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
- Allergy Testing and Immunotherapy
- Ambulatory Surgery Payment Policy
- Anesthesia Services
- Behavioral Health Outpatient (Medicare Advantage and Medicare Maximum)
- Bilateral Procedures
- Bundled Codes
- Chiropractic Services
- Claims Reconsideration
- Clinical Trials
- 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
- Evaluation and Management Services (Modifier 25)
- FQHC RHC
- Fraud, Waste, and Abuse
- 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
- Inpatient and Intermediate/Diversionary Behavioral Health Services
- Laboratory & Pathology Services
- Modifier Policy
- Multi-function Home Ventilators
- 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
- Nurse Practitioner/Physician Assistants (Medicare Advantage)
- Nursing Facility
- Observation Services
- Obstetric Anesthesia Services
- Opioid Replacement Therapy and Medication Assisted Treatment
- Out-of-Network Provider Policy
- Outpatient Rehab
- Overpayment Policy
- Oxygen
- Prior Authorization
- Radiology Payment Policy
- Readmission Within 30 Days
- Re-bundling and NCCI Edits
- Reduced Services and Discontinued Procedures
- Referring Provider NPI (National Provider Identifiers)
- Revenue Codes Requiring Procedure Codes
- Robotic-Assisted Surgery Payment Policy
- Same Day/Same Service
- Serious Reportable Events (SRE)
- Skilled Nursing (Medicare Advantage)
- Telemedicine—Telehealth Policy
- T Status Codes Payment Policy
- Unlisted Procedure Codes
- Urine Drug Test
- Ventricular Assist Devices
- Vision Services