Questions: Contact your professional relations representative or provider network services in Topeka at (785) 291-4135 or (800) 432-3587.

Acknowledgement: Current Procedural Terminology (CPT®) is copyright 2014 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT®. The AMA assumes no liability for the data contained herein. Applicable ARS/DFARS Restrictions Apply to Government Use.

Current Procedural Terminology © 2014 American Medical Association. All Rights Reserved.Codes published herein are current on the publication/effective date and are subject to change.

Sent To: CAP excluding Dentists and PharmaciesContains Public Information

Ordering and referring provider edits expanded

Blue Cross and Blue Shield of Kansas requires the submission of ordering and referring provider information on 837 professional claims with a radiology procedure, laboratory service, diagnostic or HCPC code (excluding ambulance), as stated in Policy Memo No. 1, section XV. Claims Filing.

Ordering provider information must be submitted in the 2420E and referring provider information must be submitted in the 2310A and/or 2420F. Otherwise, the claim will be rejected. Please refer to the 837P TR3/Implementation Guide or contact your vendor for more information.

The ordering and/or referring provider’s name and NPI should appear in Box 17/17b of a paper claim.

Edit logic can be found in the ASK Professional Edit document at http://www.ask-edi.com/HIPAA/user_documentation/EditDocumentation.htm. Please note you will need the Claim Status Category Code and Claim Status Code returned on the 277CA.

If you have questions regarding Policy Memo No. 1, please contact your BCBSKS professional relations representative or call provider network services. If you have questions regarding the 837 Professional transactions, contact the EDI Help Desk at (800) 472-6481, option number 1.

APRIL 7, 2014S-1-14

A Newsletter forProfessional Providers and their Staff Members

WHAT’S INSIDE ?• Expanded ordering

and referring provider edits ...........1

• ICD indicator on claim forms ........2

• Not medically necessary injections for osteoarthritis ............2

• Imaging acute rhinosinusitis .........2

• Biologic Immunomodulator drug quantity limits ........................2

• Pharmaceutical Formulary Update .........................2

• Walk@Lunch Day .........................3

• Receiving full QBRP .....................3

• Billing reminder: Physical therapy modalities ..........3

• Medical policy updates .................4

The Blue Shield Report is published by the professional relations department of Blue Cross and Blue Shield of Kansas.

OUR WEB ADDRESS:http://www.bcbsks.com

Dustin Kimmel, Communications Coordinator

An Independent Licensee of the Blue Cross and Blue Shield Association

April 7, 2014 BLUE SHIELD REPORT S-1-14

Page 2 Sent To: CAP excluding Dentists and PharmaciesContains Public Information

When using the new CMS-1500 claimform(2/12),becertaintofillinthe ICD indicator in box 21.

Blue Cross and Blue Shield of Kansas began accepting the new CMS-1500 claim form (2/12) Jan. 6, 2014. One of the key differences between the new form and the older CMS-1500 kclaim form (8/05) is the addition of the ICD indicator in box 21. The indicator was added because of ICD-10 implementation, beginning Oct. 1, 2015.

Before Oct .1, 2015 use “9” to indicate ICD-9 coding is being submitted in Box 21. On or after Oct. 1, 2015use“0”inthisfieldtoindicateICD-10 or “9” to indicate ICD-9.

At this time, BCBSKS will accept both versions of the claim form.

Include ICD indicator on new claim forms

The Blue Cross and Blue Shield of Kansas policy position for Intra-articular Hyaluronan Injections for Osteoarthritis is changing from medically necessary to not medically necessary effective May 1, 2014. Treatment plans for

viscosupplementation approved before May 1, 2014 will not be affected. For more information on the updated medical policy see: http://www.bcbsks.com/CustomerService/Providers/MedicalPolicies/policies.htm.

Intra-articular Hyaluronan Injections for Osteoarthritis not medically necessary

Quantity Limits

Biologic Immunomodulator drugs require prior authorization. Beginning June 1, quantity limits will apply. Members currently using a quantity greater than supported by product labeling may continue. Members new to therapy on or after June 1 will have to adhere to labeling limits. To review the policy, go to http://bcbsks.com/CustomerService/Providers/MedicalPolicies/policies.htm.

Imaging acute rhinosinusitis (sinus x-ray)Radiographic imaging

for the evaluation and treatment of most acute rhinosinusitis cases is considered not medically necessary.

