Coverage Policies

Use the index below to search for coverage information on specific medical conditions.

Note: For Arkansas State or Public School employees, services subject to pre-authorization are managed by Active Health Management, as noted in their Summary Plan Description.

For coverage information on high tech imaging (MRI, CT, PET) and nuclear medicine, administered by Evicore, click here.

Medical Providers: Payment for care or services is based on eligibility, medical necessity and available benefits at time of service and is subject to all contractual exclusions and limitations, including pre-existing conditions if applicable.

Future eligibility cannot be guaranteed and should be rechecked at time of service. Verify benefits by signing into My Account or calling Customer Service at 800.235.7111 or 501.228.7111.

If not specified in a QualChoice coverage policy (Benefit Interpretation), QualChoice follows care guidelines published by MCG Health.

QualChoice reserves the right to alter, amend, change or supplement medical policies as needed. QualChoice reviews and authorizes services and substances. CPT and HCPCS codes are listed as a convenience and any absent, new or changed codes do not alter the intent of the policy.

INDEX:
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Effective Date: 09/18/1995 Title: Care Plan Oversight Services
Revision Date: 11/13/2008 Document: BI088:00
CPT Code(s): 99366-99368, 99374-99380
Public Statement

Effective Date:

a)    This policy will apply to all services performed on or after the above revision date which will become the new effective date.

b)    For all services referred to in this policy that were performed before the revision date, contact customer service for the rules that would apply.

Charges by physicians for participation in care management team conferences are generally considered to be included in the other services rendered relating to that care, and are not separately reimbursable. Charges by physicians for care plan oversight services will be reimbursed, when considered to be medically necessary.


Medical Statement

1)    Care plan oversight services are significant services rendered by a physician to oversee and coordinate the complex care requirements of some patients confined at home, enrolled in hospice, or in a nursing facility. These charges are subject to audit.

2)    Team conferences are considered to be a part of the routine care provided by physicians, other caregivers, and facilities to patients confined in acute, subacute and rehabilitation facilities.

 

Codes Used In This BI:

99366

Team conf w/pat by hc pro

99367

Team conf w/o pat by phys

99368

Team conf w/o pat by hc pro

99374

Home health care supervision

99375

Home health care supervision

99377

Hospice care supervision

99378

Hospice care supervision

99379

Nursing fac care supervision

99380

Nursing fac care supervision


Application to Products

This policy applies to all health plans and products administered by QualChoice, both those insured by QualChoice and those that are self-funded by the sponsoring employer, unless there is indication in this policy otherwise or a stated exclusion in your medical plan booklet.  Consult the individual plan sponsor Summary Plan Description (SPD) for self-insured plans or the specific Evidence of Coverage (EOC) or Certificate of Coverage (COC) for those plans or products insured by QualChoice.  In the event of a discrepancy between this policy and a self-insured customer’s SPD or the specific QualChoice EOC or COC, the SPD,  EOC, or COC, as applicable, will prevail.  State and federal mandates will be followed as they apply.


Changes: QualChoice reserves the right to alter, amend, change or supplement benefit interpretations as needed.
This policy has recently been updated. Please use the index above or enter policy title in search bar for the latest version.