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Payment Policies
- 3D Rendering of Tomographic Modalities (PDF)
Last updated 10/20/2022 - Add On Codes (PDF)
Last updated 07/14/2022 - Administration of Injections and Infusions in Facility Settings (PDF)
Last updated 09/15/2022 - After Hours and Weekend Care (PDF)
Last updated 03/09/2023 - Ambulance Services (PDF)
Last updated 07/14/2022 - Anesthesia Services (PDF)
Last updated 06/16/2022 - Bilateral Procedures - Professional & Institutional Billing (PDF)
Last updated 10/20/2022 - B-Status Codes (PDF)
Last updated 11/10/2022 - Care Coordination Services (PDF)
Last updated 02/09/2023 - Consultation Services (PDF)
Last updated 01/01/2023 - Co-Surgeons (Two Surgeons) (PDF)
Last updated 09/15/2022 - Discontinued Procedure-53 Modifier (PDF)
Last updated 04/14/2022 - Evaluation & Management for Office or Other Outpatient Services (PDF)
Last updated 01/01/2023 - Evaluation & Management Services by Physicians in the Same Group Practice (PDF)
Last updated 01/01/2023 - Facility Reimbursement for Clinic Services (PDF) NEW!
Last updated 12/12/2022 - Global Surgery Package (PDF)
Last updated 10/20/2022 - Hospital Related Services for or Leading to an Inpatient Admission (PDF)
Last updated 08/11/2022 - Hospital Related Services for Outpatient Claims (PDF) NEW!
Last updated 12/12/2022 - Increased Procedural Services (Modifier-22) (PDF)
Last updated 06/16/2022 - Initial Hospital Care Evaluation & Management Services (PDF) ARCHIVE
Last updated 07/14/2022 - Initial Hospital Inpatient or Observation Evaluation & Management Services (PDF)
Last updated 01/01/2023 - Institutional Payment Programs and Charge Based Reimbursement for Commercial Products (PDF)
New policy - effective 09/15/2022 - Institutional SupplIes Policy (PDF)
Lat updated 03/09/2023 - Laboratory Panels and Components (PDF)
Last updated 05/12/2022 - Maximum Units of Service (PDF)
Last updated 11/10/2022 - Moderate Sedation (PDF)
Last updated 03/09/2023 - Modifier Reference (PDF)
Last updated 09/15/2022 - Multiple Diagnostic Cardiovascular Procedure Reduction (PDF)
Last updated 08/11/2022 - Multiple Diagnostic Ophthalmology Procedure Reduction (PDF)
Last updated 08/11/2022 - Multiple Imaging Reduction (PDF)
Last updated 08/11/2022 - Multiple Procedure Reduction - Home Infusion Therapy Per-Diem (PDF)
Last updated 08/11/2022 - Multiple Surgical Procedure Reduction (Including Multiple Endoscopic Procedure Reduction) (PDF)
Last updated 08/11/2022 - Multiple Therapy Reduction (PDF)
Last updated 08/11/2022 - Multiple Visit Reduction (PDF)
Last updated 01/01/2023 - National Correct Coding Initiative (PDF)
Last updated 07/14/2022 - Never Event – Hospital Acquired Condition (HAC) in Inpatient Setting
Last updated 07/14/2022 - Never Events - Wrong Surgery (PDF)
Last updated 07/14/2022 - New Patient Visits (PDF)
Last updated 01/01/2023 - NonPhysician Healthcare Professionals Billing E-M Codes (PDF)
Last updated 01/12/2023 - Observation and Discharge Policy (PDF)
Last updated 01/01/2023 - Observation and Discharge Policy (PDF) ARCHIVE
Last updated 09/16/2021 - Obstetric Services (PDF)
Last updated 02/09/2023 - Portable X-Ray and EKG Supplier Services (PDF)
Last updated 07/14/2022 - Professional Technical Component (PDF)
Last updated 09/15/2022 - Prolonged Services (PDF)
Last updated 01/01/2023 - Prolonged Services (PDF) ARCHIVE
Last updated 04/14/2022 - Readmissions Review Quality Program for MA & Comm (PDF)
Last updated 01/01/2023 - Reduced Services-52 Modifier (PDF)
Last updated 04/14/2022 - Reporting Habilitative and Rehabilitative Services (PDF)
Last updated 09/15/2022 - Robotic Assisted Surgery (PDF)
Last updated 04/14/2022 - Robotic Assisted Surgery Facility Policy (PDF)
Last updated 04/14/2022 - Split Surgical Package (PDF)
Last updated 10/20/2022 - Standby Services (PDF)
Last updated 03/09/2023 - Supplies (PDF)
Last updated 10/20/2022 - Surgical Assistant (PDF)
Last updated 11/10/2022 - Telehealth Facility Procedure Q3014 (PDF)
Last updated 01/12/2023 - Third Party Billing When a Member is Inpatient (PDF) NEW!
Last updated 12/12/2022 - T-Status Codes (PDF)
Last updated 05/12/2022 - Unbundled, Incidental, and Mutually Exclusive Services (PDF)
Last updated 11/10/2022 - Unclassified Drugs (PDF)
Last updated 05/12/2022 - Unlisted Procedure Codes (PDF)
Last updated 05/12/2022 - Virtual Visits (PDF)
Last updated 01/12/2023