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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

Adjunct Professional Services – Payment Policy

Adult Day Health Services – Payment Policy

Adult Foster Care Services (AFC) – Payment Policy

Advanced Primary Care Management – Payment Policy

Ambulatory Surgery – Medicare – Payment Policy

Anesthesia Services – Payment Policy

Behavioral Health Diversionary Services – Payment Policy

Behavioral Health Inpatient Services – Payment Policy

Behavioral Health Outpatient Services – Payment Policy

Bilateral Procedures – Payment Policy

B Bundled Codes – Payment Policy

Chiropractic Services – Payment Policy

Claims Reconsideration – Payment Policy

Clinical Trials – Payment Policy

Community Behavioral Health Centers – Payment Policy

Coordination of Benefits – Payment Policy

Co-Surgeon & Team Surgeon – Payment Policy

COVID-19 Services – Payment Policy

Dental Providers Filing Eval & MGMT for Medical Reasons – Payment Policy

Dialysis – Payment Policy

Drug and Biologicals with Discards – Payment Policy

Durable Medical Equipment – Payment Policy

Emergency and Post-Stabilization Services – Payment Policy

Emergency Department – Payment Policy

Evaluation & Management Services – Payment Policy

Fraud, Waste, and Abuse – Payment Policy

General Coding and Billing – Payment Policy

Global Days – Payment Policy

Home Health Care – Payment Policy

Home Health Services – Payment Policy

Home Infusion Therapy – Payment Policy

Hospice Services – Payment Policy

Individual Consideration Codes – Payment Policy

Interest – Payment Policy

Laboratory & Pathology Services – Payment Policy

Modifier – Payment Policy

Modifier 22 – Payment Policy

Modifier 59 – Payment Policy

Multiple Procedure Payment Reduction for Diagnostic Services – Payment Policy

Multiple Procedure Payment Reduction for Medical and Surgical Services – Payment Policy

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

Obstetric Anesthesia Services – Payment Policy

Opioid Replacement Therapy and Medication Assisted Treatment – Payment Policy

Ordering Provider National Provider Identifiers (NPI) – Payment Policy

Out of Network Provider – Payment Policy

Outpatient Rehabilitation – Payment Policy

Overpayment – Payment Policy

Oxygen – Payment Policy

Preadmission Services – Payment Policy

Prior Authorization – Payment Policy

Radiology – Payment Policy

Readmission Within 30 Days – Payment Policy

Reduced Services and Discontinued Procedures – Payment Policy

Revenue Codes Requiring Procedure Codes – Payment Policy

Robotic Assisted Surgery – Payment Policy

Same Day/Same Service – Payment Policy

Serious Reportable Events (SRE) – Payment Policy

Skilled Nursing Facility – Payment Policy

Telehealth/Telemedicine – Payment Policy

T Status Codes – Payment Policy

Unlisted Procedure Costs – Payment Policy

Urine Drug Test – Payment Policy

Ventricular Assist Devices – Payment Policy

Vision Services – Payment Policy