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.
The following Payment Policy documents will be available for 2/15/2022:
- Acupuncture Services
- Anesthesia Services
- Adult Day Health Payment Policy
- Adult Foster Care Payment Policy
- Bundled Codes
- Bilateral Procedures
- Chiropractic Services
- Claims Reconsideration
- COVID-19 Services
- Co-Surgeon & Team Surgeon
- Distinct Procedural Services (Modifier 59)
- Drugs and Biologicals
- Durable Medical Equipment (DME)
- Emergency Ambulance Services
- Evaluation and Management Services (Modifier 25)
- Fraud, Waste, and Abuse
- FQHC RHC
- General Coding Policy
- Global Days
- Home Health Care
- 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
- Nurse Practitioner/Physician Assistants
- Observation Services
- Out-of-Network Provider Policy
- Overpayment Policy
- Oxygen
- Prior Authorization
- Readmission Within 30 Days
- Re-bundling and NCCI Edits
- Referring Provider NPI (National Provider Identifiers)
- Serious Reportable Events (SRE)
- Skilled Nursing Facilities
- Telemedicine—Telehealth Policy
- Unlisted Procedure Codes
- Vision Services