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Reimbursement Policies

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Reimbursement Policies

Title	Download (PDF)
After Hours and Weekend Care	Download (PDF)
Allergy Testing Immunotherapy	Download (PDF)
Ambulatory Surgical Groupers	Download (PDF)
Anesthesia Billing	Download (PDF)
Assistant at Surgery – Modifiers 80/81/82 and AS (Commercial)	Download (PDF)
Multiple & Bilateral Surgical Procedures	Download (PDF)
Billing for Habilitative and Rehabilitative Services	Download (PDF)
Biomarkers Testing for Autoimmune Rheumatic Disease (LBM)	Download (PDF)
Bundled Services (Commercial and Medicare)	Download (PDF)
Co-Surgeon/Team Surgeon-Modifiers 62/66	Download (PDF)
Coding Edits Policy (Commercial and Medicare)	Download (PDF)
Colorectal Cancer (LBM)	Download (PDF)
Compression Garments	Download (PDF)
Computer Assisted Surgical Navigation	Download (PDF)
Coronavirus Testing in the Outpatient Setting (LBM)	Download (PDF)
Corrected Claim Submission	Download (PDF)
CPT and HCPCS Billing Guidelines	Download (PDF)
Daily Maximum Units (Commercial/Medicare)	Download (PDF)
Diabetes Mellitus Testing (LBM)	Download (PDF)
Diagnosis Code Guidelines: Manifestation/Secondary Diagnosis Codes	Download (PDF)
Discarded Drugs/Biologicals – Modifiers JW and JZ (Commercial)	Download (PDF)
Discontinued Procedures – Modifiers 53, 73 & 74 (Commercial)	Download (PDF)
DME In-Office/Non-Facility	Download (PDF)
DME Rental vs. Purchase	Download (PDF)
Drug Alcohol Testing (Commercial)	Download (PDF)
Drugs and Biologicals	Download (PDF)
Emergency Department Facility E&M Coding	Download (PDF)
Evaluation and Management (E&M) Services	Download (PDF)
Facility Fees for E&M Services on Outpatient Facility Claims	Download (PDF)
From/To Date Span	Download (PDF)
Hepatitis Testing (LBM)	Download (PDF)
Home Health Care Services	Download (PDF)
Hospital Readmissions	Download (PDF)
Human Immunodeficiency Virus (HIV) (LBM)	Download (PDF)
Intraoperative Neurophysiology Monitoring Services (IONM)	Download (PDF)
Laboratory/Venipuncture	Download (PDF)
Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Tremor	Download (PDF)
Mid-Level Practitioner Reimbursement Policy (Commercial)	Download (PDF)
Modifier Reference Policy	Download (PDF)
Modifier SU – Procedure Performed in Physician’s Office (Commercial)	Download (PDF)
Modifiers PN & PO for Clinic Visit Services (G0463) – (Medicare)	Download (PDF)
Multiple Diagnostic Imaging Payment Reduction Policy (Commercial)	Download (PDF)
Multiple Procedure Reduction Cardiology/Ophthalmology	Download (PDF)
National Drug Code (NDC) Requirements for Drug Claims – Commercial and Medicare	Download (PDF)
Never Events/Adverse Events & Serious Reportable Events (Commercial)	Download (PDF)
No Cost/Reduced Cost Drugs, Implants & Devices	Download (PDF)
Non-Participating Provider Advance Member Notification Form	Download (PDF)
Observation Stay - Commercial	Download (PDF)
Observation Stay – Medicare and Medicaid	Download (PDF)
Operating Microscope/Microsurgery (CPT 64727/69990)	Download (PDF)
Ophthalmology Reimbursement Policy	Download (PDF)
Preventive Care Services (Commercial)	Download (PDF)
Preventive Care Services (Medicare)	Download (PDF)
Preventive Medicine and Screening (Commercial)	Download (PDF)
Prolonged Services (Commercial and Medicare)	Download (PDF)
Revenue Codes Requiring Detailed Coding	Download (PDF)
Robotic Surgery	Download (PDF)
Routine Foot Care Services	Download (PDF)
Split Surgical Care (Modifiers 54/55/56) (Commercial)	Download (PDF)
Telehealth/Virtual Care Services	Download (PDF)
Therapeutic Drug Monitoring of 5-Fluorouracil (LBM)	Download (PDF)
Treatment Room	Download (PDF)
Unlisted Codes	Download (PDF)
Use of Non-Participating Provider Advance Member Notification Policy	Download (PDF)
B-Hemolytic Streptococcus Testing (LBM)	Download (PDF)
Biochemical Markers of Alzheimer Disease and Dementia (LBM)	Download (PDF)
