All PlansBilling CodesMedium impact
May 2019 In The Know
EmblemHealth·Provider News
Effective date
Jul 1, 2019
We identified it
Jun 20, 2026
Summary
EmblemHealth updated multiple billing policies including drug testing codes (80305-80307), pilonidal cyst procedures requiring specific ICD-10 codes, fundus photography frequency limits, duplicate claims rules for non-physician practitioners, and expanded Medicaid child wellness visit coverage from every 12 months to annually.
Action Required
By July 1, 2019: Update billing system to limit presumptive drug testing to one code per date of service from 80305-80307 range. Ensure pilonidal cyst procedures (10080-10081, 11770-11772) include appropriate ICD-10 diagnosis codes. Limit fundus photography to maximum twice per 365 days. Add QW modifier only to CLIA-waived tests per CMS fee schedule. Update Medicaid child wellness visit frequency from every 12 months to once per calendar year for members under 21.