Clinical Payment and Coding Policy - Archived Documents

Anesthesia Clinical Payment and Coding InformationPolicy NumberEffective DateEnd Date
Anesthesia Clinical Payment and Coding Information PDF Document CPCP010 02/01/2019 07/19/2020
Anesthesia Clinical Payment and Coding Information PDF Document CPCP010 10/01/2018 01/31/2019
Applied Behavior AnalysisPolicy NumberEffective DateEnd Date
Applied Behavior Analysis for Autism Spectrum Disorders PDF Document CPCP011 07/10/2020 03/02/2021
Applied Behavior Analysis for Autism Spectrum Disorders PDF Document CPCP011 06/18/2019 07/09/2020
Applied Behavior Analysis for Autism Spectrum Disorders PDF Document CPCP011 06/01/2018 06/17/2019
Co-Surgeon/Team Surgeon ModifiersPolicy NumberEffective DateEnd Date
Co-Surgeon/Team Surgeon Modifiers PDF Document CPCP009 09/03/2019 10/14/2020
Co-Surgeon/Team Surgeon Modifiers PDF Document CPCP009 10/15/2018 09/02/2019
Co-Surgeon/Team Surgeon Modifiers PDF Document CPCP009 06/28/2018 10/14/2018
Coordinated Home Care/Private Duty Nursing Policy NumberEffective DateEnd Date
Coordinated Home Care /Private Duty Nursing Policy Guideline PDF Document CPCP005 01/01/2020 10/14/2020
Coordinated Home Care Policy PDF Document CPCP005 02/15/2019 12/31/2019
Chiropractic ServicesPolicy NumberEffective DateEnd Date
Chiropractic Services PDF Document CPCP016 12/03/2019 10/14/2020
Chiropractic Services PDF Document CPCP016 10/25/2019 12/02/2019
Chiropractic Services PDF Document CPCP016 09/01/2018 10/24/2019
Corrected Claim SubmissionsPolicy NumberEffective DateEnd Date
Corrected Claim Submissions PDF Document CPCP025 01/15/2020 08/14/2020
Drug Testing Clinical Payment and Coding PolicyPolicy NumberEffective DateEnd Date
Drug Testing Clinical Payment and Coding Policy PDF Document CPCP020 12/28/2020 08/31/2021
Drug Testing Clinical Payment and Coding Policy PDF Document CPCP020 05/01/2020 12/27/2020
Drug Testing Clinical Payment and Coding Policy PDF Document CPCP020 04/01/2019 04/30/2020
Emergency Department Evaluation and Management (E/M) Services Coding – Facility ServicesPolicy NumberEffective DateEnd Date
Emergency Department Services Evaluation and Management (E/M) Services Coding – Facility Services PDF Document CPCP003 01/25/2020 02/24/2021
Facility & Professional Coding of Evaluation and Management of Emergency Department Services PDF Document CPCP003 03/01/2019 01/24/2020
Evaluation and Management of Emergency Department Coding PDF Document CPCP003 06/01/2018 02/28/2019
Evaluation and Management of Emergency Department Coding PDF Document CPCP003 7/24/2017 05/31/2018
Evaluation and Management (E/M) Coding – Professional ProviderPolicy NumberEffective DateEnd Date
Evaluation and Management (E/M) Coding – Professional Provider PDF Document (Updated 12/16/2020 to add AMA code change) CPCP024 01/01/2021 01/01/2021
Evaluation and Management (E/M) Coding – Professional Provider PDF Document (Note:CPCP024 was originally part of CPCP003) CPCP024 01/25/2020 12/31/2020
Facility & Professional Coding of Evaluation and Management of Emergency Department Services PDF Document CPCP003 03/01/2019 01/24/2020
Evaluation and Management of Emergency Department Coding PDF Document CPCP003 06/01/2018 02/28/2019
Evaluation and Management of Emergency Department Coding PDF Document CPCP003 7/24/2017 05/31/2018
Global Surgical PackagePolicy NumberEffective DateEnd Date
Global Surgical Package PDF Document CPCP014 08/15/2021 05/25/2021
Global Surgical Package PDF Document CPCP014 06/18/2019 08/14/2020
Global Surgical Package PDF Document CPCP014 06/28/2018 06/17/2019
Hernia RepairPolicy NumberEffective DateEnd Date
Hernia Repair PDF Document CPCP012 09/15/2020 09/30/2021
Hernia Repair PDF Document CPCP012 06/18/2019 09/14/2020
Hernia Repair PDF Document CPCP012 06/28/2018 06/17/2019
Home InfusionPolicy NumberEffective DateEnd Date
Home Infusion PDF Document CPCP019 10/10/2020 12/20/2021
Home Infusion PDF Document CPCP019 01/01/2020 10/09/2020