Bone Turnover Markers Testing (LBM)	Download (PDF)
Celiac Disease Testing (LBM)	Download (PDF)
Cervical Cancer Screening (LBM)	Download (PDF)
Diagnosis of Vaginitis (LBM)	Download (PDF)
Diagnostic Testing of Common Sexually Transmitted Infections (LBM)	Download (PDF)
Diagnostic Testing of Influenza (LBM)	Download (PDF)
Epithelial Cell Cytology in Breast Cancer Risk Assessment (LBM)	Download (PDF)
Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing (LBM)	Download (PDF)
Fecal Calprotectin Testing in Adults (LBM)	Download (PDF)
Flow Cytometry (LBM)	Download (PDF)
Folate Testing (LBM)	Download (PDF)
Gamma-Glutamyl Transferase (LBM)	Download (PDF)
General Inflammation Testing (LBM)	Download (PDF)
Helicobacter Pylori Testing (LBM)	Download (PDF)
Immunohistochemistry (LBM)	Download (PDF)
Immunopharmacologic Monitoring of Therapeutic Serum Antibodies (LBM)	Download (PDF)
In Vitro Chemoresistance and Chemosensitivity Assays (LBM)	Download (PDF)
Lyme Disease Testing (LBM)	Download (PDF)
Measurement of Thromboxane Metabolites for ASA Resistance (LBM)	Download (PDF)
Nerve Fiber Density Testing (LBM)	Download (PDF)
Onychomycosis Testing (LBM)	Download (PDF)
Oral Cancer Screening and Testing (LBM)	Download (PDF)
Parathyroid Hormone, Phosphorus, Calcium, and Magnesium Testing (LBM)	Download (PDF)
Pediatric Preventive Screening (LBM)	Download (PDF)
Plasma HIV-1 and HIV-2 RNA Quantification for HIV Infection (LBM)	Download (PDF)
Prescription Medication and Illicit Drug Testing in Outpatient Setting (LBM)	Download (PDF)
Prostate Biopsy Specimen Analysis (LBM)	Download (PDF)
Radiopharmaceuticals and Contrast Media	Download (PDF)
Salivary Hormone Testing (LBM)	Download (PDF)
Testing For Alpha-1 Antitrypsin Deficiency (LBM)	Download (PDF)
Testing for Diagnosis of Active or Latent Tuberculosis (LBM)	Download (PDF)
Testing for Vector-Borne Infections (LBM)	Download (PDF)
Testing of Homocysteine Metabolism-Related Conditions (LBM)	Download (PDF)
Testosterone Testing (LBM)	Download (PDF)
Thyroid Disease Testing (LBM)	Download (PDF)
Urine Culture Testing for Bacteria (LBM)	Download (PDF)
Vitamin B12 & Methylmalonic Acid Testing (LBM)	Download (PDF)
Vitamin D Testing (LBM)	Download (PDF)
Zika Virus Risk Assessment (LBM)	Download (PDF)
Allergen Testing (LBM)	Download (PDF)
Biomarkers for Myocardial Infarction and Chronic Heart Failure (LBM)	Download (PDF)
Cardiovascular Disease Risk Assessment (LBM)	Download (PDF)
Diagnosis of Idiopathic Environmental Intolerance (LBM)	Download (PDF)
Diagnostic Testing of Iron Homeostasis & Metabolism (LBM)	Download (PDF)
Erectile Dysfunction (LBM)	Download (PDF)
Evaluation of Dry Eyes Testing (LBM)	Download (PDF)
Genetic Testing for Adolescent Idiopathic Scoliosis (LBM)	Download (PDF)
Identification of Microorganisms Using Nucleic Acid Probes (LBM)	Download (PDF)
Immune Cell Function Assay (LBM)	Download (PDF)
Intracellular Micronutrient Analysis (LBM)	Download (PDF)
Lab Testing for the Diagnosis of IBD (LBM)	Download (PDF)
Metabolite Markers of Thiopurines Testing (LBM)	Download (PDF)
Pancreatic Enzyme Testing for Acute Pancreatitis (LBM)	Download (PDF)
Pathogen Panel Testing (LBM)	Download (PDF)
Pharmacy Medical Claim Edit	Download (PDF)
Prenatal Screening-Nongenetic (LBM)	Download (PDF)
Preventive Screening in Adults (LBM)	Download (PDF)
Prostate Specific Antigen (PSA) Testing (LBM)	Download (PDF)
Serum Testing for Evidence of Mild Traumatic Brain Injury (LBM)	Download (PDF)
Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease (LBM)	Download (PDF)
Serum Tumor Markers for Malignancies (LBM)	Download (PDF)
ST2 Assay for Chronic Heart Failure (LBM)	Download (PDF)
Urinary Tumor Markers for Bladder Cancer (LBM)	Download (PDF)
Vectra DA Blood Test for Rheumatoid Arthritis (LBM)	Download (PDF)
Venous and Arterial Thrombosis Risk Testing (LBM)	Download (PDF)
Split/Fragmented Billing	Download (PDF)
Medicare Part D Vaccines	Download (PDF)

