News

Clinical Payment Policy Revisions: Effective July 1, 2023

Date: 03/27/23

The following clinical payment policies have been revised for future implementation. The following policies have been updated, and are posted on Superior’s Clinical, Payment and Pharmacy Policies webpage for reference in the provision of service and for claims adjudication purposes, as indicated.

POLICY	EFFECTIVE DATE	APPLICABLE PRODUCTS	NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS
Allergy Testing and Therapy (TX.CP.MP.100)	07/01/2023	Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, Health Insurance Marketplace (Ambetter from Superior HealthPlan), Medicare (Wellcare by Allwell	Policy revisions include: Updated criteria for antigen preparation; and New background information on training requirements for immunotherapy preparation and administration; and Revisions to medically necessary procedural and diagnosis codes for provision of service and claims adjudication and reimbursement for applicable allergy and testing services.
Testing for Select Genitourinary (GU) Conditions (CP.MP.97)	07/01/2023	Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, Health Insurance Marketplace (Ambetter from Superior HealthPlan), Medicare (Wellcare by Allwell	Policy revisions include modifications to new 2023 diagnosis codes and the addition of applicable HCPCs codes applicable for testing for genitourinary conditions.

POLICY

EFFECTIVE DATE

APPLICABLE PRODUCTS

NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS

Allergy Testing and Therapy (TX.CP.MP.100)

07/01/2023

Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, Health Insurance Marketplace (Ambetter from Superior HealthPlan), Medicare (Wellcare by Allwell

Policy revisions include:

Updated criteria for antigen preparation; and
New background information on training requirements for immunotherapy preparation and administration; and
Revisions to medically necessary procedural and diagnosis codes for provision of service and claims adjudication and reimbursement for applicable allergy and testing services.

Testing for Select Genitourinary (GU) Conditions (CP.MP.97)

07/01/2023

Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, Health Insurance Marketplace (Ambetter from Superior HealthPlan), Medicare (Wellcare by Allwell

Policy revisions include modifications to new 2023 diagnosis codes and the addition of applicable HCPCs codes applicable for testing for genitourinary conditions.

To review all payment policies, please visit Superior’s Clinical, Payment and Pharmacy Polices webpage.

For questions or additional information, please contact Provider Services at:

1-877-391-5921 Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, Medicare
1-877-687-1196 Health Insurance Marketplace (Ambetter from Superior HealthPlan)