Coding Payment Policy

 Add-on Coding

 Anesthesia Bundling

 CMS Replacement Codes

 Co Surgeon Team Surgeon Professional

 Critical Care Codes when Discharging Home from the Emergency Department

 Decision for Surgery Modifier 57

 Diagnosis Code Coding

 Diagnosis Code Y65 XX

 Discontinued Procedures

 Emergency EM Codesand Place of Service

 Global Surgical Packages for Professional Providers

 Hospice Value Code 61

 Hydrolyzed Enteral Formula Diagnosis

 ICD-10 First Listed Diagnosis Coding Policy

 ICD-10 Specificity

  Incarceration Diagnosis Code

 Inpatient services billed on Outpatient bill types

 Medically Unlikely Edits

  Member PCP as Attending Provider in a ER Facility Setting

 Modifier TC

 Modifier 25

 Modifier 26

 Modifier KX

 Modifiers XE XS XP XU and 59 Usage

  MP Facility Bilateralor Anatomical Modifier Use

 Multiple EM codes for the same provider same date of service

 NCCI PTP with Modifiers

 NPFS Status Indicator T

 Outpatient Hospital Blood and Blood Products Policy Facility

 Physical Therapy Max Units Per Day

 Podiatric Q Modifiers

 Procedure to Place of Service Policy Professional

 PT OT Initial Evaluations

 PT OT Initial Evaluations

 Reduced Services and Discontinued Procedures

 Repeat Procedure Modifiers 76 77

 Status Indicator Flag B Bundled Codes

 Tendon Injections Missing Diagnosis

 Therapy Modifier Coding

 Treatment Room Revenue Codes Billed with E&M Services

 Unlisted Coding

 Unspecified Codes in an Inpatient Setting

 Clinical Payment Policies

 DRG Clinical Validation

 Excludes 1 Note

 Facility Emergency Department Evaluation and Management leveling

 High Level Evaluation and Management with Preventive Medicine

 Hospice

 Hospital Routine Supplies Services

 Newborn and NICU

 Observation

 Psychotherapy Add On with High Level EM

 Readmission

 Sepsis

 Split-Night-Sleep-Study

 Appropriate Level of Care Reimbursement

 Breast Cancer Genetic Testing Tier 1 vs Tier 2

 Optum Pause and Pay

 General Anesthesia and IV Sedation for Pediatric Dental Services

 Optum EDC Analyzer - Facility ER E&M Leveling Prepayment

 Outpatient Hospital Blood and Blood Products Policy Facility

Lab Payment Policies

 Allergy Testing

 Lab Codes with Modifiers 59 and 91

 Lab Panel

 Labs Overlapping with Facility

 Molecular Pathology

 Packaged and conditionally packaged lab services

 Specimen Validity Testing

 Non-Invasive Prenatal Testing

 Physician Office Laboratory Testing

 Clinical Diagnostic Laboratory Services

 STI Lab Panel Testing

 Payment Policy G2031 Allergen Testing

 Payment Policy G2022 ANA ENA Testing

 Payment Policy G2048 Biochemical Markers of Alzheimer Disease and Dementia

 Payment Policy G2123 Biomarker Testing for Multiple Sclerosis and Related Neurologic Diseases

 Payment Policy G2056 Diagnosis of Idiopathic Environmental Intolerance

 Payment Policy M2057 Diagnosis of Vaginitis Including Multi Target PCR Testing

 Payment Policy G2157 Diagnostic Testing of Common Sexually Transmitted Infections

 Payment Policy G2119 Diagnostic Testing of Influenza

 Payment Policy G2011 Diagnostic Testing of Iron Homeostasis and Metabolism

 Payment Policy G2138 Evaluation of Dry Eyes

 Payment Policy G2059 Epithelial Cell Cytology In Breast Cancer Risk Assessment

 Payment Policy G2132 Erectile Dysfunction

 Payment Policy G2060 Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing

 Payment Policy G2061 Fecal Calprotectin Testing in Adults

 Payment Policy F2019 Flow Cytometry

 Payment Policy G2154 Folate Testing

 Payment Policy G2173 Gamma-Glutamyl Transferase

 Payment Policy G2155 General Inflammation Testing

 Payment Policy M2058 Genetic Testing for Adolescent Idiopathic Scoliosis

 Payment Policy G2044 Helicobacter pylori Testing

 Payment Policy G2006 Hemoglobin A1c

  Payment Policy G2036 Hepatitis C

 Payment Policy M2097 Identification Of Microorganisms Using Nucleic Acid Probes

 Payment Policy G2098 Immune Cell Function Assay

 Payment Policy G2105 Immunopharmacologic Monitoring of Therapeutic Serum Antibodies

 Payment Policy G2100 In Vitro Chemoresistance and Chemosensitivity Assays

 Payment Policy G2099 Intracellular Micronutrient Analysis

 Payment Policy R2162 Laboratory Procedures Reimbursement Policy

 Payment Policy G2121 Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease

 Payment Policy G2143 Lyme Disease

 Payment Policy G2153 Pancreatic Enzyme Testing for Acute Pancreatitis

 Payment Policy G2164 Parathyroid Hormone Phosphorus Calcium and Magnesium Testing

