| 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) |
| 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 – 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) |
| 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) |
| 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) |
| Mid-Level Practitioner Reimbursement Policy (Commercial) |
Download (PDF) |
| Modifier SU – Procedure Performed in Physician’s Office (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) |
| 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) |
| 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) |
| 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 Media |
Download (PDF) |
| Revenue Codes Requiring Detailed Coding |
Download (PDF) |
| Robotic Surgery |
Download (PDF) |
| Routine Foot Care Services |
Download (PDF) |
| Split Surgical Care (Modifiers 54/55/56) (Commercial) |
Download (PDF) |
| Telehealth/Virtual Care Services |
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 |
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) |
| 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 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 Thrombosis Risk Testing (LBM) |
Download (PDF) |
