Clinical Payment and Coding Policies — Archive

Anesthesia Information Policy Number Effective Date End Date
Anesthesia Information CPCP010 01/01/2025 10/31/2025
Anesthesia Information CPCP010 03/22/2023 12/31/2024
Anesthesia Information CPCP010 09/08/2022 03/21/2023
Applied Behavioral Analysis Policy Number Effective Date End Date
Applied Behavioral Analysis CPCP011 05/30/2023 10/27/2024
Applied Behavioral Analysis CPCP011 12/20/2021 05/29/2023
Chiropractic Care Services Policy Number
 Effective Date
 End Date
Chiropractic Care Services CPCP016 01/22/2024 06/19/2025
Chiropractic Care Services CPCP016 03/22/2023 01/21/2024
Chiropractic Care Services CPCP016 02/21/2022 03/21/2023
Corrected Claim Submissions Policy Number Effective Date End Date
Corrected Claim Submissions CPCP025 07/01/2024 01/21/2025
Corrected Claim Submissions CPCP025 07/01/2020 06/30/2024
Co-Surgeon/Team Surgeon Policy - Professional Provider Policy Number Effective Date End Date
Co-Surgeon/Team Surgeon Policy - Professional Provider CPCP009 01/22/2024 04/17/2025
Co-Surgeon/Team Surgeon Policy - Professional Provider CPCP009 09/12/2023 01/21/2024
Co-Surgeon/Team Surgeon Policy - Professional Provider CPCP009 10/31/2022 09/11/2023
Drug Testing CPCP Policy Number
 Effective Date
 End Date
Drug Testing CPCP CPCP020 12/07/2023 11/17/2024
Drug Testing CPCP CPCP020 03/22/2023 12/06/2023
Drug Testing CPCP CPCP020 12/29/2021 03/21/2023
Emergency Department Services Evaluation and Management: E/M Coding – Facility Services Policy Number Effective Date End Date
Emergency Department Services Evaluation and Management: E/M Coding – Facility Services CPCP003 07/29/2024 10/05/2025
Emergency Department Services Evaluation and Management: E/M Coding – Facility Services CPCP003 08/01/2023 07/28/2024
Emergency Department Services Evaluation and Management: E/M Coding – Facility Services CPCP003 02/01/2023 07/31/2023
Emergency Department Services Evaluation and Management: E/M Coding – Facility Services CPCP003 01/10/2022 01/31/2023
Emergency Department Services Evaluation and Management - E/M Coding – Professional Services Policy Number Effective Date End Date
Emergency Department Services Evaluation and Management - E/M Coding – Professional Services CPCP042 10/03/2024 11/13/2025
Emergency Department Evaluation and Management (E/M) Services Coding – Professional Services CPCP042 08/01/2023 10/02/2024
Evaluation and Management Coding – Professional Provider Services Policy Number Effective Date
 End Date
Evaluation and Management Coding – Professional Provider Services CPCP024 12/07/2023 11/17/2024
Evaluation and Management Coding – Professional Provider Services CPCP024 04/17/2023 12/06/2023
Evaluation and Management Coding – Professional Provider Services CPCP024 02/28/2022 04/16/2023
Global Surgical Package-Professional Providers Policy Number Effective Date End Date
Global Surgical Package-Professional Providers CPCP014 01/22/2024 04/14/2024
Global Surgical Package-Professional Providers CPCP014 06/27/2023 01/21/2024
Global Surgical Package-Professional Providers CPCP014 04/01/2022 06/26/2023
Hernia Repair Policy Number Effective Date End Date
Hernia Repair CPCP012 05/15/2023 07/15/2024
Hernia Repair CPCP012 05/09/2022 05/14/2023
Home Health Care/Private Duty Nursing Policy Policy Number
 Effective Date
 End Date
Home Health Care/Private Duty Nursing Policy CPCP005 11/03/2023 03/20/2025
