Payment Policies
Our payment policies are designed to assist providers when submitting claims. These policies are updated regularly to promote accurate coding, billing, and policy clarification.
If you are looking to access the Experimental and Investigational Services document, or other guidelines, please visit the Medical Necessity Guidelines page.
Acupuncture Services – Payment Policy
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Adjunct Professional Services – Payment Policy
Adult Day Health Services – Payment Policy
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Adult Foster Care Services (AFC) – Payment Policy
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Advanced Primary Care Management – Payment Policy
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Ambulatory Surgery – Medicare – Payment Policy
Anesthesia Services – Payment Policy
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Behavioral Health Diversionary Services – Payment Policy
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Behavioral Health Inpatient Services – Payment Policy
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Behavioral Health Outpatient Services – Payment Policy
Bilateral Procedures – Payment Policy
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B Bundled Codes – Payment Policy
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Chiropractic Services – Payment Policy
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Claims Reconsideration – Payment Policy
Clinical Trials – Payment Policy
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Community Behavioral Health Centers – Payment Policy
Coordination of Benefits – Payment Policy
Co-Surgeon & Team Surgeon – Payment Policy
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COVID-19 Services – Payment Policy
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Dental Providers Filing Eval & MGMT for Medical Reasons – Payment Policy
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Dialysis – Payment Policy
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Drug and Biologicals with Discards – Payment Policy
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Durable Medical Equipment – Payment Policy
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Emergency and Post-Stabilization Services – Payment Policy
Emergency Department – Payment Policy
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Evaluation & Management Services – Payment Policy
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Fraud, Waste, and Abuse – Payment Policy
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General Coding and Billing – Payment Policy
Global Days – Payment Policy
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Home Health Care – Payment Policy
Home Health Services – Payment Policy
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Home Infusion Therapy – Payment Policy
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Hospice Services – Payment Policy
Individual Consideration Codes – Payment Policy
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Interest – Payment Policy
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Laboratory & Pathology Services – Payment Policy
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Modifier – Payment Policy
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Modifier 22 – Payment Policy
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Modifier 59 – Payment Policy
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Multiple Procedure Payment Reduction for Diagnostic Services – Payment Policy
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Multiple Procedure Payment Reduction for Medical and Surgical Services – Payment Policy
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National Drug Code (NDC) Requirements for Physician-Administered Medications – Payment Policy
Non-Emergency Medical Transportation Services – Payment Policy
Non-Physician Providers – Payment Policy
Observation Studies – Payment Policy
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Obstetric Anesthesia Services – Payment Policy
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Opioid Replacement Therapy and Medication Assisted Treatment – Payment Policy
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Ordering Provider National Provider Identifiers (NPI) – Payment Policy
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Out of Network Provider – Payment Policy
Outpatient Rehabilitation – Payment Policy
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Overpayment – Payment Policy
Oxygen – Payment Policy
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Preadmission Services – Payment Policy
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Prior Authorization – Payment Policy
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Radiology – Payment Policy
Readmission Within 30 Days – Payment Policy
Reduced Services and Discontinued Procedures – Payment Policy
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Revenue Codes Requiring Procedure Codes – Payment Policy
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Robotic Assisted Surgery – Payment Policy
Same Day/Same Service – Payment Policy
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Serious Reportable Events (SRE) – Payment Policy
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Skilled Nursing Facility – Payment Policy
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Telehealth/Telemedicine – Payment Policy
T Status Codes – Payment Policy
Unlisted Procedure Costs – Payment Policy
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Urine Drug Test – Payment Policy
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Ventricular Assist Devices – Payment Policy
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Vision Services – Payment Policy
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Archived Provider Payment Policies
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