Reimbursement Policy

The purpose of our Reimbursement Policy Manual is to document the sources and principles used in writing our Reimbursement Policies. This information is to be used as a general reference resource regarding our Reimbursement Policies and not intended to address every aspect of a reimbursement situation. Reasonable discretion may be used in applying our Reimbursement Policies to individual situations.

The following nationally recognized sources are consulted in the development of our health plan Reimbursement Policies.

  • Centers for Medicare & Medicaid Services (CMS) written policy
  • CMS Local Carrier and National Carrier Determinations (LCD NCD)
  • CMS Manuals and Publications
  • CPT Assistant
  • CPT Manual, including code definitions and associated text
  • Federal Register
  • HCPCS Manual, including code definitions and associated text
  • Integrated Outpatient Code Editor (I/OCE)
  • International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) official guidelines for coding and reporting
  • International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) official guidelines for coding and reporting
  • Medically Unlikely Edits
  • National Correct Coding Policy Manual for Part B Medicare Carriers (NCCI)
  • National Physician Fee Schedule Relative Value File

Save time!

  • Do not submit the reimbursement policy feedback form for questions regarding pricing, benefits, claims, EOB statements or contract issues.
  • Reimbursement policy staff cannot answer or forward these issues.
  • Please contact the Provider Contact Center if you have questions regarding these issues.

Send your policy comments:

Reimbursement policy comments from physicians and other health care professionals regarding reimbursement policies are welcome.

Your use of this Reimbursement Policy constitutes your agreement to be bound by and comply with the terms and conditions of the Reimbursement Policy Disclaimer.

Administrative

Policy name

Effective date

Policy number

11/2021

100

4/2022

121

3/2022

119

9/2021

105

1/2022

122

11/2021

138

8/2022

129

6/2022

137

9/2021

102

8/2022

128

2/2022

141

5/2022

131

9/2021

101

9/2021

125

5/2022

108

11/2021

109

8/2022

111

9/2021

110

5/2022

120

12/2021

114

4/2022

107

12/2021

136

3/2022

130

5/2022

134

4/2022

127

11/2021

106

11/2021

133

8/2022

113

1/2022

135

Virtual Care

4/2022

132

Behavioral health

Policy name

Effective date

Policy number

3/2022

100

Disclaimer

Your use of this Reimbursement Policy constitutes your agreement to be bound by and comply with the terms and conditions of the Reimbursement Policy Disclaimer.