Learn about the Academy’s payer advocacy efforts, how you can use Academy template appeal letters to help your practice receive payment instead of denials from private payers and much more.
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The Latest
AAO-HNS Submits Comment Letter to EviCore on Unfair Imaging Facility Network Standards Policy
Advocacy, Private Payer AdvocacyOn December 3, 2024, the Academy submitted a letter to EviCore regarding the unfair imaging facility network standards policy. The Academy’s letter details tha…
AAO-HNS Submits Letter to Point 32 Regarding Non-Payment of 31237 in the Setting of a FESS/Septoplasty
Advocacy, Private Payer AdvocacyOn October 22, 2024, the Academy submitted a letter to Point 32 regarding non-payment of CPT code 31237 following Functional Endoscopic Sinus Surgery (FESS) wh…
AAO-HNS Leads Coalition Efforts to Submit Letter to CGS Administrators Proposed Local Coverage Determination (LCD) – Botulinum Toxin Injections
Advocacy, Physician Payment Reform, Private Payer Advocacy, Regulatory Relief, ReimbursementFollowing coalition advocacy by the Academy, the American Laryngological Association (ALA) and the American Broncho-Esophagological Association (ABEA) a joint …
AAO-HNS Advocacy Efforts Lead to Blue Cross Blue Shield of North Carolina Modifier 25 Policy Retraction
Advocacy, Private Payer AdvocacyFollowing coordinated advocacy by the Academy, the North Carolina Medical Society and physician advocates in the state, Blue Cross Blue Shield of North Carolin…
AAO-HNS Submits Comments to Blue Shield of California Regarding Global Surgical Period Evaluation and Management (E/M) Reimbursement Policy
Advocacy, Private Payer AdvocacyOn May 17, 2024 the Academy submitted a detailed letter to Blue Shield of California regarding its update to the Global Surgical period Evaluation and Manageme…
AAO-HNS Comments on CY 2024 MPFS/QPP Proposed Rule
Advocacy, Physician Payment Reform, Private Payer Advocacy, Regulatory Relief, ReimbursementSeptember 12, 2023On September 11, the AAO-HNS submitted a comment letter to the Centers for Medicare and Medicaid Services (CMS) on the calendar year (CY) 202…
AAO-HNS Opposition Leads to Positive Update on United Healthcare’s Rhinoplasty and Nasal Procedures Policy
Private Payer AdvocacyFollowing advocacy efforts by the AAO-HNS and the American Academy for Facial Plastic and Reconstructive Surgery (AAFPRS), on June 1 United Healthcare (UHC) up…
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…
