Clinical Payment and Coding Policy — Archived Documents

Observation Services Policy Policy Number Effective Date End Date
Observation Services Policy CPCP001 04/30/2017 04/24/2018
Observation Services Policy CPCP001 04/25/2018 12/14/2019
Observation Services Policy CPCP001 12/15/2019 06/30/2020
Observation Services Policy CPCP001 07/01/2020 09/05/2021
Observation Services Policy CPCP001 09/06/2021 05/29/2023
Observation Services Policy CPCP001 05/30/2023 07/13/2023
Inpatient/Outpatient Unbundling Policy - Facility Policy Number Effective Date End Date
Inpatient/Outpatient Unbundling Policy - Facility CPCP002 07/30/2018 12/16/2018
Inpatient/Outpatient Unbundling Policy - Facility CPCP002 12/17/2018 06/06/2019
Inpatient/Outpatient Unbundling Policy - Facility CPCP002 06/07/2019 11/30/2019
Inpatient/Outpatient Unbundling Policy - Facility CPCP002 12/01/2019 01/31/2021
Inpatient/Outpatient Unbundling Policy - Facility CPCP002 02/01/2021 02/20/2022
Inpatient/Outpatient Unbundling Policy - Facility CPCP002 02/21/2022 12/26/2023
Evaluation and Management of Emergency Department Coding Policy Number Effective Date End Date
Evaluation and Management of Emergency Department Coding CPCP003 05/30/2018 12/02/2018
Evaluation and Management of Emergency Department Coding CPCP003 12/03/2018 04/30/2020
Evaluation and Management of Emergency Department Coding CPCP003 05/01/2020 12/31/2020
Evaluation and Management of Emergency Department Coding CPCP003 01/01/2021 01/09/2022
Evaluation and Management of Emergency Department Coding CPCP003 01/10/2022 01/31/2023
Evaluation and Management of Emergency Department Coding CPCP003 02/01/2023 07/31/2023
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 05/30/2018 09/06/2018
Neonatal Intensive Care Unit (NICU) Level of Care Authorization and Reimbursement Policy CPCP004 09/07/2018 05/14/2019
Neonatal Intensive Care Unit (NICU) Level of Care Authorization and Reimbursement Policy CPCP004 05/15/2019 06/30/2020
Neonatal Intensive Care Unit (NICU) Level of Care Authorization and Reimbursement Policy CPCP004 07/01/2020 02/01/2021
Neonatal Intensive Care Unit (NICU) Level of Care Authorization and Reimbursement Policy CPCP004 02/02/2021 02/20/2022
Neonatal Intensive Care Unit (NICU) Level of Care Authorization and Reimbursement Policy CPCP004 02/21/2022 11/28/2023
Home Health Care/Private Duty Nursing Policy Policy Number
Effective Date
End Date
Home Health Care/Private Duty Nursing Policy CPCP005 12/17/2018 10/31/2019
Home Health Care/Private Duty Nursing Policy CPCP005 11/01/2019 11/30/2019
Home Health Care/Private Duty Nursing Policy CPCP005 12/01/2020 12/31/2021
Home Health Care/Private Duty Nursing Policy CPCP005 01/01/2022 12/12/2022
Home Health Care/Private Duty Nursing Policy CPCP005 12/13/2022 11/02/2023
Preventive Services Policy Policy Number
Effective Date
End Date
Preventive Services Policy CPCP006 07/14/2017 07/29/2018
Preventive Services Policy CPCP006 07/30/2018 01/31/2019
Preventive Services Policy CPCP006 02/01/2019 09/30/2019
Preventive Services Policy CPCP006 10/01/2019 12/31/2019
Preventive Services Policy CPCP006 01/01/2020 03/31/2020
Preventive Services Policy CPCP006 04/01/2020 06/30/2020
Preventive Services Policy CPCP006 07/01/2020 09/30/2020
Preventive Services Policy CPCP006 10/01/2020 12/31/2020
Preventive Services Policy CPCP006 01/01/2021 03/31/2021
Preventive Services Policy CPCP006 04/01/2021 06/30/2021
Preventive Services Policy CPCP006 07/01/2021 09/30/2021
Preventive Services Policy CPCP006 10/01/2021 03/31/2021
Preventive Services Policy CPCP006 04/01/2022 06/30/2022
Preventive Services Policy CPCP006 07/01/2022 08/31/2022
Preventive Services Policy CPCP006 09/01/2022 09/30/2022
Preventive Services Policy CPCP006 10/01/2022 12/31/2022
Preventive Services Policy CPCP006 01/01/2023 02/28/2023
Preventive Services Policy CPCP006 03/01/2023 03/31/2023
Preventive Services Policy CPCP006 04/01/2023 06/30/2023
Preventive Services Policy CPCP006 07/01/2023 09/30/2023
