Learn about the updates before submitting your claims

November 14, 2016 - As a result of Maryland legislation, updates have been made regarding coverage of habilitative services.

What does this mean for you?

  • Beginning Jan. 1, 2017 and moving forward, you should bill the SZ modifier along with the procedure code when submitting claims for habilitiative services.
  • Covered habilitative services include Oral (dental), PT, OT, ST, and Applied Behavioral Analysis (ABA).
  • There are no changes to your current pre-authorization process for all services listed above.

Looking for more information?

  • To view the updated medical policies associated with these services, refer to the Medical Policy Reference Manual at www.carefirst.com/medicalpolicy. Search for 8.01.011A or 'Habilitative Services.
  • Look for covered procedure codes associated with Oral (dental) services in our December issue of BlueImpressions.