Home Health Care/Private Duty Nursing Policy CPCP005 12/13/2022 11/02/2023
Implant, Device, and Tissue Policy Policy Number
 Effective Date
 End Date
Implant, Device, and Tissue Policy CPCP007 02/27/2023 10/07/2024
Implant, Device, and Tissue Policy CPCP007 09/01/2020 02/26/2023
Increased Procedural Services (Modifier 22) Policy Number Effective Date End Date
Increased Procedural Services (Modifier 22) CPCP013 01/22/2024 04/14/2025
Increased Procedural Services (Modifier 22) CPCP013 05/15/2023 01/21/2024
Increased Procedural Services (Modifier 22) CPCP013 04/01/2022 05/14/2023
Infusion Services Policy Number Effective Date
 End Date
Infusion Services CPCP019 07/18/2025 07/18/2025
Home Infusion CPCP019 11/03/2023 07/17/2025
Home Infusion CPCP019 12/28/2022 11/02/2023
Inpatient Readmission Policy Number
 Effective Date End Date
Inpatient Readmission CPCP027 10/13/2023 12/17/2024
Inpatient Readmission CPCP027 07/01/2023 10/12/2023
Inpatient Readmission CPCP027 05/01/2023 06/30/2023
Inpatient Readmission CPCP027 01/24/2022 04/30/2023
Inpatient/Outpatient Unbundling Policy - Facility Policy Number Effective Date End Date
Inpatient/Outpatient Unbundling Policy - Facility CPCP002 02/21/2022 12/26/2023
Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Policy Policy Number
 Effective Date End Date
Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Policy CPCP032 10/03/2024 10/30/2025
Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Policy CPCP032 09/12/2023 10/02/2024
Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Policy CPCP032 05/09/2022 09/11/2023
Laboratory Panel Billing Policy Number Effective Date
 End Date
Laboratory Panel Billing CPCP021 07/16/2024 09/21/2025
Laboratory Panel Billing CPCP021 06/27/2023 07/15/2024
Laboratory Panel Billing CPCP021 05/05/2022 06/26/2023
Medical Record Documentation Policy Number
 Effective Date
 End Date
Medical Record Documentation CPCP029 11/18/2024 10/30/2025
Medical Record Documentation CPCP029 11/03/2023 11/17/2024
Medical Record Documentation CPCP029 09/21/2022 11/02/2023
Modifier Reference Policy Policy Number Effective Date
 End Date
Modifier Reference Policy CPCP023 01/22/2024 10/30/2025
Modifier Reference Policy CPCP023 11/03/2023 01/21/2024
Modifier Reference Policy CPCP023 04/01/2023 11/02/2023
Modifier Reference Policy CPCP023 05/24/2022 03/21/2023
Multiple Surgical Procedures - Professional Provider Services Policy Number
 Effective Date
 End Date
Multiple Surgical Procedures - Professional Provider Services CPCP015 01/22/2024 04/22/2025
Multiple Surgical Procedures - Professional Provider Services CPCP015 09/12/2023 01/21/2024
Multiple Surgical Procedures - Professional Provider Services CPCP015 06/29/2022 09/11/2023
Neonatal Intensive Care Unit (NICU) Level of Care Authorization and Reimbursement Policy Policy Number
 Effective Date
 End Date
Neonatal Intensive Care Unit (NICU) Level of Care Authorization and Reimbursement Policy CPCP004 07/29/2024 08/24/2025
Neonatal Intensive Care Unit (NICU) Level of Care Authorization and Reimbursement Policy CPCP004 11/29/2023 07/28/2024
Neonatal Intensive Care Unit (NICU) Level of Care Authorization and Reimbursement Policy CPCP004 02/21/2022 11/28/2023
Non-Reimbursable Experimental, Investigational and /or Unproven Services (EIU) Policy Number
 Effective Date
 End Date
