Reimbursement Policies

We want to assist physicians, facilities and other providers in accurate claims submissions and to outline the basis for reimbursement if the service is covered by a member’s benefit plan. Keep in mind that determination of coverage under a member's benefit plan does not necessarily ensure reimbursement. Please note:

• These policies may be superseded by state, federal or Centers for Medicare and Medicaid Services (CMS) requirements.  
• Providers and facilities are required to use industry standard codes for claim submissions.  
• Services should be billed with Current Procedure Terminology (CPT) codes, Healthcare Common Procedure Coding System (HCPCS) codes and/or revenue codes.  
• The billed code(s) should be fully supported in the medical record and/or office notes.  
• Industry practices are constantly changing, and we reserve the right to review and revise policies periodically.

Reimbursement policy disclaimer 

Reimbursement policy definitions