Payment Integrity Policies
Medicaid Payment Integrity Payment Policies
Policy Number | Policy Name | Effective Date | Service Area | Policy Type | Link |
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13 | ADD-ON Code | 11/01/2020 | Outpatient | Coding Payment Policy | View Policy |
34 | Appropriate Level of Care Reimbursement | 01/07/2022 | Outpatient/Inpatient | Coding Payment Policy | View Policy |
Policy Number | Policy Name | Effective Date | Service Area | Policy Type | Link |
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Policy Number | Policy Name | Effective Date | Service Area | Policy Type | Link |
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42 | Corrected Claims | 10/21/2022 | Professional/Labs/Inpatient/Outpatient | Billing 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 |
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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 |
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 |
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24 | Excludes 1 Note | 11/01/2020 | Professional | Coding Payment Policy | View Policy |
Policy Number | Policy Name | Effective Date | Service Area | Policy Type | Link |
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Policy Number | Policy Name | Effective Date | Service Area | Policy Type | Link |
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0 | General Coding Policy | 11/01/2020 | Professional | Coding Payment Policy | View Policy |
Policy Number | Policy Name | Effective Date | Service Area | Policy Type | Link |
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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 | 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 |
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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 |
18 | Image Guided Radiation Therapy Coding Policy | 11/01/2020 | Professional | Clinical Payment Policy | View Policy |
Policy Number | Policy Name | Effective Date | Service Area | Policy Type | Link |
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Policy Number | Policy Name | Effective Date | Service Area | Policy Type | Link |
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Policy Number | Policy Name | Effective Date | Service Area | Policy Type | Link |
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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 |
Policy Number | Policy Name | Effective Date | Service Area | Policy Type | Link |
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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 |
Policy Number | Policy Name | Effective Date | Service Area | Policy Type | Link |
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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 |
Policy Number | Policy Name | Effective Date | Service Area | Policy Type | Link |
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33 | Outpatient Definitive Drug Testing | 09/01/2021 | Outpatient | Billing Payment Policy | View Policy |
Policy Number | Policy Name | Effective Date | Service Area | Policy Type | Link |
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10 | Packaged and conditionally packaged lab services Coding Policy | 11/01/2020 | Outpatient | Billing Payment Policy | View Policy |
47 | Psychotherapy Add On with High Level EM | 10/18/2022 | Professional | Coding Payment Policy | View Policy |
Policy Number | Policy Name | Effective Date | Service Area | Policy Type | Link |
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Policy Number | Policy Name | Effective Date | Service Area | Policy Type | Link |
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Policy Number | Policy Name | Effective Date | Service Area | Policy Type | Link |
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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 |
Policy Number | Policy Name | Effective Date | Service Area | Policy Type | Link |
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10 | Therapy Modifier Coding Policy | 11/01/2020 | Modifier/Outpatient | Coding Payment Policy | View Policy |
Policy Number | Policy Name | Effective Date | Service Area | Policy Type | Link |
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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 |
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Policy Number | Policy Name | Effective Date | Service Area | Policy Type | Link |
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Policy Number | Policy Name | Effective Date | Service Area | Policy Type | Link |
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Policy Number | Policy Name | Effective Date | Service Area | Policy Type | Link |
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Policy Number | Policy Name | Effective Date | Service Area | Policy Type | Link |
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