Prior Authorization & Claims

MMP 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 Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan) benefit plan. Keep in mind that determination of coverage under a member’s benefit plan does not necessarily ensure reimbursement. These policies may be superseded by state, federal or CMS requirements. Providers and facilities are required to use industry standard codes for claim submissions. Services should be billed with CPT codes, 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 Anthem Blue Cross reserves the right to review and revise its policies periodically.

Reimbursement Policy Disclaimer

These policies serve as a guide to assist you in accurate claim submissions and to outline the basis for reimbursement if the service is covered by a member’s Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan) benefit plan. The determination that a service, procedure, item, etc. is covered under a member's benefit plan is not a determination that you will be reimbursed. Services must meet authorization and medical necessity guidelines appropriate to the procedure and diagnosis as well as to the member’s state of residence. You must follow proper billing and submission guidelines. You are required to use industry standard, compliant codes on all claim submissions. Services should be billed with CPT codes, HCPCS codes and/or revenue codes. The codes denote the services and/or procedures performed. The billed code(s) are required to be fully supported in the medical record and/or office notes. Unless otherwise noted within the policy, our policies apply to both participating and nonparticipating providers and facilities.

If appropriate coding/billing guidelines or current reimbursement policies are not followed, Anthem Blue Cross (Anthem) may:

  • Reject or deny the claim
  • Recover and/or recoup claim payment

Anthem reimbursement policies are developed based on nationally accepted industry standards and coding principles. These policies may be superseded by mandates in provider or state contracts, or state, federal or CMS requirements. System logic or setup may prevent the loading of policies into the claims platforms in the same manner as described; however, Anthem strives to minimize these variations.

Anthem reserves the right to review and revise its policies periodically when necessary. When there is an update, we will publish the most current policy to this site.

reimbursement-policies.js
TitleApproval StatusRPCategoryMarketName (for use in forms)
Drugs and Injectable Limits ApprovedDrugsVirginiaVAVA_CAID_RP_DrugsInjectableLimits.pdf
Assistant at Surgery (Modifiers 80/81/82/AS) ApprovedCodingVirginiaVAVA_CAID_RP_AssistantSurgery.pdf
Requirements for Documentation of Proof of Timely FilingApprovedReimbursement Administration - GeneralVirginiaVAVA_CAID_RP_ClaimsTimelyFiling.pdf
Code and Clinical Editing GuidelinesApprovedReimbursement Administration - GeneralVirginiaVAVA_CAID_RP_CodeClinicalEditingGuidelines.pdf
Documentation Standards for Episodes of CareApprovedReimbursement Administration - GeneralVirginiaVAVA_CAID_RP_DocumentationStandards.pdf
Locum Tenens Physicians/Fee-for-Time CompensationApprovedReimbursement Administration - GeneralVirginiaVAVA_CAID_RP_LocumTenensPhysicians.pdf
Multiple and Bilateral Surgery: Professional and Facility ReimbursementApprovedCodingVirginiaVAVA_CAID_RP_MultipleandBilateralSurgery.pdf
Vaccines for Children (VFC) ProgramApprovedPreventionVirginiaVAVA_CAID_RP_VaccinesforChildren.pdf
Abortion (Termination of Pregnancy)ApprovedSurgeryKentuckyKYKY_CAID_RP_Abortion.pdf
Assistant at Surgery (Modifiers 80/81/82/AS)ApprovedCodingKentuckyKYKY_CAID_RP_AssistantatSurgery.pdf
Claims Requiring Additional DocumentationApprovedReimbursement Administration - GeneralVirginiaVAVA_CAID_RP_ClaimsReqAddDocs.pdf
Claims Submission – Required Information for Professional ProvidersApprovedReimbursement Administration - GeneralVirginiaVAVA_CAID_RP_ClaimsSub.pdf
Claims Submission – Required Information for FacilitiesApprovedReimbursement Administration - GeneralVirginiaVAVA_CAID_RP_ClaimsSubReqInfoFacilites.pdf
ConsultationsApprovedEvaluation and ManagementVirginiaVAVA_CAID_RP_Consultations.pdf
Duplicate or Subsequent Services on the Same Date of ServiceApprovedReimbursement Administration - GeneralVirginiaVAVA_CAID_RP_DuplicateofSubseqServ.pdf
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)ApprovedPreventionVirginiaVAVA_CAID_RP_EPSDT.pdf
Global Surgical PackageApprovedSurgeryVirginiaVAVA_CAID_RP_GlobalSurgicalPackg.pdf
Distinct Procedural Services (Modifiers 59, XE, XP, XS, XU)ApprovedCodingVirginiaVAVA_CAID_RP_Mod59DistinctProceduralSvc.pdf
Modifier 66 Surgical TeamsApprovedCodingVirginiaVAVA_CAID_RP_Mod66.pdf
Modifier 76: Repeat Procedure by the Same PhysicianApprovedCodingVirginiaVAVA_CAID_RP_Mod76RepeatProcedSamePhys.pdf
Modifier 77: Repeat Procedure by another PhysicianApprovedCodingVirginiaVAVA_CAID_RP_Mod77RepeatProcedAnothPhysician.pdf
Modifier 78: Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure during the Postoperative PeriodApprovedCodingVirginiaVAVA_CAID_RP_Mod78UnplanRettoORProcPostop.pdf
Modifier 91: Repeat Clinical Diagnostic Laboratory TestApprovedCodingVirginiaVAVA_CAID_RP_Modifier91RepeatLabTest.pdf
Modifiers LT and RT: Left Side/Right Side ProceduresApprovedCodingVirginiaVAVA_CAID_RP_ModifierLTandRT.pdf
Modifier UsageApprovedCodingVirginiaVAVA_CAID_RP_ModifierUsage.pdf
Multiple Radiology Payment ReductionApprovedRadiologyVirginiaVAVA_CAID_RP_MultipleRadiologyPayReduction.pdf
Other Provider Preventable Conditions (OPPC)ApprovedReimbursement Administration - GeneralVirginiaVAVA_CAID_RP_OtherProvPreventableConditions.pdf
Portable/Mobile/Handheld Radiology ServicesApprovedRadiologyVirginiaVAVA_CAID_RP_PortableMobileHandheldRadiology.pdf
Preventive Medicine and Sick Visits on the Same DayApprovedEvaluation and ManagementVirginiaVAVA_CAID_RP_PreventiveandSickonSameDay.pdf
SterilizationApprovedSurgeryVirginiaVAVA_CAID_RP_Sterilization.pdf
Emergency Services: Nonparticipating Providers and FacilitiesApprovedReimbursement Administration - GeneralVirginiaVAVA_CAID_RP_EmergServNonParticProvFac.pdf
HysterectomyApprovedSurgeryVirginiaVAVA_CAID_RP_Hysterectomy.pdf
Prosthetic and Orthotic DevicesApprovedProsthetics and OrthoticsVirginiaVAVA_CAID_RP_ProstheticOrthoticDevices.pdf
Reimbursement of Claims with Charge DiscrepanciesApprovedReimbursement Administration - GeneralVirginiaVAVA_CAID_RP_ReimbClaimswithChargeDiscrep.pdf
Reimbursement for Items under WarrantyApprovedReimbursement Administration - GeneralVirginiaVAVA_CAID_RP_ReimbItemsunderWarranty.pdf
Reimbursement of Sanctioned ProvidersApprovedReimbursement Administration - GeneralVirginiaVAVA_CAID_RP_ReimbSanctionedOptOutProv.pdf
Robotic Assisted SurgeryApprovedSurgeryVirginiaVAVA_CAID_RP_RoboticAssistedSurgery.pdf
Scope of PracticeApprovedReimbursement Administration - GeneralVirginiaVAVA_CAID_RP_ScopeofPractice.pdf
Site of Service Payment Differential — ProfessionalApprovedReimbursement Administration - GeneralVirginiaVAVA_CAID_RP_SiteofSvcPayDifferential.pdf
Split-Care Surgical ModifiersApprovedCodingVirginiaVAVA_CAID_RP_SplitCareModifiers.pdf
Claims Requiring Additional DocumentsApprovedReimbursement Administration - GeneralKentuckyKYKY_CAID_RP_ClaimsRequiringAdditionalDocumentation.pdf
Claims Submission - Required Information for FacilitiesApprovedReimbursement Administration - GeneralKentuckyKYKY_CAID_RP_ClaimsSubmissionRequiredInformationFacilities.pdf
Claims Timely FilingApprovedReimbursement Administration - GeneralKentuckyKYKY_CAID_RP_ClaimsTimelyFiling.pdf
Code and Clinical Editing GuidelinesApprovedReimbursement Administration - GeneralKentuckyKYKY_CAID_RP_CodeandClinicalEditingGuidelines.pdf
ConsultationsApprovedEvaluation and ManagementKentuckyKYKY_CAID_RP_Consultations.pdf
