| Anesthesia Clinical Payment and Coding Information | Policy Number | Effective Date | End Date |
|---|---|---|---|
| Anesthesia Clinical Payment and Coding Information | CPCP010 | 3/14/2023 | 8/13/2024 |
| Anesthesia Clinical Payment and Coding Information | CPCP010 | 9/2/2022 | 3/13/2023 |
| Anesthesia Clinical Payment and Coding Information | CPCP010 | 9/13/2021 | 9/1/2022 |
| Anesthesia Clinical Payment and Coding Information | CPCP010 | 4/3/2020 | 9/12/2021 |
| Applied Behavior Analysis | Policy Number | Effective Date | End Date |
| Applied Behavior Analysis | CPCP011 | 5/23/2023 | 10/6/2024 |
| Applied Behavior Analysis | CPCP011 | 11/9/2021 | 5/22/2023 |
| Applied Behavior Analysis | CPCP011 | 11/25/2020 | 11/8/2021 |
| Chiropractic Services | Policy Number | Effective Date | End Date |
| Chiropractic Services | CPCP016 | 3/15/2023 | 1/11/2024 |
| Chiropractic Services | CPCP016 | 1/1/2022 | 3/14/2023 |
| Chiropractic Services | CPCP016 | 9/25/2020 | 12/31/2021 |
| Corrected Claim Submissions | Policy Number | Effective Date | End Date |
| Corrected Claim Submissions | CPCP025 | 7/1/24 | 12/23/24 |
| Corrected Claim Submissions | CPCP025 | 5/1/2020 | 6/30/2024 |
| Co-Surgeon/Team Surgeon Modifiers | Policy Number | Effective Date | End Date |
| Co-Surgeon/Team Surgeon Modifiers | CPCP009 | 9/5/2023 | 1/11/2024 |
| Co-Surgeon/Team Surgeon Modifiers | CPCP009 | 10/27/2022 | 9/4/2023 |
| Co-Surgeon/Team Surgeon Modifiers | CPCP009 | 10/5/2021 | 10/26/2022 |
| Co-Surgeon/Team Surgeon Modifiers | CPCP009 | 9/16/2020 | 10/4/2021 |
| Drug Testing Clinical Payment and Coding Policy | Policy Number | Effective Date | End Date |
| Drug Testing Clinical Payment and Coding Policy | CPCP020 | 12/01/2023 | 11/04/2024 |
| Drug Testing Clinical Payment and Coding Policy | CPCP020 | 3/17/2023 | 11/30/2023 |
| Drug Testing Clinical Payment and Coding Policy | CPCP020 | 12/29/2021 | 3/16/2023 |
| Drug Testing Clinical Payment and Coding Policy | CPCP020 | 9/4/2020 | 12/28/2021 |
| Emergency Department Evaluation and Management (EM) Services Coding - Facility Services | Policy Number | Effective Date | End Date |
| Emergency Department Evaluation and Management (E/M) Services Coding – Facility Services | CPCP003 | 7/20/2023 | 7/21/2024 |
| Emergency Department Evaluation and Management (E/M) Services Coding – Facility Services | CPCP003 | 1/30/2023 | 7/19/2023 |
| Emergency Department Evaluation and Management (E/M) Services Coding – Facility Services | CPCP003 | 12/1/2021 | 1/29/2023 |
| Emergency Department Evaluation and Management (E/M) Services Coding – Facility Services | CPCP003 | 11/6/2020 | 11/30/2021 |
| Emergency Department Evaluation and Management (E/M) Services Coding - Professional Services | Policy Number | Effective Date | End Date |
| Emergency Department Evaluation and Management (E/M) Services Coding – Professional Services | CPCP042 | 11/1/2023 | 9/23/2024 |
| Evaluation and Management (E/M) Coding – Professional Provider | Policy Number | Effective Date | End Date |
| Evaluation and Management (E/M) Coding – Professional Provider | CPCP024 | 4/12/2023 | 11/30/2023 |
| Evaluation and Management (E/M) Coding – Professional Provider | CPCP024 | 12/23/2021 | 04/11/2023 |
