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Clinical & Payment Policies

Clinical Policies

Clinical policies are one set of guidelines used to assist in administering health plan benefits, either by prior authorization or payment rules.  They include but are not limited to policies relating to evolving medical technologies and procedures, as well as pharmacy policies.  Clinical policies help identify whether services are medically necessary based on information found in generally accepted standards of medical practice; peer-reviewed medical literature; government agency/program approval status; evidence-based guidelines and positions of leading national health professional organizations; views of physicians practicing in relevant clinical areas affected by the policy; and other available clinical information. 

All policies found in the MHS Health Wisconsin Clinical Policy Manual apply to MHS Health Wisconsin members. Policies in the MHS Health Wisconsin Clinical Policy Manual may have either a MHS Health Wisconsin or a “Centene” heading.  MHS Health Wisconsin utilizes InterQual® criteria for those medical technologies, procedures or pharmaceutical treatments for which a MHS Health Wisconsin clinical policy does not exist.  InterQual is a nationally recognized evidence-based decision support tool.  You may access the InterQual® SmartSheet(s)™ for Adult and Pediatric procedures, durable medical equipment and imaging procedures by logging into the secure provider portal or by calling MHS Health Wisconsin. In addition, MHS Health Wisconsin may from time to time delegate utilization management of specific services; in such circumstances, the delegated vendor’s guidelines may also be used to support medical necessity and other coverage determinations. Other non-clinical policies (e.g., payment policies) or contract terms may further determine whether a technology, procedure or treatment that is not addressed in the Clinical Policy Manuals or  InterQual®criteria is payable by MHS Health Wisconsin.   

If you have any questions regarding these policies, please contact Member Services and ask to be directed to the Medical Management department.

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ADHD Assessment and Treatment CP.MP.124 (PDF)
Effective Date: 8/1/16
Inhaled Nitric Oxide CP.MP.87 (PDF)
Effective Date: 8/1/13
Reduction Mammoplasty (PDF)
Effective Date: 7/1/15
Allogenic Hematopoietic Cell Transplants for Sickle Cell CP.MP.108 (PDF)
Effective Date: 3/1/16
Intensity-Modulated Radiotherapy CP.MP.69 (PDF)
Effective Date: 3/1/14
Sacoiliac Joint Fusion CP.MP.126 (PDF)
Effective Date: 9/1/16
Ambulatory Electroencephalography CP.MP.96 (PDF)
Effective Date: 9/1/15
Intestinal and Multivisceral Transplant CP.MP.58 (PDF)
Effective Date: 2/1/14
Sacroiliac Joint Interventions for Pain Management CP.MP.166 (PDF)
Applied Behavioral Analysis for Autism CP.MP.104 (PDF)
Effective Date: 8/1/09
Intradiscal Steriod Injections for Pain Management CP.MP.167 (PDF) Selective Nerve Root Blocks and Transforaminal Epidural Injections for Pain Management CP.MP.165 (PDF)
Balloon Sinus Ostial Dilation CP.MP.119 (PDF)
Effective Date: 11/1/16
Intrathecal Infusion Pumps for Spasticity or Pain (PDF)
Effective Date: 5/1/14
Sickle Cell Disease Observation CP.MP.88 (PDF)
Effective Date: 9/1/14
Bariatric Surgery CP.MP.37 (PDF)
Effective Date: 8/1/14
Laser Therapy for Skin Conditions CP.MP.123 (PDF)
Effective Date: 8/1/16
Spinal Cord Stimulation CP.MP.117 (PDF)
Effective Date: 7/1/16
Bariatric Surgery Requires Prior Authorization (PDF)
Effective Date: 8/2/18
Lung Transplantation CP.MP.57 (PDF)
Effective Date: 2/1/14
Spinal Stimulator Surgeries (PDF)
Effective Date: 9/1/13
Bone Growth Stimulator (PDF)
Effective Date: 7/1/15
Lysis of Epidural Lesions CP.MP.116 (PDF)
Effective Date: 7/1/16
Stereotactic Body Radiation Therapy CP.MP.22 (PDF)
Effective Date: 12/1/13
Botox Used to Treat Chronic Migraines Prior Authorization Not Required (PDF)
Effective Date: 6/1/16
Medical Necessity Criteria CP.MP.68 (PDF)
Effective Date: 6/1/13