Diagnoses Used in DRG ComputationApprovedCodingKentuckyKYKY_CAID_RP_DiagnosesUsedinDRGComputation.pdf
Drugs and Injectable LimitsApprovedDrugsKentuckyKYKY_CAID_RP_DrugandInjectableLimits.pdf
Duplicate or Subsequent Services on the Same Date of ServiceApprovedReimbursement Administration - GeneralKentuckyKYKY_CAID_RP_DuplicateorSubsequentSvcsonSameDateSvc.pdf
Emergency Services: Nonparticipating Providers and FacilitiesApprovedReimbursement Administration - GeneralKentuckyKYKY_CAID_RP_EmergencySvcsNonParProvidersFacilities.pdf
Early and Periodic Screening, Diagnostic and Treatment (EPSDT)ApprovedPreventionKentuckyKYKY_CAID_RP_EPSDT.pdf
Facility Take-Home DrugsApprovedDrugsKentuckyKYKY_CAID_RP_FacilityTakeHomeDrugs.pdf
Global Surgical Package for Professional ProvidersApprovedSurgeryKentuckyKYKY_CAID_RP_GlobalSurgicalPackage.pdf
HysterectomyApprovedSurgeryKentuckyKYKY_CAID_RP_Hysterectomy.pdf
Inpatient ReadmissionApprovedReimbursement Administration - GeneralKentuckyKYKY_CAID_RP_InpatientReadmissions.pdf
Locum Tenens Physicians/Fee-for-Time CompensationApprovedReimbursement Administration - GeneralKentuckyKYKY_CAID_RP_LocumTenensPhysicians.pdf
Modifier 22: Increased Procedural ServiceApprovedCodingKentuckyKYKY_CAID_RP_Modifier22IncreasedProcSvc.pdf
Modifier 24: Unrelated Evaluation and Management Service by the Same Physician during the Postoperative PeriodApprovedCodingKentuckyKYKY_CAID_RP_Modifier24UnrelatedEMService.pdf
Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other ServiceApprovedCodingKentuckyKYKY_CAID_RP_Modifier25SignificantSeparatelyIdentifiableEMServices.pdf
Modifier 57: Decision for SurgeryApprovedCodingKentuckyKYKY_CAID_RP_Modifier57DecisionforSurgery.pdf
Distinct Procedural Services (Modifiers 59, XE, XP, XS, XU)ApprovedCodingKentuckyKYKY_CAID_RP_Modifier59DistinctProceduralService.pdf
Modifier 62 Co-SurgeonsApprovedCodingKentuckyKYKY_CAID_RP_Modifier62CoSurgeons.pdf
Modifier 66 Surgical TeamsApprovedCodingKentuckyKYKY_CAID_RP_Modifier66SurgicalTeams.pdf
Modifier 76: Repeat Procedure by Same PhysicianApprovedCodingKentuckyKYKY_CAID_RP_Modifier76RepeatProcedurebySamePhysician.pdf
Modifier 77: Repeat Procedure by Another PhysicianApprovedCodingKentuckyKYKY_CAID_RP_Modifier77RepeatProcedurebyAnotherPhysician.pdf
Modifiers LT and RT: Left Side/Right Side ProceduresApprovedCodingKentuckyKYKY_CAID_RP_ModifierLTandRT.pdf
Modifier UsageApprovedCodingKentuckyKYKY_CAID_RP_ModifierUsage.pdf
Multiple and Bilateral Surgery: Professional and Facility ReimbursementApprovedCodingKentuckyKYKY_CAID_RP_MultipleandBilateralSurgery.pdf
Multiple Radiology Payment ReductionApprovedRadiologyKentuckyKYKY_CAID_RP_MultipleRadiologyPaymentReduction.pdf
Other Provider Preventable Conditions (OPPC)ApprovedReimbursement Administration - GeneralKentuckyKYKY_CAID_RP_OtherProviderPreventableConditions.pdf
Portable/Mobile/Handheld Radiology ServicesApprovedRadiologyKentuckyKYKY_CAID_RP_PortableMobileHandheldRadiologyServices.pdf
Preadmission Services for Inpatient StaysApprovedFacilitiesKentuckyKYKY_CAID_RP_PreAdmissionServicesforInpatientStay.pdf
Present on Admission Indicator for Health Care Acquired ConditionsApprovedReimbursement Administration - GeneralKentuckyKYKY_CAID_RP_PresentonAdmissionHospitalAcquiredCond.pdf
Requirements for Documentation of Proof of Timely FilingApprovedReimbursement Administration - GeneralKentuckyKYKY_CAID_RP_ProofofTimelyFiling.pdf
Prosthetic and Orthotic DevicesApprovedProsthetics and OrthoticsKentuckyKYKY_CAID_RP_ProstheticandOrthoticDevices.pdf
Reimbursement for Reduced and Discontinued ServicesApprovedCodingKentuckyKYKY_CAID_RP_ReducedandDiscontinuedServices.pdf
Reimbursement of Claims with Charge DiscrepanciesApprovedReimbursement Administration - GeneralKentuckyKYKY_CAID_RP_ReimbursementClaimswithChargeDiscrepancies.pdf
Reimbursement for Items Under WarrantyApprovedReimbursement Administration - GeneralKentuckyKYKY_CAID_RP_ReimbursementItemsUnderWarranty.pdf
Reimbursement of Services with Obsolete CodesApprovedCodingKentuckyKYKY_CAID_RP_ReimbursementofObsoleteCodes.pdf
Reimbursement of Sanctioned ProvidersApprovedReimbursement Administration - GeneralKentuckyKYKY_CAID_RP_ReimbursementSanctionedandOptOutProviders.pdf
Robotic Assisted SurgeryApprovedSurgeryKentuckyKYKY_CAID_RP_RoboticAssistedSurgery.pdf
Scope of PracticeApprovedReimbursement Administration - GeneralKentuckyKYKY_CAID_RP_ScopeofPractice.pdf
Site of Service Payment Differential – Professional ApprovedReimbursement Administration - GeneralKentuckyKYKY_CAID_RP_SiteofServicePaymentDifferential.pdf
Split-Care Surgical ModifiersApprovedCodingKentuckyKYKY_CAID_RP_SplitCareSurgicalModifiers.pdf
SterilizationApprovedSurgeryKentuckyKYKY_CAID_RP_Sterilization.pdf
Unlisted, Unspecified or Miscellaneous CodesApprovedCodingKentuckyKYKY_CAID_RP_UnlistedorMiscCodes.pdf
Vaccines for Children (VFC) ProgramApprovedPreventionKentuckyKYKY_CAID_RP_VaccinesforChildrenProgram.pdf
Documentation Standards for Episodes of CareApprovedReimbursement Administration - GeneralKentuckyKYKY_CAID_RP_DocumentationStandardsEpisodesCare.pdf
Abortion (Termination of Pregnancy)ApprovedSurgeryWisconsinWIWI_CAID_RP_Abortion.pdf
Assistant at Surgery (Modifiers 80/81/82/AS)ApprovedCodingWisconsinWIWI_CAID_RP_Assistant_at_Surgery.pdf
Claims Submission – Required Information for FacilitiesApprovedReimbursement Administration - GeneralWisconsinWIWI_CAID_RP_Claims_Submission_Required_Info_Facilities.pdf
Claims Submission – Required Information for Professional ProvidersApprovedReimbursement Administration - GeneralWisconsinWIWI_CAID_RP_Claims_Submission_Required_Info_Prof_Providers.pdf
Requirements for Documentation of Proof of Timely FilingApprovedReimbursement Administration - GeneralWisconsinWIWI_CAID_RP_Claims_Timely_Filing.pdf
Code and Clinical Editing GuidelinesApprovedReimbursement Administration - GeneralWisconsinWIWI_CAID_RP_Code_Clinical_Editing.pdf
Consultations ApprovedEvaluation and ManagementWisconsinWIWI_CAID_RP_Consultations.pdf
Diagnoses Used in DRG ComputationApprovedCodingWisconsinWIWI_CAID_RP_Diagnoses_DRG_Computation.pdf
Documentation Standards for Episodes of CareApprovedReimbursement Administration - GeneralWisconsinWIWI_CAID_RP_Documentation_Episodes_Care.pdf
Duplicate or Subsequent Services on the Same Date of ServiceApprovedReimbursement Administration - GeneralWisconsinWIWI_CAID_RP_Duplicate_Subsequent_Services_Same_Date.pdf
Emergency Services: Nonparticipating Providers and FacilitiesApprovedReimbursement Administration - GeneralWisconsinWIWI_CAID_RP_Emergency_Services_Non-Participating_Providers.pdf
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)ApprovedPreventionWisconsinWIWI_CAID_RP_EPSDT.pdf
Global Surgical Package for Professional ProvidersApprovedSurgeryWisconsinWIWI_CAID_RP_Global_Surgical_Package.pdf
Hysterectomy ApprovedSurgeryWisconsinWIWI_CAID_RP_Hysterectomy.pdf
Locum Tenens Physicians/Fee-for-Time CompensationApprovedReimbursement Administration - GeneralWisconsinWIWI_CAID_RP_Locum_Tenens_Physicians.pdf
Modifiers LT and RT: Left Side/Right Side ProceduresApprovedCodingWisconsinWIWI_CAID_RP_Mod_Left_Right_Side_Procedures.pdf
Modifier 22: Increased Procedural ServiceApprovedCodingWisconsinWIWI_CAID_RP_Mod22_Increased_Procedural_Service.pdf
Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other ServiceApprovedCodingWisconsinWIWI_CAID_RP_Mod25_Signif_Separately_Identif_EM_Svc.pdf
Modifier 57: Decision for SurgeryApprovedCodingWisconsinWIWI_CAID_RP_Mod57_Decision_for_Surgery.pdf
Distinct Procedural Services (Modifiers 59, XE, XP, XS, XU)ApprovedCodingWisconsinWIWI_CAID_RP_Mod59_Distinct_Procedural_Service_External.pdf
Modifier 62: Co-SurgeonsApprovedCodingWisconsinWIWI_CAID_RP_Mod62_Co-Surgeons.pdf
Modifier 63: Procedure Performed on Infants less than 4 kgApprovedCodingWisconsinWIWI_CAID_RP_Mod63_Proced_Performed_Infants_4kg.pdf
