Updates to the Asuris Clinical Edits by Code list will be posted on a monthly basis. The following editing rules apply to claims for our commercial products:

CPT code definitions and rules are followed for:

• Gender,
• Age,
• New Patient and
• organ or disease-oriented Laboratory Panels.

Asuris also follows the Centers for Medicare & Medicaid Services (CMS) guidelines for:

• Same Day and
• Follow Up Day edits.

The following Asuris Clinical Edits by Code lists are based on Asuris Medical and Reimbursement Policy:

• Asuris Clinical Edits by Code list (PDF) - updated October 1, 2008. Sorted by code and contains all cosmetic, investigational and Asuris invalid codes and supporting documentation requirements for each.
  • Edit Add List (PDF)
  • Edit Removal List (PDF)
• Previous Lists

Note: Asuris will not routinely require submission of clinical information in connection with adjudication of claims except for unlisted codes, codes without allowables, claims to which a modifier 22 is appended, or other limited categories of claims included on the Asuris Clinical Edits by Code list.

Asuris utilizes Medicare’s National Correct Coding Initiative (NCCI) as the basis for clinical edits. NCCI identifies pairs of services that normally should not be billed by the same physician for the same patient on the same day. Asuris has identified additional code pair edits to be used as a supplement to Medicare's NCCI. These code pair edits were developed using nationally accepted, logical and predictable coding principles.

• Correct Code Editor

NCCI bypass modifiers, as defined by CMS, will be processed in accordance with the current CMS superscript rules on the new claims system. Over the next year, our current claims system will be modified to align with the new system and these rules.

Relative to modifiers -25 and -59, Asuris has not determined service or procedure code combinations that are not appropriately reported together with those modifiers, beyond those identified by Centers for Medicare and Medicaid Services (CMS) in the National Correct Coding Initiative (NCCI).

Asuris may require the submission of clinical information in order to price CPT and HCPCS codes for which an allowed amount has not been established. For questions, please contact your Provider Consultant.

Asuris has established global periods for certain procedures. Services provided within this global period are considered included in the payment for the initial procedure.