Therapy Services (PT/OT/ST) CP.MP.49 (PDF)
Effective Date: 4/1/11
Bronchial Thermoplasty CP.MP.110 (PDF)
Effective Date: 5/1/16
Molecular Pathology and Diagnostic Genetic Testing (PDF)
Effective Date: 7/1/14
Total Artificial Heart CP.MP.127 (PDF)
Effective Date: 12/1/16
Burn and Gradient Compression Garments (PDF)
Effective Date: 8/2/18
Monitored Anesthesia Care for Gastrointestinal Endoscopy CP.MP.161
Effective Date: 5/1/18
Trigger Point Injections for Pain Management CP.MP.169 (PDF)
Caudal or Interlaminar Epidural Steriod Injections for Pain Management CP.MP.164 (PDF) Neonatal Abstinence Syndrome Guidelines CP.MP.86 (PDF)
Effective Date: 10/1/13
Urodynamic Testing CP.MP.98 (PDF)
Effective Date: 10/1/15
Cell-Free Fetal DNA Testing CP.MP.84 (PDF)
Effective Date: 4/1/18
Neonatal Spesis Management Guidelines CP.MP.85 (PDF)
Effective Date: 8/1/13
Vagus Nerve Stimulation CP.MP.12 (PDF)
Effective Date: 10/1/13
Clinical Trials CP.MP.94 (PDF)
Effective Date: 9/1/08
Nerve Blocks for Pain Management CP.MP.170 (PDF) Ventricular Assist Devices CP.MP.46 (PDF)
Effective Date: 12/1/09
Cochlear Implant Surgery Prior Authorization Criteria and Coverage (PDF)
Effective Date: 4/1/16
NICU Apnea Bradycardia Guidelines CP.MP.82 (PDF)
Effective Date: 6/1/13
Ventriculectomy and Cardiomyoplasty CP.MP.56 (PDF)
Effective Date: 5/1/13
Cosmetic Reconstructive Surgery CP.MP.31 (PDF)
Effective Date: 3/1/09
NICU Discharge Guidelines CP.MP.81 (PDF)
Effective Date: 6/1/13
Wearable Cardioverter Defibrillators (PDF)
Effective Date: 10/1/15
Cranial Remolding Orthosis (PDF)
Effective Date: 10/1/15
Optic Nerve Decompression Surgery CP.MP.128 (PDF)
Effective Date: 9/1/16
 
Cystic Fibrosis Carrier Screening CP.MP.83 (PDF)
Effective Date: 7/1/13
Orthopedic or Corrective Shoes and Food Orthotics (PDF)
Effective Date: 12/1/14
 
Dental Anesthesia CP.MP.61 (PDF)
Effective Date: 6/1/13
Outpatient Testing for Drugs of Abuse CP.MP.50 (PDF)
Effective Date: 10/1/14
 
Diagnosis of Vaginitis CP.MP.97 (PDF)
Effective Date: 6/1/16
Oxygen and Respiratory Equipment (PDF)
Effective Date: 8/2/18
 
Digital EEG Spike Analysis CP.MP.105 (PDF)
Effective Date: 1/1/16
Pancreas Transplantation CP.MP.102 (PDF)
Effective Date: 4/1/16
 
Digitized Speech Generating Devices (PDF)
Effective Date: 5/1/17
Panniculectomy and Lipectomy Surgeries (PDF)
Effective Date: 2/3/14
 
Disc Decompression Procedures CP.MP.114 (PDF)
Effective Date: 7/1/16
Panniculectomy CP.MP.109 (PDF)
Effective Date: 4/1/16
 
DME Coverage Guidelines CP.MP.107 (PDF)
Effective Date: 7/1/16
Passive Motion Exercise Device (PDF)
Effective Date: 8/2/18
 
DNA Analysis of Stool CP.MP.125 (PDF)
Effective Date: 9/1/18
Pectus Carinatum Surgery (PDF)
Effective Date: 10/1/15
 
Donor Lymphocyte Infusion CP.MP.101 (PDF)
Effective Date: 11/1/15
Pediatric Heart Transplant CP.MP.138 (PDF)
Effective Date: 1/1/17
 
Enteral Nutrition Products (PDF)
Effective Date: 11/12/12
Personal Continuous Glucose Monitoring (PDF)
Effective Date: 1/1/17
 
Enteral Nutrition Products Requiring Prior Authorization (PDF)
Effective Date: 8/2/18
Posterior Nerve Stimulation for Voiding Dysfunction CP.MP.133 (PDF)
Effective Date: 10/1/16
 
Evoked Potentials CP.MP.134 (PDF)
Effective Date: 11/1/16
Power Operated Vehicles (Scooters and Wheelchairs)(PDF)
Effective Date: 7/30/18
 
