| Home Health Care/Private Duty Nursing Policy |
Policy Number |
Effective Date |
End Date |
|---|
| Coordinated Home Care/Private Duty Nursing Policy |
CPCP005 |
08/08/2021 |
11/12/2023 |
| Preventive Services Policy |
Policy Number |
Effective Date |
End Date |
|---|
| Preventive Services Policy |
CPCP006 |
07/01/2024 |
09/30/2024 |
| Preventive Services Policy |
CPCP006 |
04/01/2024 |
06/30/2024 |
| Preventive Services Policy |
CPCP006 |
01/01/2024 |
03/31/2024 |
| Preventive Services Policy |
CPCP006 |
11/01/2023 |
12/31/2023 |
| Preventive Services Policy |
CPCP006 |
10/01/2023 |
10/31/2023 |
| Preventive Services Policy |
CPCP006 |
07/01/2023 |
09/30/2023 |
| Preventive Services Policy |
CPCP006 |
04/01/2023 |
06/30/2023 |
| Preventive Services Policy |
CPCP006 |
03/01/2023 |
03/30/2023 |
| Preventive Services Policy V1 |
CPCP006 |
01/01/2023 |
02/28/2023 |
| Preventive Services Policy V1 |
CPCP006 |
10/01/2022 |
12/31/2022 |
| Preventive Services Policy V1 |
CPCP006 |
09/01/2022 |
09/30/2022 |
| Preventive Services Policy V1 |
CPCP006 |
07/01/2022 |
08/31/2022 |
| Preventive Services Policy V1 |
CPCP006 |
03/01/2022 |
06/30/2022 |
| Preventive Services Policy V1 |
CPCP006 |
01/01/2022 |
03/31/2022 |
| Preventive Services Policy V2 |
CPCP006 |
07/01/2021 |
09/30/2021 |
| Preventive Services Policy V2 |
CPCP006 |
04/01/2021 |
07/01/2021 |
| Preventive Services Policy V2 |
CPCP006 |
01/15/2021 |
04/01/2021 |
| Preventive Services Policy V2 |
CPCP006 |
01/01/2021 |
01/15/2021 |
| Preventive Services Policy V2 |
CPCP006 |
07/01/2020 |
09/30/2020 |
| Preventive Services Policy V 2.0 |
CPCP006 |
10/15/2019 |
01/01/2020 |
| Preventive Services Policy V 1.0 |
CPCP006 |
04/01/2020 |
|
| Preventive Services Policy V 6.0 |
CPCP006 |
01/01/2020 |
N/A |
| Preventive Services Policy V1 |
CPCP006 |
10/01/2020 |
01/01/20 |
| Psychological and Neuropsychological Testing |
Policy Number |
Effective Date |
End Date |
|---|
| Psychological and Neuropsychological Testing V1 |
CPCP008 |
12/04/2023 |
11/14/2024 |
| Psychological and Neuropsychological Testing V1 |
CPCP008 |
12/16/2022 |
12/04/2023 |
| Psychological and Neuropsychological Testing V1 |
CPCP008 |
03/31/2021 |
12/16/2022 |
| Psychological and Neuropsychological Testing V2 |
CPCP008 |
03/04/2020 |
03/31/2021 |
| Psychological and Neuropsychological Testing V5 |
ECPCP008 |
3/01/2018 |
3/4/2020 |
| Co-Surgeon/Team Surgeon Modifiers |
Policy Number |
Effective Date |
End Date |
|---|
| Co-Surgeon/Team Surgeon Modifiers |
CPCP009 |
09/26/2023 |
01/25/2024 |
| Co-Surgeon/Team Surgeon Modifiers V1 |
CPCP009 |
09/16/2020 |
09/25/2023 |
| Co-Surgeon/Team Surgeon Modifiers V1 |
CPCP009 |
09/16/2020 |
10/04/2021 |
| Co-Surgeon/Team Surgeon Modifiers V4 |
CPCP009 |
01/01/2019 |
09/16/2020 |
| Anesthesia Information |
Policy Number |
Effective Date |
End Date |
|---|
| Anesthesia Information |
CPCP010 |
03/30/2023 |
08/14/2024 |
| Anesthesia Information |
CPCP010 |
10/01/2022 |
03/30/2023 |
| Anesthesia Clinical Payment and Coding Information |
CPCP010 |
10/13/2021 |
9/30/2020 |
| Applied Behavior Analysis |
Policy Number |
Effective Date |
End Date |
|---|
| Applied Behavior Analysis V9 |
CPCP011 |
02/22/2019 |
