SPPM Annual Conference in Las Vegas Feb 27-March 1, 2019

Don’t miss this Comprehensive Billing, Coding and Practice Management Course. This one of a kind course is designed to update you and your practice on the 2019 changes, and clarify the tough areas of pain management billing & practice issues.

We have done the homework and brought the outstanding educators in this field. We answer your tough questions and help you solve your pain management billing & practice issues. View the course information


New year, new changes. 
An Update From CE Medical

Changes in medical billing are inevitable, especially for our specialty. In addition to annual changes in policies, we have noticed that some practices have seen a dramatic slow in their regular payments from Medicare during the government shut down.  We have confirmed with CMS representatives that they are experiencing delays due to operating with less staff than normal.  

Each region, carrier, and contract can vary on how changes can impact your practice. Below are a few policies that were updated 1/1/2019: 

  • Anthem Drug Testing or Screening in the Context of Substance Use and Chronic Pain
    • Updated coding section with 01/01/2019 CPT changes, added 0082U.
  • Anthem Hyaluronan injections
    • Updated coding section with 1/1/2019 HCPCS changes, added J7318, J7329, removed C9465 deleted 12/31/2108.
  • Regence UDS
    •  Limitations of coverage 
  • UHC Drug testing policy, Professional
    • Annual policy version change, policy verbiage change: updated Definitive codes section to remove code 0020 (deleted code as of 10/1/2018, added code 0082U (added 1/1/2019), and updated code description for 0006U. 
  • UHC Percutaneous Vertebroplasty  and Kyphoplasty
    • Updated and reformatted coverage rationale: Simplified content, rep[laced reference “serve debilitating pain” with “pain causing functional or physical Impairment”, added a definition of “functional or Physical Impairment”. 
  • UHC Occipital neuralgia headache treatment
    • Simplified coverage rationale (no change to guideline), added a definition of Neuroectomy, Rhizotomy, Updated list of applicable CPT codes, removed 95972 and updated supporting information to reflect most current references. 
  • UHC Epidural steroid facet injections spinal pain
    • Updated coverage rationale; modified language to clarify the listed services are: proven and medically necessary  (as described) or unproven and not medically necessary (as described).  
  • UHC Botulinum toxins a and b
    • Revised coverage criteria for the use of Botox for chronic migraine headaches. 
  • UHC Ablative treatment for spinal pain
    • Replaced reference to “regional pain disorders and syndromes” with “complex regional pain syndrome”, modified list of examples of unproven and not medically necessary pain indications, removed “diabetic neuropathy”, added a definition of CRPS, Facet Nerve Block, Pulsed Radiofrequency Ablation, updated supporting information to reflect the most current references. 
  • Asuris Urine Drug testing for substance use and pain management  
    • Removed code 0020U, review medical policy criteria
  • Medicare LCD updates can be found HERE 

It is critical that you and your billing team are aligned with the most up to date coding and billing policies. Additional updates for your top payers can be found on their websites.