Experimental Policy CP.MP.36 (PDF)
Effective Date: 6/1/09
Prophylactic Mastectomies Prior Authorization Criteria and Coverage (PDF)
Effective Date: 4/1/16
 
Facet Joint Interventions for Pain Management CP.MP.171 (PDF) Proton Beam and Neutron Beam Therapy CP.MP.70 (PDF)
Effective Date: 3/1/14
 
Facial Prosthetics (PDF)
Effective Date: 5/1/17
   
Fecal Calprotectin Assay CP.MP.135 (PDF)
Effective Date: 11/1/16
   
Fecal Incontinence Treatments CP.MP.137 (PDF)
Effective Date: 12/1/16
   
Ferriscan R2-MRI CP.MP.53 (PDF)
Effective Date: 11/1/14
   
Fetal Surgery in Utero CP.MP.129 (PDF)
Effective Date: 10/1/16
   
Fractionated Exhaled Nitric Oxide (FeNO) Measurement CP.MP.103 (PDF)
Effective Date: 1/1/16
   
Gait Trainers (PDF)
Effective Date: 8/1/16
   
Gastric Electric Stimulation CP.MP.40 (PDF)
Effective Date: 11/1/11
   
Genetic Testing CP.MP.89 (PDF)
Effective Date: 11/1/13
   
Gynecomastia Surgery Prior Authorization Criteria and Coverage (PDF)
Effective Date: 4/1/16
   