Medicare Overview of Billing and Claims Payment Policy
Commercial Overview of Billing and Claims Policy

ConnectiCare will process Medicare claims according to Medicare payment rules and specialty society guidelines, unless specified otherwise in a provider contract. If a billing or claims payment policy for a particular service is not addressed in this section, follow procedures that are considered standard rules of the Centers for Medicare & Medicaid Services (CMS). This information is available at the CMS website.

ConnectiCare applies the CMS National Correct Coding Initiative (NCCI) edits for claims editing. Certain inpatient evaluation and management procedures are identified in the NCCI manual as not being separately reimbursable, even if a modifier such as modifier 25 is added to the procedure code. NCCI edits apply to claims from all providers in the same specialty and group. There are no exceptions to these edits based on sub-specialty or different diagnoses. Please refer to the CMS NCCI manual regarding reporting of evaluation and management services as needed.

Medicare PPM/11.12

Overview of policy

Title	Effective date	Policy statement	Billing instructions	Reimbursement information
All providers
Bilateral Procedures	January 2009	Professional claims should be submitted using the five-digit CPT code describing the procedure, followed by the bilateral Modifier ’-50’, or with modifier RT on one line and modifier LT on the subsequent line with the applicable CPT or HCPCS code. Facility claims must be submitted with modifier RT on one line and modifier LT on the subsequent line with the applicable CPT or HCPCS code.	Bilateral services may be submitted for codes identified by Medicare in the Physician RVU file.	Reimbursement will be made based on traditional Medicare unless otherwise specified in your contract.
Diagnosis and Procedure Coding	January 2009	Current diagnosis and procedure codes are required. Deleted codes will be denied.
Medicare Status Codes	January 2009	Medicare claims will be processed in accordance with CMS Relative Value Unit (RVU) file status code recommendations. Status N codes are not covered unless otherwise specified under the benefit plan. Refer to the Physician Relative Value Files located under "Medicare" at cms.gov.
Modifiers	January 2009	ConnectiCare follows CMS guidelines for CPT and HCPCS modifiers.
Nutritional Counseling	January 2000	ConnectiCare will cover nutritional counseling according to the applicable benefit plan.	Bill with CPT codes 97802, 97803, 97804, 99078 or 0942.
Radiology Services with an Evaluation and Management (E&M) visit	June 2012	Radiology copayment applies if radiology services are provided during an Evaluation and Management (E&M) visit. Please go to Provider Connections and check the member's benefits for the appropriate copayment amount.
Routine Vision Examination	January 2009	ConnectiCare will cover routine eye examinations according to the applicable benefit plan.		Reimbursement will be made according to applicable fee schedules when covered. Note: In accordance with CMS, refraction is not a covered service.

If you have any questions, please call Provider Services at 860-674-5850 or 800-828-3407.

Medicare PPM/4.19

Administrative procedures

Claim Edits

ConnectiCare evaluates medical billing information and coding for accuracy and appropriateness. This practice is designed to detect coding patterns such as unbundling, integral procedures, and mutually exclusive procedures.

In addition, ConnectiCare’s claims payment system will adjudicate claims based on CMS (Centers for Medicare & Medicaid Services) and NCCI (National Correct Coding Initiative) edits. ConnectiCare considers coding edits that are based on industry sources, including but not limited to CPT guidelines from the American Medical Association, specialty organizations, and CMS. In coding scenarios where there are conflicts between sources, ConnectiCare will apply edits that ConnectiCare determines are most appropriate.

