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Payment Policies

Payment Policies

File Name Format Updated
3D Rendering of Tomographic Modalities PDF October 2024
Add On Codes PDF July 2024
Administration of Injections and Infusions in Facility Settings PDF September 2024
After Hours and Weekend Care PDF March 2024
Ambulance Services PDF July 2024
Anatomical Modifier Requirement Policy PDF October 2024
Anesthesia Services PDF June 2024
Bilateral Procedures - Professional & Institutional Billing PDF November 2024
Bilateral Procedures - Professional & Institutional Billing - ARCHIVE PDF October 2023
B-Status Codes PDF November 2024
Care Coordination Services PDF February 2024
Consultation Services PDF May 2024
Co-Surgeons (Two Surgeons) PDF September 2024
Discontinued Procedure-53 Modifier PDF April 2024
Evaluation & Management for Office or Other Outpatient Services PDF October 2024
Evaluation & Management Services by Physicians in the Same Group Practice PDF June 2024
Facility Reimbursement for Clinic Services PDF December 2023
Global Surgery Package PDF October 2024
Hospital Related Services for or Leading to an Inpatient Admission PDF August 2024
Hospital Related Services for Outpatient Claims PDF December 2023
Hospital Inpatient or Observation Discharge Policy PDF September 2024
Increased Procedural Services (Modifier-22) PDF June 2024
Initial Hospital Inpatient or Observation Evaluation & Management Services PDF July 2024
Inpatient Clotting Factor Reimbursement and Billing - Medicare Advantage *NEW* PDF November 2024
Institutional Payment Programs and Charge Based Reimbursement for Commercial Products PDF September 2024
Institutional Reimbursement as Inpatient versus Outpatient NEW PDF August 2023
Institutional Supplies Policy PDF October 2024
Laboratory Panels and Components PDF May 2024
Maximum Units of Service PDF November 2024
Modifier Reference PDF September 2024
Multiple Diagnostic Cardiovascular Procedure Reduction PDF August 2024
Multiple Diagnostic Cardiovascular Procedure Reduction *ARCHIVE* PDF August 2023
Multiple Diagnostic Ophthalmology Procedure Reduction PDF August 2024
Multiple Diagnostic Ophthalmology Procedure Reduction *ARCHIVE* PDF August 2023
Multiple Imaging Reduction PDF August 2024
Multiple Imaging Reduction *ARCHIVE* PDF August 2023
Multiple Procedure Reduction - Home Infusion Therapy Per-Diem PDF August 2024
Multiple Surgical Procedure Reduction (Including Multiple Endoscopic Procedure Reduction) PDF August 2024
Multiple Therapy Reduction PDF August 2024
Multiple Visit Reduction PDF August 2024
National Correct Coding Initiative PDF July 2024
Never Event – Hospital Acquired Condition (HAC) in Inpatient Setting PDF November 2024
Never Events - Wrong Surgery PDF July 2024
New Patient Visits PDF June 2024
NonPhysician Healthcare Professionals Billing E-M Codes PDF January 2024
Outpatient Facility Alternate Procedure Code Reimbursement PDF August 2024
Outpatient “Token Charges” Reimbursement and Billing - Medicare Advantage *New* PDF November 2024
Obstetric Services PDF February 2024
Physical Therapy Assistant and Occupational Therapy Assistant Services *NEW* PDF December 2024
Portable X-Ray and EKG Supplier Services PDF July 2024
Professional Technical Component PDF September 2024
Prolonged Services PDF April 2024
Readmissions Review Quality Program for MA & Comm PDF December 2023
Reduced Services-52 Modifier PDF April 2024
Reporting Habilitative and Rehabilitative Services PDF September 2024
Robotic Assisted Surgery PDF April 2024
Robotic Assisted Surgery Facility Policy PDF April 2024
Sepsis PDF October 2024
Split Surgical Package PDF October 2024
Standby Services PDF March 2024
Supplies PDF October 2024
Surgical Assistant PDF November 2024
Telehealth Facility Procedure Q3014 PDF January 2024
Third Party Billing When a Member is Inpatient PDF December 2023
T-Status Codes PDF May 2024
Unbundled, Incidental, and Mutually Exclusive Services PDF October 2024
Unclassified Drugs PDF May 2024
Unlisted Procedure Codes PDF May 2024
Virtual Visits PDF January 2024