Reimbursement Policies

EmblemHealth has updated the following reimbursement policies. See revision history for updates and effective dates.

• Ambulatory Surgical Groupers.
• Bundled Services (Commercial and Medicare).
• Compression Garments.
• Radiopharmaceuticals and Contrast Agents (Administered by EviCore).
• Radiopharmaceuticals and Contrast Media.

The following Payment Integrity Policies were also updated. See revision history for updates and effective dates.

• Annual Fee Schedule Updates – CMS and Medicaid.
• Device, Implant and Skin Substitutes Coding Guidelines (Facilities).
• Medicaid State Directed Payments and Benchmark Rate Adjustments.
  Please note new policy title. Formerly Medicaid Benchmark Rate Adjustments.