 Payment Policy G2149 Pathogen Panel Testing

 Payment Policy G2042 Pediatric Preventive Screening

 Payment Policy M2116 Plasma HIV1 and HIV2 RNA Quantification for HIV Infection

 Payment Policy G2009 Preventive Screening in Adults

 Payment Policy G2007 Prostate Biopsies

 Payment Policy G2008 Prostate Specific Antigen PSA Testing

 Payment Policy G2120 Salivary Hormone Testing

 Payment Policy G2110 Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease

 Payment Policy G2124 Serum Tumor Markers for Malignancies

 Payment Policy G2130 ST2 Assay for Chronic Heart Failure

 Payment Policy M2068 Testing for Alpha 1 Antitrypsin Deficiency

 Payment Policy G2063 Testing for Diagnosis of Active or Latent Tuberculosis

 Payment Policy G2158 Testing for Mosquito- or Tick-Related Infections

 Payment Policy G2013 Testosterone Testing

 Payment Policy G2045 Thyroid Disease Testing

 Payment Policy M2091 Transplant Rejection Testing

 Payment Policy G2125 Urinary Tumor Markers For Bladder Cancer

 Payment Policy G2156 Urine Culture Testing For Bacteria

 Payment Policy G2127 Vectra DA Blood Test for Rheumatoid Arthritis

 Payment Policy M2041 Venous and Arterial Thrombosis Risk Testing

 Payment Policy G2014 Vitamin B12 and Methylmalonic Acid Testing

 Payment Policy G2005 Vitamin D Testing

 Payment Policy G2133 ZIKA Virus Risk Assessment

 Payment Policy M2172 Onychomycosis Testing

 Payment Policy G2113 Oral Screening Lesion Identification Systems and Genetic Screening

 Payment Policy M2112 Nerve Fiber Density Testing

 Payment Policy G2115 Metabolite Markers of Thiopurines Testing

 Payment Policy P2018 Immunohistochemistry

 Payment Policy G2159 BHemolytic Streptococcus Testing

 Payment Policy G2051 Bone Turnover Markers Testing

 Payment Policy G2150 Cardiac Biomarkers for Myocardial Infarction

 Payment Policy G2050 Cardiovascular Disease Risk Assessment

 Payment Policy G2043 Celiac Disease Testing

 Payment Policy G2002 Cervical Cancer Screening

 Payment Policy G2002 Cervical Cancer Screening

Administrative Payment Policies

 After Hours and Weekend Care Professional

 Authorization Review

 Children and Cancer Hospitals Marketplace

 Cross-Departmental Recovery Policy

 Duplicate Claims

 Fee Schedule

 General Billing and Coding Policy

 Interim Hospital Claims

 Marketplace FQHC and RHC

 Medical Supplies Home Health Consolidated Billingl

 MemberNotActive12162024l

 Multiple Procedure Payment Reduction

 Paid Amount Exceeded Billed Amount

 Recovery Policy for Billed Units Service Accumulator

 Recovery Policy for CPT to CPT Code

 Recovery Policy for Diagnosis Codes

 Recovery Policy for Revenue to CPT Code Review

 Recovery Policy Variable Discount Payments for Providers

 Semiprivate Vs Private Room

 Urgent Care Marketplace

 Advanced Beneficiary Notice ABN Modifiers GA GX GY GZ

 Overlapping Room and Borad

 Corrected Claims

 Annual Wellness Visit sooner than 11 months following Initial IPPE

 Targeted Case Management Policy

DME Payment Policies

 DME KF Modifier

 DME Non Invasive Ventilator Settings

 DME Place of Service 31or 32

 DME Rental Vs Purchase

 DME Rental Vs Purchase

ESRD Payment Policies

 ESRD 90999 No Modifer Weekly and Monthly Limits

 ESRD Billing for J0406 or J0606 with Modifier AX

 ESRD Consolidated Billing

 ESRD Maximum Units of Service and Modifier Policy

Medical Transportation Payment Policies

 Ambulance Modifier

Radiology Payment Policies

 Ambulatory Echocardiograph Monitoring

 Aortography and Peripheral Angiography

 Autonomic FunctionTesting

 CT Computed Tomography of the Abdomen and Pelvis

 Electrocardiographic EKG or ECG Monitoring Holteror Real Time Monitoring

 Image Guided Radiation Therapy

 Non Invasive Abdominal Visceral Vascular Studies

 Pulmonary Function Testing

 Radiology Bone Density

 Radiology for chest

 Colonoscopy and Sigmoidoscopy

 PolysomnographyStudies and Home Sleep Testing

 Radiology Frequency for Simple Syncope Policy

Pharmacy Payment Policies

 NDC

 High Dollar Pharmacy

 Opioid Treatment Service

 Self Administered Drugs

 Authorized Pain Management Services with a Claim Modifier Mismatch

 Discarded Drugs and Biologicals Waste

 EpiduralSteroidInjectionsForPainManagement

Marketplace Pharmacy Policies are located here. Select your State at the top right of the page.

For Medicaid Pharmacy Policies, please review your State specific webpage via the MolinaHealthCare.com main page – select your State at the top of the page. For further questions, please contact Member Services.

• 3D Interpretation and Reporting of Imaging Studies MEDICARE