Reimbursement Policies

EmblemHealth has updated the following Reimbursement Policies. See revision history for updates and effective dates for the following policies:  

• Ambulatory Surgical Groupers.
• Coding Edits Policy (commercial, Medicare, and Medicaid).
• Preventive Care Services (commercial and Medicaid).

Updated Lab Benefit Management (LBM) Reimbursement Policies:

• Biomarkers for Myocardial Infarction and Chronic Heart Failure (LBM).
• Colorectal Cancer (LBM).
• Coronavirus Testing in the Outpatient Setting (LBM).
• Diabetes Mellitus Testing (LBM).
• Gamma-Glutamyl Transferase (LBM).
• General Inflammation Testing (LBM).
• Identification of Microorganisms Using Nucleic Acid Probes (LBM).
• Oral Cancer Screening and Testing (LBM).
• Pathogen Panel Testing (LBM).
• Prenatal Screening (Nongenetic) (LBM).
• Serum Testing for Evidence of Mild Traumatic Brain Injury (LBM).
• Testing for Alpha-1 Antitrypsin Deficiency (LBM).
• Urine Culture Testing for Bacteria (LBM).