Implant Payment and Coding PolicyPolicy NumberEffective DateEnd Date
Implant Payment and Coding Policy PDF Document CPCP007 08/01/2019 10/09/2020
Implant Payment and Coding Policy PDF Document CPCP007 11/15/2018 07/31/2019
Implant Payment and Coding Policy PDF Document CPCP007 10/01/2018 11/14/2018
Implant Payment and Coding Policy PDF Document CPCP007 11/15/2017 09/30/2018
Increased Procedural Services (Modifier 22)Policy NumberEffective DateEnd Date
Increased Procedural Services (Modifier 22) PDF Document CPCP013 07/20/2020 08/11/2021
Increased Procedural Services (Modifier 22) PDF Document CPCP013 02/20/2019 07/19/2020
Increased Procedural Services (Modifier 22) PDF Document CPCP013 06/27/2018 02/19/2019
Inpatient/Outpatient Unbundling PolicyPolicy NumberEffective DateEnd Date
Inpatient/Outpatient Unbundling Policy CPCP002 10/15/2019 03/17/2021
Inpatient/Outpatient Unbundling Policy CPCP002 08/01/2019 10/14/2019
Inpatient/Outpatient Unbundling Policy CPCP002 11/15/2018 07/31/2019
Inpatient/Outpatient Unbundling Policy CPCP002 10/01/2018 11/14/2018
Inpatient Unbundling Policy PDF Document CPCP002 07/24/2017 09/30/2018
Laboratory Panel BillingPolicy NumberEffective DateEnd Date
Laboratory Panel Billing CPCP021 06/10/2021 11/09/2021
Laboratory Panel Billing Guideline CPCP021 09/01/2020 06/09/2021
Laboratory Panel Billing Guideline CPCP021 07/18/2019 08/31/2020
Medical Record Documentation GuidelinePolicy NumberEffective DateEnd Date
Medical Record Documentation Guideline CPCP029 03/10/2020 07/11/2021
Medical Record Documentation Guideline CPCPG01 11/01/2019 03/09/2020
Medical Record Documentation Guideline PDF Document CPCPG01 04/01/2019 10/31/2019
Modifier Reference GuidelinesPolicy NumberEffective DateEnd Date
Modifier Reference Guideline CPCP023 07/15/2021 07/15/2021
Modifier Reference Guideline CPCP023 07/10/2020 07/14/2021
Modifier Reference Guideline CPCP023 04/01/2019 07/09/2020
Multiple Surgical ProceduresPolicy NumberEffective DateEnd Date
Multiple Surgical Procedures CPCP015 08/07/2020 11/30/2021
Multiple Surgical Procedures CPCP015 06/22/2019 11/09/2020
Neonatal Intensive Care Unit (NICU) Level of Care Authorization and Reimbursement PolicyPolicy NumberEffective DateEnd Date
Neonatal Intensive Care Unit (NICU) Level of Care Authorization and Reimbursement Policy PDF Document CPCP004 06/15/2020 04/04/2021
Neonatal Intensive Care Unit (NICU) Level of Care Authorization and Reimbursement Policy PDF Document CPCP004 07/15/2019 06/14/2020
Neonatal Intensive Care Unit (NICU) Level of Care Authorization and Reimbursement Policy PDF Document CPCP004 06/01/2018 07/14/2019
Neonatal Intensive Care Unit (NICU) Level of Care Authorization and Reimbursement Policy PDF Document CPCP004 10/01/2017 05/31/2018
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU)Policy NumberEffective DateEnd Date
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) PDF Document Version updated with new AMA codes CPCP028 08/15/2021 08/15/2021
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) PDF Document CPCP028 07/01/2021 08/14/2021
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) PDF Document CPCP028 05/15/2021 06/30/2021
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) PDF Document CPCP028 04/01/2021 05/14/2021
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) PDF Document Revised 12/14/2020 to include 01/01/2021 AMA code changes CPCP028 03/01/2021 03/31/2021
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) PDF Document (Replaced before effective with above version due to AMA changes) CPCP028 03/01/2021 03/01/2021
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) PDF Document CPCP028 01/01/2021 02/28/2021
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) PDF Document CPCP028 12/01/2020 12/31/2020
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) PDF Document (Refer to Revision to Non-Reimbursable Experimental, Investigational and/or Unproven Services Policy) CPCP028 12/01/2020 12/01/2020
