Molina Healthcare Billing and Reimbursment Policies
Molina Healthcare of AZ Medicaid Billing and Reimbursement Policies
For Molina Healthcare Active Medicare and Marketplace, Please click the link.
Molina Healthcare Medicare and Marketplace Billing and Reimbursement Policies-
Add-on Coding - Anesthesia Bundling
- CMS Replacement Codes
- Critical Care Codes when Discharging Home from the Emergency Department
- Decision for Surgery Modifier 57
- Diagnosis Code Coding
- Global Surgical Packages for Professional Providers
- 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
- Physical Therapy Max Units Per Day
- Podiatric Q Modifiers
- 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
- Unlisted Coding
- Unspecified Codes in an Inpatient Setting
- Appropriate Level of Care Reimbursement
- Breast Cancer Genetic Testing Tier 1 vs Tier 2
- 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
- Optum EDC Analyzer - Facility ER E&M Leveling Prepayment
- Optum Pause and Pay
- Outpatient Hospital Blood and Blood Products Policy Facility
- Psychotherapy Add On with High Level EM
- Readmission
- Sepsis
- Split-Night-Sleep-Study
- Allergy Testing
- Clinical Diagnostic Laboratory Services
- Lab Codes with Modifiers 59 and 91
- Lab Panel
- Labs Overlapping with Facility
- Molecular Pathology
- Non-Invasive Prenatal Testing
- Packaged and conditionally packaged lab services
- Physician Office Laboratory Testing
- Specimen Validity Testing
- STI Lab Panel Testing
- After Hours and Weekend Care Professional
- General Billing and Coding Policy
- Interim Hospital Claims
- Marketplace FQHC and RHC
- Medical Supplies Home Health Consolidated Billingl
- Multiple Procedure Payment Reduction
- Recovery Policy for Diagnosis Codes
- Recovery Policy for Revenue to CPT Code Review
- Semiprivate Vs Private Room
- 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
- Ambulatory Echocardiograph Monitoring
- Aortography and Peripheral Angiography
dt>
- 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
Autonomic FunctionTesting