Holter Monitoring CP.MP.113 (PDF)
Effective Date: 8/1/16
   
Home Birth CP.MP.136 (PDF)
Effective Date: 12/1/16
   
Home Ventilator Rental (PDF)
Effective Date: 3/1/17
   
Homocysteine Testing CP.MP.121 (PDF)
Effective Date: 8/1/16
   
Hyperbaric Oxygen Therapy CP.MP.27 (PDF)
Effective Date: 6/1/09
   
Hospice Clinical Coverage CP.MP.54 (PDF)
Effective Date: 7/1/14
   
Hyperemesis Gravidarum Treatment CP.MP.34 (PDF)
Effective Date: 6/1/13
   
Hyperhidrosis Treatments CP.MP.62 (PDF)
Effective Date: 5/1/13
   

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ADHD Assessment and Treatment CP.MP.124 (PDF)
Effective Date: 8/1/16
Inhaled Nitric Oxide CP.MP.87 (PDF)
Effective Date: 8/1/13
Reduction Mammoplasty (PDF)
Effective Date: 7/1/15
Allogenic Hematopoietic Cell Transplants for Sickle Cell CP.MP.108 (PDF)
Effective Date: 3/1/16
Intensity-Modulated Radiotherapy CP.MP.69 (PDF)
Effective Date: 3/1/14
Sacoiliac Joint Fusion CP.MP.126 (PDF)
Effective Date: 9/1/16
Ambulatory Electroencephalography CP.MP.96 (PDF)
Effective Date: 9/1/15
Intestinal and Multivisceral Transplant CP.MP.58 (PDF)
Effective Date: 2/1/14
Sacroiliac Joint Interventions for Pain Management CP.MP.166 (PDF)
Applied Behavioral Analysis for Autism CP.MP.104 (PDF)
Effective Date: 8/1/09
Intradiscal Steriod Injections for Pain Management CP.MP.167 (PDF) Selective Nerve Root Blocks and Transforaminal Epidural Injections for Pain Management CP.MP.165 (PDF)
Balloon Sinus Ostial Dilation CP.MP.119 (PDF)
Effective Date: 11/1/16
Intrathecal Infusion Pumps for Spasticity or Pain (PDF)
Effective Date: 5/1/14
Sickle Cell Disease Observation CP.MP.88 (PDF)
Effective Date: 9/1/14
Bariatric Surgery CP.MP.37 (PDF)
Effective Date: 8/1/14
Laser Therapy for Skin Conditions CP.MP.123 (PDF)
Effective Date: 8/1/16
Spinal Cord Stimulation CP.MP.117 (PDF)
Effective Date: 7/1/16
Bariatric Surgery Requires Prior Authorization (PDF)
Effective Date: 8/2/18
Lung Transplantation CP.MP.57 (PDF)
Effective Date: 2/1/14
Spinal Stimulator Surgeries (PDF)
Effective Date: 9/1/13
Bone Growth Stimulator (PDF)
Effective Date: 7/1/15
Lysis of Epidural Lesions CP.MP.116 (PDF)
Effective Date: 7/1/16
Stereotactic Body Radiation Therapy CP.MP.22 (PDF)
Effective Date: 12/1/13
Botox Used to Treat Chronic Migraines Prior Authorization Not Required (PDF)
Effective Date: 6/1/16
Medical Necessity Criteria CP.MP.68 (PDF)
Effective Date: 6/1/13
Therapy Services (PT/OT/ST) CP.MP.49 (PDF)
Effective Date: 4/1/11
Bronchial Thermoplasty CP.MP.110 (PDF)
Effective Date: 5/1/16
Molecular Pathology and Diagnostic Genetic Testing (PDF)
Effective Date: 7/1/14
Total Artificial Heart CP.MP.127 (PDF)
Effective Date: 12/1/16
Burn and Gradient Compression Garments (PDF)
Effective Date: 8/2/18
Monitored Anesthesia Care for Gastrointestinal Endoscopy CP.MP.161
Effective Date: 5/1/18
Trigger Point Injections for Pain Management CP.MP.169 (PDF)
Caudal or Interlaminar Epidural Steriod Injections for Pain Management CP.MP.164 (PDF) Neonatal Abstinence Syndrome Guidelines CP.MP.86 (PDF)
Effective Date: 10/1/13
Urodynamic Testing CP.MP.98 (PDF)
Effective Date: 10/1/15
Cell-Free Fetal DNA Testing CP.MP.84 (PDF)
Effective Date: 4/1/18
Neonatal Spesis Management Guidelines CP.MP.85 (PDF)
Effective Date: 8/1/13
Vagus Nerve Stimulation CP.MP.12 (PDF)
Effective Date: 10/1/13
Clinical Trials CP.MP.94 (PDF)
Effective Date: 9/1/08
Nerve Blocks for Pain Management CP.MP.170 (PDF) Ventricular Assist Devices CP.MP.46 (PDF)
Effective Date: 12/1/09
Cochlear Implant Surgery Prior Authorization Criteria and Coverage (PDF)
Effective Date: 4/1/16
NICU Apnea Bradycardia Guidelines CP.MP.82 (PDF)
Effective Date: 6/1/13
Ventriculectomy and Cardiomyoplasty CP.MP.56 (PDF)
Effective Date: 5/1/13
Cosmetic Reconstructive Surgery CP.MP.31 (PDF)
Effective Date: 3/1/09
NICU Discharge Guidelines CP.MP.81 (PDF)
Effective Date: 6/1/13
Wearable Cardioverter Defibrillators (PDF)
Effective Date: 10/1/15
Cranial Remolding Orthosis (PDF)
Effective Date: 10/1/15
Optic Nerve Decompression Surgery CP.MP.128 (PDF)
Effective Date: 9/1/16
 
Cystic Fibrosis Carrier Screening CP.MP.83 (PDF)
Effective Date: 7/1/13
Orthopedic or Corrective Shoes and Food Orthotics (PDF)
Effective Date: 12/1/14
 
Dental Anesthesia CP.MP.61 (PDF)
Effective Date: 6/1/13
Outpatient Testing for Drugs of Abuse CP.MP.50 (PDF)
Effective Date: 10/1/14
 
Diagnosis of Vaginitis CP.MP.97 (PDF)
Effective Date: 6/1/16
Oxygen and Respiratory Equipment (PDF)
Effective Date: 8/2/18
 
Digital EEG Spike Analysis CP.MP.105 (PDF)
Effective Date: 1/1/16
Pancreas Transplantation CP.MP.102 (PDF)
Effective Date: 4/1/16
 
Digitized Speech Generating Devices (PDF)
Effective Date: 5/1/17
Panniculectomy and Lipectomy Surgeries (PDF)
Effective Date: 2/3/14
 
Disc Decompression Procedures CP.MP.114 (PDF)
Effective Date: 7/1/16
Panniculectomy CP.MP.109 (PDF)
Effective Date: 4/1/16
 
DME Coverage Guidelines CP.MP.107 (PDF)
Effective Date: 7/1/16
Passive Motion Exercise Device (PDF)
Effective Date: 8/2/18
 
DNA Analysis of Stool CP.MP.125 (PDF)
Effective Date: 9/1/18
Pectus Carinatum Surgery (PDF)
Effective Date: 10/1/15
 
Donor Lymphocyte Infusion CP.MP.101 (PDF)
Effective Date: 11/1/15
Pediatric Heart Transplant CP.MP.138 (PDF)
Effective Date: 1/1/17
 