Modifier 66 Surgical TeamsApprovedCodingWisconsinWIWI_CAID_RP_Mod66_Surgical_Teams.pdf
Modifier 76: Repeat Procedure by the Same PhysicianApprovedCodingWisconsinWIWI_CAID_RP_Mod76_Repeat_Proc_Same_Physician.pdf
Modifier 77: Repeat Procedure by another PhysicianApprovedCodingWisconsinWIWI_CAID_RP_Mod77_Repeat_Procedure_Another_Physician.pdf
Modifier Usage ApprovedCodingWisconsinWIWI_CAID_RP_Modifier_Usage.pdf
Multiple and Bilateral Surgery: Professional and Facility Reimbursement ApprovedCodingWisconsinWIWI_CAID_RP_Multiple_Bilateral_Surgery.pdf
Multiple Radiology Payment ReductionApprovedRadiologyWisconsinWIWI_CAID_RP_Multiple_Radiology_Payt_Reduction.pdf
Other Provider Preventable Conditions (OPPC)ApprovedReimbursement Administration - GeneralWisconsinWIWI_CAID_RP_Other_Provider_Preventable_Conditions.pdf
Portable/Mobile/Hand-held Radiology ServicesApprovedRadiologyWisconsinWIWI_CAID_RP_Portable_Mobile_Handheld_Radiology.pdf
Preadmission Services for Inpatient StaysApprovedFacilitiesWisconsinWIWI_CAID_RP_Pre_Admission_Services.pdf
Present on Admission Indicator for Health Care-Acquired ConditionsApprovedReimbursement Administration - GeneralWisconsinWIWI_CAID_RP_Present_on_Admission_Hospital_Acqd_Conds.pdf
Preventive Medicine and Sick Visits on the Same DayApprovedEvaluation and ManagementWisconsinWIWI_CAID_RP_Preventative_Sick_Visits_Same_Day.pdf
Professional Anesthesia Services ApprovedAnesthesiaWisconsinWIWI_CAID_RP_Professional_Anesthesia_Services.pdf
Prosthetic and Orthotic DevicesApprovedProsthetics and OrthoticsWisconsinWIWI_CAID_RP_Prosthetic_Orthotic_Devices.pdf
Reimbursement for Reduced and Discontinued ServicesApprovedCodingWisconsinWIWI_CAID_RP_Reduced_Discontinued_Services.pdf
Reimbursement of Sanctioned ProvidersApprovedReimbursement Administration - GeneralWisconsinWIWI_CAID_RP_Reimburse_Sanctioned_Opt_Out_Providers.pdf
Reimbursement of Claims with Charge DiscrepanciesApprovedReimbursement Administration - GeneralWisconsinWIWI_CAID_RP_Reimbursement_Claims_Charge_Discrepancies.pdf
Reimbursement for Items Under WarrantyApprovedReimbursement Administration - GeneralWisconsinWIWI_CAID_RP_Reimbursement_Items_Under_Warranty.pdf
Robotic Assisted SurgeryApprovedSurgeryWisconsinWIWI_CAID_RP_Robotic_Assisted_Surgery.pdf
Scope of Practice ApprovedReimbursement Administration - GeneralWisconsinWIWI_CAID_RP_Scope_of_Practice.pdf
Reimbursement of Services with Obsolete CodesApprovedCodingWisconsinWIWI_CAID_RP_Services_Obsolete_Codes.pdf
Site of Service Payment Differential - ProfessionalApprovedReimbursement Administration - GeneralWisconsinWIWI_CAID_RP_Site_of_Service_Payment_Differential.pdf
Split Care Surgical Modifiers ApprovedCodingWisconsinWIWI_CAID_RP_Split_Care_Surgical_Modifiers.pdf
SterilizationApprovedSurgeryWisconsinWIWI_CAID_RP_Sterilization.pdf
Facility Take-Home DrugsApprovedDrugsWisconsinWIWI_CAID_RP_Take_Home_Drugs.pdf
Unlisted, Unspecified or Miscellaneous CodesApprovedCodingWisconsinWIWI_CAID_RP_Unlisted_Miscellaneous_Codes.pdf
Vaccines for Children (VFC) ProgramApprovedPreventionWisconsinWIWI_CAID_RP_Vaccines_for_Children.pdf
Professional Anesthesia ServicesApprovedAnesthesiaVirginiaVAVA_CAID_RP_Anesthesia.pdf
Diagnoses Used in DRG ComputationApprovedCodingVirginiaVAVA_CAID_RP_DRGComputation.pdf
Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other ServiceApprovedCodingVirginiaVAVA_CAID_RP_Modifier25.pdf
Modifier 57: Decision for SurgeryApprovedCodingVirginiaVAVA_CAID_RP_Modifier57DecisionforSurgery.pdf
Modifier 62: Co-SurgeonsApprovedCodingVirginiaVAVA_CAID_RP_Modifier62Surgeons.pdf
Reimbursement of Services with Obsolete CodesApprovedCodingVirginiaVAVA_CAID_RP_ObsoleteCodes.pdf
Preadmission Services for Inpatient StaysApprovedFacilitiesVirginiaVAVA_CAID_RP_PreAdmissSvcforInpatientStays.pdf
Reimbursement for Reduced and Discontinued ServicesApprovedCodingVirginiaVAVA_CAID_RP_ReducedandDiscontinuedServices.pdf
Take-Home DrugsApprovedDrugsVirginiaVAVA_CAID_RP_TakeHomeDrugs.pdf
Unlisted, Unspecified or Miscellaneous CodesApprovedCodingVirginiaVAVA_CAID_RP_UnlistedorMisc.pdf
Preventive Medicine and Sick Visits on the Same DayApprovedEvaluation and ManagementKentuckyKYKY_CAID_RP_PreventiveSickSameDay.pdf
Inpatient ReadmissionsApprovedFacilitiesVirginiaVAVA_CAID_RP_InpatientReadmissions.pdf
Abortion (Termination of Pregnancy)ApprovedSurgeryVirginiaVAVA_CAID_RP_Abortion.pdf
Abortion (Termination of Pregnancy)ApprovedSurgeryVA MMPVAVA_MMP_RP_Abortion.pdf
AnesthesiaApprovedAnesthesiaVA MMPVAVA_MMP_RP_Anesthesia.pdf
Claims Requiring Additional DocumentationApprovedReimbursement Administration - GeneralVA MMPVAVA_MMP_RP_Claims_Requiring_Additional_Documentation.pdf
Claims Timely FilingApprovedReimbursement Administration - GeneralVA MMPVAVA_MMP_RP_ClaimsTimelyFiling.pdf
Code and Clinical Editing Guidelines ApprovedReimbursement Administration - GeneralVA MMPVAVA_MMP_RP_CodeandClinicalEditingGuidelines.pdf
Consultations ApprovedEvaluation and ManagementVA MMPVAVA_MMP_RP_Consultations.pdf
Modifier 57: Decision for Surgery ApprovedCodingVA MMPVAVA_MMP_RP_DecisionforSurgery.pdf
Diagnoses Used in DRG Computation ApprovedCodingVA MMPVAVA_MMP_RP_DiagnosesUsedinDRGComputation.pdf
Documentation Standards for Episodes of Care ApprovedReimbursement Administration - GeneralVA MMPVAVA_MMP_RP_DocumentationStandardsEpisodesofCare.pdf
Drug and Injectable LimitsApprovedDrugsVA MMPVAVA_MMP_RP_DrugandInjectableLimits.pdf
Duplicate or Subsequent Services on the Same Date of ServiceApprovedReimbursement Administration - GeneralVA MMPVAVA_MMP_RP_DuplicateServicesSameDate.pdf
Facility Take-Home DrugsApprovedDrugsVA MMPVAVA_MMP_RP_FacilityTakeHomeDrugs.pdf
Global Surgical Package ApprovedSurgeryVA MMPVAVA_MMP_RP_GlobalSurgicalPackage.pdf
HysterectomyApprovedSurgeryVA MMPVAVA_MMP_RP_Hysterectomy.pdf
Modifiers LT and RT: Left Side/Right Side ProceduresApprovedCodingVA MMPVAVA_MMP_RP_LeftSideRightSideProcedures.pdf
Locum Tenens Physicians/Fee-for-Time CompensationApprovedReimbursement Administration - GeneralVA MMPVAVA_MMP_RP_LocumTenens.pdf
Modifier 22: Increased Procedural ServiceApprovedCodingVA MMPVAVA_MMP_RP_Mod22_IncreasedProceduralService.pdf
Modifier 24: Unrelated Evaluation and Management Service by the Same Physician during the Postoperative PeriodApprovedCodingVA MMPVAVA_MMP_RP_Mod24_UnrelatedEvaluationManagementService.pdf
Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other ServiceApprovedCodingVA MMPVAVA_MMP_RP_Mod25_SignificantSeparate.pdf
Distinct Procedural Services (Modifiers 59, XE, XP, XS, XU)ApprovedCodingVA MMPVAVA_MMP_RP_Mod59_DistinctProceduralService.pdf
Modifier 62: Co-SurgeonsApprovedCodingVA MMPVAVA_MMP_RP_Mod62_Co-Surgeons.pdf
Modifier 66 Surgical TeamsApprovedCodingVA MMPVAVA_MMP_RP_Mod66_SurgicalTeams.pdf
Modifier 76: Repeat Procedure by the Same PhysicianApprovedCodingVA MMPVAVA_MMP_RP_Mod76_RepeatProcedureSamePhysician.pdf
Modifier 77: Repeat Procedure by another PhysicianApprovedCodingVA MMPVAVA_MMP_RP_Mod77_RepeatProcedureAnotherPhysician.pdf
Modifier UsageApprovedCodingVA MMPVAVA_MMP_RP_ModifierUsage.pdf
Multiple and Bilateral Surgery: Professional and Facility ReimbursementApprovedCodingVA MMPVAVA_MMP_RP_MultipleBilateralSurgery.pdf
Other Provider Preventable Conditions (OPPC)ApprovedReimbursement Administration - GeneralVA MMPVAVA_MMP_RP_OtherPreventableProviderConditions.pdf
Preadmission Services for Inpatient StaysApprovedFacilitiesVA MMPVAVA_MMP_RP_PreadmissionServicesforInpatientStays.pdf
Requirements for Documentation of Proof of Timely Filing ApprovedReimbursement Administration - GeneralVA MMPVAVA_MMP_RP_ProofTimelyFiling.pdf
Prosthetic and Orthotic DevicesApprovedProsthetics and OrthoticsVA MMPVAVA_MMP_RP_ProstheticOrthoticDevices.pdf
Reimbursement for Reduced and Discontinued Services ApprovedCodingVA MMPVAVA_MMP_RP_ReducedDiscontinuedServices.pdf
