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Payment Policies

Payment Policies

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