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 Billing Guidelines 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)
DME In-Office/Non-Facility Download (PDF)
DME Rental vs. Purchase Download (PDF)
Drug Alcohol Testing (Commercial/Medicaid) Download (PDF)
Eback to top Download (PDF)
Evaluation and Management (E&M) Services Download (PDF)
Hback to top Download (PDF)
Hospital Readmissions Download (PDF)
Iback to top Download (PDF)
Intraoperative Neurophysiology Monitoring Services (IONM) Download (PDF)
Lback to top Download (PDF)
Laboratory/Venipuncture 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, Medicare and Medicaid) Download (PDF)
Rback to top Download (PDF)
Revenue Codes Requiring Detailed Coding (Commercial) - New 2/01/2021 Download (PDF)
Robotic Surgery Download (PDF)
Sback to top Download (PDF)
Split Surgical Care (Modifiers 54/55/56) (Commercial) Download (PDF)
Tback to top Download (PDF)
Telehealth – Supplemental Telehealth Guidelines Download (PDF)
Telehealth/Virtual Care Services-effective 6/01/2022 Download (PDF)