Policies Update

Date: 01/04/22

Thank you for your continued partnership with Sunflower Health Plan. As you know, we continually review and update 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.

We are writing today to inform you of upcoming revisions to existing policies. Sunflower Health Plan will be implementing the following clinical policies, which have payment implications, effective February 1, 2022.

• CP.MP.124 ADHD Assessment and Treatment (Medicare and Marketplace) - Adding and removing procedure codes as not payable when billed with only a diagnosis of ADHD.
• CP.MP.97 Testing for Select GU Conditions (Medicare and Marketplace) - Adding procedure codes to list of non-payable codes. Removing all edits applicable to 83986 and 87210 and removing some diagnostic codes as payable.
• CP.MP.155 EEG in the Evaluation of Headache (Medicare and Marketplace) - Adding diagnostic codes as nonpayable when billed with some procedure codes.

For detailed information about these policies, please refer to our Clinical and Payment Policies page.

If you have questions about this bulletin or other provider resources, please contact your Provider Relations Representative or call Customer Service at:

• Ambetter from Sunflower Health Plan (Marketplace): 1-844-518-9505 (TTY 1-844-546-9713)
• Allwell from Sunflower Health Plan (Medicare Advantage):
  • HMO 1-855-565-9519
  • HMO D-SNP 1-833-402-6707
  • PPO 1-833-696-0634
  • TTY 711