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) PDF Document CPCP028 09/01/2020 11/30/2020
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) PDF Document Refer to Correction -Clinical Payment and Coding Policy Update CPCP028 09/01/2020 09/01/2020
Observation Services Tool For Applying MCG Care GuidelinesPolicy NumberEffective DateEnd Date
Observation Services Tool for Applying MCG Care Guidelines CPCP001 06/15/2020 11/03/2021
Observation Services Tool for Applying MCG Care Guidelines CPCP001 08/01/2019 06/14/2020
Observation Services Tool for Applying MCG Care Guidelines CPCP001 09/01/2018 07/31/2019
Observation Services Tool for Applying MCG Care Guidelines CPCP001 11/01/2016 08/31/2018
Pneumatic Compression Devices – Outpatient UsePolicy NumberEffective DateEnd Date
Pneumatic Compression Devices – Outpatient Use PDF Document CPCP022 11/01/2019 09/30/2020
Point-of-Care Ultrasound Examination PolicyPolicy NumberEffective DateEnd Date
Point-of-Care Ultrasound Examination Guideline PDF Document CPCP030 09/15/2020 06/09/2021
Preventive Services PolicyPolicy NumberEffective DateEnd Date
Preventive Services Policy PDF Document CPCP006 04/01/2021 06/30/2021
Preventive Services Policy PDF Document CPCP006 01/15/2021 03/31/2021
Preventive Services Policy PDF Document CPCP006 01/01/2020 01/14/2021
Preventive Services Policy PDF Document CPCP006 10/01/2020 12/31/2020
Preventive Services Policy PDF Document CPCP006 07/01/2020 09/30/2020
Preventive Services Policy PDF Document CPCP006 04/01/2020 06/30/2020
Preventive Services Policy PDF Document CPCP006 01/01/2020 03/31/2020
Preventive Services Policy PDF Document CPCP006 10/15/2019 12/31/2019
Preventive Services Policy PDF Document CPCP006 10/01/2019 10/14/2019
Preventive Services Policy PDF Document CPCP006 01/01/2019 09/30/2019
Preventive Services Policy PDF Document CPCP006 11/01/2018 12/31/2018
Preventive Services Policy PDF Document CPCP006 06/28/2018 10/31/2018
Preventive Services Policy PDF Document CPCP006 07/07/2017 06/27/2018
Psychological and Neuropsychological TestingPolicy NumberEffective DateEnd Date
Psychological and Neuropsychological Testing PDF Document CPCP008 07/10/2020 07/11/2021
Psychological and Neuropsychological Testing PDF Document CPCP008 02/15/2019 07/09/2020
Psychological and Neuropsychological Testing PDF Document CPCP008 08/01/2018 02/14/2019
Psychological and Neuropsychological Testing PDF Document CPCP008 01/01/2018 07/31/2018
Trauma ActivationPolicy NumberEffective DateEnd Date
Trauma Activation CPCP031 09/01/2020 08/25/2021
Trauma Activation TXCPCP02 07/01/2019 08/31/2020
Revenue Codes Requiring CPT or HCPCS CodesPolicy NumberEffective DateEnd Date
Revenue Codes Requiring CPT® or HCPCS Codes PDF Document CPCP018 07/01/2020 02/09/2021
Revenue Codes Requiring CPT or HCPCS Codes PDF Document CPCP018 10/25/2019 06/30/2020
Revenue Codes Requiring CPT or HCPCS Codes PDF Document CPCP018 11/01/2018 10/24/2019
Telemedicine and Telehealth ServicesPolicy NumberEffective DateEnd Date
Telemedicine and Telehealth Services PDF Document Effective 02/12/2021 –
added coverage for IOP Services
CPCP033 02/12/2021 03/24/2021
Telemedicine and Telehealth Services PDF Document *adding CMS footnote CPCP033 02/12/2021 02/12/2021
Telemedicine and Telehealth Services PDF Document CPCP033 02/12/2021 02/12/2021
Telemedicine and Telehealth Services PDF Document TXCPCP01 01/01/2021 02/11/2021
Telemedicine and Telehealth Services PDF Document TXCPCP01 05/10/2020 12/31/2020
Telemedicine and Telehealth Services PDF Document TXCPCP01 07/01/2019 05/09/2020
Telemedicine and Telehealth Services PDF Document TXCPCP01 11/01/2018 06/30/2019
Telemedicine and Telehealth Services PDF Document TXCPCP01 04/04/2018 10/31/2018
Wasted/Discarded Drugs and Biologicals GuidelinePolicy NumberEffective DateEnd Date
Wasted/Discarded Drugs and Biologicals Guideline CPCP017 10/25/2019 01/09/2021
Wasted/Discarded Drugs and Biologicals Guideline CPCP017 10/12/2018 10/24/2019