Reimbursement Policies

Reimbursement Policies are listed in alphabetical order.


A back to top Download (PDF)
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)
Cback to top 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 Testing Download (PDF)
COVID-19 Vaccine and Monoclonal Antibody Infusions Policy - Revised August 2021 Download (PDF)
Dback to top 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)
Drug Alcohol Testing (Commercial/Medicaid) Download (PDF)
Eback to top Download (PDF)
E/M Supplemental Reimbursement Policy 2021 Update - New 1/01/2021 Download (PDF)
Iback to top Download (PDF)
Intraoperative Neurophysiology Monitoring Services (IONM) Download (PDF)
Mback to top 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)
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)
Nback to top 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)
Oback to top Download (PDF)
Operating Microscope/Microsurgery (CPT 64727/69990) (Commercial & Medicare) Download (PDF)
Ophthalmology Reimbursement Policy Download (PDF)
Outpatient Diagnostic Imaging Self-Referral Payment Policy Download (PDF)
Pback to top Download (PDF)
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 and Medicare) - New 1/1/2021 Download (PDF)
Rback to top Download (PDF)
Revenue Codes Requiring Detailed Coding (Commercial) - New 2/01/2021 Download (PDF)
Sback to top Download (PDF)
Split Surgical Care (Modifiers 54/55/56) (Commercial) Download (PDF)
Tback to top Download (PDF)
Telehealth/Virtual Care Services-effective 6/01/2022 Download (PDF)