Reimbursement for Items Under WarrantyApprovedReimbursement Administration - GeneralVA MMPVAVA_MMP_RP_ReimbursementItemsUnderWarranty.pdf
Reimbursement of Services with Obsolete CodesApprovedCodingVA MMPVAVA_MMP_RP_ReimbursementObsoleteCodes.pdf
Reimbursement of Claims with Charge DiscrepanciesApprovedReimbursement Administration - GeneralVA MMPVAVA_MMP_RP_ReimbursementofClaimswithChargeDiscrepancies.pdf
Claims Submission – Required Information for FacilitiesApprovedReimbursement Administration - GeneralVA MMPVAVA_MMP_RP_RequiredInfoFacilities.pdf
Claims Submission – Required Information for Professional ProvidersApprovedReimbursement Administration - GeneralVA MMPVAVA_MMP_RP_RequiredInfoProviders.pdf
Robotic Assisted SurgeryApprovedSurgeryVA MMPVAVA_MMP_RP_RoboticAssistedSurgery.pdf
Same Day Preventive Medicine & Sick VisitsApprovedEvaluation and ManagementVA MMPVAVA_MMP_RP_SameDayPreventativeSickVisits.pdf
Scope of PracticeApprovedReimbursement Administration - GeneralVA MMPVAVA_MMP_RP_ScopeofPractice.pdf
Site of Service Payment DifferentialApprovedReimbursement Administration - GeneralVA MMPVAVA_MMP_RP_SiteofServicePaymentDifferential.pdf
Split-Care Surgical ModifiersApprovedCodingVA MMPVAVA_MMP_RP_Split-Care_Surgical_Modifiers.pdf
SterilizationApprovedSurgeryVA MMPVAVA_MMP_RP_Sterilization.pdf
Transportation ServicesApprovedTransportationVA MMPVAVA_MMP_RP_TransportationServices.pdf
Unlisted or Miscellaneous CodesApprovedCodingVA MMPVAVA_MMP_RP_UnlistedorMiscCodes.pdf
Reimbursement of Sanctioned and Opt-Out ProvidersApprovedReimbursement Administration - GeneralVA MMPVAVA_MMP_RP_ReimbursementSanctionedOptOutProviders.pdf
Transportation Services: Ambulance and Non-Emergent TransportApprovedTransportationKentuckyKYKY_CAID_RP_Transportation.pdf
Modifier 91: Repeat Clinical Diagnostic Laboratory TestApprovedCodingKentuckyKYKY_CAID_RP_Modifier91RepeatClinicalDiagnosticLabTest.pdf
Modifier 78: Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure during the Postoperative PeriodApprovedCodingKentuckyKYKY_CAID_RP_Modifier78UnplannedReturntotheOperatingRoom.pdf
Emergency Services: Nonparticipating Providers and FacilitiesApprovedReimbursement Administration - GeneralVA MMPVAVA_MMP_RP_EmergencyServicesNonparticipating.pdf
Modifier 78: Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure during the Postoperative PeriodApprovedCodingVA MMPVAVA_MMP_RP_Mod78UnplannedReturntoOperating.pdf
Modifier 91: Repeat Clinical Diagnostic Laboratory TestApprovedCodingVA MMPVAVA_MMP_RP_Mod91RepeatClinicalDiagnosticTest.pdf
Multiple Radiology Payment ReductionsApprovedRadiologyVA MMPVAVA_MMP_RP_MultipleRadiologyPaymentReductions.pdf
Present on Admission Indicator for Health Care-Acquired ConditionsApprovedReimbursement Administration - GeneralVA MMPVAVA_MMP_RP_PresentonAdmissionAcquiredConditions.pdf
DRG Inpatient Facility TransfersApprovedFacilitiesKentuckyKYKY_CAID_RP_InpatientFacilityTransfers.pdf
Maternity ServicesApprovedSurgeryKentuckyKYKY_CAID_RP_MaternityServices.pdf
Modifier 63: Procedure Performed on Infants less than 4 kgApprovedCodingKentuckyKYKY_CAID_RP_Mod63_ProceduresonInfants.pdf
Maternity ServicesApprovedSurgeryVirginiaVAVA_CAID_RP_MaternityServices.pdf
Modifier 63: Procedure Performed on Infants less than 4 kgApprovedCodingVirginiaVAVA_CAID_RP_Mod63ProceduresonInfants.pdf
Inpatient ReadmissionApprovedReimbursement Administration - GeneralWisconsinWIWI_CAID_RP_InpatientReadmissions.pdf
Maternity ServicesApprovedSurgeryWisconsinWIWI_CAID_RP_MaternityServices.pdf
Transportation Services: Ambulance and Nonemergent TransportApprovedTransportationWisconsinWIWI_CAID_RP_TransportationServices.pdf
DRG Inpatient Facility TransfersApprovedFacilitiesWisconsinWIWI_CAID_RP_InpatientFacilityTransfers.pdf
Modifier 78: Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure during the Postoperative PeriodApprovedCodingWisconsinWIWI_CAID_RP_Mod78_UnplannedReturn.pdf
Present on Admission Indicator for Health Care-Acquired ConditionsApprovedReimbursement Administration - GeneralVirginiaVAVA_CAID_RP_PreAdmissionHospAcqCond.pdf
AnesthesiaApprovedAnesthesiaKentuckyKYKY_CAID_RP_Anesthesia.pdf
Modifier 24: Unrelated Evaluation and Management Service by the Same Physician during the Postoperative PeriodApprovedCodingVirginiaVAVA_CAID_RP_Mod24UnrelatedEMSvc.pdf
Transportation Services: Ambulance and Non-Emergent TransportApprovedTransportationVirginiaVAVA_CAID_RP_TransportationServices.pdf
Modifier 24: Unrelated Evaluation and Management Service by the Same Physician during the Postoperative PeriodApprovedCodingWisconsinWIWI_CAID_RP_Mod24_UnrelatedEvalPostOp.pdf
DRG Inpatient Facility TransfersApprovedFacilitiesVirginiaVAVA_CAID_RP_InpatientFacilityTransfers.pdf
Abortion (Termination of Pregnancy)ApprovedSurgeryIndianaININ_CAID_RP_Abortion.pdf
Assistant at Surgery (Modifiers 80/81/82/AS)ApprovedCodingIndianaININ_CAID_RP_AssistantSurgery.pdf
Claims Requiring Additional DocumentationApprovedReimbursement Administration - GeneralIndianaININ_CAID_RP_ClaimsRequiringDocumentation.pdf
Claims Submission — Required Information for Professional ProvidersApprovedReimbursement Administration - GeneralIndianaININ_CAID_RP_ClaimsSubmissionRequiredInfoProfessionalProviders.pdf
ConsultationsApprovedEvaluation and ManagementIndianaININ_CAID_RP_Consultations.pdf
Modifier 62: Co-SurgeonsApprovedCodingIndianaININ_CAID_RP_CoSurgeons.pdf
Modifier 57: Decision for SurgeryApprovedCodingIndianaININ_CAID_RP_DecisionSurgery.pdf
Distinct Procedural Services (Modifiers 59, XE, XP, XS, XU)ApprovedCodingIndianaININ_CAID_RP_DistinctProceduralService.pdf
Drugs and Injectable LimitsApprovedDrugsIndianaININ_CAID_RP_DrugsInjectableLimits.pdf
Early and Periodic Screening, Diagnostic and Treatment (EPSDT)ApprovedPreventionIndianaININ_CAID_RP_EPSDT.pdf
Emergency Services: Non-Participating Providers and FacilitiesApprovedReimbursement Administration - GeneralIndianaININ_CAID_RP_ERNonparticipatingProviders.pdf
Facility Take-Home DrugsApprovedDrugsIndianaININ_CAID_RP_FacilityTakeHomeDrugs.pdf
Global Surgical Package for Professional ProvidersApprovedSurgeryIndianaININ_CAID_RP_GlobalSurgicalPackageProfessionalProviders.pdf
HysterectomyApprovedSurgeryIndianaININ_CAID_RP_Hysterectomy.pdf
Modifier 22: Increased Procedural ServiceApprovedCodingIndianaININ_CAID_RP_IncreasedProceduralService.pdf
DRG Inpatient Facility TransfersApprovedFacilitiesIndianaININ_CAID_RP_InpatientFacilityTransfers.pdf
Inpatient ReadmissionsApprovedReimbursement Administration - GeneralIndianaININ_CAID_RP_InpatientReadmissions.pdf
Locum Tenens Physicians/Fee-for-Time CompensationApprovedReimbursement Administration - GeneralIndianaININ_CAID_RP_LocumTenens.pdf
Maternity ServicesApprovedSurgeryIndianaININ_CAID_RP_MaternityServices.pdf
Modifiers LT and RT: Left Side/Right Side ProceduresApprovedCodingIndianaININ_CAID_RP_ModifiersLTRTProcedures.pdf
Modifier UsageApprovedCodingIndianaININ_CAID_RP_ModifierUsage.pdf
Multiple and Bilateral Surgery: Professional and Facility ReimbursementApprovedCodingIndianaININ_CAID_RP_MultipleBilateralSurgery.pdf
Other Provider Preventable Conditions (OPPC)ApprovedReimbursement Administration - GeneralIndianaININ_CAID_RP_OtherProviderPreventableConditions.pdf
Portable/Mobile/Handheld Radiology ServicesApprovedRadiologyIndianaININ_CAID_RP_PortableRadiologyServices.pdf
Preadmission Services for Inpatient StaysApprovedFacilitiesIndianaININ_CAID_RP_PreadmissionInpatient.pdf
Present on Admission Indicator for Health Care-Acquired ConditionsApprovedReimbursement Administration - GeneralIndianaININ_CAID_RP_PresentAdmissionsHCAcquiredConditions.pdf
Preventive Medicine and Sick Visits on the Same DayApprovedEvaluation and ManagementIndianaININ_CAID_RP_PreventiveMedsSickVisits.pdf
Modifier 63: Procedure Performed on Infants Less Than 4 kgApprovedCodingIndianaININ_CAID_RP_ProcedureInfantsUnder4kg.pdf