For questions about why a particular claim was denied based on a coding edit, refer to your remittance, or call Provider Services at 877-224-8230.

Medicare PPM/2.10

ConnectiCare has policies in place that reflect billing or claims payment processes unique to our health plans. Current billing and claims payment policies apply to all our products, unless otherwise noted. ConnectiCare will inform you of new policies or changes in policies through updates to the Provider Manual and/or provider news. If a billing or claims payment policy for a particular service is not addressed in this outline, follow procedures that are considered standard throughout the health care industry. Most of ConnectiCare’s billing and claims payment policies are standard in the health insurance industry, and you should follow industry standard procedures for issues that are not specifically addressed in the Provider Manual.

We also evaluate medical billing information to detect coding patterns such as unbundling, integral procedures, and mutually exclusive procedures. ConnectiCare reserves the right to audit physician documentation in order to verify coding and billing accuracy.

ConnectiCare's claims system will process claims based on Centers for Medicare & Medicaid Services (CMS) and National Correct Coding Initiative (NCCI) edits. ConnectiCare follows coding edits that are based on industry sources, including, but not limited to, CPT guidelines from the American Medical Association, specialty organizations, and CMS. In coding scenarios where there appears to be conflicts between sources, we will apply the edits we determine are appropriate. ConnectiCare uses industry-standard claims editing software products when making decisions about appropriate claim editing practices. Upon request, we will provide an explanation of how ConnectiCare handles specific coding issues.

