FYI: This post originally ran in October 2020 when UHC first announced this move. We have bumped it to the top of our blog as a reminder the policy change is now in effect. After making the move to align prostate biopsies with G0416 for Medicare Advantage plans...
We’ve recently seen many commercial payers move to only paying prostate biopsies coded G0416 instead of 88305 (for instance, Cigna will institute this rule effective Aug. 18). It’s not exactly a major surprise to see them adopting CMS guidelines on this...
At a time when patients and providers alike are being severely impacted by the COVID-19 Public Health Emergency, UnitedHealthcare (UHC) has taken the opportunity to push some aggressive policy changes to limit care — all while reaping record profits. As of July...
In a recent letter to providers, Cigna announced it will no longer reimburse prostate needle biopsies billed with CPT 88305 beginning Aug. 18. Instead, claims on or after that date must be submitted with HCPCS code G0416, one unit, to be eligible for payment. This...
Problem: A quarterly audit for an independent Southern pathology lab unveiled the lab received $31.94 less for its global 88305 CPT codes (a microscopic tissue examination to provide diagnosis) than its contracted rate with a large commercial insurance carrier allowed...