| Evaluation and Management (E/M) Coding – Professional Provider | CPCP024 | 12/7/2020 | 12/22/2021 |
| Global Surgical Package | Policy Number | Effective Date | End Date |
| Global Surgical Package | CPCP014 | 6/21/2023 | 1/11/2024 |
| Global Surgical Package | CPCP014 | 3/1/2022 | 6/20/2023 |
| Global Surgical Package | CPCP014 | 5/11/2021 | 2/28/2022 |
| Global Surgical Package | CPCP014 | 5/1/2020 | 5/10/2021 |
| Hernia Repair | Policy Number | Effective Date | End Date |
| Hernia Repair | CPCP012 | 5/3/2023 | 6/27/2024 |
| Hernia Repair | CPCP012 | 4/22/2022 | 5/2/2023 |
| Hernia Repair | CPCP012 | 6/18/2021 | 4/21/2022 |
| Hernia Repair | CPCP012 | 5/29/2020 | 6/17/2021 |
| Home Health Care/Private Duty Nursing | Policy Number | Effective Date | End Date |
| Home Health Care /Private Duty Nursing Policy Guideline | CPCP005 | 10/8/2022 | 10/29/2023 |
| Home Health Care /Private Duty Nursing Policy Guideline | CPCP005 | 10/8/2021 | 10/7/2022 |
| Home Health Care /Private Duty Nursing Policy Guideline | CPCP005 | 9/25/2020 | 10/7/2021 |
| Home Infusion | Policy Number | Effective Date | End Date |
| Home Infusion | CPCP019 | 12/22/2022 | 10/22/2023 |
| Home Infusion | CPCP019 | 9/7/2021 | 12/21/2022 |
| Implant Payment and Coding Policy | Policy Number | Effective Date | End Date |
| Implant Payment and Coding Policy | CPCP007 | 2/22/2023 | 9/23/2024 |
| Implant Payment and Coding Policy | CPCP007 | 07/06/2020 | 02/21/2023 |
| Increased Procedural Services (Modifier 22) | Policy Number | Effective Date | End Date |
| Increased Procedural Services (Modifier 22) | CPCP013 | 5/3/2023 | 1/11/2024 |
| Increased Procedural Services (Modifier 22) | CPCP013 | 2/24/2022 | 5/2/2023 |
| Increased Procedural Services (Modifier 22) | CPCP013 | 5/1/2021 | 2/23/2022 |
| Increased Procedural Services (Modifier 22) | CPCP013 | 4/2/2020 | 4/30/2021 |
| Inpatient Readmissions | Policy Number | Effective Date | End Date |
| Inpatient Readmissions | CPCP027 | 10/11/2023 | 12/03/2024 |
| Inpatient Readmissions | CPCP027 | 7/1/2023 | 10/10/2023 |
| Inpatient Readmissions | CPCP027 | 12/1/2021 | 10/10/2023 |
| Inpatient Readmissions | CPCP027 | 3/1/2020 | 11/30/2021 |
| Inpatient/Outpatient Unbundling Policy | Policy Number | Effective Date | End Date |
| Inpatient/Outpatient Unbundling Policy | CPCP002 | 12/16/2021 | 12/20/2023 |
| Inpatient/Outpatient Unbundling Policy | CPCP002 | 12/4/2020 | 12/15/2021 |
| Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Guideline | Policy Number | Effective Date | End Date |
| Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Guideline | CPCP032 | 9/5/2023 | 9/23/2024 |
| Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Guideline | CPCP032 | 4/22/2022 | 9/4/2023 |
| Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Guideline | CPCP032 | 7/30/2021 | 4/21/2022 |
| Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Guideline | CPCP032 | 7/20/2021 | 7/29/2021 |
| Laboratory Panel Billing | Policy Number | Effective Date | End Date |
| Laboratory Panel Billing | CPCP021 | 6/21/2023 | 6/27/2024 |
| Laboratory Panel Billing | CPCP021 | 4/6/2022 | 6/20/2023 |
| Laboratory Panel Billing | CPCP021 | 7/30/2021 | 4/5/2022 |
| Medical Record Documentation Guideline | Policy Number | Effective Date | End Date |