Non-Reimbursable Experimental, Investigational and /or Unproven Services (EIU) CPCP028 10/01/2024 05/14/2025
Non-Reimbursable Experimental, Investigational and /or Unproven Services (EIU) CPCP028 07/01/2024 09/30/2024
Non-Reimbursable Experimental, Investigational and /or Unproven Services (EIU) CPCP028 05/15/2024 06/30/2024
Non-Reimbursable Experimental, Investigational and /or Unproven Services (EIU) CPCP028 04/01/2024 05/14/2024
Non-Reimbursable Experimental, Investigational and /or Unproven Services (EIU) CPCP028 01/15/2024 03/31/2024
Non-Reimbursable Experimental, Investigational and /or Unproven Services (EIU) CPCP028 12/01/2023 01/14/2024
Non-Reimbursable Experimental, Investigational and /or Unproven Services (EIU) CPCP028 10/01/2023 11/30/2023
Non-Reimbursable Experimental, Investigational and /or Unproven Services (EIU) CPCP028 09/01/2023 09/30/2023
Non-Reimbursable Experimental, Investigational and /or Unproven Services (EIU) CPCP028 07/01/2023 08/31/2023
Non-Reimbursable Experimental, Investigational and /or Unproven Services (EIU) CPCP028 01/01/2023 06/30/2023
Observation Services Policy Policy Number Effective Date End Date
Observation Services Policy CPCP001 07/14/2023 08/07/2024
Observation Services Policy CPCP001 05/30/2023 07/13/2023
Observation Services Policy CPCP001 09/06/2021 05/29/2023
Outpatient Facility Service(s) Overlapping During an Inpatient Stay Policy Number Effective Date
 End Date
Outpatient Facility Service(s) Overlapping During an Inpatient Stay CPCP039 07/16/2024 06/19/2025
Outpatient Facility Service(s) Overlapping During an Inpatient Stay CPCP039 07/01/2023 07/15/2024
Outpatient Services Prior to an Inpatient Admission Policy Number Effective Date End Date
Outpatient Services Prior to an Inpatient Admission CPCP038 03/01/2024 06/19/2025
Outpatient Services Prior to an Inpatient Admission CPCP038 06/01/2023 02/29/2024
Paravertebral Facet Injection Procedure Coding & Billing Policy Policy Number
 Effective Date
 End Date
Paravertebral Facet Injection Procedure Coding & Billing Policy CPCP036 11/18/2024 11/20/2025
Paravertebral Facet Injection Procedure Coding & Billing Policy CPCP036 11/03/2023 11/17/2024
Paravertebral Facet Injection Procedure Coding & Billing Policy CPCP036 12/28/2022 11/02/2023
Physical Medicine and Rehabilitation Services Policy Number
 Effective Date
 End Date
Physical Medicine and Rehabilitation Services CPCP040 09/22/2025 11/06/2025
Physical Medicine and Rehabilitation Services CPCP040 01/22/2024 09/21/2025
Physical Medicine and Rehabilitation Services CPCP040 03/22/2023 01/21/2024
Pneumatic Compression Devices – Outpatient Use Policy Number Effective Date End Date
Pneumatic Compression Devices – Outpatient Use CPCP022 03/01/2024 10/30/2025
Pneumatic Compression Devices – Outpatient Use CPCP022 02/01/2023 02/29/2024
Pneumatic Compression Devices – Outpatient Use CPCP022 02/21/2022 01/31/2023
Point-of-Care Ultrasound (POCUS) Examination Policy Policy Number
 Effective Date
 End Date
Point-of-Care Ultrasound (POCUS) Examination Policy CPCP030 09/12/2023 01/06/2025
Point-of-Care Ultrasound (POCUS) Examination Policy CPCP030 04/01/2022 09/11/2023
Preventive Services Policy Policy Number
 Effective Date
 End Date
Preventive Services Policy CPCP006 07/01/2025 09/30/2025
Preventive Services Policy CPCP006 04/01/2025 06/30/2025
Preventive Services Policy CPCP006 02/01/2025 03/31/2025
