Reimbursement and Modifier Policies - Commercial

Document Title Document Type Document Size Effective Date
A
Advanced Notification - Evaluation and Management Services - (R30) PDF 284kB 06/01/2025
Advanced Notification - Modifier - Bilateral Procedures - (M50) PDF 190kB 03/15/2025
Advanced Notification - Retail Pharmacy Reimbursement Policy - (R48) PDF 187kB 09/01/2024
Advanced Practice Health Care Providers - (R37) PDF 155kB 01/10/2025
Ambulance Services - (R18) PDF 307kB 01/01/2025
Anesthesia Services - (R39)

PDF 322kB 01/10/2025
C
Care Integration Services - (R32) PDF 293kB 03/16/2025
Coding and Billing Accuracy - (R46) PDF 178kB 01/13/2025
COVID-19 Interim Billing Guidelines - (R33)

PDF 368kB 01/10/2025
D
Diagnosis Coding Guidelines - (R47) PDF 175kB 01/10/2025
Dialysis Services and Supplies - (R16) PDF 190kB 01/10/2025
DRG Clinical Review Program - (R20) PDF 172kB 01/01/2025
DRG Readmissions - (R35) PDF 155kB 01/01/2025
Drug Testing Billing Requirements - (R25)

PDF 246kB 01/10/2025
E
Emergency Room Services - (R36) PDF 303kB 01/10/2025
Evaluation and Management Services - (R30)

PDF 284kB 02/28/2025
F
Facility Services, Supplies and Equipment - (R12) PDF 610kB 01/01/2025
Frequency Editing - (R34)

PDF 143kB 01/10/2025
G
Genetic Testing Panels - (R28) PDF 189kB 01/15/2025
Global Maternity Obstetric Package - (R11) PDF 201kB 01/10/2025
Global Surgical Package and Related Modifiers (24, 54, 55, 56, 57, 58, 76, 77, 78 and 79) - (R23)

PDF 235kB 01/10/2025
H
Hospital Acquired Conditions - (R19) PDF 190kB 01/10/2025
Hospital in the Home - (R42)

PDF 142kB 01/01/2025
I
Implant Billing Requirements - (R13)

PDF 174kB 01/01/2025
L
Laboratory Services - (R17)

PDF 244kB 01/10/2025
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 200kB 01/10/2025
Modifier - Bilateral Procedures - (M50) PDF 204kB 01/10/2025
Modifier - Distinct Procedural Service - (M59) PDF 200kB 01/10/2025
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 179kB 01/10/2025
Modifier - Modifier 25 - Code List XLS 42kB 01/10/2024
Modifier - Multiple Procedures - (M51) PDF 184kB 01/10/2025
Modifier - Professional Component - (M26) PDF 165kB 01/10/2025
Modifier Reference Guide - (MRG) PDF 256kB 01/10/2025
Modifier - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service - (M25) PDF 188kB 01/10/2025
Modifier - Technical Component (MTC) PDF 157kB 01/10/2025
Multiple Births - (R03) PDF 202kB 01/10/2025
Multiple Procedure Reduction - Radiology - (R01)

PDF 169kB 01/10/2025
N
Never Events - (R05) PDF 212kB 01/10/2025
Newborn Inpatient Level of Care Billing Guidelines - (R29)

PDF 80kB 01/01/2025
O
Omnibus Reimbursement Policy - (R24)

PDF 247kB 01/10/2025
P
Pharmacy and Infusion Services - (R14) PDF 267kB 01/01/2025
Physician Interpretation and Report (I&R) Services - (R26) PDF 167kB 01/10/2025
Postoperative Continuous Local Delivery of Analgesia - (R06) PDF 136kB 01/10/2025
Precertification - (R21) PDF 102kB 01/02/2019
Preventive Medicine Evaluation and Management Service and Problem Based Evaluation and Management Service on the Same Day - (R02) PDF 230kB 01/10/2025
Procedure and Place of Service - (R43) PDF 386kB 02/14/2025
Professional Bundled Services - (R44) PDF 162kB 01/10/2025
Professional Services Performed by Facility Owned Practices - (R40)

PDF 322kB 01/01/2025
R
Refractive Vision Services - (R10) PDF 166kB 01/10/2025
Related Services, Supplies, Drugs, and Equipment - (R27) PDF 170kB 01/10/2025
Respiratory Services and Supplies - (R15) PDF 219kB 01/01/2025
Retail Pharmacy Reimbursement Policy - (R48) PDF 200kB 01/10/2025
Revenue Code Billing Requirements - (R41) PDF 254kB 01/01/2025
Robotic Assisted Surgery - (R04)

PDF 121kB 07/18/2023
U
Unacceptable Primary/Principal Diagnosis Policy - (R38) PDF 161kB 01/10/2025
Unlisted Codes - (R08)

PDF 173kB 01/10/2025
V
Virtual Care - (R31)

PDF 444kB 01/22/2025