3/6/2020 |
| Applied Behavior Analysis V1 |
CPCP011 |
03/28/2020 |
11/25/2020 |
| Applied Behavior Analysis V2 |
CPCP011 |
11/25/2020 |
12/18/2020 |
| Applied Behavior Analysis V1 |
CPCP011 |
11/09/2021 |
06/12/2023 |
| Applied Behavior Analysis |
CPCP011 |
06/12/2023 |
11/06/2024 |
| Hernia Repair |
Policy Number |
Effective Date |
End Date |
|---|
| Hernia Repair |
CPCP012 |
05/17/2023 |
07/10/2024 |
| Hernia Repair |
CPCP012 |
04/28/2022 |
05/17/2023 |
| Hernia Repair |
CPCP012 |
04/28/2022 |
05/17/2023 |
| Increased Procedural Services (Modifier 22) |
Policy Number |
Effective Date |
End Date |
|---|
| Increased Procedural Services (Modifier 22) |
CPCP013 |
05/17/2023 |
01/25/2024 |
| Increased Procedural Services (Modifier 22) |
CPCP013 |
02/24/2022 |
05/17/2023 |
| Global Surgical Package |
Policy Number |
Effective Date |
End Date |
|---|
| Global Surgical Package |
CPCP014 |
01/25/2019 |
04/30/2020 |
| Global Surgical Package |
CPCP014 |
04/30/2020 |
05/11/2021 |
| Global Surgical Package |
CPCP014 |
05/11/2021 |
08/02/2022 |
| Global Surgical Package |
CPCP014 |
08/02/2022 |
06/26/2023 |
| Global Surgical Package |
CPCP014 |
06/26/2023 |
01/25/2024 |
| Multiple Surgical Procedures |
Policy Number |
Effective Date |
End Date |
|---|
| Multiple Surgical Procedures v1 |
CPCP015 |
09/26/2023 |
01/25/2024 |
| Multiple Surgical Procedures v1 |
CPCP015 |
06/24/2022 |
09/26/2023 |
| Multiple Surgical Procedures v1 |
CPCP015 |
08/24/2021 |
06/24/2022 |
| Multiple Surgical Procedures V1 |
CPCP015 |
07/07/2020 |
08/24/2021 |
| Multiple Surgical Procedures V6 |
CPCP015 |
02/22/2019 |
07/07/2020 |
| Chiropractic Services |
Policy Number |
Effective Date |
End Date |
|---|
| Chiropractic Services |
CPCP016 |
08/15/2019 |
09/25/2020 |
| Chiropractic Services |
CPCP016 |
12/16/2021 |
03/28/2023 |
| Chiropractic Services |
CPCP016 |
03/28/2023 |
01/25/2024 |
| Wasted/Discarded Drugs and Biologicals Guideline |
Policy Number |
Effective Date |
End Date |
|---|
| Wasted/Discarded Drugs and Biologicals Guideline |
CPCP017 |
02/13/2023 |
02/28/2024 |
| Wasted/Discarded Drugs and Biologicals Guideline V4 |
CPCP017 |
10/26/2021 |
02/13/2023 |
| Wasted/Discarded Drugs and Biologicals Guideline V3 |
CPCP017 |
09/11/2020 |
10/26/2021 |
| Wasted/Discarded Drugs and Biologicals Guideline V5 |
CPCP017 |
06/26/2019 |
09/11/2020 |
| Home Infusion |
Policy Number |
Effective Date |
End Date |
|---|
| Home Infusion |
CPCP019 |
01/03/2023 |
11/12/2023 |
| Home Infusion V 3.0 |
CPCP019 |
09/07/2021 |
01/03/2023 |
| Home Infusion V 2.0 |
CPCP019 |
6/17/2020 |
09/07/2021 |
| Home Infusion V 2.0 |
CPCP019 |
06/30/2020 |
04/30/2020 |
| Drug Testing |
Policy Number |
Effective Date |
End Date |
|---|
| Drug Testing Clinical Payment and Coding Policy |
CPCP020 |
12/04/2023 |
11/14/2024 |
| Drug Testing Clinical Payment and Coding Policy |
CPCP020 |
03/30/2023 |
12/04/2023 |
| Drug Testing Clinical Payment and Coding Policy |
CPCP020 |
01/14/2022 |
03/30/2023 |
| Drug Testing Clinical Payment and Coding Policy (Retired 12/31/2021) |
CPCP020 |
10/22/2021 |
12/31/2021 |
| Drug Testing Policy |
CPCP020 |
09/04/2020 |
10/21/2021 |
| Drug Testing Policy |
CPCP020 |
12/20/2020 |