| Medical Record Documentation Guideline | CPCP029 | 10/30/2023 | 11/4/2024 |
| Medical Record Documentation Guideline | CPCP029 | 9/16/2022 | 10/29/2023 |
| Medical Record Documentation Guideline | CPCP029 | 9/22/2021 | 9/15/2022 |
| Medical Record Documentation Guideline | CPCP029 | 4/1/2021 | 9/21/2021 |
| Medical Record Documentation Guideline | CPCP029 | 3/1/2020 | 3/31/2021 |
| Modifier Reference Guideline Policy | Policy Number | Effective Date | End Date |
| Modifier Reference Guideline | CPCP023 | 10/30/2023 | 1/11/2024 |
| Modifier Reference Guideline | CPCP023 | 3/17/2023 | 10/29/2023 |
| Modifier Reference Guideline | CPCP023 | 5/13/2022 | 3/16/2023 |
| Modifier Reference Guideline | CPCP023 | 4/1/2021 | 5/12/2022 |
| Multiple Surgical Procedures | Policy Number | Effective Date | End Date |
| Multiple Surgical Procedures | CPCP015 | 9/5/2023 | 1/11/2024 |
| Multiple Surgical Procedures | CPCP015 | 6/24/2022 | 9/4/2023 |
| Multiple Surgical Procedures | CPCP015 | 8/24/2021 | 6/23/2022 |
| Multiple Surgical Procedures | CPCP015 | 7/7/2020 | 8/23/2021 |
| Neonatal Intensive Care Unit (NICU) Level of Care Authorization and Reimbursement Policy | Policy Number | Effective Date | End Date |
| Neonatal Intensive Care Unit (NICU) Level of Care Authorization and Reimbursement Policy | CPCP004 | 11/17/2023 | 7/21/2024 |
| Neonatal Intensive Care Unit (NICU) Level of Care Authorization and Reimbursement Policy | CPCP004 | 12/13/2021 | 11/16/2023 |
| Neonatal Intensive Care Unit (NICU) Level of Care Authorization and Reimbursement Policy | CPCP004 | 5/27/2020 | 12/12/2021 |
| 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 | 5/15/2024 | 6/30/2024 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) | CPCP028 | 4/1/2024 | 5/14/2024 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) | CPCP028 | 1/15/2024 | 3/31/2024 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) | CPCP028 | 12/1/2023 | 1/14/2024 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) | CPCP028 | 10/1/2023 | 11/30/2023 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) | CPCP028 | 9/1/2023 | 9/30/2023 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) | CPCP028 | 7/1/2023 | 9/1/2023 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) | CPCP028 | 4/1/2023 | 7/1/2023 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) | CPCP028 | 1/1/2023 | 3/31/2023 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) | CPCP028 | 8/1/2022 | 12/31/2022 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) | CPCP028 | 4/1/2022 | 7/31/2022 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) | CPCP028 | 8/15/2021 | 3/31/2022 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) | CPCP028 | 12/1/2020 | 8/14/2021 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) | CPCP028 | 9/1/2020 | 11/30/2020 |
| Observation Services Policy | Policy Number | Effective Date | End Date |
| Observation Services Policy | CPCP001 | 7/6/2023 | 7/29/2024 |
| Observation Services Policy | CPCP001 | 5/22/2023 | 7/5/2023 |
| Observation Services Policy | CPCP001 | 7/20/2021 | 5/21/2023 |
| Observation Services Policy | CPCP001 | 5/26/2020 | 7/19/2021 |
| Outpatient Facility and Hospital Claims: Revenue Codes Requiring CPT or HCPCS Codes | Policy Number | Effective Date | End Date |
