Updated Payment Policies
Date: 03/23/22
Heritage Health (Medicaid):
Nebraska Total Care continually reviews and updates our payment and utilization policies to ensure that they are designed to comply with industry standards while delivering the best patient experience to our members. As a part of that review, the below policies have been revised or changed. Nebraska Total Care will be implementing effective June 1, 2022.
For more detailed information about these policies, please refer to the Clinical and Payment Policies on our website.
| Number | Policy Name | Policy Revisions/Changes | Line of Business |
|---|---|---|---|
| CP.MP.155 | EEG in the evaluation of headache (PDF) | Add R51.9 as non-payable when listed as the only diagnosis code, and billed with 95812, 95813, 95816, or 95819. Add the following ICD-10 codes as non-payable (if listed as the only diagnosis code) when billed with CPT 95822: G43.411, G43.419, G43.501, G43.509, G43.511, G43.519, G43.601, G43.609, G43.611, G43.619, G43.701, G43.709, G43.711, G43.719, G43.A0, G43.A1, G43.B0, G43.B1, G43.C0, G43.C1, G43.D0, G43.D1, G43.801, G43.919, G44.001, G44.009, G44.011, G44.019, G44.021, G44.029, G44.031, G44.039, G44.041, G44.049, G44.229, G44.301, G44.309, G44.311, G44.319, G44.321, G44.329, G44.40, G44.41, G44.51, G44.52, G44.53, G44.59, G44.81, G44.82, G44.83, G44.84, G44.85, G44.89, R51.0, R51.9 | Medicaid |
| Medicaid |