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
- Adjunct Professional Services Payment Policy
- Adult Day Health Payment Policy
- Adult Foster Care Payment Policy
- Advanced Primary Care Management
- Allergy Testing and Immunotherapy
- Ambulatory Surgery Payment Policy
- Anesthesia Services
- Behavioral Health Diversionary Services
- Behavioral Health Inpatient
- Behavioral Health Outpatient (Senior Care Options and One Care)
- Bilateral Procedures
- Bundled Codes
- Chiropractic Services
- Claims Reconsideration
- Clinical Trials
- Community Behavioral Health Centers (CBHC)
- Co-surgeon & Team Surgeon
- COVID-19 Services
- Dental Providers for Medical Reasons
- Dialysis
- Distinct Procedural Services (Modifier 59)
- Drugs and Biologicals
- Durable Medical Equipment (DME)
- Emergency Ambulance Services
- Emergency and Post Stabilization Payment Policy
- Evaluation and Management Services (Modifier 25)
- Fraud, Waste, and Abuse
- General Coding and Billing
- General Coding Policy (Medicare Advantage)
- Global Days
- Home Health Care
- Home Infusion Therapy
- Hospice Services
- Hospice VBID Program
- Increased Procedural Services (Modifier 22)
- Individual Consideration Codes
- Laboratory & Pathology Services
- Modifier Policy
- Multiple Procedure Payment Reduction for Diagnostic Services
- Multiple Procedure Payment Reduction for Medical and Surgical Services
- National Drug Code Requirements
- Non-Physician Provider Payment Policy
- Nursing Facility (Senior Care Options and One Care)
- Observation Services
- Obstetric Anesthesia Services
- Opioid Replacement Therapy and Medication Assisted Treatment
- Ordering Provider NPI (National Provider Identifiers)
- Out-of-Network Provider Policy
- Outpatient Rehab
- Overpayment Policy
- Oxygen
- Preadmission Services
- Prior Authorization
- Radiology Payment Policy
- Readmission Within 30 Days
- Re-bundling and NCCI Edits
- Reduced Services and Discontinued Procedures
- Revenue Codes Requiring Procedure Codes
- Robotic-Assisted Surgery Payment Policy
- Same Day/Same Service
- Serious Reportable Events (SRE)
- Skilled Nursing (MAPD)
- Telemedicine—Telehealth Policy
- T Status Codes Payment Policy
- Unlisted Procedure Codes
- Urine Drug Test
- Ventricular Assist Devices
- Vision Services