Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link
13	ADD-ON Code	11/01/2020	Outpatient	Coding Payment Policy	View Policy
54	After Hours and Weekend Care Professional	8/1/2023	Professional	Coding Payment Policy	View Policy
111	Allergy Test	01/04/2024	Outpatient	Billing Payment Policy	View Policy
14	Ambulance Modifier Coding Policy	11/01/2020	Professional	Coding Payment Policy	View Policy
108	Anesthesia Bundling	01/04/2024	Professional	Billing Payment Policy	View Policy
34	Appropriate Level of Care Reimbursement	01/07/2022	Outpatient/Inpatient	Coding Payment Policy	View Policy
119	Autonomic Function Testing	01/04/2024	Outpatient	Billing Payment Policy	View Policy

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link
102	BRCA1 and BRCA2 Genetic Testing	01/04/2024	Professional/Labs	Billing Payment Policy	View Policy	35	Breast Cancer Genetic Testing Tier 1 vs Tier 2	01/04/2023	Professional/Labs	Billing Payment Policy	View Policy

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link
98	Colonoscopy and Sigmoidoscopy	09/11/2023	Professional/Labs/Inpatient/Outpatient	Clinical Payment Policy	View Policy
42	Corrected Claims	10/21/2022	Professional/Labs/Inpatient/Outpatient	Billing Payment Policy	View Policy
53	Co Surgeon Team Surgeon Professional	09/01/2023	Professional	Coding Payment Policy	View Policy
38	Critical Care Codes when Discharging Home from the Emergency Department	08/04/2022	Professional	Clinical Payment Policy	View Policy

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link
16	Decision for Surgery Modifier 57 Coding Policy	11/01/2020	Professional	Clinical Payment Policy	View Policy
2	Diagnosis Code Coding Policy	11/01/2020	Professional	Coding Payment Policy	View Policy
90	DME Place of Service 31 or 32	09/11/2023	DME Professional Services	Billing Payment Policy	View Policy
25	DRG Clinical Validation	01/07/2022	Inpatient	Billing Payment Policy	View Policy
45	Duplicate Claims	11/01/2022	Professional	Billing Payment Policy	View Policy

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link
24	Excludes 1 Note	11/01/2020	Professional	Coding Payment Policy	View Policy

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link
80	Fee Schedule	09/01/2023	Professional/Outpatient	Billing Payment Policy	View Policy

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link
0	General Coding Policy	11/01/2020	Professional	Coding Payment Policy	View Policy
51	Global Surgical Packages for Professional Providers	09/01/2023	Professional	Coding Payment Policy	View Policy

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link
56	High Dollar Pharmacy	08/01/2023	Pharmacy	Billing Payment Policy	View Policy
37	High Level Evalution and Managment with Preventive Medicine	10/18/2022	Professional	Coding Payment Policy	View Policy
48	Hospice Value Code 61	01/01/2023	Professional	Coding Payment Policy	View Policy
70	Hospice	10/19/2023	Professional	Clinical Payment Policy	View Policy
01	Hospital Routine Supplies Services	12/01/2017	Inpatient	Billing Payment Policy	View Policy
36	Hydrolyzed Enteral Formula Diagnosis	01/01/2023	Professional	Clinical/Payment Policy	View Policy

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link
20	ICD-10 First Listed Diagnosis Coding Policy	11/01/2020	Professional	Coding Payment Policy	View Policy
3	ICD-10 Specificity Coding Policy	11/01/2020	Professional	Coding Payment Policy	View Policy
77	Injection and Infusions in the ER with 25 Modifier	09/01/2023	Outpatient	Coding Payment Policy	View Policy
71	Inpatient services billed on Outpatient bill types	09/01/2023	Outpatient	Coding Payment Policy	View Policy
125	Interim Hospital Claims	01/02/2024	Outpatient	Coding Payment Policy	View Policy

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link
4	Lab Codes with Modifiers 59 and 91	11/01/2020	Modifier/Professional	Coding Policy	View Policy
17	Lab Panel	11/01/2020	Labs	Payment Policy	View Policy
101	Labs Overlapping with Facility	09/25/2023	Labs	Coding/Payment Policy	View Policy

