Reimbursement and Modifier Policies - Commercial

Document Title Document Type Document Size Effective Date
A
Advanced Notification - Ambulance Services - (R18) PDF 298kB 10/11/2025
Advanced Notification - Evaluation and Management Coding and Accuracy - (R49) PDF 210kB 10/01/2025
Advanced Notification - Facility Services, Supplies and Equipment - (R12) PDF 614kB 10/01/2025
Advanced Practice Health Care Providers - (R37) PDF 121kB 12/01/2021
Ambulance Services - (R18) PDF 249kB 07/15/2010
Anesthesia Services - (R39)

PDF 353kB 12/21/2022
C
Care Integration Services - (R32) PDF 261kB 11/14/2019
Coding and Billing Accuracy - (R46) PDF 168kB 10/14/2024
COVID-19 Interim Billing Guidelines - (R33)

PDF 368kB 01/10/2025
D
Diagnosis Coding Guidelines - (R47) PDF 168kB 03/15/2024
Dialysis Services and Supplies - (R16) PDF 182kB 07/15/2010
DRG Readmissions - (R35) PDF 151kB 07/20/2021
DRG Review Program - (R20) PDF 166kB 05/15/2011
Drug Testing Billing Requirements - (R25)

PDF 188kB 09/01/2015
E
Emergency Room Services - (R36) PDF 225kB 08/14/2021
Evaluation and Management Services - (R30)

PDF 131kB 07/18/2019
F
Facility Services, Supplies and Equipment - (R12) PDF 626kB 07/15/2010
Frequency Editing - (R34)

PDF 159kB 08/16/2020
G
Genetic Testing Panels - (R28) PDF 194kB 12/15/2018
Global Maternity Obstetric Package - (R11) PDF 209kB 07/15/2010
Global Surgical Package and Related Modifiers (24, 54, 55, 56, 57, 58, 76, 77, 78 and 79) - (R23)

PDF 235kB 02/28/2014
H
Hospital Acquired Conditions - (R19) PDF 214kB 04/15/2008
Hospital in the Home - (R42)

PDF 141kB 07/01/2023
I
Implant Billing Requirements - (R13)

PDF 167kB 07/15/2010
L
Laboratory Services - (R17)

PDF 122kB 07/15/2010
M
Modifier - Assistant Surgeon, Co-Surgeon (Two-Surgeons), and Surgical Team Code List - (MAS) XLSX 261kB 07/08/2021
Modifier - Assistant Surgeon – Modifiers 80, 81, 82 Assistant-At-Surgery – Modifier AS Co-Surgeon (Two Surgeons) – Modifier 62 Surgical Team – Modifier 66 - (MAS) PDF 211kB 06/12/2007
Modifier - Bilateral Procedures - (M50) PDF 155kB 05/29/2007
Modifier - Distinct Procedural Service - (M59) PDF 203kB 10/01/2005
Modifier - Distinct Procedural Service Code List - CMS/NCCI Documentation Requirement List - (M59) XLSX 56kB 08/19/2013
Modifier - Healthcare Common Procedure Coding System (HCPCS) National Level II Modifiers - (MHCPCS) PDF 322kB 01/10/2025
Modifier - Increased Procedural Services - (M22) PDF 170kB 05/21/2007
Modifier - Modifier 25 - Code List XLS 42kB 01/10/2024
Modifier - Multiple Procedures - (M51) PDF 174kB 02/01/2006
Modifier - Professional Component - (M26) PDF 156kB 05/15/2007
Modifier Reference Guide - (MRG) PDF 261kB 11/30/2017
Modifier - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service - (M25) PDF 201kB 04/20/2009
Modifier - Technical Component - (MTC) PDF 167kB 05/21/2007
Multiple Births - (R03) PDF 186kB 05/21/2007
Multiple Procedure Reduction - Radiology - (R01)

PDF 133kB 05/21/2007
N
Never Events - (R05) PDF 178kB 04/15/2008
Newborn Inpatient Level of Care Billing Guidelines - (R29)

PDF 149kB 04/18/2019
O
Omnibus Reimbursement Policy - (R24)

PDF 259kB 11/01/2014
P
Pharmacy and Infusion Services - (R14) PDF 262kB 07/15/2010
Physician Interpretation and Report (I&R) Services - (R26) PDF 158kB 12/07/2015
Postoperative Continuous Local Delivery of Analgesia - (R06) PDF 148kB 04/24/2008
Precertification - (R21) PDF 243kB 07/01/2025
Preventive Medicine Evaluation and Management Service and Problem Based Evaluation and Management Service on the Same Day - (R02) PDF 200kB 05/21/2007
Procedure and Place of Service - (R43) PDF 422kB 05/12/2023
Professional Bundled Services - (R44) PDF 165kB 08/12/2023
Professional Services Performed by Facility Owned Practices - (R40)

PDF 131kB 12/15/2022
R
Refractive Vision Services - (R10) PDF 135kB 10/15/2009
Related Services, Supplies, Drugs, and Equipment - (R27) PDF 146kB 04/07/2017
Respiratory Services and Supplies - (R15) PDF 122kB 07/15/2010
Retail Pharmacy Reimbursement Policy - (R48) PDF 203kB 09/01/2024
Revenue Code Billing Requirements - (R41) PDF 254kB 01/01/2025
Robotic Assisted Surgery - (R04)

PDF 132kB 09/22/2007
U
Unacceptable Primary/Principal Diagnosis Policy - (R38) PDF 157kB 11/12/2021
Unlisted Codes - (R08)

PDF 147kB 07/01/2009
V
Virtual Care - (R31)

PDF 450kB 03/12/2020