In cases of recurrent or complicated infections when imaging may be medically necessary, plain sinus x-rays (70210/70220) have limited clinical utility and are not considered medically necessary.

In complicated or recurrent infections that require imaging, a Limited Sinus CT scan (70486) would be the study of choice and considered medically necessary. Pharmaceutical Formulary Update

Prime Therapeutics updates the Blue Cross and Blue Shield of Kansas formulary (preferred medication list) on a quarterly basis. Please refer to the link at right when prescribing or dispensing medications for your BCBSKS patients. Coverage is subject to the limitations of the member's individual plan.

►https://www.myprime.com/MyRx/MyRxHealth/forms/KS_Alpha_Drug_List.pdf

A searchable version of the formulary is available at: ►https://www.myprime.com/

MyRx/MyPrime/Commercial/findDrugs/KSBCBS/SAMST#ViewFindDrugsEvent

BCBSKS encourages Walk @ Lunch Day

April 7, 2014BLUE SHIELD REPORT S-1-14

Wouldyouliketofindwaystoencourage your employees, patients or members of your community to become more physically active? If so, a great opportunity awaits you April 30 during National Walk @ Lunch Day.

Walking is one of the easiest and most effective forms of exercise. Takingabrisk,30-minutewalkfivetimes a week can reduce stress and anxiety, lower blood pressure and beapositiveinfluenceon heart disease, diabetes and osteoporosis.

But it can be challenging tofindeven30 minutes a day in our busy lives. That is why Blue Cross and Blue Shield of Kansas is sponsoring the eighth annual National Walk @ Lunch Day, encouraging busy people to take a walk during their lunch break. Participation is fun and easy. It is as simple as bringing comfortable shoes to work and taking a 30-minute walk.

BCBSKS and its employees are hosting organized walks in the

downtown areas of Hutchinson, Salina, Topeka and Wichita, and encourage organizations and businesses outside of these areas to plan walks for their employees and/or communities.

A variety of promotional materials are available at www.bcbsks.com to assist walk planners. Just click on the National Walk @ Lunch Day site ad on the home page. The online toolkitincludesprintableflyersandposters, as well as email templates. There also is an opportunity for some

organizations and businesses to register to receive exercise

towels or exercise bands for hosting a walk event.

Youalsowillfindmore details on the

walks BCBSKS is hosting in Hutchinson, Salina, Topeka and Wichita.

Join us April 30 and begin

walking toward a healthier Kansas!

Page 3Current Procedural Terminology © 2014 American Medical Association. All Rights Reserved.Note: Codes published herein are current on the publication/effective date and are subject to change.

Billing reminder

Physical Therapy modalities less than eight minutes should not be billed, as stated on page F-31 of the Occupational Therapy and Physical Therapy Guidelines.

Registration key to QBRPThe Quality Based

Reimbursement Program is based on submission and receipt of NPI data. Tier I No. 1, Availity or ANSI transactions, are driven by the providers group NPI.

Nos. 2 and 3 of Tier 1 are captured based on individual NPI as well as all of Tier II.

Therefore, your individual NPI needs to be registered with a KDHE-approved Health Information Network (for example, KHIN or LACIE) in order to receive full QBRP.

A user name must be established at the performing provider level (not as nursing or administrative staff) in order to meet the HIE metric for QBRP.

April 7, 2014 BLUE SHIELD REPORT S-1-14

Page 4 Sent To: CAP excluding Dentists and PharmaciesContains Public Information

Web Changes — Medical PolicySince the publication of Blue Shield Report S-7-13, the following new or revised medical policies have been

posted to our website at: http://www.bcbsks.com/CustomerService/Providers/MedicalPolicies/policies.htm• Accelerated Breast Irradiation after

Breast-Conserving Surgery for Early Stage Breast Cancer and Breast Brachytherapy as Boost with Whole-Breast Irradiation

• Acute and Maintenance Subcutaneous and Intravenous Tocolysis

• Ambulatory Blood Pressure Monitoring

• Aqueous Shunts and Stents for Glaucoma

• Barrett’s Esophagus Ablative Treatments

• Bio-Engineered Skin and Soft Tissue Substitutes

• Botulinum Toxin (BT) • BRCA 1 and BRCA 2 Testing • Breast Reconstructive Surgery after