Preventive Services Policy CPCP006 01/01/2025 01/31/2025
Preventive Services Policy CPCP006 10/01/2024 12/31/2024
Preventive Services Policy CPCP006 07/01/2024 09/30/2024
Preventive Services Policy CPCP006 04/01/2024 06/30/2024
Preventive Services Policy CPCP006 01/01/2024 03/31/2024
Preventive Services Policy CPCP006 11/01/2023 12/31/2023
Preventive Services Policy CPCP006 10/01/2023 10/31/2023
Preventive Services Policy CPCP006 07/01/2023 09/30/2023
Preventive Services Policy CPCP006 04/01/2023 06/30/2023
Preventive Services Policy CPCP006 03/01/2023 03/31/2023
Preventive Services Policy CPCP006 01/01/2023 02/28/2023
Psychological and Neuropsychological Testing Policy Number Effective Date End Date
Psychological and Neuropsychological Testing CPCP008 11/16/2023 11/17/2024
Psychological and Neuropsychological Testing CPCP008 11/02/2022 11/15/2023
Revenue Codes Requiring Supporting CPT, HCPCS and/or NDC Codes - Outpatient Facility Claims Policy Number Effective Date End Date
Revenue Codes Requiring Supporting CPT, HCPCS and/or NDC Codes - Outpatient Facility Claims CPCP018 04/14/2025 10/30/2025
Outpatient Facility and Hospital Claims: Revenue Codes Requiring Supporting CPT, HCPCS and/or NDC Codes CPCP018 11/03/2023 04/13/2025
Outpatient Facility and Hospital Claims: Revenue Codes Requiring Supporting CPT, HCPCS and/or NDC Codes CPCP018 11/02/2022 11/02/2023
Sepsis Policy Policy Number Effective Date
 End Date
Sepsis Policy CPCP041 07/16/2024 01/06/2025
Sepsis Policy CPCP041 05/30/2023 07/15/2024
Telemedicine and Telehealth/Virtual Health Care Services Policy Policy Number
 Effective Date End Date
Telemedicine and Telehealth/Virtual Health Care Services Policy CPCP033 01/01/2025 09/25/2025
Telemedicine and Telehealth/Virtual Health Care Services Policy CPCP033 03/01/2024 12/31/2024
Telemedicine and Telehealth/Virtual Health Care Services Policy CPCP033 12/07/2023 02/29/2024
Telemedicine and Telehealth/Virtual Health Care Services Policy CPCP033 03/28/2022 12/06/2023
Therapeutic, Prophylactic, Diagnostic, Injection and Infusion Administration Coding Policy Number
 Effective Date
 End Date
Therapeutic, Prophylactic, Diagnostic, Injection and Infusion Administration Coding CPCP026 08/08/2024 09/25/2025
Therapeutic, Prophylactic and Diagnostic Injection and Infusion Coding CPCP026 05/15/2023 08/07/2024
Therapeutic, Prophylactic and Diagnostic Injection and Infusion Coding CPCP026 12/28/2022 05/14/2023
Trauma Activation – Facility Services Policy Number
 Effective Date End Date
Trauma Activation – Facility Services CPCP031 07/14/2023 07/28/2024
Trauma Activation – Facility Services CPCP031 04/01/2022 07/13/2023
Unbundling Policy-Professional Providers Policy Number Effective Date End Date
Unbundling Policy-Professional Providers CPCP034 05/15/2023 06/24/2024
Unbundling Policy-Professional Providers CPCP034 05/05/2022 05/14/2023
Unlisted/Not Otherwise Classified (NOC) Coding Policy Policy Number
 Effective Date
 End Date
Unlisted/Not Otherwise Classified (NOC) Coding Policy CPCP035 09/13/2024 10/16/2025
Unlisted/Not Otherwise Classified (NOC) Coding Policy CPCP035 09/08/2022 09/12/2024
Wasted/Discarded Drugs and Biologicals Policy Policy Number Effective Date End Date
Wasted/Discarded Drugs and Biologicals Policy CPCP017 02/01/2023 02/29/2024
Wasted/Discarded Drugs and Biologicals Policy CPCP017 02/22/2022 01/31/2023