Preventive Services Policy CPCP006 10/01/2023 10/31/2023
Preventive Services Policy CPCP006 11/01/2023 12/31/2023
Implant Payment and Coding Policy Policy Number
Effective Date
End Date
Implant Payment and Coding Policy CPCP007 07/30/2018 12/16/2018
Implant Payment and Coding Policy CPCP007 12/17/2018 06/06/2019
Implant Payment and Coding Policy CPCP007 06/07/2019 08/31/2020
Implant Payment and Coding Policy CPCP007 09/01/2020 02/26/2023
Psychological and Neuropsychological Testing Policy Number Effective Date End Date
Psychological and Neuropsychological Testing CPCP008 08/23/2017 09/14/2018
Psychological and Neuropsychological Testing CPCP008 09/15/2018 04/03/2019
Psychological and Neuropsychological Testing CPCP008 04/04/2019 05/31/2020
Psychological and Neuropsychological Testing CPCP008 06/01/2020 05/31/2021
Psychological and Neuropsychological Testing CPCP008 06/01/2021 11/01/2022
Psychological and Neuropsychological Testing CPCP008 11/02/2022 11/15/2023
Co-Surgeon/Team Surgeon Policy - Professional Provider Policy Number Effective Date End Date
Co-Surgeon/Team Surgeon Policy - Professional Provider CPCP009 04/30/2018 10/31/2019
Co-Surgeon/Team Surgeon Policy - Professional Provider CPCP009 11/01/2019 11/30/2020
Co-Surgeon/Team Surgeon Policy - Professional Provider CPCP009 12/01/2020 11/16/2021
Co-Surgeon/Team Surgeon Policy - Professional Provider CPCP009 11/17/2021 10/30/2022
Co-Surgeon/Team Surgeon Policy - Professional Provider CPCP009 10/31/2022 09/11/2023
Co-Surgeon/Team Surgeon Policy - Professional Provider CPCP009 09/12/2023 01/21/2024
Anesthesia Information Policy Number Effective Date End Date
Anesthesia Information CPCP010 04/30/2018 03/25/2019
Anesthesia Information CPCP010 03/26/2019 05/31/2020
Anesthesia Information CPCP010 06/01/2020 11/14/2021
Anesthesia Information CPCP010 11/15/2021 09/07/2022
Anesthesia Information CPCP010 09/08/2022 03/21/2023
Anesthesia Information CPCP010 03/22/2023 05/31/2024
Applied Behavioral Analysis Policy Number Effective Date End Date
Applied Behavioral Analysis CPCP011 05/30/2019 05/31/2020
Applied Behavioral Analysis CPCP011 06/01/2020 01/31/2021
Applied Behavioral Analysis CPCP011 02/01/2021 12/19/2021
Applied Behavioral Analysis CPCP011 12/20/2021 05/29/2023
Hernia Repair Policy Number Effective Date End Date
Hernia Repair CPCP012 03/26/2019 07/31/2020
Hernia Repair CPCP012 08/01/2020 05/08/2022
Hernia Repair CPCP012 05/09/2022 05/14/2023
Increased Procedural Services (Modifier 22) Policy Number Effective Date End Date
Increased Procedural Services (Modifier 22) CPCP013 05/30/2018 03/25/2019
Increased Procedural Services (Modifier 22) CPCP013 03/26/2019 05/31/2020
Increased Procedural Services (Modifier 22) CPCP013 06/01/2020 06/30/2021
Increased Procedural Services (Modifier 22) CPCP013 07/01/2021 03/31/2022
Increased Procedural Services (Modifier 22) CPCP013 04/01/2022 05/14/2023
Increased Procedural Services (Modifier 22) CPCP013 05/15/2023 01/21/2024
Global Surgical Package-Professional Providers Policy Number Effective Date End Date
Global Surgical Package-Professional Providers CPCP014 03/26/2019 06/30/2020
Global Surgical Package-Professional Providers CPCP014 07/01/2020 07/31/2021
Global Surgical Package-Professional Providers CPCP014 08/01/2021 03/31/2022
Global Surgical Package-Professional Providers CPCP014 04/01/2022 06/26/2023
Global Surgical Package-Professional Providers CPCP014 06/27/2023 01/21/2024
Multiple Surgical Procedures - Professional Provider Services Policy Number
Effective Date
End Date
Multiple Surgical Procedures - Professional Provider Services CPCP015 03/26/2019 08/31/2020
Multiple Surgical Procedures - Professional Provider Services CPCP015 09/01/2020 10/17/2021
Multiple Surgical Procedures - Professional Provider Services CPCP015 10/18/2021 06/28/2022
Multiple Surgical Procedures - Professional Provider Services CPCP015 06/29/2022 09/11/2023
Multiple Surgical Procedures - Professional Provider Services CPCP015 09/12/2023 01/21/2024