Enteral Nutrition Products (PDF)
Effective Date: 11/12/12
Personal Continuous Glucose Monitoring (PDF)
Effective Date: 1/1/17
 
Enteral Nutrition Products Requiring Prior Authorization (PDF)
Effective Date: 8/2/18
Posterior Nerve Stimulation for Voiding Dysfunction CP.MP.133 (PDF)
Effective Date: 10/1/16
 
Evoked Potentials CP.MP.134 (PDF)
Effective Date: 11/1/16
Power Operated Vehicles (Scooters and Wheelchairs)(PDF)
Effective Date: 7/30/18
 
Experimental Policy CP.MP.36 (PDF)
Effective Date: 6/1/09
Prophylactic Mastectomies Prior Authorization Criteria and Coverage (PDF)
Effective Date: 4/1/16
 
Facet Joint Interventions for Pain Management CP.MP.171 (PDF) Proton Beam and Neutron Beam Therapy CP.MP.70 (PDF)
Effective Date: 3/1/14
 
Facial Prosthetics (PDF)
Effective Date: 5/1/17
   
Fecal Calprotectin Assay CP.MP.135 (PDF)
Effective Date: 11/1/16
   
Fecal Incontinence Treatments CP.MP.137 (PDF)
Effective Date: 12/1/16
   
Ferriscan R2-MRI CP.MP.53 (PDF)
Effective Date: 11/1/14
   
Fetal Surgery in Utero CP.MP.129 (PDF)
Effective Date: 10/1/16
   
Fractionated Exhaled Nitric Oxide (FeNO) Measurement CP.MP.103 (PDF)
Effective Date: 1/1/16
   
Gait Trainers (PDF)
Effective Date: 8/1/16
   
Gastric Electric Stimulation CP.MP.40 (PDF)
Effective Date: 11/1/11
   
Genetic Testing CP.MP.89 (PDF)
Effective Date: 11/1/13
   
Gynecomastia Surgery Prior Authorization Criteria and Coverage (PDF)
Effective Date: 4/1/16
   
Holter Monitoring CP.MP.113 (PDF)
Effective Date: 8/1/16
   
Home Birth CP.MP.136 (PDF)
Effective Date: 12/1/16
   
Home Ventilator Rental (PDF)
Effective Date: 3/1/17
   
Homocysteine Testing CP.MP.121 (PDF)
Effective Date: 8/1/16
   
Hyperbaric Oxygen Therapy CP.MP.27 (PDF)
Effective Date: 6/1/09
   
Hospice Clinical Coverage CP.MP.54 (PDF)
Effective Date: 7/1/14
   
Hyperemesis Gravidarum Treatment CP.MP.34 (PDF)
Effective Date: 6/1/13
   
Hyperhidrosis Treatments CP.MP.62 (PDF)
Effective Date: 5/1/13
 

Payment Policies

Health care claims payment policies are guidelines used to assist in administering payment rules based on generally accepted principles of correct coding.  They are used to help identify whether health care services are correctly coded for reimbursement.  Each payment rule is sourced by a generally accepted coding principle. They include, but are not limited to claims processing guidelines referenced by the Centers for Medicare and Medicaid Services (CMS), Publication 100-04, Claims Processing Manual for  physicians/non-physician practitioners, the CMS National Correct Coding Initiative policy manual (procedure-to-procedure coding combination edits and medically unlikely edits), Current Procedural Technology guidance published by the American Medical Association (AMA) for reporting medical procedures and services, health plan clinical policies based on the appropriateness of health care and medical necessity, and at times state-specific claims reimbursement guidance.

All policies found in the MHS Health Wisconsin Payment Policy Manual apply with respect to MHS Health Wisconsin members. Policies in the MHS Health Wisconsin Payment Policy Manual may have either a MHS Health Wisconsin or a “Centene” heading.  In addition, MHS Health Wisconsin may from time to time employ a vendor that applies payment policies to specific services; in such circumstances, the vendor’s guidelines may also be used to determine whether a service has been correctly coded. Other policies (e.g., clinical policies) or contract terms may further determine whether a technology, procedure or treatment that is not addressed in the Payment Policy Manual is payable by MHS Health Wisconsin.     

If you have any questions regarding these policies, please contact Member Services and ask to be directed to the Medical Management department.

