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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Adult Day Health Services – Payment Policy
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Adult Foster Care Services (AFC) – Payment Policy
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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
Clinical Trials – Payment Policy
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Community Behavioral Health Centers – Payment Policy
Coordination of Benefits – Payment Policy
Deeming – Payment Policy
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Durable Medical Equipment – Payment Policy
Emergency and Post-Stabilization Services – Payment Policy
Emergency Department – Payment Policy
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Evaluation & Management Services – Payment Policy
Home Health Care – Payment Policy
Home Health Services – Payment Policy
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Hospice Services – Payment Policy
Hospital Outpatient Clinic Visit 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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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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Multiple Surgery Reduction Therapy Services
Opioid Replacement Therapy and Medication Assisted Treatment – Payment Policy
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Out of Network Provider – Payment Policy
Overpayment – Payment Policy
Readmission Within 30 Days – Payment Policy
Reduced Services and Discontinued Procedures – Payment Policy
Robotic Assisted Surgery – Payment Policy
Sequestration Payment Policy
Serious Reportable Events (SRE) – Payment Policy
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Skilled Nursing Facility – Payment Policy
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Telehealth/Telemedicine – Payment Policy
Unlisted Procedure Costs – Payment Policy
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Urine Drug Test – Payment Policy
Ventricular Assist Devices – Payment Policy
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Archived Provider Payment Policies
Adjunct Professional Services – Payment Policy – Archived on 06/01/2026
Advanced Primary Care Management – Payment Policy – Archived on 06/01/2026
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Ambulatory Surgery – Medicare – Payment Policy – Archived on 06/01/2026
B Bundled Codes – Payment Policy – Archived on 06/01/2026
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Behavioral Health Diversionary Services – Archived on 12/31/2025
Behavioral Health Outpatient Services (Senior Care Options and One Care) – Archived on 11/30/2025
Bilateral Procedures – Payment Policy – Archived on 06/01/2026
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Chiropractic Services – Payment Policy – Archived on 06/01/2026
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Claims Reconsideration – Payment Policy – Archived on 06/01/2026
Co-Surgeon & Team Surgeon – Payment Policy – Archived on 06/01/2026
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COVID-19 Services – Payment Policy – Archived on 06/01/2026
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Dental Providers Filing Eval & MGMT for Medical Reasons – Payment Policy – Archived on 06/01/2026
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Dialysis – Payment Policy – Archived on 06/01/2026
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Drug and Biologicals with Discards – Payment Policy – Archived on 06/01/2026
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Emergency Ambulance Services – Archived 11/30/2025
Fraud, Waste, and Abuse – Payment Policy – Archived on 06/01/2026
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General Coding and Billing – Payment Policy – Archived on 06/01/2026
General Coding Policy (Medicare Advantage) – Archived 12/31/2024
Global Days – Payment Policy – Archived on 06/01/2026
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Home Infusion Therapy – Payment Policy – Archived on 06/01/2026
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Hospice VBID Program – Archived on 12/31/2024
Modifier 22 – Payment Policy – Archived on 06/01/2026
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Modifier 59 – Payment Policy – Archived on 06/01/2026
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National Drug Code (NDC) Requirements for Physician-Administered Medications – Payment Policy – Archived on 06/01/2026
Non-Emergency Medical Transportation Services – Payment Policy – Archived on 06/01/2026
Non-Physician Providers – Payment Policy – Archived on 06/01/2026
Nursing Facility – Archived on 08/31/25
Observation Studies – Payment Policy – Archived on 06/01/2026
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Obstetric Anesthesia Services – Payment Policy – Archived on 06/01/2026
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Ordering Provider National Provider Identifiers (NPI) – Payment Policy – Archived on 06/01/2026
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Outpatient Rehabilitation – Payment Policy – Archived on 06/01/2026
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Oxygen – Payment Policy – Archived on 06/01/2026
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Preadmission Services – Payment Policy – Archived on 06/01/2026
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Prior Authorization – Payment Policy – Archived on 06/01/2026
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Radiology – Payment Policy – Archived on 06/01/2026
Re-Bundling and NCCI Edits – Archived on 03/27/2025
Revenue Codes Requiring Procedure Codes – Payment Policy – Archived on 06/01/2026
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Same Day/Same Service – Payment Policy – Archived on 06/01/2026
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Skilled Nursing (MAPD) – Archived on 12/31/2024
T Status Codes – Payment Policy – Archived on 06/01/2026
Vision Services – Payment Policy – Archived on 06/01/2026
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