Provider reimbursement policies

This is a library of our professional reimbursement policies.

Policy number Policy name Effective date

NR-10.001

Add-On Procedure Codes

9/1/2021

NR-30.024

Ambulance Services

1/1/2020

NR-10.005

Anesthesia and Pain Management Services

9/2/2020

NR-09.907

Anticoagulant Management - Professional Outpatient Services

8/1/2020

NR-09.904

Chemotherapy Administration

8/1/2020

NR-30.025

Chiropractic Services

1/1/2020

NR-30.019

Correct Coding and Reimbursement Methodology

9/1/2021

NR-10.012

Dental Procedures and Related Anesthesia Services

8/1/2020

NR- 30.023

Drug Testing in Pain Management and Substance Abuse Treatment

8/1/2020

NR-04.002

Failed Colonoscopy

8/1/2020

NR-30.001

General Coding Guidelines

9/30/2021

NR-05.601

Global Obstetrical Allowance and Concurrent Services

8/19/2020

NR-09.003

Immunization Administration

12/11/2020

NR-01.001

Multiple Dermatology Procedures

9/1/2021

NR-04.001

Multiple Endoscopy Procedures

8/8/2020

NR-10.006

Multiple Surgical Procedures

9/1/2021

NR-09.901

Office Visit "Incident To" Services

9/30/2021

NR- 30.020

Payment Policy Indicators (National Physician Fee Schedule Relative Value File)

10/8/2021

NR-07.003

Radiology Services

9/4/2020

NR-30.017

Reimbursement for Durable Medical Equipment (DME)

9/2/2020

NR-30.014

Reimbursement for the Diagnosis and Treatment of Autism Spectrum Disorders

12/7/2020

NR-30.022

Reimbursement of Genetic Counseling Services

10/15/2021

NR-30.009

Reimbursement of Mental Health Services

4/1/2021

NR-09.007

Reimbursement of Physical Medicine and Occupational Therapy Sessions or Visits

8/1/2020

NR-30.021

Reimbursement of Services Performed by Allied Health Professionals

8/1/2020

NR-30.003

Reimbursement of Services Performed by Certified Nurse Midwives (CNM)

9/30/2021

NR-06.503

Reimbursement for Surgical Correction of Strabismus

8/7/2020

NTWK- P118

Retroactive Payment Adjustment Policy

11/1/2020

NR-09.902

Services in Addition to a Basic Service

8/3/2020

NR-10.011

Services Performed in Part by a Resident Under the Direction of a Teaching Physician

9/30/2021

NR-30.013

Surgical Techniques

9/2/2020

NR-30.016

Surgical or Other Invasive Procedure Misadventures

8/7/2020

NR- 30.026

Telehealth Services

3/16/2020


Telehealth Services Covered


This is a library of our facility reimbursement policies.

Policy number Policy name Effective date

FR-02.001

Avoidable Inpatient Readmissions

1/1/2018

FR-02.002

Observation Stay/Services

5/1/2021

These active policies have broader content that cover the listed retired policies' reimbursement guidelines.

Correct Coding Reimbursement Methodology

  • Allergy Immunotherapy and Testing
  • Cardiac Monitoring
  • Integral Procedures - Correct Coding Initiative (CCI)
  • Modifier -51 Exempt Procedure Codes
  • Radiation Therapy and Related Services
  • Screening Versus Diagnostic Mammography
  • Venipuncture

Payment Policy Indicators (National Physician Fee Schedule Relative Value File)

  • Assistant-at-Surgery
  • Bilateral Procedures
  • Correction of Trichiasis
  • Co-Surgery Procedures
  • Global Surgery Period
  • Measurement Codes
  • Reimbursement of Professional and Technical Components
  • Services Not Eligible When Reported With Another Physician Service - Status "T" Code
  • Team Surgery

Reimbursement of Services Performed by Allied Health Professionals

  • Reimbursement and Medical Direction of CRNAs
  • Supervision and Reimbursement of Certified Registered Nurse Practitioners
  • Supervision and Reimbursement of Physician Assistants (PA)