Payment Policies

 Assistant at Surgery

               Published Date  August 7, 2026 Effective Date September 7,2026

Breast Cancer Genetic Testing Tier 1 vs Tier 2 

               Published Date October 5, 2026 Effective Date November 5, 2026 

Comprehensive Community Support Services (CCSS) (H2015)

               Published Date March 19, 2026 Effective Date April 19, 2026

Corrected Claims 

               Published Date June 18, 2025 Effective Date July 18, 2025

Critical Care Codes when Discharged to Home 

               Published Date October 5, 2023 Effective Date November 5, 2023

DRG Clinical Validation 

               Published Date July 25, 2023 Effective Date August 25, 2023

Duplicate Claim Reimbursement Policy 

               Published Date June 18, 2025 Effective Date July 18, 2025 

Early Elective Delivery Payment Policy 

               Published Date May 20, 204 Effective Date June 20, 2024

Facility Emergency Department Evaluation and Management Leveling 

               Published Date December 5, 2024 Effective Date January 5, 2025

High Level E/M with Preventive Medicine Policy 

               Published Dated October 5, 2023 Effective Date November 5, 2023

Hospital Routine Supplies Services Reimbursement 

               Published Date November 13, 2023 Effective Date December 13, 2023

Hydrolyzed Enteral Formula Diagnosis 

               Published Date March 16, 2026 Effective Date April 16, 2026

In-Office Lab Policy 

               Published Date February 8, 2026 Effective Date March 8, 2026

Inpatient Only Procedure Codes 

               Published Date March 1, 2024Effective Date April 1, 2024

Intensive Outpatient Program (H0015, S9480 and Revenue code 0905)

               Published Date August 21, 2026 Effective Date September 21, 2026

Newborn and NICU 

               Published Dated May 1, 2026 Effective Date June 1, 2026

Observation Reimbursement Policy 

               Published Dated May 17, 2024 Effective Date June 17, 2024

Optum Pause and Pay

               Published Date January 22, 2024 Effective Date February 22, 2024

Outpatient Definitive Presumptive Drug Testing Medicaid Medicare 

               Published Date July 12, 2023 Effective Date August 12, 2023

Radiology-Bone Density (DXA)

               Published Date August 21, 2026 Effective Date September 21, 2026

Reduced Services and Discontinued Procedures, Professional and Facility

               Published Date December 17, 2025 Effective Date January 17, 2026

Split Night Sleep Study 

               Published Date September 5, 2023 Effective Date November 5, 2023

Sterilization 

               Published Date June 18, 2025 Effective Date July 18,2025

Telehealth Service Policy

               Published Date August 21, 2026 Effective Date September 21, 2026

Therapeutic Behavioral Health Services H2019_H2020 

               Published Date March 16, 2026 Effective Date April 16, 2026 

Timely Filing Reimbursement Policy 

               Published Date January 23, 2026 Effective Date February 23, 2026

Vitamin D Assay Testing 

               Published Date June 18, 2025 Effective Date July 18,2025