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)
Bilateral/Multiple Surgical Procedures 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 – Modifier JW (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)
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 Radiology Download (PDF)
Multiple Procedure Reduction Cardiology/Ophthalmology Download (PDF)
Multiple Surgical Procedures 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 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)
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 including Multi-target PCR Testing (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 (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 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)

JP 60750 12/2022