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Medical policies
Payment policies
Ambulance and transportation service payment policy
Current policy
(pdf, 126 KB)
Revised policy, effective July 1, 2012
(pdf, 128 KB)
Ambulatory surgery — facility payment policy
(pdf, 84 KB)
Ambulatory surgery — professional payment policy
(pdf, 84 KB)
Anesthesia payment policy
(pdf, 83 KB)
Assistant surgeon payment policy
(pdf, 120 KB)
Autism services payment policy
(pdf, 60 KB)
Cardiology services payment policy
(pdf, 74 KB)
Claims auditing software policy
(59 KB)
Clinical trials payment policy
(pdf, 96 KB)
Code review payment policy
(pdf, 56 KB)
Coding analysis policy
(pdf, 54 KB)
Counseling/risk factor reduction intervention services payment policy
(pdf, 51 KB)
Dermatology payment policy
(pdf, 78 KB)
Durable medical equipment payment policy
(pdf, 77 KB)
Emergency department payment policy
(pdf, 80 KB)
Evaluation and management payment policy
(pdf, 120 KB)
Eye examinations and refraction payment policy
Current policy
(pdf, 68 KB)
Revised policy, effective July 1, 2012
, (pdf, 80 KB)
Gastroenterology payment policy (pdf, 72 KB)
Global surgical payment policy
(pdf, 82 KB)
Hearing aid and hearing aid exam payment policy
(pdf, 61 KB)
Home health care payment policy
(pdf, 74 KB)
Hospice payment policy
(pdf, 115 KB)
Hospital acquired conditions payment policy
(pdf, 88 KB)
Human leukocyte antigen testing payment policy
(pdf, 77 KB)
Infertility/assisted reproductive technology services payment policy
(pdf, 169 KB)
Inpatient medical review and payment policy
(pdf, 71 KB)
Laboratory and pathology payment policy
(pdf, 68 KB)
Limited services clinics payment policy
(pdf, 55 KB)
Maximum units payment policy
(pdf, 74 KB)
Medical nutrition therapy payment policy
(pdf 59 KB)
Medical supplies and surgical dressing payment policy
(pdf, 709 KB)
Member liability policy
(pdf, 64 KB)
Neonatal intensive care services payment policy
(pdf, 66KB)
Non-covered services payment policy
(pdf, 166 KB)
Nurse midwife policy
(78 KB)
Nurse practitioner payment policy
(pdf, 79 KB)
Observation status payment policy
(pdf, 72 KB)
Obstetrics/Gynecology Payment Policy
(pdf, 96 KB)
Outpatient drugs payment policy
(pdf, 59 KB)
Palliative care consultation payment policy
(pdf, 66 KB)
Physician assistant payment policy
(pdf, 65 KB)
Physician standby services policy
(pdf, 54 KB)
Physical therapy assistant payment policy
(pdf, 58 KB)
Post-operative nasal debridement payment policy
(pdf, 65 KB)
Preoperative autologous blood donation payment policy
(pdf, 89 KB)
Preventive services payment policy, effective January 1, 2012
(pdf, 51 KB)
Provider audit payment policy
(pdf, 84 KB)
Radiology/diagnostic imaging payment policy
(pdf, 90 KB)
Registered nurse first assistant payment policy
(pdf, 48 KB)
Serious reportable events payment policy
(pdf, 87 KB)
Sleep studies payment policy
(pdf, 78 KB)
Special services, procedures and reports payment policy
(pdf, 74 KB)
Team conferences and telephone consults service payment policy
(pdf, 56 KB)
Timely filing payment policy
(pdf, 55 KB)
Transplant payment policy
(pdf, 94 KB)
Unlisted procedures and services payment policy
(pdf, 68 KB)
Vaccine payment policy
(pdf, 199 KB)
Well baby/well child care visits payment policy
(pdf, 76 KB)
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