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  3. Medical & Payment Policies

Medical
picture_as_pdfAmbulance - Air
picture_as_pdfAmbulance - Ground
picture_as_pdfAmbulatory Blood Pressure Monitors
picture_as_pdfArtificial Pancreas
picture_as_pdfBariatric Surgery
picture_as_pdfBCR-ABL1 Testing in Chronic Myelogenous Leukemia and Acute Lymphoblastic Leukemia
picture_as_pdfBRAF Mutation Analysis
picture_as_pdfBRCA1 and BRCA2 Genetic Mutation Testing and Related Genetic Counseling
picture_as_pdfBreast Reconstruction
picture_as_pdfBronchial Thermoplasty
picture_as_pdfCapsule Endoscopy
picture_as_pdfCardiac Rehabilitation, Phase II Outpatient
picture_as_pdfCarpal Tunnel
picture_as_pdfChromosomal Microarray Analysis
picture_as_pdfCochlear Implants
picture_as_pdfColorectal Cancer Screening
picture_as_pdfCustom Made Oral Appliances
picture_as_pdfDeep Brain Stimulation
picture_as_pdfEGD
picture_as_pdfElectrical Bone Growth Stimulation-Spinal
picture_as_pdfElectrical Bone Growth Stimulators in Long Bones
picture_as_pdfEnteral Feeding In-line Cartridge
picture_as_pdfFecal Transplant
picture_as_pdfFetal Aneuploidy
picture_as_pdfGender Transition Services
picture_as_pdfGene Expression Profiling in Tumor Tissue (Oncotype DX)
picture_as_pdfGenetic Testing for Colorectal Cancer Susceptibility
picture_as_pdfGenetic Testing for Cystic Fibrosis
picture_as_pdfGenetic Testing for Warfarin Therapy
picture_as_pdfGenetic Testing Panels
picture_as_pdfHome Oxygen Therapy
picture_as_pdfHyperbaric Oxygen Therapy
picture_as_pdfHypoglossal Nerve Stimulator
picture_as_pdfImplantable Cardioverter Defibrillator (ICD)
picture_as_pdfLabiaplasty
picture_as_pdfLong-Term Use Continuous Glucose Monitoring of Interstitial Fluid
picture_as_pdfMacular Degeneration
picture_as_pdfMagnetic Resonance-Guided Focused Ultrasound (MRgFUS)
picture_as_pdfMaternal Genetic Testing
picture_as_pdfMolecular Markers for Lung Cancer
picture_as_pdfMolecular Markers Thyroid
picture_as_pdfMyoelectric Upper Extremity Orthoses
picture_as_pdfNegative Pressure Wound Therapy (NPWT) in the Outpatient Setting
picture_as_pdfNoninvasive Assessment of Liver Fibrosis in Chronic Hepatitis C
picture_as_pdfNoninvasive Positive Pressure Ventilation
picture_as_pdfOncologic Genetic Panels
picture_as_pdfPanniculectomy
picture_as_pdfPassive Oscillatory Devices in the Outpatient Setting
picture_as_pdfPercutaneous Left Atrial Appendage
picture_as_pdfPlace of Service
picture_as_pdfProstate Cancer Testing
picture_as_pdfPulmonary Rehabilitation
picture_as_pdfScanning Computerized Ophthalmic Imaging
picture_as_pdfSingle Use ECG Monitoring
picture_as_pdfSkin Replacement Therapy in Chronic Wounds
picture_as_pdfSupervised Exercise Therapy for Peripheral Artery Disease (PAD)
picture_as_pdfTesting for Genetic Disease
picture_as_pdfTranscranial Magnetic Stimulators
picture_as_pdfUltrasound Bone Growth Stimulators
picture_as_pdfUpper Gastrointestinal Endoscopy
picture_as_pdfWearable Cardioverter-Defibrillators
picture_as_pdfWhole Exome and Whole Genome Sequencing for Diagnosis of Genetic Disorders

Payment Policies
picture_as_pdfAmbulatory Surgical Centers Medical Claims Processing Guidelines
picture_as_pdfFederally Qualified Health Centers Claims Processing Guidelines
picture_as_pdfICD-10-CM Official Guidelines and Reporting Excludes Notes Policy
picture_as_pdfObservation and Extended Assessment and Management in Facilities
picture_as_pdfPractitioner and Facility Emergency Department Policy
picture_as_pdfTelehealth Policy
picture_as_pdfTelehealth Policy Appendix

Post-Service Claim Edit Policies
picture_as_pdfBrineura
picture_as_pdfInterleukin 5 Inhibitors
picture_as_pdfLupron
picture_as_pdfVelcade