The Latest
AAO-HNS Joins Multispecialty Coalition letter to UHC on Implementation of Prior Authorization for Gastroenterology Services
Private Payer AdvocacyThe undersigned organizations urge you not to implement United Healthcare’s (UHC) gastrointestinal (GI) endoscopy prior authorization program.
AAO-HNS Fights New Modifier 25 Policy in New Jersey
Letter of Opposition, Private Payer AdvocacyOn February 17, the Academy sent a letter of opposition to Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) in response to the company’s updated reimburse…
AAO-HNS Comments on UHC Changes to Rhinoplasty and Other Nasal Surgeries Policy
Private Payer AdvocacyOn January 27, the Academy sent comments to United Healthcare (UHC) regarding revisions made to the coverage criteria in its Rhinoplasty and Other Nasal Surger…
AAO-HNS Summary of CY 2023 MPFS Final Rule
Advocacy, Physician Payment Reform, Private Payer Advocacy, Regulatory Relief, ReimbursementFollowing the Centers for Medicare & Medicaid Services’ (CMS) release of the CY 2023 Final Rule for the Medicare Physician Fee Schedule (MPFS), which also …
AAO-HNS Advocates for Immediate Change to Horizon’s Modifier 25 Policy
Advocacy, Private Payer AdvocacyEffective August 1, 2022, Horizon Blue Cross Blue Shield will reimburse E/M services appended with Modifier 25 at 50% if a procedural code is reported on the s…
AAO-HNS Summary of CY 2023 MPFS Proposed Rule
Advocacy, Physician Payment Reform, Private Payer Advocacy, Regulatory Relief, ReimbursementOn July 7, the Centers for Medicare & Medicaid Services (CMS) released the CY 2023 Proposed Rule for the Medicare Physician Fee Schedule (MPFS), which also…
Cigna Delays New Modifier 25 Policy
Private Payer AdvocacyFollowing advocacy efforts by the AAO-HNS and other impacted specialties, Cigna announced that it plans to delay the implementation of their reimbursement poli…
Cigna Announces Reimbursement Policy Update Related to Modifier 25
Private Payer AdvocacyEffective August 13, 2022, Cigna will require the submission of office notes with claims submitted with evaluation and management (E/M) CPT codes 99212, 99213,…
Anthem Announces Extension of Telehealth Flexibility (4/12/21)
Private Payer AdvocacyOn April 6, Anthem Blue Cross Blue Shield announced that, until further notice, they will continue to cover telephone-only medical services from in-network and…
Wellmark Reverses Negative Coverage Policy for Balloon Sinus Ostial Dilation (11/19/20)
Private Payer AdvocacyFollowing extensive advocacy efforts by the AAO-HNS, the Iowa Academy of Otolaryngology, and other stakeholders, Wellmark revised its medical policy, “Function…
AAO-HNS Comments on Humana’s New Imaging and Interpretation Criteria (11/2/20)
Private Payer AdvocacyOn November 2, the Academy sent comments to Humana opposing their new Imaging and Interpretation Criteria for Diagnostic Imaging Authorizations. The new criter…
AAO-HNS Advocates for Coverage of Balloon Sinus Ostial Dilation (8/5/20)
Private Payer AdvocacyOn July 1, following the Academy’s advocacy efforts and submission of clinical input, the Blue Cross Blue Shield Federal Employee Program updated its medical p…
AAO-HNS Continues Advocacy on Hypoglossal Nerve Stimulation Coverage for Treatment of Obstructive Sleep Apnea (7/20/20)
Private Payer AdvocacyOn July 20, the AAO-HNS sent comments to Anthem opposing their medical policy designating hypoglossal nerve stimulation (HGNS) as experimental / investigationa…
AAO-HNS Comments on Cigna Obstructive Sleep Apnea Treatment Services Coverage Policy (6/24/2020)
Private Payer AdvocacyOn June 15, the AAO-HNS sent comments to Cigna opposing their medical policy on “Obstructive Sleep Apnea Treatment Services” which designated hypoglossal nerve…
AAO-HNS Continues Advocacy on Balloon Ostial Dilation for Treatment of Chronic Rhinosinusitis (2/5/2020)
Private Payer AdvocacyOn February 5, the AAO-HNS sent comments to Blue Cross Blue Shield’s Federal Employee Program (BCBS FEP) opposing their medical policy designating balloon osti…
UHC Revises Medical Policies on Functional Endoscopic Sinus Surgery and Balloon Sinus Ostial Dilation (11/14/2019)
Private Payer AdvocacyIn response to comments submitted by the AAO-HNS, United Healthcare (UHC) has revised its Functional Endoscopic Sinus Surgery and Balloon Sinus Ostial Dilation…
AAO-HNS Comments on Anthem BCBS of Virginia’s Modifier 25 Policy (7/23/2019)
Private Payer AdvocacyOn July 23, the Academy sent a letter to Anthem BCBS of Virginia expressing our strong opposition to their revised modifier 25 reimbursement policy. According…
AAO-HNS Comments on Anthem’s Modifier 25 Policy (6/11/2019)
Private Payer AdvocacyOn June 11, the Academy sent a letter to Anthem expressing our strong opposition to their revised modifier 25 reimbursement policy. According to the new polic…
AAO-HNS Comments on Moda Health’s Reimbursement Policy (5/21/2019)
Private Payer AdvocacyOn May 21, the Academy commented on Moda Health’s reimbursement policy on postoperative sinus endoscopy and/or debridement procedures. According to the policy …
AAO-HNS Comments on Emblem Health’s Modifier 25 and E/M Policy (4/11/19)
Private Payer AdvocacyOn April 3, the Academy submitted a comment letter to Emblem Health opposing the company’s reimbursement policy to deny E/M services billed with modifier 25 wi…
Highmark Now Covers Eustachian Tube Balloon Dilation (4/11/2019)
Private Payer AdvocacyEffective April 8, 2019, Highmark Blue Shield now considers eustachian tube balloon dilation medically necessary in adult individuals (22 years and older) when…
Highmark Now Covers Standalone Balloon Sinus Ostial Dilation of the Sinus (2/28/2019)
Private Payer AdvocacyEffective February 18, 2019, Blue Cross Blue Shield Highmark updated its commercial medical policies in Delaware, Pennsylvania, and West Virginia to cover stan…
Academy Continues Advocacy on Balloon Sinus Ostial Dilation (1/23/2019)
Private Payer AdvocacyIn response to member feedback, the AAO-HNS submitted multiple comment letters to various private payers opposing their coverage policies designating balloon s…
