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 1/1/2022:
- Acupuncture Services
- Adult Day Health Payment Policy
- Adult Foster Care Payment Policy
- Assistant at Surgery Payment Policy
- Chiropractic Services
- Claims Reconsideration
- COVID-19 Services
- Distinct Procedural Services (Modifier 59)
- Durable Medical Equipment (DME)
- Emergency Ambulance Services
- Evaluation and Management Services (Modifier 25)
- Fraud, Waste, and Abuse
- General Coding Policy
- Hospice VBID Program
- Increased Procedural Services (Modifier 22)
- Modifier Policy
- National Drug Code Requirements
- Nurse Practitioner/Physician Assistants
- Observation Services
- Out-of-Network Provider Policy – Effective 8/1/2021
- Overpayment Policy
- Prior Authorization
- Readmission Within 30 Days
- Robotic Assistance
- Serious Reportable Events (SRE)
- Skilled Nursing Facilities
- Telemedicine—Telehealth Policy
- Unlisted Procedure Codes
- Vision Services