09/04/2020 |
| Laboratory Panel Billing |
Policy Number |
Effective Date |
End Date |
|---|
| Laboratory Panel Billing |
CPCP021 |
06/04/2021 |
07/30/2021 |
| Laboratory Panel Billing |
CPCP021 |
07/30/21 |
04/06/22 |
| Laboratory Panel Billing |
CPCP021 |
04/06/22 |
06/26/23 |
| Laboratory Panel Billing |
CPCP021 |
06/26/23 |
07/10/24 |
| Pneumatic Compression Devices – Outpatient Use |
Policy Number |
Effective Date |
End Date |
|---|
| Pneumatic Compression Devices – Outpatient Use |
CPCP022 |
02/13/2023 |
02/16/2024 |
| Pneumatic Compression Devices – Outpatient Use |
CPCP022 |
01/14/2022 |
02/13/2023 |
| Pneumatic Compression Devices – Outpatient Use |
CPCP022 |
07/01/2019 |
08/31/2020 |
| Modifier Reference Policy |
Policy Number |
Effective Date |
End Date |
|---|
| Modifier Reference Policy |
CPCP023 |
11/13/23 |
01/25/24 |
| Modifier Reference Policy |
CPCP023 |
03/30/23 |
11/12/23 |
| Modifier Reference Guideline V1 |
CPCP023 |
05/13/22 |
03/30/23 |
| Modifier Reference Guideline V1 |
CPCP023 |
04/08/22 |
05/13/22 |
| Modifier Reference Guideline V2 |
CPCP023 |
03/31/21 |
04/08/22 |
| Evaluation and Management (E/M) Coding – Professional Provider Services |
Policy Number |
Effective Date |
End Date |
|---|
| Evaluation and Management (E/M) Coding – Professional Provider Services |
CPCP024 |
06/22/23 |
12/04/23 |
| Evaluation and Management (E/M) Coding – Professional Provider Services V3 |
CPCP024 |
12/07/20 |
06/22/23 |
| Corrected Claim Submissions |
Policy Number |
Effective Date |
End Date |
|---|
| Corrected Claim Submissions |
CPCP025 |
04/30/20 |
06/30/24 |
| Therapeutic, Prophylactic and Diagnostic Injection and Infusion Coding |
Policy Number |
Effective Date |
End Date |
|---|
| Therapeutic, Prophylactic and Diagnostic Injection and Infusion Coding V3 |
CPCP026 |
10/05/21 |
01/03/23 |
| Therapeutic, Prophylactic and Diagnostic Injection and Infusion Coding V3 |
CPCP026 |
01/03/23 |
05/17/23 |
| Therapeutic, Prophylactic and Diagnostic Injection and Infusion Coding V1 |
CPCP026 |
05/17/23 |
08/29/24 |
| Inpatient Readmissions |
Policy Number |
Effective Date |
End Date |
|---|
| Inpatient Readmissions |
CPCP027 |
03/01/23 |
06/30/23 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) |
Policy Number |
Effective Date |
End Date |
|---|
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) |
CPCP028 |
07/01/24 |
09/30/24 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) |
CPCP028 |
07/01/24 |
07/01/24 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) |
CPCP028 |
05/15/24 |
06/30/24 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) |
CPCP028 |
04/01/24 |
05/15/24 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) |
CPCP028 |
01/15/24 |
05/15/24 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) |
CPCP028 |
12/01/23 |
01/15/24 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) |
CPCP028 |
10/01/23 |
11/30/23 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) |
CPCP028 |
09/01/23 |
09/30/23 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) |
CPCP028 |
06/01/23 |
08/31/23 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) V3 |
CPCP028 |
03/27/23 |
05/31/23 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) V3 |
