Reimbursement Policies

05/19/2025

The following reimbursement policies have been updated. Please refer to the website applicable to the member’s plan (EmblemHealth | ConnectiCare) and see the revision histories for effective dates and applicable changes. Laboratory Benefit Management program policies have “(LBM)” at the end of their names.

  • Ambulatory Surgical Groupers Reimbursement Policy. 
  • Bundled Services. 
  • Compression Garments Reimbursement Policy. 
  • Evaluation of Dry Eyes Testing (LBM).
  • Intracellular Micronutrient Analysis (LBM).
  • Lyme Disease Testing (LBM).
  • Allergen Testing (LBM).
  • Biomarker Testing for Autoimmune Rheumatic Disease (LBM).
  • Coding Edits Policy.
  • Colorectal Cancer Screening (LBM).
  • Diagnosis of Vaginitis (LBM).
  • DME Rental vs. Purchase Reimbursement Policy.
  • Flow Cytometry (LBM).
  • Helicobacter Pylori Testing (LBM).
  • Human Immunodeficiency Virus (HIV) (LBM).
  • Modifier Reference Reimbursement Policy.
  • Onychomycosis Testing (LBM).
  • Parathyroid Hormone, Phosphorus, Calcium, and Magnesium Testing (LBM).
  • Pediatric Preventive Screening (LBM).
  • Prenatal Screening-(Nongenetic) (LBM).
  • Prescription Medication and Illicit Drug Testing in the Outpatient Setting (LBM).
  • Preventive Care Services Commercial and Medicare.
  • Prostate Specific Antigen (PSA) Testing (LBM).
  • Salivary Hormone Testing (LBM).
  • Split/Fragmented Billing Reimbursement Policy.
  • Thyroid Disease Testing (LBM).
  • Urinary Tumor Markers for Bladder Cancer (LBM).

JP 69205 5/2025

Provider Update