Reimbursement Policies

05/19/2025

The following reimbursement policies have been updated. Please refer to the website applicable to the member’s plan (EmblemHealthConnectiCare) and see the revision histories for effective dates and applicable changes. Laboratory Benefit Management program policies have “(LBM)” at the end of their names.

  • Ambulatory Surgical Groupers Reimbursement Policy.
  • Bundled Services.
  • Compression Garments Reimbursement Policy.
  • Evaluation of Dry Eyes Testing (LBM).
  • Intracellular Micronutrient Analysis (LBM).
  • Lyme Disease Testing (LBM).
  • Allergen Testing (LBM).
  • Biomarker Testing for Autoimmune Rheumatic Disease (LBM).
  • Coding Edits Policy.
  • Colorectal Cancer Screening (LBM).
  • Diagnosis of Vaginitis (LBM).
  • DME Rental vs. Purchase Reimbursement Policy.
  • Flow Cytometry (LBM).
  • Helicobacter Pylori Testing (LBM).
  • Human Immunodeficiency Virus (HIV) (LBM).
  • Modifier Reference Reimbursement Policy.
  • Onychomycosis Testing (LBM).
  • Parathyroid Hormone, Phosphorus, Calcium, and Magnesium Testing (LBM).
  • Pediatric Preventive Screening (LBM).
  • Prenatal Screening-(Nongenetic) (LBM).
  • Prescription Medication and Illicit Drug Testing in the Outpatient Setting (LBM).
  • Preventive Care Services Commercial and Medicare.
  • Prostate Specific Antigen (PSA) Testing (LBM).
  • Salivary Hormone Testing (LBM).
  • Split/Fragmented Billing Reimbursement Policy.
  • Thyroid Disease Testing (LBM).
  • Urinary Tumor Markers for Bladder Cancer (LBM).