Professional Anesthesia ServicesApprovedAnesthesiaIndianaININ_CAID_RP_ProfessionalAnesthesiaServices.pdf
Prosthetic and Orthotic DevicesApprovedProsthetics and OrthoticsIndianaININ_CAID_RP_ProstheticOrthoticDevices.pdf
Reimbursement for Reduced and Discontinued ServicesApprovedCodingIndianaININ_CAID_RP_ReducedDiscontinuedServices.pdf
Modifier 91: Repeat Clinical Diagnostic Laboratory TestApprovedCodingIndianaININ_CAID_RP_RepeatClinicalDiagnosticLabTest.pdf
Modifier 77: Repeat Procedure by Another PhysicianApprovedCodingIndianaININ_CAID_RP_RepeatProcedureAnotherPhysician.pdf
Modifier 76: Repeat Procedure by the Same PhysicianApprovedCodingIndianaININ_CAID_RP_RepeatProcedureSamePhysician.pdf
Requirements for Documentation of Proof of Timely FilingApprovedReimbursement Administration - GeneralIndianaININ_CAID_RP_RequiredDocumentationProofTimelyFiling.pdf
Robotic Assisted SurgeryApprovedSurgeryIndianaININ_CAID_RP_RoboticAssistedSurgery.pdf
Scope of PracticeApprovedReimbursement Administration - GeneralIndianaININ_CAID_RP_ScopeofPractice.pdf
Reimbursement of Services with Obsolete CodesApprovedCodingIndianaININ_CAID_RP_ServicesObsoleteCodes.pdf
Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other ServiceApprovedCodingIndianaININ_CAID_RP_SignificantEvalMgmtSamePhysicianSameDay.pdf
Site of Service Payment Differential – ProfessionalApprovedReimbursement Administration - GeneralIndianaININ_CAID_RP_SoSPaymentDifferential.pdf
Split-Care Surgical ModifiersApprovedCodingIndianaININ_CAID_RP_SplitCareSurgicalModifiers.pdf
SterilizationApprovedSurgeryIndianaININ_CAID_RP_Sterilization.pdf
Modifier 66 Surgical TeamsApprovedCodingIndianaININ_CAID_RP_SurgicalTeams.pdf
Transportation Services: Ambulance and Nonemergent TransportApprovedTransportationIndianaININ_CAID_RP_Transportation.pdf
Modifier 78: Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure during the Postoperative PeriodApprovedCodingIndianaININ_CAID_RP_UnplannedReturnORSamePhysician.pdf
Vaccines for Children ProgramApprovedPreventionIndianaININ_CAID_RP_VaccinesforChildrenProgram.pdf
Reimbursement for Items Under WarrantyApprovedReimbursement Administration - GeneralIndianaININ_CAID_RP_WarrantyItems.pdf
Claims Requiring Additional DocumentationApprovedReimbursement Administration - GeneralWisconsinWIWI_CAID_RP_ClaimsRequiringAdditionalDocumentation.pdf
Drugs and Injectable LimitsApprovedDrugsWisconsinWIWI_CAID_RP_DrugsandInjectableLimits.pdf
Reimbursement for Eligible Billed ChargesApprovedReimbursement Administration - GeneralVirginiaVAVA_CAID_RP_ReimbursementforEligibleBilledCharges.pdf
Reimbursement for Eligible Billed ChargesApprovedReimbursement Administration - GeneralWisconsinWIWI_CAID_RP_ReimbursementforEligibleBilledCharges.pdf
Reimbursement for Eligible Billed ChargesApprovedReimbursement Administration - GeneralKentuckyKYKY_CAID_RP_ReimbursementforEligibleBilledCharges.pdf
Reimbursement for Eligible Billed ChargesApprovedReimbursement Administration - GeneralVA MMPVAVA_MMP_RP_ReimbursementforEligibleBilledCharges.pdf
Reimbursement for Eligible Billed ChargesApprovedReimbursement Administration - GeneralIndianaININ_CAID_RP_EligibleBilledChargesReimbursement.pdf
Assistant at Surgery (Modifiers 80/81/82/AS)ApprovedCodingVA MMPVAVA_MMP_RP_AssistatSurgery.pdf
DRG Inpatient Facility TransfersApprovedFacilitiesVA MMPVAVA_MMP_RP_InpatientFacilityTransfers.pdf
Facility Take-Home DME and Medical SuppliesApprovedDME and SuppliesKentuckyKYKY_CAID_RP_FacilityTakeHomeDMEandMedicalSupplies.pdf
Facility Take-Home DME and Medical SuppliesApprovedReimbursement Administration - GeneralVirginiaVAVA_CAID_RP_FacilityTakeHomeDMEandMedicalSupplies.pdf
Facility Take-Home DME and Medical SuppliesApprovedDME and SuppliesVA MMPVAVA_MMP_RP_FacilityTakeHomeDMEandMedicalSupplies.pdf
Facility Take-Home DME and Medical SuppliesApprovedDME and SuppliesWisconsinWIWI_CAID_RP_FacilityTakeHomeDMEandMedicalSupplies.pdf
Facility Take-Home DME and Medical SuppliesApprovedDME and SuppliesIndianaININ_CAID_RP_TakeHomeDMEMedicalSupplies.pdf
Claims Submission – Required Information for Professional Providers ApprovedReimbursement Administration - GeneralKentuckyKYKY_CAID_RP_ClaimsSubmissionRequiredInformationProviders.pdf
Medical RecallsApprovedReimbursement Administration - GeneralKentuckyKYKY_CAID_RP_MedicalRecalls.pdf
Medical RecallsApprovedReimbursement Administration - GeneralWisconsinWIWI_CAID_RP_MedicalRecalls.pdf
Medical RecallsApprovedReimbursement Administration - GeneralIndianaININ_CAID_RP_MedicalRecalls.pdf
Medical RecallsApprovedReimbursement Administration - GeneralVA MMPVAVA_MMP_RP_MedicalRecalls.pdf
Medical RecallsApprovedReimbursement Administration - GeneralVirginiaVAVA_CAID_RP_MedicalRecalls.pdf
Durable Medical Equipment (Rent to Purchase)ApprovedDME and SuppliesIndianaININ_CAID_RP_DMERenttoPurchase.pdf
DME Modifiers for New, Rented and Used EquipmentApprovedCodingIndianaININ_CAID_RP_DMEModifiersRentedUsedEquipment.pdf
Reimbursement for Maximum Units Per DayApprovedReimbursement Administration - GeneralIndianaININ_CAID_RP_ReimbursementMaxUnitsPerDay.pdf
Durable Medical Equipment (Rent to Purchase)ApprovedDME and SuppliesWisconsinWIWI_CAID_RP_DurableMedicalEquipment.pdf
DME Modifiers for New, Rented and Used EquipmentApprovedCodingWisconsinWIWI_CAID_RP_DMEModifiersNewRentedUsedEquipment.pdf
Reimbursement for Maximum Units Per DayApprovedReimbursement Administration - GeneralWisconsinWIWI_CAID_RP_ReimbursementMaxUnitsPerDay.pdf
DME Modifiers for New, Rented and Used EquipmentApprovedCodingVirginiaVAVA_CAID_RP_DMEModifiersNewRentedUsedEquipment.pdf
Durable Medical Equipment (Rent to Purchase)ApprovedDME and SuppliesVirginiaVAVA_CAID_RP_DurableMedicalEquipment.pdf
Reimbursement for Maximum Units Per DayApprovedReimbursement Administration - GeneralVirginiaVAVA_CAID_RP_MaxUnitsPerDay.pdf
DME Modifiers for New, Rented and Used EquipmentApprovedCodingKentuckyKYKY_CAID_RP_DMEModifiersNewRentedUsedEquipment.pdf
Durable Medical Equipment (Rent to Purchase)ApprovedDME and SuppliesKYKY_CAID_RP_DurableMedicalEquipment.pdf
Reimbursement for Maximum Units Per DayApprovedReimbursement Administration - GeneralKentuckyKYKY_CAID_RP_MaxUnitsPerDay.pdf
Durable Medical Equipment (Rent to Purchase)ApprovedDME and SuppliesVA MMPVAVA_MMP_RP_DurableMedicalEquipment.pdf
DME Modifiers for New, Rented and Used EquipmentApprovedCodingVA MMPVAVA_MMP_RP_DMEModifiersNewRentedUsedEquipment.pdf
Reimbursement for Maximum Units Per DayApprovedReimbursement Administration - GeneralVA MMPVAVA_MMP_RP_ReimbursementMaxDaysPerUnit.pdf
Duplicate or Subsequent Services on the Same Date of ServiceApprovedReimbursement Administration - GeneralIndianaININ_CAID_RP_DuplicateSubsequentServicesSameDOS.pdf
Durable Medical Equipment (Rent to Purchase)ApprovedDME and SuppliesKentuckyKYKY_CAID_RP_DMERenttoPurchase.pdf
Diagnoses Used in DRG ComputationApprovedCodingIndianaININ_CAID_RP_DiagnosesUsedDRGComputation.pdf
Reimbursement of Sanctioned ProvidersApprovedReimbursement Administration - GeneralIndianaININ_CAID_RP_ReimbursementSanctionedProviders.pdf
Reimbursement of Claims with Charge DiscrepanciesApprovedReimbursement Administration - GeneralIndianaININ_CAID_RP_ClaimsChargeDiscrepancies.pdf
Diagnosis-Related Group (DRG) Inpatient Facility TransfersApprovedFacilitiesCaliforniaCACA_CAID_RP_DRGInpatientFacilityTransfers.pdf
Corrected ClaimsApprovedReimbursement Administration - GeneralVA MMPVAVA_MMP_RP_CorrectClaims.pdf
Correct ClaimsApprovedReimbursement Administration - GeneralVirginiaVAVA_CAID_RP_CorrectedClaims.pdf
Modifier 26 and TC: Professional and Technical ComponentApprovedCodingVirginiaVAVA_CAID_RP_Mod26TechnicalComponent.pdf
Corrected ClaimsApprovedReimbursement Administration - GeneralIndianaININ_CAID_RP_CorrectedClaims.pdf
Modifier 26 and TC: Professional and Technical ComponentApprovedCodingIndianaININ_CAID_RP_ProfessionalTechnicalComponent.pdf
