Reimbursement Policies

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Notification of Reimbursement Policy Revisions Effective June 1, 2022 (Posted March 31, 2022)

Reimbursement Policy Revision
Add-on codes New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Anesthesia, Professional and Facility New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Bundling guidelines New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Co-surgeon, assistant surgeon, team surgeon and assistant-at-surgery guidelines New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Consistency guidelines New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Diagnosis validity & code guidelines New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Evaluation and management services New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Facility billing guidelines New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Global surgery New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Immunization guidelines New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Maximum Units of Service New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Multiple Cardiovascular, Radiology, And Ophthalmology Services New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Modifier guidelines New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
NCCI editing New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Observation New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Once in a Lifetime New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Outpatient Code Editor (OCE) edits New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Partial hospitalization and intensive outpatient programs New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Place of Service New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Preadmission and Preoperative Services New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Pricing and adjudication principles New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Revenue codes requiring procedure codes, facility New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Split surgical package New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Status codes New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.
Supply and Equipment Reimbursement New policy developed. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022.