Reimbursement Policy Manual
- Administrative
- Add-on Codes (last updated 04/2017)
- After Hours and Other Special Circumstances (last updated 03/2018)
- Clinical Editing (last updated 01/2017)
- Diagnosis Code Requirements - Level Of Detail and Number of Characters (last updated 11/2017)
- Diagnosis Code Requirements - Invalid As Primary (last updated 11/2017)
- Hospital Routine Supplies and Services (last updated 11/2016)
- Incident-To Services (last updated 10/2017)
- Medical Records Documentation Standards (last updated 01/2016)
- Medical, Surgical, and Routine Supplies (last updated 05/2017)
- Medically Unlikely Edits (MUEs) (last updated 11/2017)
- Moda Health Reimbursement Policy Overview (last updated 01/2017)
- Preventive Services versus Diagnostic and/or Medical Services (last updated 10/2017)
- Procedures Designated as "Separate Procedure" (last updated 10/2017)
- Records Fees, Copying Fees (last updated 03/2018)
- Revenue Codes Ending in "9" ("Other" Categories) (last updated 07/2017)
- Risk Adjustment/HCC Coding and Documentation (last updated 07/2017)
- Anesthesia
- Anesthesia Physical Status Modifiers (P1 - P6) (last updated 07/2017)
- Modifier 50 - Bilateral Procedure (last updated 04/2018)
- Modifiers AA, AD, GC, QK, QX, QY, QZ - Anesthesia Payment Modifiers (last updated 03/2018)
- Qualifying Circumstances for Anesthesia (last updated 07/2017)
- Documentation
- E0486 Oral Sleep Apnea Device/Appliance Documentation (last updated 11/2017)
- Evaluation & Management
- Critical Care, Evaluation and Management Services (last updated 10/2017)
- Gynecologic or Annual Women's Exam Visit & Use of Q0091 (Pap, Pelvic, & Breast Visit) (last updated 10/2017)
- Facility-Specific
- Facility Reimbursement of Respiratory Therapy Services (last updated 06/2017)
- Laboratory & Pathology
- Clinical Drug Screening and/or Drug Testing (last updated 03/2017)
- Molecular Pathology Procedure (MPP) Codes (a.k.a. Genetic Testing) (last updated 02/2017)
- Routine Venipuncture (last updated 01/2017)
- Medicine
- Drugs and Biologicals, Wastage and/or Discarded Amounts (Modifier JW) (last updated 05/2017)
- Moderate (Conscious) Sedation (last updated 11/2017)
- Telehealth And Telemedicine (last updated 03/2018)
- Modifiers
- Modifier 22 - Increased Procedural Services (last updated 07/2017)
- Modifier 25 - Significant, Separately Identifiable E/M Service (last updated 06/2017)
- Modifier 47 - Modifier 47 - Anesthesia By Surgeon (last updated 07/2017)
- Modifier 51 - Multiple Procedure Fee Reductions (last updated 04/2018)
- Modifier 52 - Reduced Services (last updated 03/2018)
- Modifier 53 – Discontinued Procedure (last updated 03/2018)
- Modifiers 54, 55, and 56 - Split Surgical Care (last updated 03/2018)
- Modifier 57 - Decision For Surgery (last updated 10/2017)
- Modifiers 58, 78, and 79 - Staged, Related, and Unrelated Procedures (last updated 03/2018)
- Modifiers XE, XS, XP, XU, and 59 - Distinct Procedural Service (last updated 10/2017)
- Modifiers 62 & 66 - Co-surgery (Two Surgeons) and Team Surgery (More Than Two Surgeons) (last updated 03/2018)
- Modifiers 73 & 74 - Discontinued Procedures For Facilities (last updated 04/2018)
- Modifiers 80, 81, 82, and AS - Assistant At Surgery (last updated 07/2017)
- Modifiers GA, GX, GY, and GZ (last updated 11/2017)
- Modifier SL - State Supplied Vaccine (last updated 08/2017)
- Reference (Outside) Laboratory -- Modifier 90 (last updated 10/2017)
- Technical Component (TC), Professional Component (PC/26), and Global Service Billing (last updated 03/2018)
- Valid Modifier to Procedure Code Combinations (last updated 01/2017)
- Preventive Services
- Colorectal Cancer Screening And Related Ancillary Services (last updated 11/2017)
- Surgery
- Computer Assisted Navigation (last updated 07/2017)
- Global Surgery Package for Professional Claims (last updated 04/2018)
- Intra-joint and Surgical Site Postoperative Pain Relief Drug Delivery System (Pain Pump) (last updated 04/2018)
- Maternity Care (last updated 04/2018)
- Operating Microscope (CPT Code 69990) (last updated 04/2017)
- Postoperative Sinus Endoscopy and/or Debridement Procedures (last updated 07/2017)
- Procedure Codes Assigned to Surgical Benefit Categories (last updated 04/2017)
- Robotic Assisted Surgery (last updated 03/2018)
The Moda Health Reimbursement Policy Manual is intended only for physicians, facilities, and other healthcare professionals, except where otherwise indicated. By using the Moda Health Reimbursement Policy Manual you acknowledge your understanding of, and agreement with the Moda Health Reimbursement Policy Disclaimer.
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