Provider Alerts - June 14, 2019

UPDATE – Recovery Payments – Non-Invasive Vascular Diagnostic Studies

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Date: June 13, 2019
To: Health Plan of San Joaquin (HPSJ) Practitioners and Providers and Dialysis Clinics
From: HPSJ Claims Departmen
Subject: UPDATE – Recovery Payments – Non-Invasive Vascular Diagnostic Studies
Business: Medi-Cal

HPSJ recently identified a system issue which may have caused erroneous payments on specific codes for Non-Invasive Vascular Diagnostic Studies (NVDS). We will be updating our system to reflect the Medi-Cal frequency guidelines, as it pertains to these services and requesting recoveries on claims where the plan paid in error. Below is a brief description of the codes and billing frequency limitations. For more information please visit the Department of Health Care Services Medi-Cal website, https://medi-cal.gov and search Medicine: Non-Invasive Vascular Diagnostic Studies.

Non-Invasive Vascular Diagnostic Studies (NVDS)

CPT-4 codes 93880 – 93931, 93970 – 93998

  • Should be used to bill for NVDS, for males age 21 years and older CPT-4 codes 93980 and 93981
  • No age restriction Authorization is required for these codes No authorization within frequency limitations

Billing Frequency Limitations

For CPT-4 codes 93880 – 93931, 93970 – 93981 and 93990

  • Only one NVDS is reimbursable when billed by the same provider, for the same
    recipient and same date of service.
  • Reimbursement for an NVDS is not to exceed the price on file for the complete
    test if both the complete and limited test procedure codes of the same service
    are billed by the same provider, for the same recipient and same date of
    service.

UPDATE – Non-Invasive Vascular Diagnostic Studies (NVDS)
June 13, 2019

For CPT-4 codes 93880 – 93888 and 93925 – 93931, 93970 – 93979

  • Billing frequency is limited to two per consecutive 12-month period, per code, by any provider, for the same recipient.

For CPT-4 codes 93890, 93892 and 93893

  • Billing frequency is limited to four procedures per consecutive 12-month period, per code, by any provider, for the same recipient.

CPT-4 code 93998

Must be billed “By Report.”

If you have questions, please contact our Customer Service Department at 209-942-6320. Health Plan of San Joaquin is dedicated to providing all members the best health care available in the most effective and efficient manner. Thank you for being one of our valued partners.
REMINDER: If not already submitting your billings electronically (EDI) and not receiving your payments deposited directly into your bank account (EFT) and receiving your remittance advice (RA) electronically (ERA), please call your Provider Services Representative today By signing up for EDI, EFT and ERA services, you typically receive your payments 2-3 days sooner instead.


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