Inpatient ReadmissionsApprovedFacilitiesCaliforniaCACA_CAID_RP_InpatientReadmissions.pdf
Correct ClaimsApprovedReimbursement Administration - GeneralWisconsinWIWI_CAID_RP_CorrectClaims.pdf
Modifier 26 and TC: Professional and Technical ComponentApprovedCodingWisconsinWIWI_CAID_RP_Mod26andTC_ProfandTechComponent.pdf
Modifier 91: Repeat Clinical Diagnostic Laboratory TestApprovedCodingWisconsinWIWI_CAID_PU_Mod91_RepeatLabTest.pdf
Corrected ClaimsApprovedReimbursement Administration - GeneralKentuckyKYKY_CAID_RP_CorrectedClaims.pdf
Modifier 26 and TC: Professional and Technical ComponentApprovedCodingKentuckyKYKY_CAID_RP_Modifier26.pdf
Modifier 24: Unrelated Evaluation and Management Service By the Same Physician During the Postoperative PeriodApprovedCodingIndianaININ_CAID_RP_Mod24UnrelatedEvaluation.pdf
Code and Clinical Editing GuidelinesApprovedReimbursement Administration - GeneralIndianaININ_CAID_RP_CodeClinicalEditingGuidelines.pdf
Unlisted, Unspecified or Miscellaneous CodesApprovedCodingIndianaININ_CAID_RP_UnlistedMiscCodes.pdf
Multiple Radiology Payment ReductionApprovedRadiologyIndianaININ_CAID_RP_MultipleRadiologyPaymentReduction.pdf
Professional Anesthesia ServicesApprovedAnesthesiaCAMMPCACA_MMP_RP_ProfessionalAnesthesiaServices.pdf
Durable Medical Equipment (Rent to Purchase)ApprovedDME and SuppliesCAMMPCACA_MMP_RP_DMERenttoPurchase.pdf
Facility Take-Home DME and Medical SuppliesApprovedDME and SuppliesCAMMPCACA_MMP_RP_FacilityTakeHomeDME.pdf
Drugs and Injectable LimitsApprovedDrugsCAMMPCACA_MMP_RP_DrugsInjectableLimits.pdf
Facility Take-Home DrugsApprovedDrugsCAMMPCACA_MMP_RP_FacilityTakeHomeDrugs.pdf
ConsultationsApprovedEvaluation and ManagementCAMMPCACA_MMP_RP_Consultations.pdf
Diagnosis-Related Group Inpatient Facility TransfersApprovedFacilitiesCAMMPCACA_MMP_RP_DRGInpatientFacilityTransfers.pdf
Inpatient ReadmissionsApprovedFacilitiesCAMMPCACA_MMP_RP_PreadmissionServicesInpatientStays.pdf
Prosthetic and Orthotic DevicesApprovedProsthetics and OrthoticsCAMMPCACA_MMP_RP_ProstheticOrthoticDevices.pdf
Multiple Radiology Payment ReductionApprovedRadiologyCAMMPCACA_MMP_RP_MultipleRadiologyPaymentReduction.pdf
Portable/Mobile/Handheld Radiology ServicesApprovedRadiologyCAMMPCACA_MMP_RP_PortableMobileHandheldRadiologyServices.pdf
Abortion (Termination of Pregnancy)ApprovedSurgeryCAMMPCACA_MMP_RP_Abortion.pdf
Global Surgical Package for Professional ProvidersApprovedSurgeryCAMMPCACA_MMP_RP_GlobalSurgicalPackage.pdf
HysterectomyApprovedSurgeryCAMMPCACA_MMP_RP_Hysterectomy.pdf
Maternity ServicesApprovedSurgeryCAMMPCACA_MMP_RP_MaternityServices.pdf
Multiple Delivery ServicesApprovedSurgeryCAMMPCACA_MMP_RP_MultipleDeliveryServices.pdf
Robotic Assisted SurgeryApprovedSurgeryCAMMPCACA_MMP_RP_RoboticAssistedSurgery.pdf
SterilizationApprovedSurgeryCAMMPCACA_MMP_RP_Sterilization.pdf
Assistant at Surgery (Modifier 80/81/82/AS)ApprovedCodingCAMMPCACA_MMP_RP_AssistantatSurgery.pdf
Modifier 62: Co-SurgeonsApprovedCodingCAMMPCACA_MMP_RP_CoSurgeons.pdf
Modifier 57: Decision for SurgeryApprovedCodingCAMMPCACA_MMP_RP_DecisionforSurgery.pdf
Diagnoses Used in Diagnosis-Related Groups ComputationApprovedCodingCAMMPCACA_MMP_RP_DiagnosisUsedDRGComputation.pdf
Distinct Procedural Services (Modifiers 59, XE, XP, XS, XU)ApprovedCodingCAMMPCACA_MMP_RP_DistinctProceduralServices.pdf
Durable Medical Equipment (DME) Modifiers for New, Rented and Used EquipmentApprovedCodingCAMMPCACA_MMP_RP_DMEModifiers.pdf
Modifier 22: Increased Procedural ServiceApprovedCodingCAMMPCACA_MMP_RP_IncreasedProceduralService.pdf
Modifiers LT and RT: Left Side/Right Side ProceduresApprovedCodingCAMMPCACA_MMP_RP_LeftRightSideProcedures.pdf
Modifier UsageApprovedCodingCAMMPCACA_MMP_RP_ModifierUsage.pdf
Multiple and Bilateral Surgery: Professional and Facility ReimbursementApprovedCodingCAMMPCACA_MMP_RP_MultipleBilateralSurgery.pdf
Reimbursement of Services with Obsolete CodesApprovedCodingCAMMPCACA_MMP_RP_ObsoleteCodes.pdf
Modifier 26 and TC: Professional and Technical ComponentApprovedCodingCAMMPCACA_MMP_RP_ProfessionalTechnicalComponent.pdf
Reimbursement for Reduced and Discontinued ServicesApprovedCodingCAMMPCACA_MMP_RP_ReducedDiscontinuedServices.pdf
Modifier 91: Repeat Clinical Diagnostic Laboratory TestApprovedCodingCAMMPCACA_MMP_RP_RepeatClinicalDiagnosticLabTest.pdf
Modifier 77: Repeat Procedure by Another PhysicianApprovedCodingCAMMPCACA_MMP_RP_RepeatProcedureAnotherPhysician.pdf
Modifier 76: Repeat Procedure by the Same PhysicianApprovedCodingCAMMPCACA_MMP_RP_RepeatProcedureSamePhysician.pdf
Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other ServiceApprovedCodingCAMMPCACA_MMP_RP_SignificantSeparatelyIdentifiableEvalMgmtService.pdf
Split-Care Surgical ModifiersApprovedCodingCAMMPCACA_MMP_RP_SplitCareSurgicalModifiers.pdf
Modifier 66: Surgical TeamsApprovedCodingCAMMPCACA_MMP_RP_SurgicalTeams.pdf
Unlisted, Unspecified or Miscellaneous CodesApprovedCodingCAMMPCACA_MMP_RP_UnlistedMiscCodes.pdf
Modifier 78: Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative PeriodApprovedCodingCAMMPCACA_MMP_RP_UnplannedReturnOperatingRoomSamePhysician.pdf
Modifier 24: Unrelated Evaluation and Management Service by the Same Physician During the Postoperative PeriodApprovedCodingCAMMPCACA_MMP_RP_UnrelatedEvalMgmtServiceSamePhysician.pdf
Claims Requiring Additional DocumentationApprovedReimbursement Administration - GeneralCAMMPCACA_MMP_RP_ClaimsAdditionalDocumentation.pdf
Reimbursement of Claims with Charge DiscrepanciesApprovedReimbursement Administration - GeneralCAMMPCACA_MMP_RP_ClaimsChargeDiscrepancies.pdf
Claims Submission - Required Information for FacilitiesApprovedReimbursement Administration - GeneralCAMMPCACA_MMP_RP_ClaimsInfoforFacilities.pdf
Claims Submissions - Required Information for Professional ProvidersApprovedReimbursement Administration - GeneralCAMMPCACA_MMP_RP_ClaimsInfoforProfessionalProviders.pdf
Claims Timely FilingApprovedReimbursement Administration - GeneralCAMMPCACA_MMP_RP_ClaimsTimelyFiling.pdf
Code and Clinical Editing GuidelinesApprovedReimbursement Administration - GeneralCAMMPCACA_MMP_RP_CodeClinicalEditingGuidelines.pdf
Corrected ClaimsApprovedReimbursement Administration - GeneralCAMMPCACA_MMP_RP_CorrectedClaims.pdf
Requirements for Documentation of Proof of Timely FilingApprovedReimbursement Administration - GeneralCAMMPCACA_MMP_RP_DocProofTimelyFiling.pdf
Duplicate or Subsequent Services on the Same Date of ServiceApprovedReimbursement Administration - GeneralCAMMPCACA_MMP_RP_DuplicateSubsequentServicesSameDOS.pdf
Reimbursement for Eligible Billed ChargesApprovedReimbursement Administration - GeneralCAMMPCACA_MMP_RP_EligibleBilledCharges.pdf
Reimbursement for Items Under WarrantyApprovedReimbursement Administration - GeneralCAMMPCACA_MMP_RP_ItemsUnderWarranty.pdf
Locum Tenens Physicians/Fee-for-Time CompensationApprovedReimbursement Administration - GeneralCAMMPCACA_MMP_RP_LocumTenens.pdf
Reimbursement for Maximum Units Per DayApprovedReimbursement Administration - GeneralCAMMPCACA_MMP_RP_MaximumUnitsPerDay.pdf
Medical RecallsApprovedReimbursement Administration - GeneralCAMMPCACA_MMP_RP_MedicalRecalls.pdf
Emergency Services: Nonparticipating Providers and FacilitiesApprovedReimbursement Administration - GeneralCAMMPCACA_MMP_RP_NonparticipatingProvidersFacilities.pdf
Other Provider Preventable ConditionsApprovedReimbursement Administration - GeneralCAMMPCACA_MMP_RP_OtherProviderPreventableConditions.pdf
Present on Admission Indicator for Health Care-Acquired ConditionsApprovedReimbursement Administration - GeneralCAMMPCACA_MMP_RP_PresentonAdmissionIndicatorHealthCareAcquiredConditions.pdf
Reimbursement of Sanctioned and Opt-Out ProvidersApprovedReimbursement Administration - GeneralCAMMPCACA_MMP_RP_SanctionedOptOutProviders.pdf
