Reimbursement Policies

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Reimbursement Policies

Title Download (PDF)
After Hours and Weekend Care Download (PDF)
Allergy Testing Immunotherapy Download (PDF)
Anesthesia Reimbursement Policy Download (PDF)
Assistant at Surgery – Modifiers 80/81/82 and AS (Commercial) Download (PDF)
Bundled Services (Commercial and Medicare) Download (PDF)
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 Download (PDF)
CPT and HCPCS Billing Guidelines Download (PDF)
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)
Evaluation and Management (E&M) Services Download (PDF)
From/To Date Span Download (PDF)
Home Health Care Services Download (PDF)
Hospital Readmissions Download (PDF)
Intraoperative Neurophysiology Monitoring Services (IONM) Download (PDF)
Laboratory/Venipuncture - 2/10/2023 Download (PDF)
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)
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)
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)
Operating Microscope/Microsurgery (CPT 64727/69990) Download (PDF)
Ophthalmology Reimbursement Policy Download (PDF)
Outpatient Diagnostic Imaging Self-Referral Payment Policy Download (PDF)
Preventive Care Services (Commercial) Download (PDF)
Preventive Care Services (Medicare) Download (PDF)
Preventive Medicine and Screening (Commercial) Download (PDF)
Prolonged Services (Commercial, Medicare and Medicaid) Download (PDF)
Revenue Codes Requiring Detailed Coding (Commercial) Download (PDF)
Robotic Surgery Download (PDF)
Routine Foot Care Services Download (PDF)
Split Surgical Care (Modifiers 54/55/56) (Commercial) Download (PDF)
Telehealth – Supplemental Telehealth Guidelines Download (PDF)
Telehealth/Virtual Care Services-effective 6/01/2022 Download (PDF)
Treatment Room Download (PDF)
Unlisted Codes Download (PDF)
B-Hemolytic Streptococcus Testing (LBM) Download (PDF)
Biochemical Markers of Alzheimer Disease and Dementia (LBM) Download (PDF)
Bone Turnover Markers Testing (LBM) Download (PDF)
Celiac Disease Testing (LBM) Download (PDF)
Cervical Cancer Screening (LBM) Download (PDF)
Diagnosis of Vaginitis including Multi-target PCR Testing (LBM) Download (PDF)
Diagnostic Testing of Common Sexually Transmitted Infections (LBM) Download (PDF)
Diagnostic Testing of Influenza (LBM) Download (PDF)
Epithelial Cell Cytology in Breast Cancer Risk Assessment (LBM) Download (PDF)
Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing (LBM) Download (PDF)
Fecal Calprotectin Testing in Adults (LBM) Download (PDF)
Flow Cytometry (LBM) Download (PDF)
Folate Testing (LBM) Download (PDF)
Gamma-Glutamyl Transferase (LBM) Download (PDF)
General Inflammation Testing (LBM) Download (PDF)
Helicobacter Pylori Testing (LBM) Download (PDF)
Hemoglobin A1c (LBM) Download (PDF)
Hepatitis C (LBM) Download (PDF)
Immunohistochemistry (LBM) Download (PDF)
Immunopharmacologic Monitoring of Therapeutic Serum Antibodies (LBM) Download (PDF)
In Vitro Chemoresistance and Chemosensitivity Assays (LBM) Download (PDF)
Lyme Disease (LBM) Download (PDF)
Measurement of Thromboxane Metabolites for ASA Resistance (LBM) Download (PDF)
Nerve Fiber Density Testing (LBM) Download (PDF)
Onychomycosis Testing (LBM) Download (PDF)
Oral Screening, Lesion Identification Systems, and Genetic Screening (LBM) Download (PDF)
Parathyroid Hormone, Phosphorus, Calcium, and Magnesium Testing (LBM) Download (PDF)
Pediatric Preventive Screening (LBM) Download (PDF)
Plasma HIV-1 and HIV-2 RNA Quantification for HIV Infection (LBM) Download (PDF)
Prescription Medication and Illicit Drug Testing in Outpatient Setting (LBM) Download (PDF)
Prostate Biopsies (LBM) Download (PDF)
Salivary Hormone Testing (LBM) Download (PDF)
Testing For Alpha-1 Antitrypsin Deficiency (LBM) Download (PDF)
Testing for Diagnosis of Active or Latent Tuberculosis (LBM) Download (PDF)
Testing for Mosquito or Tick Related Infections (LBM) Download (PDF)
Testosterone Testing (LBM) Download (PDF)
Thyroid Disease Testing (LBM) Download (PDF)
Urine Culture Testing for Bacteria (LBM) Download (PDF)
Vitamin B12 & Methylmalonic Acid Testing (LBM) Download (PDF)
Vitamin D Testing (LBM) Download (PDF)
Zika Virus Risk Assessment (LBM) Download (PDF)
Allergen Testing (LBM) Download (PDF)
ANA/ENA Testing (LBM) Download (PDF)
Cardiac Biomarkers for Myocardial Infarction (LBM) Download (PDF)
Cardiovascular Disease Risk Assessment (LBM) Download (PDF)
Diagnosis of Idiopathic Environmental Intolerance (LBM) Download (PDF)
Diagnostic Testing of Iron Homeostasis & Metabolism (LBM) Download (PDF)
Erectile Dysfunction (LBM) Download (PDF)
Evaluation of Dry Eyes Testing (LBM) Download (PDF)
Genetic Testing for Adolescent Idiopathic Scoliosis (LBM) Download (PDF)
HIV Genotyping and Phenotyping (LBM) Download (PDF)
Identification of Microorganisms Using Nucleic Acid Probes (LBM) Download (PDF)
Immune Cell Function Assay (LBM) Download (PDF)
Intracellular Micronutrient Analysis (LBM) Download (PDF)
Lab Testing for the Diagnosis of IBD (LBM) Download (PDF)
Metabolite Markers of Thiopurines Testing (LBM) Download (PDF)
Medicare Part D Vaccines Download (PDF)
Pancreatic Enzyme Testing for Acute Pancreatitis (LBM) Download (PDF)
Pathogen Panel Testing (LBM) Download (PDF)
Prenatal Screening-Nongenetic (LBM) Download (PDF)
Preventive Screening in Adults (LBM) Download (PDF)
Prostate Specific Antigen (PSA) Testing (LBM) Download (PDF)
Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease (LBM) Download (PDF)
Serum Tumor Markers for Malignancies (LBM) Download (PDF)
ST2 Assay for Chronic Heart Failure (LBM) Download (PDF)
Split/Fragmented Billing Download (PDF)
Urinary Tumor Markers for Bladder Cancer (LBM) Download (PDF)
Vectra DA Blood Test for Rheumatoid Arthritis (LBM) Download (PDF)
Venous and Arterial Thrombosis Risk Testing (LBM) Download (PDF)
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