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Reimbursement Policies
| Title | Download (PDF) |
|---|---|
| After Hours and Weekend Care | Download (PDF) |
| Allergy Testing Immunotherapy | Download (PDF) |
| Ambulatory Surgical Groupers | Download (PDF) |
| Anesthesia Reimbursement Policy | Download (PDF) |
| Assistant at Surgery – Modifiers 80/81/82 and AS (Commercial) | Download (PDF) |
| Billing for Habilitative and Rehabilitative Services | Download (PDF) |
| Biomarkers Testing for Autoimmune Rheumatic Disease (LBM) | Download (PDF) |
| Biomarker Testing for Multiple Sclerosis and Related Neurologic Diseases (LBM) | Download (PDF) |
| Bundled Services (Commercial and Medicare) | Download (PDF) |
| Coding Edits Policy (Commercial, Medicare, and Medicaid) | Download (PDF) |
| Colorectal Cancer (LBM) | Download (PDF) |
| Compression Garments | Download (PDF) |
| Computer Assisted Surgical Navigation | Download (PDF) |
| Coronavirus Testing in the Outpatient Setting (LBM) | Download (PDF) |
| Corrected Claim Submission | Download (PDF) |
| Co-Surgeon/Team Surgeon-Modifiers 62/66 | 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 – Modifiers JW and JZ (Commercial) | Download (PDF) |
| Discontinued Procedures/Reduced Services – Modifiers 52, 53, 73 & 74 | Download (PDF) |
| DME In-Office/Non-Facility | Download (PDF) |
| DME Rental vs. Purchase | Download (PDF) |
| Drug Alcohol Testing (Commercial/Medicaid) | Download (PDF) |
| Drugs and Biologicals | Download (PDF) |
| Emergency Department Facility E&M Coding’ | Download (PDF) |
| Evaluation and Management (E&M) Services | Download (PDF) |
| Facility Fees for E&M Services on Outpatient Facility Claims | Download (PDF) |
| Facility Transfer – Commercial | Download (PDF) |
| Facility Transfer – Medicare and Medicaid | Download (PDF) |
| From/To Date Span | Download (PDF) |
| Hepatitis Testing (LBM) | Download (PDF) |
| Home Health Care Services | Download (PDF) |
| Hospital Readmissions | Download (PDF) |
| Human Immunodeficiency Virus (HIV) (LBM) | Download (PDF) |
| Intraoperative Neurophysiology Monitoring Services (IONM) | Download (PDF) |
| Laboratory/Venipuncture | Download (PDF) |
| Laboratory/Venipuncture - Effective 1/1/2025 | Download (PDF) |
| Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Tremor | Download (PDF) |
| Medicaid – NY Rx Pharmacy | Download (PDF) |
| Mid-Level Practitioner Reimbursement Policy (Commercial) | Download (PDF) |
| Modifier Reference Policy | 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) |
| Multiple Procedure Reduction Cardiology/Ophthalmology | 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) |
| Nutritional Counseling Services | Download (PDF) |
| Observation Stay - Commercial | Download (PDF) |
| Observation Stay – Medicare and Medicaid | Download (PDF) |
| Operating Microscope/Microsurgery (CPT 64727/69990) | Download (PDF) |
| Ophthalmology Reimbursement Policy | Download (PDF) |
| Outpatient Diagnostic Imaging Self-Referral Payment Policy | Download (PDF) |
| Prenatal Testing for Fetal Aneuploidy (LBM) | Download (PDF) |
| Preventive Care Services (Commercial and Medicaid) | Download (PDF) |
| Preventive Care Services (Medicare) | Download (PDF) |
| Preventive Medicine and Screening (Commercial) | Download (PDF) |
| Procedure/Surgery Performed in Physician’s Office (Commercial) | Download (PDF) |
| Prolonged Services (Commercial, Medicare and Medicaid) | Download (PDF) |
| Radiology Cardiology Ultrasound Bundling Rules (Administered by EviCore) | Download (PDF) |
| Radiology Cardiology Ultrasound Frequency Rules (Administered by EviCore) | Download (PDF) |
| Radiology Cardiology Ultrasound Correct Coding Rules (Administered by EviCore) | Download (PDF) |
| Radiopharmaceuticals and Contrast Agents (Administered by EviCore) | Download (PDF) |
| Radiopharmaceuticals and Contrast Media | Download (PDF) |
| Revenue Codes Requiring Detailed Coding | Download (PDF) |
| Robotic Surgery | Download (PDF) |
| Routine Foot Care Services | Download (PDF) |
| Specialty Pharmacy Requirements Drug List | Download (PDF) |
| Split Surgical Care (Modifiers 54/55/56) (Commercial) | Download (PDF) |
| Telehealth/Virtual Care Services | Download (PDF) |
| Therapeutic Drug Monitoring of 5-Fluorouracil (LBM) | 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 (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) |
| Immunohistochemistry (LBM) | Download (PDF) |
| Immunopharmacologic Monitoring of Therapeutic Serum Antibodies (LBM) | Download (PDF) |
| In Vitro Chemoresistance and Chemosensitivity Assays (LBM) | Download (PDF) |
| Lyme Disease Testing (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 Cancer Screening and Testing (LBM) | Download (PDF) |
| Parathyroid Hormone, Phosphorus, Calcium, and Magnesium Testing (LBM) | Download (PDF) |
| Pediatric Preventive Screening (LBM) | Download (PDF) |
| Pharmacy Medical Claim Edit – Applicable to Dates of Service on/before 12/31/2025 | 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 Biopsy Specimen Analysis (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 Vector-Borne Infections (LBM) | Download (PDF) |
| Testing of Homocysteine Metabolism-Related Conditions (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) |
| Biomarkers for Myocardial Infarction and Chronic Heart Failure (LBM) | Download (PDF) |
| Cardiovascular Disease Risk Assessment (LBM) | Download (PDF) |
| Diabetes Mellitus Testing (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) |
| Identification of Microorganisms Using Nucleic Acid Probes (LBM) | Download (PDF) |
| Immune Cell Function Assay (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) |
| Micronutrient Testing (LBM) | 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 Evidence of Mild Traumatic Brain Injury (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) |