Archived Reimbursement Policies
The policies below are in PDF format. If you do not have Adobe Acrobat Reader, you may download it here.
A
C
D
- Dental Procedures in a Hospital, Outpatient Facility or Ambulatory Surgery Center
- Dental Procedures in Hospital Outpatient Facility or Ambulatory Surgery Center
- Dental Procedures in Hospital Outpatient Facility or Ambulatory Surgery Center
- Drug Testing
- Drug Testing
- Drug Testing
- Drug Testing
- Durable Medical Equipment (DME) Modifiers
- Durable Medical Equipment (DME) Modifiers
E
F
G
H
I
J
M
- Modifier 25
- Modifier 25
- Modifier 59, XE, XP, XS, XU
- Modifier 59, XE, XP, XS, XU
- Modifiers
- Modifiers
- Molecular Diagnostic Testing for Gastrointestinal Illness
- Molecular Diagnostic Testing for Hepatitis B and C
- Molecular Diagnostic Testing for Hepatitis B and C
- Molecular Diagnostic Testing for Influenza Virus Infection
- Molecular Diagnostic Testing for Respiratory Virus
- Molecular Diagnostic Testing for Streptococcus A and B Infection
N
O
P
- Payment to Out of Network Providers
- Payment to Out of Network Providers
- Payment to Out of Network Providers
- Payment to Out of Network Providers
- Positive Airway Pressure Devices for Pulmonary Disorders
- Pre-Exposure Prophylaxis Preventive Services
- Preventive Evaluation and Management Services and Acute
- Preventive Evaluation and Management Services and Acute Care Visit on Same Date of Service
- Provider Home Visits