Reimbursement policies

These policies are developed in accordance with guidance from criteria from specialized professional societies, national guidelines and the Centers for Medicare & Medicaid Services.

These policies aren’t intended to provide billing or coding advice, but to serve as a reference for facilities and providers.

Conformance to reimbursement policy is not a guaranty of payment. All other requirements continue to apply, including but not limited to eligibility at the time of service, medical necessity and other terms, conditions, limitations and exclusions set forth in the member’s coverage document.