Title	Date	Policy Statement	Billing Instructions	Reimbursement Information
All Providers
Add-on Codes	Revised July 2015	ConnectiCare recognizes CMS and AMA CPT Add-on code guidelines.	According to the CMS HCPCS Manual, an add-on code describes additional intra-service work associated with the primary procedure and must never be reported as a stand-alone code.	Add-on codes billed with the primary procedure will be reimbursed.
Assignment of Benefit	Effective November 2012	ConnectiCare, in compliance with the 5010 standard, will pay the provider or member based on what the provider submitted under the Benefits Assignment Certification Indicator on the claim.	If the provider wants the payment to be sent to the member, the provider should enter "N" under the Benefits Assignment Certification Indicator. If the provider wants to receive the payment, the provider should enter "Y" under the Benefits Assignment Certification Indicator. If the provider does not include any designation, the payment will be made to the member.
Clinical Documentation with Initial Claim Submission	Revised July 2015	Clinical documentation is not required with initial claim submission, unless otherwise specified.	When submitting clinical documentation for the purpose of ensuring the claim will be reviewed prior to payment, please contact Provider Services to request that the documentation be reviewed prior to payment.	Paper claims are converted to electronic format and will be processed as an electronic claim.
Colonoscopy Services, Incomplete	Revised July 2015	Colonoscopy frequency is limited to once every 12 months with exceptions.	CPT code 45378 should be billed no more frequently than every 12 months. If an incomplete colonoscopy is performed, submit CPT code 45378 with modifier 53 in order to allow a second one in a 12-month period.	Reimbursement will be provided when billed according to Billing Instructions. Also see Preventive Services.
CPT, HCPCS and ICD Coding	Effective June 1997, revised January 2005	ConnectiCare requires the use of current CPT, HCPCS and ICD-10 coding. Deleted procedure codes will no longer be accepted after the deleted date.
End Stage Renal Services	Revised July 2015	Monthly end stage renal disease services are payable on a monthly basis.	Bill with appropriate CPT code with a date of service at the beginning or at the end of each month. CPT codes 90951-90962.	Monthly reimbursement may be provided.
Evoked Potential Testing	Revised July 2015	Evoked Potential Testing is allowed for patients who are less than 17 years old and have a diagnosis of Multiple Sclerosis or other demyelinating disease or intraoperative testing.	CPT codes 95925, 95926, 95927, 95939 may be reimbursed when billed according to the policy.	Services will be reimbursed according to the policy.
Extended Electroencephalography (EEG) Services	Revised July 2015	Extended EEG services are not allowed in the office location.	Bill CPT codes 95812, 95813, 95816, 95819, 95822, and 95827 with a diagnosis code that supports the use of extended EEG testing. Not allowed for separate reimbursement when performed in the office setting.	Services will be reimbursed according to the policy.
Facility Location Only Services	Effective July 2015	ConnectiCare recognizes CMS facility location only services.		Procedure codes restricted to facility location, as indicated by CMS, are not payable in the office location unless documentation supports the level of coding.
Gastric Bypass Rider	Effective August 2012	CPT code 43999 billed with ICD-10 codes E66.01 & Z46.51 will not require prior authorization if the member has the Gastric Bypass Rider. If the member does not have the Gastric Bypass Rider, the claims will deny as not covered.
Global Surgical Billing	Effective August 1998	ConnectiCare recognizes CMS (Centers for Medicare & Medicaid Services) global surgical periods. Physicians should not require members to have a separate encounter solely for the purpose of being able to bill for an office visit separate from a diagnostic or therapeutic procedure.
Incidental Arthroscopic Procedures	Revised July 2015	When more than 1 procedure is performed through the same arthroscopic portal (incision), the most clinically intensive procedure will be allowed. Other services performed through the same portal will be denied as incidental in accordance with NCCI edits, and will be upheld upon appeal.	Please refer to NCCI edits to determine when the use of modifier 59 is acceptable.
"Incident to" Services	Revised July 2015	"Incident to" services, as identified by CMS, may only be billed for the office location.		"Incident to" services will be payable in the office location, unless otherwise indicated.
Injection Codes	Revised June 2016	ConnectiCare recognizes CMS guidelines including code status values. Certain codes are identified on the Physician RVU file as status "T" for Injections. Example CPT codes with a status "T" are: 36591, 36592, 36598, 94760, 94761.	Submit all services rendered during a single encounter on one claim.	ConnectiCare will not reimburse services with "T" status if there are no other services payable under the physician fee schedule billed on the same date by the same provider. If any other services payable under the physician fee schedule are billed on the same date by the same provider, these services are not payable and the reimbursement is considered bundled into the physician services for which payment is made.
Inpatient Only Codes	Effective July 2015	ConnectiCare recognizes CMS inpatient only services.		Procedure codes restricted to inpatient only, as indicated by CMS, are not payable as outpatient unless documentation supports the level of coding.
Maternity Billing Procedures	Effective May 1994	ConnectiCare requires the use of global delivery codes when the same physician or same physician group provides care throughout the pregnancy and delivery. These codes include one postpartum visit.	• Bill antepartum care as part of the global delivery codes 59400 and 59510. Either 59425 or 59426 may be used if the physician or group did not provide care throughout the pregnancy and delivery. • Modifier 22 can be billed in conjunction with any delivery service for high-risk patients who require 16 or more antepartum visits, or in the case of a multiple gestation pregnancy.
Moderate Sedation	Effective January 2006	ConnectiCare follows: • AMA CPT coding guidelines • CMS NCCI Manual (edits and policies), • CMS Medicare Claims Processing Manual (Publication 100-04, Chapter 12, Section 50) for moderate (conscious) sedation.	• Moderate sedation codes are CPT 99143-99145 and 99148-99150. • CPT codes 99148-99150 require documentation supporting the need for the second physician to administer moderate sedation. These codes are not to be reported when performed in a non-facility setting (e.g., physician office). • Moderate sedation does not include 00100-01999.	• Moderate sedation codes will be reimbursed in accordance with AMA CPT guidelines and applicable CMS references. • Moderate sedation codes will not be reimbursed when the medication administration record indicates the services were rendered by individuals other than the billing provider.