Chiropractic Services Policy Number
Effective Date
End Date
Chiropractic Services CPCP016 04/30/2018 08/31/2019
Chiropractic Services CPCP016 09/01/2019 10/31/2019
Chiropractic Services CPCP016 11/01/2019 11/30/2020
Chiropractic Services CPCP016 12/01/2020 02/20/2022
Chiropractic Services CPCP016 02/21/2022 03/21/2023
Chiropractic Services CPCP016 03/22/2023 01/21/2024
Wasted/Discarded Drugs and Biologicals Policy Policy Number Effective Date End Date
Wasted/Discarded Drugs and Biologicals Policy CPCP017 07/30/2018 08/31/2019
Wasted/Discarded Drugs and Biologicals Policy CPCP017 09/01/2019 11/30/2020
Wasted/Discarded Drugs and Biologicals Policy CPCP017 12/01/2020 12/05/2021
Wasted/Discarded Drugs and Biologicals Policy CPCP017 12/06/2021 02/21/2022
Wasted/Discarded Drugs and Biologicals Policy CPCP017 02/22/2022 01/31/2023
Wasted/Discarded Drugs and Biologicals Policy CPCP017 02/01/2023 02/29/2024
Outpatient Facility and Hospital Claims: Revenue Codes Requiring Supporting CPT, HCPCS and/or NDC Codes Policy Number Effective Date End Date
Outpatient Facility and Hospital Claims: Revenue Codes Requiring Supporting CPT, HCPCS and/or NDC Codes CPCP018 07/30/2018 08/31/2019
Outpatient Facility and Hospital Claims: Revenue Codes Requiring Supporting CPT, HCPCS and/or NDC Codes CPCP018 09/01/2019 08/31/2020
Outpatient Facility and Hospital Claims: Revenue Codes Requiring Supporting CPT, HCPCS and/or NDC Codes CPCP018 09/01/2020 12/31/2020
Outpatient Facility and Hospital Claims: Revenue Codes Requiring Supporting CPT, HCPCS and/or NDC Codes CPCP018 01/01/2021 01/23/2022
Outpatient Facility and Hospital Claims: Revenue Codes Requiring Supporting CPT, HCPCS and/or NDC Codes CPCP018 01/24/2022 11/01/2022
Outpatient Facility and Hospital Claims: Revenue Codes Requiring Supporting CPT, HCPCS and/or NDC Codes CPCP018 11/02/2022 11/02/2023
Home Infusion Policy Number Effective Date
End Date
Home Infusion CPCP019 03/26/2019 08/31/2020
Home Infusion CPCP019 09/01/2020 10/17/2021
Home Infusion CPCP019 10/18/2021 12/27/2022
Home Infusion CPCP019 12/28/2022 11/02/2023
Drug Testing CPCP Policy Number
Effective Date
End Date
Drug Testing CPCP CPCP020 12/17/2018 04/30/2020
Drug Testing CPCP CPCP020 05/01/2020 10/31/2020
Drug Testing CPCP CPCP020 11/01/2020 12/28/2021
Drug Testing CPCP CPCP020 12/29/2021 03/21/2023
Drug Testing CPCP CPCP020 03/22/2023 12/06/2023
Laboratory Panel Billing Guideline Policy Number Effective Date
End Date
Laboratory Panel Billing Guideline CPCP021 05/24/2019 06/30/2020
Laboratory Panel Billing Guideline CPCP021 07/01/2020 07/31/2021
Laboratory Panel Billing Guideline CPCP021 08/01/2021 09/05/2021
Laboratory Panel Billing Guideline CPCP021 09/06/2021 05/04/2022
Laboratory Panel Billing Guideline CPCP021 05/05/2022 06/26/2023
Pneumatic Compression Devices – Outpatient Use Policy Number Effective Date End Date
Pneumatic Compression Devices – Outpatient Use CPCP022 09/01/2019 10/31/2020
Pneumatic Compression Devices – Outpatient Use CPCP022 11/01/2020 02/20/2022
Pneumatic Compression Devices – Outpatient Use CPCP022 02/21/2022 01/31/2023
Pneumatic Compression Devices – Outpatient Use CPCP022 02/01/2023 02/29/2024
Modifier Reference Policy Policy Number Effective Date
End Date
Modifier Reference Policy CPCP023 06/01/2020 05/31/2021
Modifier Reference Policy CPCP023 06/01/2021 05/23/2022
Modifier Reference Policy CPCP023 05/24/2022 03/21/2023
Modifier Reference Policy CPCP023 04/01/2023 11/02/2023
Modifier Reference Policy CPCP023 11/03/2023 01/21/2024
Evaluation and Management (E/M) Coding – Professional Provider Services Policy Number Effective Date
End Date
Evaluation and Management (E/M) Coding – Professional Provider Services CPCP024 01/01/2021 02/27/2022
Evaluation and Management (E/M) Coding – Professional Provider Services CPCP024 02/28/2022 04/16/2023
Evaluation and Management (E/M) Coding – Professional Provider Services CPCP024 04/17/2023 12/06/2023
Therapeutic, Prophylactic and Diagnostic Injection and Infusion Coding Policy Number
