change TypeNo material changes
Effective DateN/A
Next Review DateN/A
Key ActionObtain a Pre-Service Organization Determination (PSOD) for Medicare indications that do not meet NCD/LCD or specific medical policy.
SourceLink
POLICY UPDATE CHANGES
No material clinical or coverage changes in this revision.
Category IIItype covered
5yrlifecycle
RequiredPSOD note
CMS NCCImodifier guidance
Documentation and Billing Requirements
Documentation and Billing Criteria
Documentation, coding, and modifier requirements that affect coverage and payment:
Providers must maintain complete and thorough documentation to substantiate the procedure performed; failure to document the service will result in denial.
Documentation specifics: Providers should consult any specific documentation requirements in applicable defined guidelines and the provider manual.
Coding and Billing Compliance: Use industry-standard CPT, HCPCS, and revenue codes only for services actually performed and fully documented to the highest level of specificity; improper coding or failure to follow billing requirements may result in claim rejection, denial, or recovery of payments.
Authorization note:
Policy Summary
Payerpriority health
PolicyCategory III CPT Codes (T codes) - Documentation, Coding and Billing Guidance
Policy CodePolicy N/A
Change TypeNo material changes
Effective DateN/A
Next Review DateN/A
Key ActionObtain a Pre-Service Organization Determination (PSOD) for Medicare indications that do not meet NCD/LCD or specific medical policy.
SourceLink
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