CPCP028 |
12/07/22 |
06/31/23 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) V3 |
CPCP028 |
10/07/22 |
03/31/23 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) V3 |
CPCP028 |
08/01/22 |
12/31/22 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) V3 Effective Date 4/22/22 |
CPCP028 |
08/01/22 |
12/31/22 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) V2 Effective Date 4/15/22 |
CPCP028 |
04/15/22 |
04/15/2022 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) V2 |
CPCP028 |
07/01/2021 |
04/01/2022 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) V10 Effective Date 1/1/21 |
CPCP028 |
01/01/2021 |
03/01/2021 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) V10 Effective Date 3/1/21 |
CPCP028 |
03/01/2021 |
04/01/2021 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) V10 Effective Date 4/1/21 |
CPCP028 |
04/01/2021 |
05/15/2021 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) V1 Effective Date 5/15/21 |
CPCP028 |
05/15/2021 |
07/01/2021 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) |
CPCP028 |
11/20/2020 |
|
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) |
CPCP028 |
09/01/2020 |
12/01/2020 |
| Medical Record Documentation |
Policy Number |
Effective Date |
End Date |
|---|
| Medical Record Documentation |
CPCP029 |
11/13/2023 |
11/14/2024 |
| Medical Record Documentation |
CPCP029 |
09/16/2022 |
11/12/2023 |
| Medical Record Documentation Guidelines V5 |
CPCP029 |
09/22/2021 |
09/15/2022 |
| Medical Record Documentation Guidelines V1 |
CPCP029 |
03/31/2021 |
09/21/2021 |
| Medical Record Documentation Guidelines V1 |
CPCP029 |
02/06/2020 |
03/31/2021 |
| Medical Record Documentation |
OKCPCP01 |
09/01/2018 |
02/05/2020 |
| Trauma Activation- Facility Services |
Policy Number |
Effective Date |
End Date |
|---|
| Trauma Activation- Facility Services V1 |
CPCP031 |
07/12/2023 |
07/26/2024 |
| Trauma Activation- Facility Services V1 |
CPCP031 |
02/24/2022 |
07/12/2023 |
| Trauma Activation- Facility Services V1 |
CPCP031 |
05/22/2021 |
02/24/2022 |
| Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Guideline |
Policy Number |
Effective Date |
End Date |
|---|
| Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Guideline |
CPCP032 |
09/26/2023 |
10/03/2024 |
| Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Guideline |
CPCP032 |
04/22/2022 |
09/26/2023 |
| Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Guideline V3 |
CPCP032 |
07/30/2021 |
04/22/2022 |
| |
| Telemedicine and Telehealth/Virtual Health Care Services Policy |
Policy Number |
Effective Date |
End Date |
|---|
| Telemedicine and Telehealth Services V5 |
CPCP033 |
02/08/2020 |
03/18/2021 |
| Telemedicine and Telehealth Services V10 |
CPCP033 |
01/01/2021 |
02/08/2021 |
| Telemedicine and Telehealth Services V9 |
CPCP033 |
01/01/2021 |
01/01/2021 |
| Telemedicine and Telehealth Services V10 |
CPCP033 |
03/18/2022 |
03/28/2022 |
| Telemedicine and Telehealth Services V10 |
CPCP033 |
03/18/2021 |
03/28/2022 |
| Telemedicine and Telehealth Services |
CPCP033 |
03/28/2022 |
12/05/2023 |
| Telemedicine and Telehealth/Virtual Health Care Services Policy |
CPCP033 |
12/05/2023 |
02/28/2024 |
