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BLUECONNECT
Providers
March 2024
In This Issue
► March news: Executive summary
► CMS changes delay annual fee schedule updates
► AZ Blue welcomes you to the Availity Essentials portal
► Introducing two new code edits
► Prior authorization updates effective April 1
► Where to find FEP UM guidelines
2024 code edit updates effective April 15
In alignment with industry standards, we are implementing two code edit updates, effective for service dates on or after April 15, 2024. Here’s what you need to know: 
Pay Percent—Expansion of Surgical Cutbacks
Effective for service dates on or after April 15.
Applies to professional claims for all plans except Medicare Advantage.
Billing Update
Additional surgical procedures that are valid to bill with modifier 51 have been added to this code edit. Some example codes affected by this change include 11721, 15002, 15004, 17004, and 51798.
Reference 
The CPT Coding Guidelines from AMA provide guidance as to which procedures are modifier 51 exempt.
Modifier 78
Effective for service dates on or after April 15.
Applies to professional claims for Medicare Advantage plans only.
Billing Update
We will apply pay percent adjustments in alignment with CMS guidelines when there is an unplanned return to the operating room. 
Note: The PPRRVU files from CMS identify the Intra Op percentage to be applied.
Reference 
You can check current lists of procedures and RVUs on the CMS website. 
For more information, view or download a comprehensive list of our code edits via our provider portal at “azblue.com/providers > Provider Resources > Guidelines > Coding > Code Edit Guidelines and C3 Tool > Medical Code Edit Guidelines.” 

If you have questions about these code edit updates, contact your Provider Relations Contact or call us at 602-864-4231 or 1-800-232-2345, ext. 4231.
In This Issue
► March news: Executive summary
► CMS changes delay annual fee schedule updates
► AZ Blue welcomes you to the Availity Essentials portal
► Introducing two new code edits
► Prior authorization updates effective April 1
► Where to find FEP UM guidelines
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