General Reimbursement Information


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Medical Policy Request Form

Medical Policy Request Form

Clinical Payment and Coding Policies

View Clinical Payment and Coding Policies

Preauthorization/Notification/Referral Requirements Lists

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Recoupment Process

Refund Policy

Reimbursement Schedules and Related Information


Compound Drugs

Hospital/Ambul. Surg Ctr./Endoscopy Ctr.

Rehabilitation Facility/LTAC/SNF/Acquired Brain Injury


Ancillary/Hospital Fee Schedule Request

Bundling Information

All Product News

Allergy Services


Assistant at Surgery Logic

Modifier Reimbursement

Modifiers — Prof. Claims

Molecular Pathology Procedure Test Codes 

Multiple Imaging Procedures Reduction

Multiple Procedure Payment Reduction

Multiple Surgery — Prof

Pass-Through Billing

Procedure Plus an Evaluation and Management Service

Texas HMO Outpatient Clinical Reference Lab Services Effective 9/1/2017

For HMO physicians and other professional providers located in counties on the HMO Reimbursable Lab County Listing, lab services on the Reimbursable Lab Services List will be reimbursed on a fee-for-service basis if performed in the physician's or professional provider’s office. All other lab services for HMO members must be referred to the exclusive HMO lab provider - Quest Diagnostics, Inc.

Blue EssentialsSM Outpatient Clinical Reference Lab Service through 08/31/17

(Performed in the Physician or other Professional Provider office)

Member Liability Estimate

Member Liability Estimate