Scope of PracticeApprovedReimbursement Administration - GeneralCAMMPCACA_MMP_RP_ScopeofPractice.pdf
Site of Service Payment Differential - ProfessionalApprovedReimbursement Administration - GeneralCAMMPCACA_MMP_RP_SiteofServicePaymentDifferential.pdf
Documentation Standards for Episodes of CareApprovedReimbursement Administration - GeneralCAMMPCACA_MMP_RP_StandardsEpisodesofCare.pdf
Documentation Standards for Episodes of CareApprovedReimbursement Administration - GeneralIndianaININ_CAID_RP_DocStandardsforEpisodesCare.pdf
Modifier 22: Increased Procedural ServiceApprovedCodingVirginiaVAVA_CAID_RP_Mod22IncreasedProcSvs.pdf
Maternity ServicesApprovedSurgeryVA MMPVAVA_MMP_RP_MaternityServices.pdf
DRG Inpatient Facility TransfersApprovedFacilitiesCaliforniaCACA_MMP_RP_Transportation.pdf
Claims Submission — Required Information for FacilitiesApprovedReimbursement Administration - GeneralIndianaININ_CAID_RP_ClaimsSubmissionRequiredInfoFacilities.pdf
Abortion (Termination of Pregnancy)ApprovedSurgeryCaliforniaCACA_CAID_RP_Abortion.pdf
Global Surgical Package for Professional ProvidersApprovedSurgeryCaliforniaCACA_CAID_RP_GlobalSurgical.pdf
HysterectomyApprovedSurgeryCaliforniaCACA_CAID_RP_Hysterectomy.pdf
Maternity ServicesApprovedSurgeryCaliforniaCACA_CAID_RP_MaternityServices.pdf
Multiple Delivery ServicesApprovedSurgeryCaliforniaCACA_CAID_RP_MultipleDelivery.pdf
Robotic Assisted SurgeryApprovedSurgeryCaliforniaCACA_CAID_RP_RoboticAssisted.pdf
SterilizationApprovedSurgeryCaliforniaCACA_CAID_RP_Sterilization.pdf
Reimbursement of Claims with Charge DiscrepanciesApprovedReimbursement Administration - GeneralCaliforniaCACA_CAID_RP_ClaimsChargeDiscrepencies.pdf
Claims Requiring Additional DocumentationApprovedReimbursement Administration - GeneralCaliforniaCACA_CAID_RP_ClaimsRequiringAdditional.pdf
Claims Submission – Required Information for FacilitiesApprovedReimbursement Administration - GeneralCaliforniaCACA_CAID_RP_ClaimsSubmissionsFacilities.pdf
Claims Submission — Required Information for Professional ProvidersApprovedReimbursement Administration - GeneralCaliforniaCACA_CAID_RP_ClaimsSubmissionsProviders.pdf
Claims Timely FilingApprovedReimbursement Administration - GeneralCaliforniaCACA_CAID_RP_ClaimsTimelyFiling.pdf
Code and Clinical Editing GuidelinesApprovedReimbursement Administration - GeneralCaliforniaCACA_CAID_RP_CodeClinicalEditing.pdf
Corrected ClaimsApprovedReimbursement Administration - GeneralCaliforniaCACA_CAID_RP_CorrectedClaimsFINAL.pdf
Duplicate or Subsequent Services on the Same Date of ServiceApprovedReimbursement Administration - GeneralCaliforniaCACA_CAID_RP_DuplicateSubsequent.pdf
Reimbursement for Eligible Billed ChargesApprovedReimbursement Administration - GeneralCaliforniaCACA_CAID_RP_EligibleBilledCharges.pdf
Emergency Services: Nonparticipating Providers and FacilitiesApprovedReimbursement Administration - GeneralCaliforniaCACA_CAID_RP_EmergencyServices.pdf
Documentation Standards for Episodes of CareApprovedReimbursement Administration - GeneralCaliforniaCACA_CAID_RP_EpisodesofCare.pdf
Reimbursement for Items Under WarrantyApprovedReimbursement Administration - GeneralCaliforniaCACA_CAID_RP_ItemsUnderWarranty.pdf
Locum Tenens Physicians/Fee-for-Time CompensationApprovedReimbursement Administration - GeneralCaliforniaCACA_CAID_RP_LocumTenens.pdf
Reimbursement for Maximum Units Per DayApprovedReimbursement Administration - GeneralCaliforniaCACA_CAID_RP_MaximunUnits.pdf
Medical RecallsApprovedReimbursement Administration - GeneralCaliforniaCACA_CAID_RP_MedicalRecalls.pdf
Other Provider Preventable Conditions (OPPC)ApprovedReimbursement Administration - GeneralCaliforniaCACA_CAID_RP_OPPC.pdf
Present on Admission Indicator for Health Care-Acquired ConditionsApprovedReimbursement Administration - GeneralCaliforniaCACA_CAID_RP_PresentonAdmission.pdf
Requirements for Documentation of Proof of Timely FilingApprovedReimbursement Administration - GeneralCaliforniaCACA_CAID_RP_ProofTimelyFiling.pdf
Scope of PracticeApprovedReimbursement Administration - GeneralCaliforniaCACA_CAID_RP_ScopeofPractice.pdf
Site of Service Payment Differential — ProfessionalApprovedReimbursement Administration - GeneralCaliforniaCACA_CAID_RP_SiteofService.pdf
Facility Take-Home DME and Medical SuppliesApprovedDME and SuppliesCaliforniaCACA_CAID_RP_FacilityTakeHomeDME.pdf
Durable Medical Equipment (Rent to Purchase)ApprovedDME and SuppliesCaliforniaCACA_CAID_RP_RentToPurchaseDME.pdf
Drugs and Injectable LimitsApprovedDrugsCaliforniaCACA_CAID_RP_DrugsInjectableLimit.pdf
Facility Take-Home DrugsApprovedDrugsCaliforniaCACA_CAID_RP_FacilityTakeHomeDrugs.pdf
Portable/Mobile/Handheld RadiologyApprovedRadiologyCaliforniaCACA_CAID_RP_PortableHandheldRaidiology.pdf
Prosthetics and OrthoticsApprovedProsthetics and OrthoticsCaliforniaCACA_CAID_RP_ProstheticandOrtho.pdf
Diagnoses Used in DRG ComputationApprovedCodingCaliforniaCACA_CAID_RP_DiagnosisusedDRG.pdf
Distinct Procedural Services (Modifiers 59, XE, XP, XS, XU)ApprovedCodingCaliforniaCACA_CAID_RP_DistinctProcServices.pdf
DME Modifiers for New, Rented and Used EquipmentApprovedCodingCaliforniaCACA_CAID_RP_DMEModifiers.pdf
Modifier UsageApprovedCodingCaliforniaCACA_CAID_RP_ModfierUsage.pdf
Modifier 22: Increased Procedural ServiceApprovedCodingCaliforniaCACA_CAID_RP_Modifier22.pdf
Modifier 24: Unrelated Evaluation and Management Service by the Same Physician during the Postoperative PeriodApprovedCodingCaliforniaCACA_CAID_RP_Modifier24.pdf
Modifier 26 and TC: Professional and Technical ComponentApprovedCodingCaliforniaCACA_CAID_RP_Modifier26.pdf
Modifier 57: Decision for SurgeryApprovedCodingCaliforniaCACA_CAID_RP_Modifier57.pdf
Modifier 62: Co-SurgeonsApprovedCodingCaliforniaCACA_CAID_RP_Modifier62.pdf
Modifier 66: Surgical TeamsApprovedCodingCaliforniaCACA_CAID_RP_Modifier66.pdf
Modifier 76: Repeat Procedure by the Same PhysicianApprovedCodingCaliforniaCACA_CAID_RP_Modifier76.pdf
Modifier 77: Repeat Procedure by Another Physician or other Qualified Health Care ProfessionalApprovedCodingCaliforniaCACA_CAID_RP_Modifier77.pdf
Modifier 78: Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure during the Postoperative PeriodApprovedCodingCaliforniaCACA_CAID_RP_Modifier78.pdf
Modifier 91: Repeat Clinical Diagnostic Laboratory TestApprovedCodingCaliforniaCACA_CAID_RP_Modifier91.pdf
Modifiers LT and RT: Left Side/Right Side ProceduresApprovedCodingCaliforniaCACA_CAID_RP_ModifiersLTandRT.pdf
Reimbursement of Services with Obsolete CodesApprovedCodingCaliforniaCACA_CAID_RP_ObsoleteCodes.pdf
Reimbursement for Reduced and Discontinued ServicesApprovedCodingCaliforniaCACA_CAID_RP_ReducedDisconSrv.pdf
Unlisted, Unspecified or Miscellaneous CodesApprovedCodingCaliforniaCACA_CAID_RP_UnlistedMisc.pdf
Transportation Services: Ambulance and Nonemergent TransportApprovedTransportationCaliforniaCACA_CAID_RP_TranspServ.pdf
Vaccines for Children (VFC) ProgramApprovedPreventionCaliforniaCACA_CAID_RP_VFC.pdf
Preadmission Services for Inpatient StaysApprovedFacilitiesCaliforniaCACA_CAID_RP_PreadmissionServicesInpatient.pdf
Ambulance and Nonemergent TransportApprovedTransportationCAMMPCACA_MMP_RP_EmergentTransportation.pdf
ConsultationsApprovedEvaluation and ManagementCaliforniaCACA_CAID_RP_Consultations.pdf
Preventive Medicine and Sick Visits on the Same DayApprovedEvaluation and ManagementCaliforniaCACA_CAID_RP_PreventiveMedicine.pdf
Multiple Delivery ServicesApprovedSurgeryKentuckyKYKY_CAID_RP_MultiDelivery.pdf
Multiple Delivery ServicesApprovedSurgeryVirginiaVAVA_CAID_RP_MultiDelivery.pdf
Multiple Delivery ServicesApprovedSurgeryWisconsinWIWI_CAID_RP_MultiDelivery.pdf
Multiple Delivery ServicesApprovedSurgeryIndianaININ_CAID_RP_MultiDelivery.pdf
Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other ServiceApprovedCodingCaliforniaCACA_CAID_RP_Modifier25.pdf
Vaccines for Children (VFC) ProgramApprovedPreventionNevadaNVNV_CAID_RP_VaccinesforChildren.pdf
