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 |
Policy language updated throughout. 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 |
Policy language updated throughout. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022. |
Consistency guidelines |
Policy language updated throughout. Age group definitions updated. 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 |
Policy language updated throughout. 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. |
Guidelines for Global Maternity Reimbursement |
Policy language updated throughout. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022. |
Immunization guidelines |
Policy language updated throughout. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022. |
Maximum Units of Service |
Policy language updated throughout. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022. |
Modifier guidelines |
Policy language updated throughout. 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 |
Policy language updated throughout. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022. |
Outpatient Code Editor (OCE) edits |
Policy language updated throughout. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022. |
Partial hospitalization and intensive outpatient programs |
Policy language updated throughout. 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. |
Pricing and adjudication principles |
Policy renamed from “Pricing and Adjudication Principles for Professional Providers” to “Pricing and Adjudication Principles”. Policy language updated throughout. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022. |
Radiation therapy services |
Policy language updated throughout. 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 |
Policy language updated throughout. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022. |
Status codes |
Policy language updated throughout. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022. |
Supply and Equipment Reimbursement |
Policy language updated throughout. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022. |