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For Members About Molina

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Molinalogo

Payment Integrity Policies

Medicaid

A

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link
13	ADD-ON Code	11/01/2020	Outpatient	Coding Payment Policy	View Policy
14	Ambulance Modifier Coding Payment Policy	11/01/2020	Professional	Coding Payment Policy	View Policy
34	Appropriate Level of Care Reimbursement	01/07/2022	Outpatient/Inpatient	Coding Payment Policy	View Policy

B

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

C

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	Payment Policy	View Policy
53	Co-Surgeon_Team-Surgeon	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

D

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link
16	Decision for Surgery Modifier 57 Coding Payment Policy	11/01/2020	Professional	Clinical Payment Policy	View Policy
2	Diagnosis Code Coding Payment Policy	11/01/2020	Professional	Coding Payment Policy	View Policy
59	Discontinued Procedures	04/06/2023	Professional Labs/Inpatient/Outpatient	Coding Payment Policy	View Policy
65	DME KF Modifier	08/01/2023	DME Professional Services	Coding Payment Policy	View Policy
25	DRG Clinical Validation	01/07/2022	Inpatient	Payment Policy	View Policy
45	Duplicate Claims	11/01/2022	Professional	Payment Policy	View Policy

E

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link
24	Excludes1 Note Coding Payment Policy	11/01/2020	Professional	Coding Payment Policy	View Policy

F

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link
39	Facility Emergency Department Evaluation and Management leveling	08/15/2022	Facility	Coding Payment Policy	View Policy

G

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

H

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

I

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link
20	ICD-10 First Listed Diagnosis Coding Payment Policy	11/01/2020	Professional	Coding Payment Policy	View Policy
3	ICD-10 Specificity Coding Payment Policy	11/01/2020	Professional	Coding Payment Policy	View Policy
18	Image Guided Radiation Therapy Coding Payment Policy	11/01/2020	Professional	Clinical 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

J

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link

K

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link

L

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

M

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link
15	Medically Unlikely Edits Coding Payment Policy	11/01/2020	Professional Outpatient	Coding Payment Policy	View Policy
5	Modifer 26 Coding Payment Policy	11/01/2020	Modifier, Professional	Coding Payment Policy	View Policy
6	Modifier KK Coding Payment Policy	11/01/2020	Modifier, Professional	Coding Payment Policy	View Policy
7	Modifier TC Coding Payment Policy	11/01/2020	Modifier, Professional	Coding Payment Policy	View Policy
66	Molina Healthcare Billing Requirements	06/01/2023	Professional	Payment Policy	View Policy
67	Multiple EM codes for the same provider same date of service	09/01/2023	Professional	Coding Payment Policy	View Policy

N

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link
12	NCCI PTP with Modifiers Coding Payment Policy	11/01/2020	Modifier, Professional	Coding Payment Policy	View Policy
19	Non-Invasive Prenatal Testing Coding Payment Policy	11/01/2020	Professional	Clinical Payment Policy	View Policy
44	NDC	11/01/2022	Professional Outpatient	Coding Payment Policy	View Policy
32	Newborn and NICU	01/07/2022	Inpatient	Payment Policy	View Policy
83	Non-Invasive Abdominal/Visceral Vascular Studies	09/25/2023	Professional	Clinical Payment Policy	View Policy

O

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	Payment Policy	View Policy

P

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link
10	Packaged and conditionally packaged lab services Coding Payment Policy	11/01/2020	Outpatient	Payment Policy	View Policy
106	Physician Office Laboratory Testing	10/18/2022	Labs	Coding Payment Policy	View Policy
00	Post Pay General Policy	06/01/2023	Professional	Payment Policy	View Policy
48	Post-Pay Authorization Audit	06/01/2023	Professional Labs/Inpatient/Outpatient	Payment Policy	View Policy

Q

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link

R

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link
41	Readmission	06/01/2023	Inpatient	Payment Policy	View Policy
60	Reduced Services and Discontinued Procedures	07/10/2023	Professional	Coding Payment Policy	View Policy

S

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link
26	Sepsis	01/07/2022	Inpatient	Coding Payment Policy	View Policy
46	Split-Night-Sleep-Study	10/18/2022	Professional	Coding Payment Policy	View Policy

T

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link

U

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

V

W

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link

X

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link

Y

Policy Number	Policy Name	Effective Date	Link

Z

Policy Number	Policy Name	Effective Date	Service Area	Policy Type	Link

For Medicare and Marketplace Policies Please visit

Medicare and Marketplace Payment Integrity Policies