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Reimbursement Policies

02/18/2025
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The following reimbursement policies have been updated. If the policy name does not have a company name shown, the policy applies to both EmblemHealth and ConnectiCare. See their revision histories for effective dates and applicable changes:

  • Bundled Services.
  • Multiple & Bilateral Surgical Procedures Policy.
  • Assistant at Surgery – Modifiers 80/81/82 and AS (Commercial).
  • Ambulatory Surgical Groupers.
  • DME Rental vs. Purchase.
  • Telehealth/Virtual Care Services.
  • EmblemHealth’s Coding Edits Policy.
  • ConnectiCare’s Coding Edits Policy.
  • EmblemHealth’s Preventive Care Services (Commercial).
  • EmblemHealth’s Preventive Care Services (Medicare).
  • ConnectiCare’s Preventive Care Services (Commercial).
  • ConnectiCare’s Preventive Care Services (Medicare).
  • ConnectiCare’s Laboratory/Venipuncture Policy.
  • EmblemHealth’s Laboratory/Venipuncture Policy.

JP 68539 02/2025

Provider Update
Also of Interest: 
Enterprise Pharmacy Medical Policies   |   Coding updates for Medical Policies   |   Payment Integrity Policies
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Any information provided on this Website is for informational purposes only. It is not medical advice and should not be substituted for regular consultation with your health care provider. If you have any concerns about your health, please contact your health care provider's office. Also, this information is not intended to imply that services or treatments described in the information are covered benefits under your plan. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage.

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