| Outpatient Facility and Hospital Claims: Revenue Codes Requiring CPT or HCPCS Codes | CPCP018 | 10/27/2022 | 10/29/2023 |
| Outpatient Facility and Hospital Claims: Revenue Codes Requiring CPT or HCPCS Codes | CPCP018 | 12/1/2021 | 10/26/2022 |
| Outpatient Facility and Hospital Claims: Revenue Codes Requiring CPT or HCPCS Codes | CPCP018 | 10/30/2020 | 11/30/2021 |
| Outpatient Facility and Hospital Claims: Revenue Codes Requiring CPT or HCPCS Codes | CPCP018 | 6/16/2020 | 10/29/2020 |
| Outpatient Facility Service(s) Overlapping During an Inpatient Stay | Policy Number | Effective Date | End Date |
| Outpatient Facility Service(s) Overlapping During an Inpatient Stay | CPCP039 | 9/1/2023 | 6/24/2024 |
| Outpatient Services Prior to an Inpatient Admission | Policy Number | Effective Date | End Date |
| Outpatient Services Prior to an Inpatient Admission | CPCP038 | 8/1/2023 | 2/8/2024 |
| Paravertebral Facet Injection Procedure Coding & Billing Policy | Policy Number | Effective Date | End Date |
| Paravertebral Facet Injection Procedure Coding & Billing Policy | CPCP036 | 10/30/2023 | 11/5/2024 |
| Paravertebral Facet Injection Procedure Coding & Billing Policy | CPCP036 | 12/22/2022 | 10/29/2023 |
| Paravertebral Facet Injection Procedure Coding & Billing Policy | CPCP036 | 11/2/2022 | 12/21/2022 |
| Paravertebral Facet Injection Procedure Coding & Billing Policy | CPCP036 | 10/14/2021 | 11/1/2021 |
| Physical Medicine and Rehabilitation Services | Policy Number | Effective Date | End Date |
| Physical Medicine and Rehabilitation Services | CPCP040 | 3/15/2023 | 1/11/2024 |
| Pneumatic Compression Devices | Policy Number | Effective Date | End Date |
| Pneumatic Compression Devices | CPCP022 | 1/30/2023 | 2/8/2024 |
| Pneumatic Compression Devices | CPCP022 | 12/10/2021 | 1/29/2023 |
| Pneumatic Compression Devices | CPCP022 | 9/1/2020 | 12/9/2021 |
| Point-of-Care Ultrasound Examination Guideline | Policy Number | Effective Date | End Date |
| Point-of-Care Ultrasound Examination Guideline | CPCP030 | 9/5/2023 | 12/23/2024 |
| Point-of-Care Ultrasound Examination Guideline | CPCP030 | 2/24/2022 | 9/4/2023 |
| Point-of-Care Ultrasound Examination Guideline | CPCP030 | 6/4/2021 | 2/23/2022 |
| Point-of-Care Ultrasound Examination Guideline | CPCP030 | 5/28/2020 | 6/3/2021 |
| Preventive Services Policy | Policy Number | Effective Date | End Date |
| Preventive Services Policy | CPCP006 | 10/1/2024 | 12/31/2024 |
| Preventive Services Policy | CPCP006 | 7/1/2024 | 9/30/2024 |
| Preventive Services Policy | CPCP006 | 4/1/2024 | 6/30/2024 |
| Preventive Services Policy | CPCP006 | 1/1/2024 | 3/31/2024 |
| Preventive Services Policy | CPCP006 | 11/1/2023 | 12/31/2023 |
| Preventive Services Policy | CPCP006 | 10/1/2023 | 10/31/2023 |
| Preventive Services Policy | CPCP006 | 7/1/2023 | 9/30/2023 |
| Preventive Services Policy | CPCP006 | 4/1/2023 | 6/30/2023 |
| Preventive Services Policy | CPCP006 | 3/1/2023 | 3/31/2023 |
| Preventive Services Policy | CPCP006 | 1/1/2023 | 2/28/2023 |
| Preventive Services Policy | CPCP006 | 10/1/2022 | 12/31/2022 |
| Preventive Services Policy | CPCP006 | 9/1/2022 | 9/30/2022 |
| Preventive Services Policy | CPCP006 | 7/1/2022 | 8/31/2022 |