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link
126	Medical Supplies Home Health Consolidated Billing	01/02/2024	Outpatient	Billing Payment Policy	View Policy
15	Medically Unlikely Edits	11/01/2020	Professional/Outpatient	Coding Payment Policy	View Policy
5	Modifer 26	11/01/2020	Modifier/Professional	Coding Payment Policy	View Policy
6	Modifier KX	11/01/2020	Modifier/Professional	Coding Payment Policy	View Policy
7	Modifier TC	11/01/2020	Modifier/Professional	Coding Payment Policy	View Policy
66	Molina Healthcare Billing Requirements	06/01/2023	Professional	Billing Payment Policy	View Policy
127	Multiple Procedure Payment Reduction	01/02/2024	Professional	Billing Payment Policy	View Policy

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link
32	Newborn and NICU	01/07/2022	Inpatient	Billing Payment Policy	View Policy
12	NCCI PTP with Modifiers	11/01/2020	Modifier/Professional	Coding Payment Policy	View Policy
19	Non-Invasive Prenatal Testing	11/01/2020	Professional	Clinical Payment Policy	View Policy
83	Non-Invasive Abdominal/Visceral Vascular Studies	09/25/2023	Professional	Clinical Payment Policy	View Policy
128	NPFS Status Indicator T	01/02/2024	Professional	Billing Payment Policy	View Policy

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link
50	Observation	06/01/2023	Professional/outpatient	Clinical Payment Policy	View Policy
33	Outpatient Definitive Drug Testing	09/01/2021	Outpatient	Billing Payment Policy	View Policy
84	Overlapping Room and Board	09/25/2023	Professional	Billing Payment Policy	View Policy
29	Optum Pause and Pay	01/24/2024	Professional	Billing Payment Policy	View Policy

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link
10	Packaged and conditionally packaged lab services Coding Policy	11/01/2020	Outpatient	Billing Payment Policy	View Policy
129	Paid Amount Exceeded Billed Amount	1/02/2024	Professional	Billing Payment Policy	View Policy
130	Physical Therapy Max Units Per Day	1/02/2024	Professional	Billing Payment Policy	View Policy
106	Physician Office Laboratory Testing	10/18/2022	Labs	Coding Payment Policy	View Policy
172	Podiatric Q Modifiers	09/25/2023	Modifier/Professional	Coding Payment Policy	View Policy
104	Polysomnography Studies and Home Sleep Testing	09/25/2023	Professional	Clinical Payment Policy	View Policy
00	Post Pay General Policy	06/01/2023	Professional	Billing Payment Policy	View Policy
48	Post-Pay Authorization Audit	06/01/2023	Professional/Labs/Inpatient/Outpatient	Billing Payment Policy	View Policy
96	Presumptive and Definitive Drug Testing Limitation	09/25/2023	Professional	Billing Payment Policy	View Policy
47	Psychotherapy Add On with High Level EM	10/18/2022	Professional	Coding Payment Policy	View Policy
105	PT/OT Initial Evaluations	09/25/2023	Professional	Clinical Payment Policy	View Policy
87	PT/OT/ST Yearly Limit	09/25/2023	Professional	Clinical/Payment Policy	View Policy

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link
88	Radiology Bone Density	09/25/2023	Professional	Clinical/Payment Policy	View Policy
41	Readmission	06/01/2023	Inpatient	Payment Policy	View Policy

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link
57	Semiprivate Vs Private Room	09/25/2023	Inpatient	Billing Payment Policy	View Policy
26	Sepsis	01/07/2022	Inpatient	Coding Payment Policy	View Policy
99	Specimen Validity Testing	09/25/2023	Labs	Coding Payment Policy	View Policy
46	Split-Night-Sleep-Study	10/18/2022	Professional	Coding Payment Policy	View Policy

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link
10	Therapy Modifier Coding Policy	11/01/2020	Modifier/Outpatient	Coding Payment Policy	View Policy
82	Tendon Injections Missing Diagnosis	09/01/2023	Professional	Coding Payment Policy	View Policy

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link
61	Unspecified Codes in an Inpatient Setting Policy	04/01/2022	Inpatient	Coding Payment Policy	View Policy

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link
G2014	Vitamin B12 and Methylmalonic Acid Testing	01/07/2022	Professional Labs	Clinical Payment Policy	View Policy
G2005	Vitamin D Testing	01/07/2022	Professional Labs	Clinical Payment Policy	View Policy

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link