Payment Integrity Policies
- Coding Policies
PI Coding Policy Diagnosis Code
PI Coding Policy ICD-10 Specificity
PI Coding Policy Lab Codes with Modifiers 59 and 91
PI Coding Policy Packaged and conditionally packaged lab services
PI Coding Policy Therapy Modifier
PI Coding Policy NCCI PTP with Modifiers
PI Coding Policy Ambulance Modifier
PI Coding Policy Medically Unlikely Edits
PI Coding Policy Decision for Surgery
PI Coding Policy Image Guided Radiation Therapy
PI Coding Policy Non-Invasive Prenatal Testing
- Payment Policies
PI Payment Policy 01 Hospital Routine Supplies Services Reimbursement
PI Payment Policy 25 DRG Clinical Validation
PI Payment Policy 26 Sepsis
PI Payment Policy 32 Newborn and NICU
PI Payment Policy 34 Appropriate Level of Care Reimbursement
PI Payment Policy 35 Breast Cancer Genetic Testing Tier 1 vs Tier 2
PI Payment Policy 36 Hydrolyzed Enteral Formula Diagnosis
PI Payment Policy 37 High-Level EM with Preventive Medicine
PI Payment Policy 38 Critical Care Codes when Discharging Home from the ED
PI Payment Policy 46 Split-Night Sleep Study
PI Payment Policy 61 Unspecified Codes in an Inpatient Setting - Reimbursement Policies
Molina Healthcare Billing Requirements
Post Pay General Policy
Reimbursement Policy for After Hours and Weekend Care Professional
Reimbursement Policy for Corrected Claims<
Reimbursement Policy for Co-Surgeon Team-Surgeon
Reimbursement Policy for Discontinued Procedures
Reimbursement Policy for DME KF Modifier
Reimbursement Policy for Duplicate Claims
Reimbursement Policy for Facility Emergency Department Evaluation and Management Leveling
Reimbursement Policy for Fee Schedule
Reimbursement Policy for Global Surgical
Reimbursement Policy for High Dollar Pharmacy
Reimbursement Policy for Injection and Infusions in the ER with 25 Modifier
Reimbursement Policy for Inpatient services billed on Outpatient bill types
Reimbursement Policy for Multiple EM codes for the same provider same date of service
Reimbursement Policy for NDC
Reimbursement Policy for Observation
Reimbursement Policy for Reduced Services and Discontinued Procedures
Reimbursement Policy for Tendon Injections Missing Diagnosis
For Medicare and Marketplace Policies Please visit
Medicare and Marketplace Payment Integrity Policies