Payment Integrity Policies

Policy Number Policy Name Effective Date Link
C13 ADD-ON Code 11/01/2020 View Policy
PI54 After Hours and Weekend Care Professional 8/1/2023 View Policy
C14 Ambulance Modifier Coding Policy 11/01/2020 View Policy
PI34 Appropriate Level of Care Reimbursement 01/07/2022 View Policy
Policy Number Policy Name Effective Date Link
PI35 Breast Cancer Genetic Testing Tier 1 vs Tier 2 01/04/2023 View Policy
Policy Number Policy Name Effective Date Link
PI42 Corrected Claims 10/21/2022 View Policy
PI38 Critical Care Codes when Discharging Home from the Emergency Department 08/04/2022 View Policy
Policy Number Policy Name Effective Date Link
C16 Decision for Surgery Modifier 57 Coding Policy 11/01/2020 View Policy
C2 Diagnosis Code Coding Policy 11/01/2020 View Policy
PI65 DME KF Modifier 08/01/2023 View Policy
PI25 DRG Clinical Validation 01/07/2022 View Policy
PI45 Duplicate Claims 11/01/2022 View Policy
Policy Number Policy Name Effective Date Link
C24 Excludes1 Note Coding Policy 11/01/2020 View Policy
Policy Number Policy Name Effective Date Link
PI80 Fee Schedule 09/01/2023 View Policy
Policy Number Policy Name Effective Date Link
C0 General Coding Policy 11/01/2020 View Policy
PI51 Global Surgical Packages 09/01/2023 View Policy
Policy Number Policy Name Effective Date Link
PI37 High Level Evalution and Managment with Preventive Medicine 10/18/2022 View Policy
PI01 Hospital Routine Supplies Services 12/01/2017 View Policy
PI36 Hydrolyzed Enteral Formula Diagnosis 01/01/2023 View Policy
Policy Number Policy Name Effective Date Link
C20 ICD-10 First Listed Diagnosis Coding Policy 11/01/2020 View Policy
C3 ICD-10 Specificity Coding Policy 11/01/2020 View Policy
C18 Image Guided Radiation Therapy Coding Policy 11/01/2020 View Policy
PI71 Inpatient services billed on Outpatient bill types 09/01/2023 View Policy
Policy Number Policy Name Effective Date Link
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C4 Lab Codes with Modifiers 59 and 91 Coding Policy 11/01/2020 View Policy
C17 Lab Panel Coding Policy 11/01/2020 View Policy
Policy Number Policy Name Effective Date Link
C15 Medically Unlikely Edits Coding Policy 11/01/2020 View Policy
C5 Modifer 26 Coding Policy 11/01/2020 View Policy
C6 Modifier KK Coding Policy 11/01/2020 View Policy
C7 Modifier TC Coding Policy 11/01/2020 View Policy
PI66 Molina Healthcare Billing Requirements 06/01/2023 View Policy
PI67 Multiple EM codes for the same provider same date of service 09/01/2023 View Policy
Policy Number Policy Name Effective Date Link
C12 NCCI PTP with Modifiers Coding Policy 11/01/2020 View Policy
PI44 NDC 11/01/2022 View Policy
PI32 Newborn and NICU 01/07/2022 View Policy
C19 Non-Invasive Prenatal Testing Coding Policy 11/01/2020 View Policy
Policy Number Policy Name Effective Date Link
PI33 Outpatient Definitive Drug Testing 09/01/2021 View Policy
Policy Number Policy Name Effective Date Link
C10 Packaged and conditionally packaged lab services Coding Policy 11/01/2020 View Policy
PI106 Physician Office Laboratory Testing 10/18/2022 View Policy
PI48 Post-Pay Authorization Audit 06/01/2023 View Policy
PI00 Post Pay General Policy 06/01/2023 View Policy
PI47 Psychotherapy Add On with High Level EM 10/18/2022 View Policy
Policy Number Policy Name Effective Date Link
Policy Number Policy Name Effective Date Link
PI41 Readmission 06/01/2023 View Policy
Policy Number Policy Name Effective Date Link
PI26 Sepsis 01/07/2022 View Policy
PI46 Split-Night-Sleep-Study 10/18/2022 View Policy
Policy Number Policy Name Effective Date Link
PI82 Tendon Injections Missing Diagnosis 09/01/2023 View Policy
C10 Therapy Modifier Coding Policy 11/01/2020 View Policy
Policy Number Policy Name Effective Date Link
PI61 Unspecified Codes in an Inpatient Setting Policy 04/01/2022 View Policy
Policy Number Policy Name Effective Date Link
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Policy Number Policy Name Effective Date Link