Effective Date
End Date
Therapeutic, Prophylactic and Diagnostic Injection and Infusion Coding CPCP026 10/18/2021 12/27/2022
Therapeutic, Prophylactic and Diagnostic Injection and Infusion Coding CPCP026 12/28/2022 05/14/2023
Inpatient Readmission Policy Number
Effective Date End Date
Inpatient Readmission CPCP027 04/01/2020 01/23/2022
Inpatient Readmission CPCP027 01/24/2022 04/30/2023
Inpatient Readmission CPCP027 05/01/2023 06/30/2023
Inpatient Readmission CPCP027 07/01/2023 10/12/2023
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 09/01/2020 11/30/2020
Non-Reimbursable Experimental, Investigational and /or Unproven Services (EIU) CPCP028 12/01/2020 12/31/2020
Non-Reimbursable Experimental, Investigational and /or Unproven Services (EIU) CPCP028 01/01/2021 05/14/2021
Non-Reimbursable Experimental, Investigational and /or Unproven Services (EIU) CPCP028 05/15/2021 04/14/2022
Non-Reimbursable Experimental, Investigational and /or Unproven Services (EIU) CPCP028 04/15/2022 07/31/2022
Non-Reimbursable Experimental, Investigational and /or Unproven Services (EIU) CPCP028 08/01/2022 12/31/2022
Non-Reimbursable Experimental, Investigational and /or Unproven Services (EIU) CPCP028 01/01/2023 06/30/2023
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 09/01/2023 09/30/2023
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 12/01/2023 01/14/2024
Medical Record Documentation Policy Number
Effective Date
End Date
Medical Record Documentation CPCP029 03/01/2020 05/31/2021
Medical Record Documentation CPCP029 06/01/2021 11/14/2021
Medical Record Documentation CPCP029 11/15/2021 09/20/2022
Medical Record Documentation CPCP029 09/21/2022 11/02/2023
Point-of-Care Ultrasound (POCUS) Examination Policy Policy Number
Effective Date
End Date
Point-of-Care Ultrasound (POCUS) Examination Policy CPCP030 08/01/2020 07/31/2021
Point-of-Care Ultrasound (POCUS) Examination Policy CPCP030 08/01/2021 03/31/2022
Point-of-Care Ultrasound (POCUS) Examination Policy CPCP030 04/01/2022 09/11/2023
Trauma Activation – Facility Services Policy Number
Effective Date End Date
Trauma Activation – Facility Services CPCP031 07/01/2020 06/30/2020
Trauma Activation – Facility Services CPCP031 07/01/2021 03/31/2022
Trauma Activation – Facility Services CPCP031 04/01/2022 07/13/2023
Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Policy Policy Number
Effective Date End Date
Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Policy CPCP032 09/06/2021 05/08/2022
Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Policy CPCP032 05/09/2022 09/11/2023
Telemedicine and Telehealth/Virtual Health Care Services Policy Policy Number
Effective Date End Date
Telemedicine and Telehealth/Virtual Health Care Services Policy CPCP033 01/01/2021 03/17/2021
Telemedicine and Telehealth/Virtual Health Care Services Policy CPCP033 03/18/2021 03/27/2022
Telemedicine and Telehealth/Virtual Health Care Services Policy CPCP033 03/28/2022 12/06/2023
Telemedicine and Telehealth/Virtual Health Care Services Policy CPCP033 12/07/2023 02/29/2024
Unbundling Policy-Professional Providers Policy Number Effective Date End Date
Unbundling Policy-Professional Providers CPCP034 10/18/2021 05/04/2022
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 10/25/2021 09/07/2022
Paravertebral Facet Injection Procedure Coding & Billing Policy Policy Number
Effective Date
End Date
Paravertebral Facet Injection Procedure Coding & Billing Policy CPCP036 11/17/2021 12/12/2021
Paravertebral Facet Injection Procedure Coding & Billing Policy CPCP036 12/13/2021 12/27/2022
Paravertebral Facet Injection Procedure Coding & Billing Policy CPCP036 12/28/2022 11/02/2023
Outpatient Services Prior to an Inpatient Admission Policy Number Effective Date End Date
Outpatient Services Prior to an Inpatient Admission CPCP038 06/01/2023 02/29/2024
Physical Medicine and Rehabilitation Services Policy Number
Effective Date
End Date
Physical Medicine and Rehabilitation Services CPCP040 03/22/2023 01/21/2024