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30-Day Readmission CC.PP.501 (PDF)
Effective Date: 3/1/17
Inpatient Consultation CC.PP.038 (PDF)
Effective Date: 1/1/14
Reporting the Global Maternity Package CC.PP.016 (PDF)
Effective Date: 1/1/13
3-Day Payment Window CC.PP.500 (PDF)
Effective Date: 7/1/14
Inpatient Only Procedures CC.PP.018 (PDF)
Effective Date: 1/1/13
Robotic Surgery CC.PP.050 (PDF)
Effective Date: 9/1/17
Add-on Code Billed Without Primary Code CC.PP.030 (PDF)
Effective Date: 1/1/13
Intravenous Hydration CC.PP.012 (PDF)
Effective Date: 1/1/13
Same Day Visits CC.PP.040 (PDF)
Effective Date: 3/1/18
Assistant Surgeon CC.PP.029 (PDF)
Effective Date: 1/1/14
Maximum Units of Services CC.PP.007 (PDF)
Effective Date: 1/1/13
Sleep Studies Place of Services CC.PP.035 (PDF)
Effective Date: 5/1/17
Bilateral Procedures CC.PP.037 (PDF)
Effective Date: 1/1/14
Moderate Conscious Sedation CC.PP.015 (PDF)
Effective Date: 1/1/13
Status "B" Bundled Services CC.PP.046 (PDF)
Effective Date: 1/1/14
Cerumen Removal CC.PP.008 (PDF)
Effective Date: 1/1/14
Modifier DOS Validation CC.PP.034 (PDF)
Effective Date: 1/1/13
Status "P" Bundled Services CC.PP.049 (PDF)
Effective Date: 3/15/17
Clean Claims CC.PP.021 (PDF)
Effective Date: 1/1/13
Modifier to Procedure Code Validation CC.PP.028 (PDF)
Effective Date: 1/1/13
Supplies billed on Same Day as Surgery CC.PP.032 (PDF)
Effective Date: 1/1/13
Clinical Laboratory Improvement Amendments (CLIA) CC.PP.022 (PDF)
Effective Date: 1/1/13
Multiple CPT Code Replacement CC.PP.033 (PDF)
Effective Date: 1/1/14
Transgender Related Services CC.PP.047 (PDF)
Effective Date: 1/1/17
Clinical Validation of Modifier 25 CC.PP.013 (PDF)
Effective Date: 1/1/13
NCCI Unbundling CC.PP.031 (PDF)
Effective Date: 1/1/13
Unbundled Professional Services CC.PP.043 (PDF)
Effective Date: 1/1/14
Clinical Validation of Modifier 59 CC.PP.014 (PDF)
Effective Date: 1/1/13
Never Paid Events CC.PP.017 (PDF)
Effective Date: 1/1/13
Unbundled Surgical Procedures CC.PP.045 (PDF)
Effective Date: 1/1/14
Code Editing Overview CC.PP.011 (PDF)
Effective Date: 1/1/13
New Patient CC.PP.036 (PDF)
Effective Date: 1/1/14
Unlisted Procedure Codes CC.PP.009 (PDF)
Effective Date: 1/1/13
Cosmetic Procedures CC.PP.024 (PDF)
Effective Date: 1/1/14
Non-obstetrical Pelvic and Transvaginal Ultrasounds CC.PP.061
Effective Date: 50/30/18
Wheelchair and Accessories CC.PP.502 (PDF)
Effective Date: 8/12/16
Distinct Procedural Modifiers CC.PP.020 (PDF)
Effective Date: 1/1/13
Outpatient Consultation CC.PP.039 (PDF)
Effective Date: 1/1/14
 
Duplicate Primary Code Billing CC.PP.044 (PDF)
Effective Date: 1/1/14
Physician Visit Codes Billed with Labs CC.PP.019 (PDF)
Effective Date: 1/1/13
 
E&M Bundling Edits CC.PP.051(PDF)
Effective Date: 6/1/17
Place of Service Mismatch CC.PP.063
Effective Date: 9/1/18
 
Hospital Visit Codes Billed With Labs CC.PP.023 (PDF)
Effective Date: 1/1/13
Post-Operative Visits CC.PP.042 (PDF)
Effective Date: 1/1/14
 
  Pre-Operative Visits CC.PP.041 (PDF)
Effective Date: 1/1/14
 
  Problem Oriented Visits With Preventative Visits CC.PP.057 (PDF)
Effective Date: 12/01/17
 
  Professional Component Modifier CC.PP.027 (PDF)
Effective Date: 1/1/13
 
  Pulse Oximetry With Office Visits CC.PP.025 (PDF)
Effective Date: 1/1/14