Reimbursement Policy Manual
- Administrative
- Add-on Codes (last updated 04/2018)
- After Hours and Other Special Circumstances (last updated 01/2019)
- Clinical Editing (last updated 05/2020)
- Diagnosis Code Requirements - Level Of Detail and Number of Characters (last updated 10/2019)
- Diagnosis Code Requirements - Invalid As Primary (last updated 02/2020)
- Global Surgery Package for Professional Claims (last updated 03/2020)
- Incident-To Services (last updated 10/2017)
- Medical Records Documentation Standards (last updated 09/2019)
- Medical, Surgical, and Routine Supplies (including but not limited to 99070) (last updated 05/2018)
- Medically Unlikely Edits (MUEs) (last updated 11/2018)
- Moda Health Reimbursement Policy Overview (last updated 01/2019)
- Never Events, Adverse Events, Hospital-Acquired Conditions (HAC), and Serious Reportable Events (SRE) (last updated 04/2019)
- Preventive Services versus Diagnostic and/or Medical Services (last updated 11/2018)
- Procedures Designated as "Separate Procedure" (last updated 10/2019)
- Records Fees, Copying Fees (last updated 04/2019)
- Revenue Codes Ending in "9" ("Other" Categories) (last updated 04/2019)
- Risk Adjustment/HCC Coding and Documentation (last updated 08/2018)
- Behavioral Health
- Behavioral Health Case Management & Care Coordination (last updated 08/2019)
- Anesthesia
- Anesthesia Physical Status Modifiers (P1 - P6) (last updated 03/2019)
- Modifiers AA, AD, GC, QK, QX, QY, QZ - Anesthesia Payment Modifiers (last updated 09/2019)
- Qualifying Circumstances for Anesthesia (last updated 07/2019)
- Documentation
- E0486 Oral Sleep Apnea Device/Appliance Documentation (last updated 06/2019)
- Evaluation & Management
- Clinic Services In the Hospital Outpatient Setting - Commercial (last updated 3/2019)
- Critical Care, Evaluation and Management Services (99291, 99292) (last updated 09/2019)
- Gynecologic or Annual Women's Exam Visit & Use of Q0091 (Pap, Pelvic, & Breast Visit) (last updated 09/2019)
- Facility-Specific
- DRG Payment With Patient Transfers (last updated 4/2019)
- Hospital Routine Supplies and Services (last updated 8/2019)
- Level of Care Review (last updated 4/2019)
- Facility DRG Validation (last updated 4/2019)
- Facility Reimbursement of Respiratory Therapy Services (last updated 8/2018)
- Facility Guidelines, General Overview (last updated 5/2020)
- Readmissions (last updated 4/2019)
- Laboratory & Pathology
- Clinical Drug Screening and/or Drug Testing (last updated 04/2019)
- Molecular Pathology Procedure (MPP) Codes (a.k.a. Genetic Testing) (last updated 02/2017)
- Routine Venipuncture and/or Collection of Specimens (last updated 01/2019)
- Medicine
- Drugs and Biologicals, Wastage and/or Discarded Amounts (Modifier JW) (last updated 04/2019)
- Moderate (Conscious) Sedation (last updated 7/2018)
- Telehealth And Telemedicine (last updated 4/27/2020)
- Telehealth and Telemedicine Expanded Services for COVID-19 (last updated 07/08/2020)
- Modifiers
- Modifier 22 - Increased Procedural Services (last updated 09/2019)
- Modifier 25 - Significant, Separately Identifiable E/M Service (last updated 08/2018)
- Modifier 47 - Modifier 47 - Anesthesia By Surgeon (last updated 07/2019)
- Modifier 50 - Bilateral Procedure (last updated 04/2018)
- Modifier 51 - Multiple Procedure Fee Reductions (last updated 11/2018)
- Modifier 52 - Reduced Services (last updated 04/2019)
- Modifier 53 - Discontinued Procedure (last updated 02/2019)
- Modifiers 54, 55, and 56 - Split Surgical Care (last updated 07/2019)
- Modifier 57 -- Decision For Surgery (last updated 09/2019)
- Modifiers 58, 78, and 79 - Staged, Related, and Unrelated Procedures (last updated 02/2020)
- Modifier PO - G0463 Clinic Visit Services at Excepted Off-Campus Provider-Based Outpatient Department - Medicare Advantage (last updated 02/2019)
- Modifiers XE, XS, XP, XU, and 59 - Distinct Procedural Service (last updated 9/2019)
- Modifiers 62 & 66 - Co-surgery (Two Surgeons) and Team Surgery (More Than Two Surgeons) (last updated 07/2019)
- Modifier 63 - Procedure Performed on Infants Less Than 4 kg (last updated 10/2019)
- Modifiers 73 & 74 - Discontinued Procedures For Facilities (last updated 04/2019)
- Modifiers 80, 81, 82, and AS - Assistant At Surgery (last updated 07/2019)
- Modifiers GA, GX, GY, and GZ (last updated 11/2017)
- Modifier SL - State Supplied Vaccine (last updated 04/2019)
- Modifier SU - Procedure Performed in Physician's Office (Facility and equipment) (last updated 04/2019)
- Reference (Outside) Laboratory -- Modifier 90 (last updated 09/2019)
- Technical Component (TC), Professional Component (PC/26), and Global Service Billing (last updated 06/2020)
- Valid Modifier to Procedure Code Combinations (last updated 04/2019)
- Radiology Reductions for Technology Type - Modifiers FX and FY (last updated 07/2019)
- Transportation of Portable X-ray Equipment, Multiple Portable X-rays - Modifiers UN, UP, UQ, UR, US (last updated 10/2019)
- 340B Drug Discount Program-Acquired Drugs and Biologicals (Modifiers JG & TB) (last updated 02/2019)
- Preventive Services
- Colorectal Cancer Screening And Related Ancillary Services (last updated 01/2019)
- Surgery
- Computer Assisted Navigation (last updated 07/2019)
- Intra-joint and Surgical Site Postoperative Pain Relief Drug Delivery System (Pain Pump) (last updated 02/2020)
- Maternity Care (last updated 02/2020)
- Operating Microscope (CPT Code 69990) (last updated 04/2019)
- Postoperative Sinus Endoscopy and/or Debridement Procedures (last updated 3/2020)
- Procedure Codes Assigned to Surgical Benefit Categories (last updated 04/2019)
- Robotic Assisted Surgery (last updated 01/2019)
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Hello.
We have exciting news to share. ODS is changing its name to Moda Health.
Moda comes from the latin term "modus" and means "a way". We picked it because that's what we are here to do: help our communities find a way to better health.
Together, we can be more, be better.
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