Payment Policies Update - September 2021

Date: 07/14/21

Thank you for your continued partnership with Sunflower Health Plan. As you know, we continually review and update our payment and utilization policies to ensure that they comply with industry standards while delivering the best patient experience to our members.

The below policies have been revised or changed. Sunflower will be implementing these for Allwell (Medicare) and Ambetter (Marketplace) effective September 1, 2021.

• CP.MP.97 - Testing of Select GU Conditions: Revision to the existing policy to include additional diagnosis codes that will deny payment for CPT 87798.
• CP.MP.100 - Allergy Testing and Therapy: Revision to the existing policy to include additional accepted diagnosis codes as well as non-payable procedure codes.
• CP.MP.134 - Evoked Potentials: Revision to the existing policy to include additional accepted diagnosis codes as well as non-payable procedure codes when applied to members age 6 years and older.

For more detailed information about these policies, please refer to our Clinical and Payment Policies web page.

If you have questions about this bulletin or other provider resources, please contact your Provider Relations Representative or call Customer Service at:

• Ambetter from Sunflower Health Plan (Marketplace): 1-844-518-9505 (TTY 1-844-546-9713)
• Allwell from Sunflower Health Plan (Medicare Advantage):
  • HMO 1-855-565-9519
  • HMO D-SNP 1-833-402-6707
  • PPO 1-833-696-0634
  • TTY: 711