Mastectomy• Bronchial Thermoplasty • Cardiac Computed Tomography (CT) • Cardiac Rehabilitation Programs • Cardiovascular Magnetic Resonance

(CMR) • Cardioverter-Defibrillators• Charged-Particle (Proton or Helium

Ion) Radiation Therapy • Chelation Therapy • Computed Tomographic Angiography

(CTA) and Magnetic Resonance Angiography (MRA) of the Head, Neck, Abdomen, Pelvis, and Extremities

• Computed Tomographic Angiography (CTA) and Magnetic Resonance Angiography (MRA) of the Chest (excluding the heart)

• Cone Beam Computed Tomography (CBCT)

• Contrast-Enhanced Computed Tomography Angiography (CTA) for Coronary Artery Evaluation

• Cytochrome p450 Genotyping • Cytoreduction and Hyperthermic

Intraperitoneal Chemotherapy for the Treatment of Peritoneal Carcinomatosis of Gastrointestinal Origin

• Dynamic Posturography • Electrical Bone Growth Stimulation of

the Appendicular Skeleton • Electrical Stimulation Devices for

Home Use

• Electromyography (EMG), Nerve Conduction Studies (NCS), and Other Electrodiagnostic (EDX) Related Services

• Enhanced External Counterpulsation (EECP)

• Extracranial Carotid Angioplasty/Stenting

• Foot Care Services • Fundus Photography • Gene Expression Assay for Breast

Cancer Treatment • General Approach to Evaluating the

Utility of Genetic Panels • General Approach to Genetic Testing • Genetic Cancer Susceptibility Panels

Using Next Generation Sequencing • Genetic Testing for Cardiac Ion

Channelopathies • Genetic Testing for Predisposition

to Inherited Hypertrophic Cardiomyopathy

• Hereditary Angioedema (Berinert, Cinryze, Firazyr, Kalbitor)

• Home Phototherapy • Human Growth Hormone • Hyperbaric Oxygen Pressurization

(HBO) • IdentificationofPeriodontal

Microorganisms • Insulin Pump • Intensity Modulated Radiation

Therapy (IMRT) • Intra-articular Hyaluronan Injections

for Osteoarthritis• Intravenous and Subcutaneous

Immune Globulin Therapy • Intravenous Antibiotic Therapy and

Associated Diagnostic Testing for Lyme Disease

• Keratoprosthesis • Ketogenic Diet as a Treatment of

Refractory Epilepsy • LASIK (laser in situ keratomileusis) • Microarray-Based Gene Expression

Testing for Cancers of Unknown Primary

• Monitored and General Anesthesia Services

• Oscillatory Devices for the Treatment of Cystic Fibrosis and other Respiratory Disorders

• Pachymetry

• Panniculectomy and Abdominoplasty • Percutaneous Vertebroplasty,

Kyphoplasty and Sacroplasty • Periodontal Soft Tissue Grafting • Periureteral Bulking Agents as a

TreatmentofVesicoureteralReflux(VUR)

• Periurethral Bulking Agents for the Treatment of Urinary and Fecal Incontinence

• Pharmacogenomic and Metabolite Markers for Patients Treated with Thiopurines

• Positron Emission Tomography (PET) Scanning: Miscellaneous (Non-cardiac, Non-oncologic) Applications

• Progesterone Therapy as a Technique to Reduce Preterm Birth in High-Risk Pregnancies

• Radiofrequency Ablation of Miscellaneous Solid Tumors Excluding Liver Tumors

• Recombinant and Autologous Platelet-Derived Growth Factors as a Treatment of Wound Healing and Other Conditions

• Regional Nerve Block and General Anesthesia

• Screening for Lung Cancer Using CT Scanning

• Self Administered Oncology Agents • Sequencing-based Tests to

Determine Trisomy 21 from Maternal Plasma DNA

• Serum Tumor Markers for Breast and Gastrointestinal Malignancies

• Small Bowel/Liver and Multivisceral Transplant

• Stereotactic Radiosurgery and Radiotherapy

• Surgical Treatment of Gynecomastia • TestingforVitaminDDeficiency• Total Ankle Replacement • Transesophageal Endoscopic

Therapies for Gastroesophageal RefluxDisease

• Transplantation for Chondral Defects • Treatment of Hyperhidrosis • Video EEG Monitoring • Wireless Capsule Endoscopy as a

Diagnostic Technique in Disorders of the Small Bowel, Esophagus, and Colon