Transportation Services: Ambulance and Non-Emergent TransportApprovedTransportationNevadaNVNV_CAID_RP_Transportation.pdf
Reimbursement for Items under WarrantyApprovedFacilitiesNevadaNVNV_CAID_RP_ReimforItemsWarranty.pdf
Prosthetic and Orthotic DevicesApprovedProsthetics and OrthoticsNevadaNVNV_CAID_RP_ProstheticandOrthoDevices.pdf
Professional Anesthesia ServicesApprovedAnesthesiaNevadaNVNV_CAID_RP_ProfessionalAnesthesia.pdf
Preventive Medicine and Sick Visits on the Same DayApprovedPreventionNevadaNVNV_CAID_RP_PreventiveMedicineandSickVisitsSameDay.pdf
Preadmission Services for Inpatient StaysApprovedFacilitiesNevadaNVNV_CAID_RP_PreadmissionServices.pdf
Portable/Mobile/Handheld Radiology ServicesApprovedRadiologyNevadaNVNV_CAID_RP_PortableMobileHandheldRadiology.pdf
Facility Take-Home DrugsApprovedDrugsNevadaNVNV_CAID_RP_FacilityTakeHomeDrugs.pdf
Facility Take-Home DME and Medical SuppliesApprovedDME and SuppliesNevadaNVNV_CAID_RP_FacilityTakeHomeDME.pdf
Early and Periodic Screening, Diagnostic and Treatment (EPSDT)ApprovedPreventionNevadaNVNV_CAID_RP_EPSDT.pdf
Drugs and Injectable LimitsApprovedDrugsNevadaNVNV_CAID_RP_DrugsandInjectableLimits.pdf
Durable Medical Equipment (Rent to Purchase)ApprovedDME and SuppliesNevadaNVNV_CAID_RP_DMERenttoPurchase.pdf
ConsultationsApprovedEvaluation and ManagementNevadaNVNV_CAID_RP_Consultations.pdf
Abortion (Termination of Pregnancy)ApprovedSurgeryNevadaNVNV_CAID_RP_Abortion.pdf
Global Surgical Package for Professional ProvidersApprovedSurgeryNevadaNVNV_CAID_RP_GlobalSurgicalPackage.pdf
HysterectomyApprovedSurgeryNevadaNVNV_CAID_RP_Hysterectomy.pdf
Maternity ServicesApprovedSurgeryNevadaNVNV_CAID_RP_MaternityServices.pdf
Multiple Delivery ServicesApprovedSurgeryNevadaNVNV_CAID_RP_MultipleDeliveryServices.pdf
Robotic Assisted SurgeryApprovedSurgeryNevadaNVNV_CAID_RP_RoboticAssistedSurgery.pdf
SterilizationApprovedSurgeryNevadaNVNV_CAID_RP_Sterilization.pdf
Assist at Surgery (Modifiers 80/81/81/AS)ApprovedCodingNevadaNVNV_CAID_RP_AssistatSurgery.pdf
Distinct Procedural Services (Modifiers 59, XE, XP, XS, XU)ApprovedCodingNevadaNVNV_CAID_RP_DistinctProceduralServices.pdf
DME Modifiers for New, Rented and Used EquipmentApprovedCodingNevadaNVNV_CAID_RP_DMEModifiers.pdf
Modifier 22: Increased Procedural ServiceApprovedCodingNevadaNVNV_CAID_RP_Mod22_IncreasedProceduralService.pdf
Modifier 24: Unrelated Evaluation and Management Service by the Same Physician during the Postoperative PeriodApprovedCodingNevadaNVNV_CAID_RP_Mod24_UnrelatedEval.pdf
Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other ServiceApprovedCodingNevadaNVNV_CAID_RP_Mod25_SignificantSeparate.pdf
Modifier 26 and TC: Professional and Technical ComponentApprovedCodingNevadaNVNV_CAID_RP_Mod26_ProfandTechComponent.pdf
Decision for SurgeryApprovedCodingNevadaNVNV_CAID_RP_Mod57_DecisionforSurgery.pdf
Modifier 62 Co-SurgeonsApprovedCodingNevadaNVNV_CAID_RP_Mod62_Cosurgeons.pdf
Modifier 63: Procedure Performed onInfants less than 4 kgApprovedCodingNevadaNVNV_CAID_RP_Mod63_ProcPerformedonInfants.pdf
Modifier 66: Surgical TeamsApprovedCodingNevadaNVNV_CAID_RP_Mod66_SurgicalTeams.pdf
Modifier 76: Repeat Procedure by the Same PhysicianApprovedCodingNevadaNVNV_CAID_RP_Mod76_RepeatProcSamePhysician.pdf
Modifier 77: Repeat Procedure by Another PhysicianApprovedCodingNevadaNVNV_CAID_RP_Mod77_RepeatProcAnotherPhysician.pdf
Modifier 78: Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure during the Postoperative PeriodApprovedCodingNevadaNVNV_CAID_RP_Mod78_UnplannedReturn.pdf
Modifier 91: Repeat Clinical Diagnostic Laboratory TestApprovedCodingNevadaNVNV_CAID_RP_Mod91_RepeatClinicalDiagLabTest.pdf
Modifier UsageApprovedCodingNevadaNVNV_CAID_RP_ModifierUsage.pdf
Modifiers LT and RT: Left-Side/Right-Side ProceduresApprovedCodingNevadaNVNV_CAID_RP_ModLTandRT.pdf
Reimbursement of Services with Obsolete CodesApprovedCodingNevadaNVNV_CAID_RP_ObsoleteCodes.pdf
Reimbursement for Reduced and Discontinued ServicesApprovedCodingNevadaNVNV_CAID_RP_RedandDiscServices.pdf
Split Care Surgical ModifiersApprovedCodingNevadaNVNV_CAID_RP_SplitCareSurgicalMods.pdf
Unlisted or Miscellaneous CodesApprovedCodingNevadaNVNV_CAID_RP_UnlistedorMiscCodes.pdf
Reimbursement for Eligible Billed ChargesApprovedReimbursement Administration - GeneralNevadaNVNV__CAID_RP_ReimbursementforEligibleBilledCharges.pdf
Claims Requiring Additional DocumentationApprovedReimbursement Administration - GeneralNevadaNVNV_CAID_RP_ClaimsRequiringAddlDoc.pdf
Claims Submission – Required Information for FacilitiesApprovedReimbursement Administration - GeneralNevadaNVNV_CAID_RP_ClaimsSub_ReqdInfoforFacilities.pdf
Claims Submission – Required Information for Professional ProvidersApprovedReimbursement Administration - GeneralNevadaNVNV_CAID_RP_ClaimsSub_ReqdInfoProfessionalProviders.pdf
Claims Timely FilingApprovedReimbursement Administration - GeneralNevadaNVNV_CAID_RP_ClaimsTimeyFiling.pdf
Code and Clinical Editing GuidelinesApprovedReimbursement Administration - GeneralNevadaNVNV_CAID_RP_CodeandClinicalEditingGuidelines.pdf
Corrected ClaimsApprovedReimbursement Administration - GeneralNevadaNVNV_CAID_RP_CorrectedClaims.pdf
Documentation Standards for Episodes of CareApprovedReimbursement Administration - GeneralNevadaNVNV_CAID_RP_DocStandardsEpisodesofCare.pdf
Duplicate or Subsequent Services on the Same Date of ServiceApprovedReimbursement Administration - GeneralNevadaNVNV_CAID_RP_DupeorSubServicesonSameDate.pdf
Emergency Services: Nonparticipating Providers and FacilitiesApprovedReimbursement Administration - GeneralNevadaNVNV_CAID_RP_EmergencyServices.pdf
Locum Tenens PhysiciansApprovedReimbursement Administration - GeneralNevadaNVNV_CAID_RP_LocumTenensPhysicians.pdf
Other Provider Preventable Conditions (OPPC)ApprovedReimbursement Administration - GeneralNevadaNVNV_CAID_RP_OPPC.pdf
Present on Admission Indicator for Health Care-Acquired ConditionsApprovedReimbursement Administration - GeneralNevadaNVNV_CAID_RP_PresentonAdmisIndicator.pdf
Reimbursement for Maximum Units Per DayApprovedReimbursement Administration - GeneralNevadaNVNV_CAID_RP_ReimbMaxUnitsperDay.pdf
Reimbursement of Claims with Charge DiscrepanciesApprovedReimbursement Administration - GeneralNevadaNVNV_CAID_RP_ReimbofClaimsChargeDiscrep.pdf
Reimbursement of Sanctioned and Opt-Out ProvidersApprovedReimbursement Administration - GeneralNevadaNVNV_CAID_RP_ReimbofSanctionedandOpt-OutProviders.pdf
Requirements for Documentation of Proof of Timely FilingApprovedReimbursement Administration - GeneralNevadaNVNV_CAID_RP_ReqforDocofProofTimelyFiling.pdf
Scope of Practice​ApprovedReimbursement Administration - GeneralNevadaNVNV_CAID_RP_ScopeofPractice.pdf
Site of Service Payment Differential – ProfessionalApprovedReimbursement Administration - GeneralNevadaNVNV_CAID_RP_SiteofServicePaymentDiff.pdf
Global Surgical Package for Professional ProvidersApprovedVirginiaVAVA_CAID_RP_GlobalSurgical.pdf
Multiple Radiology Payment ReductionApprovedRadiologyCaliforniaCACA_CAID_RP_MultipleRadiologyPaymentReduction.pdf
Multiple Radiology Payment ReductionApprovedRadiologyNevadaNVNV_CAID_RP_MultipleRadiologyPaymentReduction.pdf
Diagnoses Used in DRG ComputationApprovedCodingNevadaNVNV_CAID_RP_DiagnosisUsedDRG.pdf
DRG Inpatien Facility Transfers.ApprovedFacilitiesNevadaNVNV_CAID_RP_DRGInpatient.pdf
Preventive Medicine and Sick Visits on the Same DayApprovedEvaluation and ManagementCAMMPCACA_MMP_RP_PreventiveMedicine.pdf
Medical RecallsApprovedReimbursement Administration - GeneralNevadaNVNV_CAID_RP_MedicalRecalls.pdf
DRG Newborn Inpatient StaysApprovedFacilitiesIndianaININ_CAID_RP_DRGNewbornInpatientStays.pdf
DRG Newborn Inpatient StaysApprovedFacilitiesVirginiaVAVA_CAID_RP_DRGNewbornInpatientStays.pdf
DRG Newborn Inpatient StaysApprovedFacilitiesWisconsinWIWI_CAID_RP_DRGNewbornInpatientStays.pdf