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Reimbursement Policy Manual

To learn about our reimbursement policies, please reference the linked policies on the topics listed below

NOTE: Disclosure notices for policy changes subject to Title 28 TAC §3.3703(a)(20)(D) of the Texas Administrative Code are posted at least 90 days in advance of the effective date of the change. For out-of-network providers, the policy will be effective on the date the policy is posted to this reimbursement policy provider website. See Disclosure Notices below.

Reimbursement Policies are each assigned a number (RPMxxx) for reference. Policies are available for the following topics or services:

Moda Health Reimbursement Policy Overview last updated February2024 (RPM001)

Administrative

Behavioral Health

Anesthesia

Documentation

Evaluation & Management

Facility-Specific

Laboratory & Pathology

Medicine

Modifiers

Preventive Services

Surgery

Telemedicine

Disclosure Notices

Questions?

Medical Customer Service is at 844-931-1779.

We're available 6:00 a.m. to 6:00 p.m. Monday through Friday, 9:00 a.m. to Noon Saturday, Sunday, and Holidays (Central Time).

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