Reimbursement policies
We want to assist physicians, facilities, and other providers in accurate claims submissions and to outline the basis for reimbursement if the service is covered by a member’s benefit plan.
Reimbursement policy code disclaimer
These policies may be superseded by state, federal, or CMS requirements. Providers and facilities are required to use industry-standard codes for claim submissions. Services should be billed with CPT® codes, HCPCS codes, and/or revenue codes. The billed code(s) should be fully supported in the medical record and/or office notes. Industry practices are constantly changing, and we reserve the right to review and revise policies periodically.
Note: Determination of coverage under a member's benefit plan does not necessarily ensure reimbursement.
Related information
Behavioral Health Reimbursement Policies
Visit our Behavioral Health page to locate our Behavioral Health reimbursement policies that may assist you in claims submissions for behavioral health services, substance use services, screenings, treatments, and therapies, as well as accessing billable HCPCS or CPT® codes.