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Clarification – New Clinical Editing Policy Effective 4/1/22 – Indicator “I”

Audience: Professional Providers

We would like to clarify our bulletin issued January 7, 2022, related to a new clinical editing policy that will no longer provide reimbursement for codes that have a Centers for Medicare & Medicaid Services (CMS) status indicator “I”. Indicator “I” was omitted from the original bulletin.  This clinical editing policy is effective April 1, 2022. 

The Health Plan uses the Medicare Physician Fee Schedule to apply the status indicator rules, per CMS guidelines. Access the fee schedule at cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files.html.

Thank you for the service that you provide to our valued members. If you have questions, please contact your Provider Relations representative.

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Excellus

Clinical Editing

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