Payment Integrity Policies
Policy Number | Policy Name | Effective Date | Link |
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C14 | Ambulance Modifier Coding Policy | 11/01/2020 | View Policy |
PI34 | Appropriate Level of Care Reimbursement | 01/07/2022 | View Policy |
C13 | ADD-ON Code | 11/01/2020 | View Policy |
PI54 | After Hours and Weekend Care Professional | 8/1/2023 | View Policy |
Policy Number | Policy Name | Effective Date | Link |
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PI102 | BRCA1 and BRCA2 Genetic Testing | 01/04/2023 | View Policy |
PI35 | Breast Cancer Genetic Testing Tier 1 vs Tier 2 | 01/04/2023 | View Policy |
Policy Number | Policy Name | Effective Date | Link |
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PI42 | Corrected Claims | 10/21/2022 | View Policy |
PI53 | Co-Surgeon_Team-Surgeon | 09/01/2023 | View Policy |
PI38 | Critical Care Codes when Discharging Home from the Emergency Department | 08/04/2022 | View Policy |
PI97 | CMS Replacement Codes | 09/11/2023 | View Policy |
Policy Number | Policy Name | Effective Date | Link |
---|---|---|---|
C2 | Diagnosis Code Coding Policy | 11/01/2020 | View Policy |
C16 | Decision for Surgery Modifier 57 Coding Policy | 11/01/2020 | View Policy |
PI65 | DME KF Modifier | 08/01/2023 | View Policy |
PI25 | DRG Clinical Validation | 01/07/2022 | View Policy |
PI45 | Duplicate Claims | 11/01/2022 | View Policy |
PI123 | DME Place of Service separately reimbursable | 09/11/2023 | View Policy |
PI59 | Discontinued Procedures | 04/06/2023 | View Policy |
PI73 | DME Non-Invasive Ventilator Settings | 06/21/2023 | View Policy |
Policy Number | Policy Name | Effective Date | Link |
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C24 | Excludes1 Note Coding Policy | 11/01/2020 | View Policy |
Policy Number | Policy Name | Effective Date | Link |
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PI80 | Fee Schedule | 09/01/2023 | View Policy |
PI39 | Facility Emergency Department Evaluation and Management leveling | 08/15/2022 | View Policy |
Policy Number | Policy Name | Effective Date | Link |
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C0 | General Coding Policy | 11/01/2020 | View Policy |
PI51 | Global Surgical Packages | 09/01/2023 | View Policy |
Policy Number | Policy Name | Effective Date | Link |
---|---|---|---|
PI56 | High Dollar Pharmacy | 08/01/2023 | View Policy |
PI37 | High Level Evalution and Managment with Preventive Medicine | 10/18/2022 | View Policy |
PI01 | Hospital Routine Supplies Services | 12/01/2017 | View Policy |
PI36 | Hydrolyzed Enteral Formula Diagnosis | 01/01/2023 | View Policy |
Policy Number | Policy Name | Effective Date | Link |
---|---|---|---|
C3 | ICD-10 Specificity Coding Policy | 11/01/2020 | View Policy |
C18 | Image Guided Radiation Therapy Coding Policy | 11/01/2020 | View Policy |
C20 | ICD-10 First Listed Diagnosis Coding Policy | 11/01/2020 | View Policy |
PI77 | Injection and Infusions in the ER with 25 Modifier | 09/01/2023 | View Policy |
PI71 | Inpatient services billed on Outpatient bill types | 09/01/2023 | View Policy |
Policy Number | Policy Name | Effective Date | Link |
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Policy Number | Policy Name | Effective Date | Link |
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Policy Number | Policy Name | Effective Date | Link |
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C4 | Lab Codes with Modifiers 59 and 91 Coding Policy | 11/01/2020 | View Policy |
C17 | Lab Panel Coding Policy | 11/01/2020 | View Policy |
PI101 | Labs Overlapping with Facility | 09/25/2023 | View Policy |
Policy Number | Policy Name | Effective Date | Link |
---|---|---|---|
C5 | Modifer 26 Coding Policy | 11/01/2020 | View Policy |
C6 | Modifier KK Coding Policy | 11/01/2020 | View Policy |
C7 | Modifier TC Coding Policy | 11/01/2020 | View Policy |
C15 | Medically Unlikely Edits Coding Policy | 11/01/2020 | View Policy |
PI66 | Molina Healthcare Billing Requirements | 06/01/2023 | View Policy |
PI67 | Multiple EM codes for the same provider same date of service | 09/01/2023 | View Policy |
PI94 | Molecular Pathology | 09/25/2023 | View Policy |
Policy Number | Policy Name | Effective Date | Link |
---|---|---|---|
C12 | NCCI PTP with Modifiers Coding Policy | 11/01/2020 | View Policy |
C19 | Non-Invasive Prenatal Testing Coding Policy | 11/01/2020 | View Policy |
PI44 | NDC | 11/01/2022 | View Policy |
PI32 | Newborn and NICU | 01/07/2022 | View Policy |
Policy Number | Policy Name | Effective Date | Link |
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PI50 | Observation | 06/01/2023 | View Policy |
PI84 | Overlapping Room and Board | 09/25/2023 | View Policy |
PI33 | Outpatient Definitive Drug Testing | 09/01/2021 | View Policy |
Policy Number | Policy Name | Effective Date | Link |
---|---|---|---|
C10 | Packaged and conditionally packaged lab services Coding Policy | 11/01/2020 | View Policy |
PI48 | Post-Pay Authorization Audit | 06/01/2023 | View Policy |
PI00 | Post Pay General Policy | 06/01/2023 | View Policy |
PI68 | Pulmonary Function Testing | 09/25/2023 | View Policy |
Policy Number | Policy Name | Effective Date | Link |
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Policy Number | Policy Name | Effective Date | Link |
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PI41 | Readmission | 06/01/2023 | View Policy |
PI60 | Reduced Services and Discontinued Procedures | 07/10/2023 | View Policy |
PI95 | Radiology for Chest | 09/25/2023 | View Policy |
Policy Number | Policy Name | Effective Date | Link |
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PI91 | Self-Administered Drugs | 01/07/2022 | View Policy |
PI99 | Specimen Validity Testing | 09/25/2023 | View Policy |
Policy Number | Policy Name | Effective Date | Link |
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C10 | Therapy Modifier Coding Policy | 11/01/2020 | View Policy |
PI82 | Tendon Injections Missing Diagnosis | 09/01/2023 | View Policy |
Policy Number | Policy Name | Effective Date | Link |
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PI61 | Unspecified Codes in an Inpatient Setting Policy | 04/01/2022 | View Policy |
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For Medicare and Marketplace Policies Please visit
Medicare and Marketplace Payment Integrity Policies