HealthCare News

Federal Employee Program (FEP) Benefit Changes

Issue: #398 DEC2017

Topic: Policy/Benefits

Changes to our Standard Option Members only:

For Members who do not have Medicare Part A, we cover skilled nursing facility (SNF) inpatient care for a maximum of 30 days annually, when the Member can be expected to benefit from a short-term SNF services with a goal of returning home. The following criteria must also be met:

  • Member is enrolled in case management prior to admission to the SNF (signed consent required), and actively participates in case management both prior to and during admission to the SNF
  • Precertification is obtained prior to admission
  • We approve the preliminary treatment plan prior to admission (plan must include proposed therapies and document the need for inpatient care)
  • Member participates in all treatment and care planning activities, including discharge planning/transition to home

Changes to both our Standard and Basic Option Members:

  • We now provide preventive care benefits for DNA stool analysis of stool examples as a technique for colorectal cancer screening under CPT® code 81528 and limited to one per calendar year.
  • Massage therapy code 97124 when billed as a stand-alone service or with acupuncture will not be eligible for benefits. Benefits for massage therapy will be provided if it is performed as part of PT, OT or manipulative treatment
  • Revenue code 0820 is not covered for 2018. You will need to provide a more specific revenue code for the hemodialysis service being provided
  • We now provide benefits for oral medical foods under the pharmacy benefit only. Prior approval is required. Previously, medical benefits were provided for oral medical foods. CPT® codes impacted by this change are B4100, B4102-B4104, B4149, B4150, B4152-B4154 and S9433 or S9435.