| Preventive Services Policy | CPCP006 | 4/1/2022 | 6/30/2022 |
| Preventive Services Policy | CPCP006 | 1/1/2022 | 3/31/2022 |
| Preventive Services Policy | CPCP006 | 10/1/2021 | 12/31/2021 |
| Preventive Services Policy | CPCP006 | 7/1/2021 | 9/30/2021 |
| Preventive Services Policy | CPCP006 | 4/1/2021 | 6/30/2021 |
| Preventive Services Policy | CPCP006 | 1/15/2021 | 3/31/2021 |
| Preventive Services Policy | CPCP006 | 10/1/2020 | 1/14/2021 |
| Preventive Services Policy | CPCP006 | 7/1/2020 | 9/30/2020 |
| Preventive Services Policy | CPCP006 | 4/1/2020 | 6/30/2020 |
| Preventive Services Policy | CPCP006 | 1/1/2020 | 3/31/2020 |
| Psychological and Neuropsychological Testing | Policy Number | Effective Date | End Date |
| Psychological and Neuropsychological Testing | CPCP008 | 11/13/2023 | 11/5/2024 |
| Psychological and Neuropsychological Testing | CPCP008 | 10/31/2022 | 11/12/2023 |
| Psychological and Neuropsychological Testing | CPCP008 | 4/1/2021 | 10/30/2022 |
| Psychological and Neuropsychological Testing | CPCP008 | 3/4/2020 | 3/31/2021 |
| Sepsis Policy | Policy Number | Effective Date | End Date |
| Sepsis Policy | CPCP041 | 7/1/2024 | 12/23/2024 |
| Sepsis Policy | CPCP041 | 5/22/2023 | 6/30/2024 |
| Telemedicine and Telehealth Services | Policy Number | Effective Date | End Date |
| Telemedicine and Telehealth Services | CPCP033 | 12/1/2023 | 2/25/2024 |
| Telemedicine and Telehealth Services | CPCP033 | 6/1/2022 | 11/30/2023 |
| Therapeutic, Prophylactic and Diagnostic Injection and Infusion Coding | Policy Number | Effective Date | End Date |
| Therapeutic, Prophylactic and Diagnostic Injection and Infusion Coding | CPCP026 | 5/4/2023 | 7/29/2024 |
| Therapeutic, Prophylactic and Diagnostic Injection and Infusion Coding | CPCP026 | 12/20/2022 | 5/3/2023 |
| Therapeutic, Prophylactic and Diagnostic Injection and Infusion Coding | CPCP026 | 09/07/2021 | 12/19/2022 |
| Trauma Activation | Policy Number | Effective Date | End Date |
| Trauma Activation - Facility Services | CPCP031 | 7/11/2023 | 7/21/2024 |
| Trauma Activation - Facility Services | CPCP031 | 2/24/2022 | 7/10/2023 |
| Trauma Activation - Facility Services | CPCP031 | 5/11/2021 | 2/23/2022 |
| Trauma Activation - Facility Services | CPCP031 | 5/8/2020 | 5/10/2021 |
| Unbundling Professional | Policy Number | Effective Date | End Date |
| Unbundling Professional | CPCP034 | 5/4/2023 | 6/16/2024 |
| Unbundling Professional | CPCP034 | 4/5/2022 | 5/3/2023 |
| Unbundling Professional | CPCP034 | 8/4/2021 | 8/4/2022 |
| Unlisted/Not Otherwise Classified (NOC) Coding | Policy Number | Effective Date | End Date |
| Unlisted/Not Otherwise Classified (NOC) Coding | CPCP035 | 9/2/2022 | 8/14/2024 |
| Unlisted/Not Otherwise Classified (NOC) Coding | CPCP035 | 9/21/2021 | 9/1/2022 |
| Wasted/Discarded Drugs and Biologicals Guideline | Policy Number | Effective Date | End Date |
| Wasted/Discarded Drugs and Biologicals Guideline | CPCP017 | 1/30/2023 | 2/18/2024 |
| Wasted/Discarded Drugs and Biologicals Guideline | CPCP017 | 12/21/2021 | 1/29/2023 |
| Wasted/Discarded Drugs and Biologicals Guideline | CPCP017 | 10/26/2021 | 12/20/2021 |
| Wasted/Discarded Drugs and Biologicals Guideline | CPCP017 | 9/11/2020 | 10/25/2021 |