Payment Policy
This notice is to clarify a segment of our payment policy language that is applicable to all Medicaid markets. Our payment policies are based on publicly distributed guidelines from established industry sources such as the Centers for Medicare and Medicaid Services (CMS), the American Medical Association (AMA), state health care agencies and medical specialty professional societies.
If you have questions about this information, please contact your Provider Relations representative.
- Sepsis Diagnosis: CC.PP.073 (PDF)
- Pre-Payment and Post-Payment Review: CPP-102 - English (PDF)
- Review of NOS, NEC, and Unlisted Codes: CPP-107 - English (PDF)
- Intensity Modulated Radiation Therapy (IMRT): CPP-108 - English (PDF)
- E/M Overcoding Policy: CPP-110 - English (PDF)
- Maximum Units for Reimbursement Policy: CPP-111 - English (PDF)
- Procedure to Procedure Associated Modifiers: CPP-127 - English (PDF)
- Comprehensive Payment Integrity: CPP-136 - English (PDF)
- Robotic Assisted Surgery: CPP-137 - English (PDF)
- Frequency of Comprehensive Ophthalmological Exams: CPP-151 - English (PDF)
- Pre-Payment Clinical Validation Edits: CPP-152 - English (PDF)