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Updated payment policies now available
September 30, 2022

This article is for all providers caring for our members

The following payment policies, updated in Q3 2022, are now available on Provider Central.

Payment policy Updates
Ambulance Transportation
  • Annual review; no changes
Cardiac Rehabilitation (Outpatient)
  • Annual review; template update
  • Added documentation of existing policy of 1-unit limit per date of service for physical medicine and rehabilitation modality and therapeutic procedure codes
  • Added CPT code L2999 for AposTherapy
Evaluation and Management
  • Added reimbursement policy update effective January 1, 2023: same-day E/M service with global day procedure policy to include preventative medicine E/M service codes
Drug Wastage
  • Annual review; template update
Free-standing Ambulatory Surgical Center (ASC)
  • Annual review; template update
Home Health Care
  • Annual review; template update
  • Edited to clarify home health care reimbursement
  • Annual review; template update
  • Edited to clarify billing grid for revenue codes 221 and 659
Hospital Outpatient Fee Schedule
  • Annual review; template update
  • Added Monkeypox vaccine information
Inpatient Acute Medical Admission
  • Added Hospital at Home reimbursement and billing guidelines
Interim Billing - Facility
  • Annual review; template update
Non-Reimbursable Services
  • Added updated links for non-reimbursable lists for professional and facility providers
Outpatient Rehabilitation Services - Facility
  • Annual review; template update
  • Removed outdated modifier SZ
Skilled Nursing Facility
  • Annual review; template update
Telehealth (Telemedicine) - Medical Services
  • Added update effective August 1, 2022: Mental, behavioral, and neurodevelopmental disorders diagnoses (F01-F99) will be reimbursed at parity only when submitted in the primary/principal diagnosis position
  • Edited to clarify acute care facility UB04 claim billing
  • Added reimbursement information effective January 1, 2023 for primary care providers and chronic condition diagnosis claims

Click here to download our payment policies.

To download our payment policies, log in and click Find a Payment Policy on the right side of your home page. Or, go to Office Resources>Policies & Guidelines>Payment Policies.