Reimbursement Policies & Guidelines

Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005)

Advance Care Planning

Allergy Services

Ambulance Services

Billing Requirements for Clinical Trials

Brachytherapy Billing Requirements

Breastfeeding Reimbursement

COVID 19 Antibody Testing

Centering Pregnancy Prenatal Care

Chiropractic Manipulation Diagnosis Policy

Chronic Care Management

Claim Editing Policy

DIR Services

Daily Maximum Units for Surgical Pathology and Microscopic Examination

Diabetic Screening Services

Doula Services

Early Elective Deliveries

Evaluation and Management Services billed with Global Radiology, Stress Test, Stress Echo or Myocardial Profusion Imaging

Foot Orthotic Shoes and Inserts

Frequency of Ocular Photography

Home Health Certification and Re-Certification

Laboratory Services Billed by Physicians

Maternity Reimbursement

Maximum Units Policy on Hearing Aid Batteries

Modifier JW – Drug Waste

Modifier 22 – Increased Procedural Services

Modifier 50 – Bilateral and LT/RT

Modifier 52 – Reduced Services

Modifier 53 – Discontinued Procedures

Modifier 54 – Surgical Care Only

Modifier 55 – Postoperative Management Only

Modifier 56 – Preoperative Management Only

Modifier 57 – Decision for Surgery

Modifier 62 – Two Surgeons

Modifier 66- Surgical Team

Modifier 73 - Discontinued Outpatient Procedure Prior to the Administration of Anesthesia

Modifier 76- Repeat Procedure or Service by Same Physician

Modifier 77- Repeat Procedure or Service by Another Physician

Modifier 78 – Unplanned Return to the OR

Modifiers 80, 81, 82 and AS – Assistant Surgeon

Multiple Procedure Reduction

Mutually and Non-Mutually Exclusive NCCI Edits

Outpatient Services Prior to Admission

Preventative Medicine Services with Auditory Screening

Preventive Medicine Services

PT/OT/ST Services

Pulmonary Diagnostic Procedures when billed with Evaluation and Management Codes

Readmission Policy

Self-Help/Peer Support Billing Guidelines

Distinct Procedural Service Modifiers (59, XE, XP, XS, XU)

Telemedicine and Telehealth

Transitional Care Planning

Ulcer Debridement and Ulcer Stages

Unlisted Codes

Urine Drug Testing