Provider 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 2025
Ambulance Services	PDF	July 2024
Anatomical Modifier Requirement Policy	PDF	October 2024
Anesthesia Services	PDF	June 2024
Bilateral Procedures - Professional & Institutional Billing	PDF	February 2025
Bilateral Procedures - Professional & Institutional Billing - ARCHIVE	PDF	October 2023
B-Status Codes	PDF	March 2025
Care Coordination Services	PDF	February 2025
Consultation Services	PDF	May 2024
Co-Surgeons (Two Surgeons)	PDF	September 2024
Discontinued Procedure-53 Modifier	PDF	April 2025
Evaluation & Management for Office or Other Outpatient Services	PDF	January 2025
Evaluation & Management Services by Physicians in the Same Group Practice	PDF	June 2024
Facility Reimbursement for Clinic Services	PDF	December 2024
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 2024
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	PDF	December 2024
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	February 2025
Multiple Surgical Procedure Reduction (Including Multiple Endoscopic Procedure Reduction) ARCHIVE	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 2025
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 2025
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 2025
Readmissions Review Quality Program for MA & Comm	PDF	December 2024
Reduced Services-52 Modifier	PDF	April 2025
Reporting Habilitative and Rehabilitative Services	PDF	September 2024
Robotic Assisted Surgery	PDF	April 2025
Robotic Assisted Surgery Facility Policy	PDF	April 2025
Sepsis	PDF	October 2024
Split Surgical Package	PDF	October 2024
Standby Services	PDF	March 2025
Supplies	PDF	October 2024
Surgical Assistant	PDF	November 2024
Telehealth Facility Procedure Q3014	PDF	January 2025
Third Party Billing When a Member is Inpatient	PDF	December 2024
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 2025

Disclaimers