Multiple Identical Services	Revised July 2015	Multiple claims for the same procedure code may be payable when submitted on one claim.	When billing multiples of the same code, submit on one line, on one claim and indicate the number of units in the units field.	When submitted on the same claim and when multiples of the same code are allowed, services will be reimbursed. When submitted on separate claims, multiples of the same service will be denied as duplicates.
NCCI Edits (National Correct Coding)	Revised July 2015	ConnectiCare recognizes CMS NCCI policy, including CMS MUE (Medically Unlikely Edits) for Professional and Facility claims.	Refer to National Correct Coding Initiative Edits
Needle Electromyography (EMG) Services	Revised July 2015		Bill all of the most specific diagnoses to support the EMG code.
Nerve Conduction Services	Revised July 2015		Bill the most specific diagnoses to support the nerve conduction testing codes. The number of units may be limited based on CPT manual appendix J: "Electrodiagnostic Medicine Listing of Sensory, Motor, and Mixed Nerves."
Non-Licensed Personnel	Effective January 1999	ConnectiCare will not reimburse for services provided by non-licensed health care personnel (e.g., home health aides, physical therapy assistants, nannies, certified surgical or nursing assistants).
Nutritional Counseling	Effective January 2000	ConnectiCare covers nutritional counseling, rendered by participating providers in the office or outpatient facility. Coverage is limited to two visits per member, per calendar year and must be for illnesses requiring therapeutic dietary monitoring (e.g., diabetes, heart disease, hypertension, obesity). In some cases, an additional visit may be authorized.	Bill with CPT codes 97802, 97803, 97804, 99078 or 0942.	Reimbursement will be made according to applicable fee schedules.
Osteopathic Manipulative Treatment (OMT)	Effective April 1995	Any DO may provide treatment for Osteopathic Manipulative Treatment (OMT) codes 98925-98929.	The DO may charge for a consultation in addition to the fees for OMT, in accordance with CPT guidelines for separate Evaluation and Management services.
Photochemotherapy (PUVA), Actinotherapy			CPT codes 96910-96913 must be billed with diagnosis codes that support the use of these procedures based on the American Academy of Dermatology's treatment guidelines.
Professional Component Procedures		Professional interpretation is included in Evaluation and Management services.		Not separately reimbursed when billed with an E&M service.
Removal of Skin Lesions	Effective February 2002	The cosmetic removal of benign lesions (including hypertrophic/keloid scars), or the removal of skin tags is not covered and may not be preauthorized. All other procedures for removal of skin lesions are covered benefits.	Refer to the most current CPT and ICD-10 manuals for applicable billing codes.
Rhythm Electrocardiography	Revised July 2015			CPT 93042 is not separately reimbursed when billed with E&M services or an interventional service in a facility.
Separate Procedure Codes	Revised July 2015	Procedure codes designated as "separate procedure" in the AMA CPT manual should not be reported in addition to the code for the total procedure or the service of which it is considered an integral component. Appeals for these codes will be upheld.	Do not report procedure codes designated as "Separate Procedure" when also billing another procedure code for the same date of service.	Codes with Separate Procedure designation will be denied.
Serial Visits (Identical Services Provided Over a Defined Time Span on Different Dates of Service)	Effective July 2015		When a series of identical services, such as chemotherapy, are required over multiple days, the claim should be submitted with the chemotherapy procedure code on separate lines for each individual date of service. Date spans are not acceptable and will be denied for the provider to resubmit a corrected claim in the correct billing format.	Applicable cost-share will be correctly applied for individual dates of service.
Services Associated with Preauthorized Services	Effective January 1, 2009	Services associated with procedures that require preauthorization will be denied when no authorization has been obtained or has been denied. Upon appeal, if the procedure requiring authorization is authorized retroactively, the related services may be reimbursed.
Sigmoidoscopy	Revised July 2015	CPT codes 45330-45339 are not allowed more frequently than every 6 months, unless done in the inpatient setting.
Split Billing	Revised July 2015	ConnectiCare requires that services that are provided by the same provider, for the same member, on the same date of service be billed together on one claim, including electronically submitted claims. Split billed services may result in incorrect reimbursement.
Unbundled Codes	Effective September 2013	ConnectiCare recognizes AMA, CPT, CMS, and specialty organizations (eg. AAOS, ACOG) guidelines. Services are to be reported with the most appropriate code available. Comprehensive codes that represent a group of services that also have individual codes are to be billed with the comprehensive code.	Submit all services rendered during a single encounter on one claim. Submit the code that best represents all of the services rendered when there is an appropriate comprehensive code. If services that would otherwise be part of a comprehensive code are performed during separate encounters or body sites, apply the appropriate modifier such as: E1 - E4, FA, F1 - F9, TA, T1 - T9, LT, RT, LC, LD, RC, -58, -78, -79 and -94. The medical record must include supporting documentation for the use of each modifier and may be subject to auditing.	ConnectiCare will reimburse services billed with the most appropriate code. Services billed in an unbundled method will be denied. The provider will need to submit a corrected claim with the more appropriate bundled or comprehensive code that represents the group of services. See also "Bundled Status Codes" in this section.

If you have any questions, please call Provider Services at 860-674-5850 or 800-828-3407.

PPM/04.21

JP 60750 12/2022

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Any information provided on this Website is for informational purposes only. It is not medical advice and should not be substituted for regular consultation with your health care provider. If you have any concerns about your health, please contact your health care provider's office.

Also, this information is not intended to imply that services or treatments described in the information are covered benefits under your plan. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage.