Reimbursement Policies
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After Hours and Weekend Care | Download (PDF) |
Allergy Testing Immunotherapy (Commercial/Medicare) | Download (PDF) |
Anesthesia Reimbursement Policy | Download (PDF) |
Assistant at Surgery – Modifiers 80/81/82 and AS (Commercial) | Download (PDF) |
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Coding Edits Policy (Commercial, Medicare, and Medicaid) | Download (PDF) |
Computer Assisted Surgical Navigation | Download (PDF) |
Co-Surgeon/Team Surgeon-Modifiers 62/66 | Download (PDF) |
COVID-19 Billing Guidelines | Download (PDF) |
COVID-19 Testing | Download (PDF) |
COVID-19 Vaccine and Monoclonal Antibody Infusions Policy - Revised August 2021 | Download (PDF) |
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Daily Maximum Units (Commercial/Medicare) | Download (PDF) |
Diagnosis Code Guidelines: Manifestation/Secondary Diagnosis Codes | Download (PDF) |
Discarded Drugs/Biologicals – Modifier JW (Commercial) | Download (PDF) |
Discontinued Procedures – Modifiers 53, 73 & 74 (Commercial) | Download (PDF) |
DME In-Office/Non-Facility | Download (PDF) |
DME Rental vs. Purchase | Download (PDF) |
Drug Alcohol Testing (Commercial/Medicaid) | Download (PDF) |
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Evaluation and Management (E&M) Services | Download (PDF) |
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Hospital Readmissions | Download (PDF) |
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Intraoperative Neurophysiology Monitoring Services (IONM) | Download (PDF) |
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Laboratory/Venipuncture | Download (PDF) |
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Mid-Level Practitioner Reimbursement Policy (Commercial) | Download (PDF) |
Modifier SU – Procedure Performed in Physician’s Office (Commercial) | Download (PDF) |
Modifier Reference Policy (Commercial) | Download (PDF) |
Modifier Reference Policy (Commercial) – effective 9/1/2021 | Download (PDF) |
Modifiers PN & PO for Clinic Visit Services (G0463) – (Medicare) | Download (PDF) |
Multiple & Bilateral Surgical Procedures Policy | Download (PDF) |
Multiple Diagnostic Imaging Payment Reduction Policy (Commercial) | Download (PDF) |
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National Drug Code (NDC) Requirements for Drug Claims – Commercial, Medicare, and Medicaid | Download (PDF) |
Never Events/Adverse Events & Serious Reportable Events (Commercial) | Download (PDF) |
No Cost/Reduced Cost Drugs, Implants & Devices | Download (PDF) |
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Operating Microscope/Microsurgery (CPT 64727/69990) (Commercial & Medicare) | Download (PDF) |
Ophthalmology Reimbursement Policy | Download (PDF) |
Outpatient Diagnostic Imaging Self-Referral Payment Policy | Download (PDF) |
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Preventive Care Services (Commercial) | Download (PDF) |
Preventive Care Services (Commercial) - Effective 10/01/2021 | Download (PDF) |
Preventive Care Services (Medicare) | Download (PDF) |
Preventive Medicine and Screening (Commercial) | Download (PDF) |
Prolonged Services (Commercial, Medicare and Medicaid) | Download (PDF) |
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Revenue Codes Requiring Detailed Coding (Commercial) - New 2/01/2021 | Download (PDF) |
Robotic Surgery | Download (PDF) |
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Split Surgical Care (Modifiers 54/55/56) (Commercial) | Download (PDF) |
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Telehealth – Supplemental Telehealth Guidelines | Download (PDF) |
Telehealth/Virtual Care Services-effective 6/01/2022 | Download (PDF) |