We publish billing policies to offer transparency and help you bill claims more accurately to reduce delays in processing claims, as well as avoid rebilling and additional requests for information.
The following billing policies were recently published to or updated in our Provider Manual’s Billing Policies page.
Note: If the effective date is listed as N/A, the policy represents our current system set up and/or expectations for transparency. There are either no changes for you as the policy is already in effect or was recently shared with the network and we’re implementing a clinical edit in alignment with the policy’s language.
| Billing policy | Description | Effective date |
|---|---|---|
| New policies | ||
| Bisphosphonate drug therapy | This new policy outlines secondary doctor requirements | Dec. 16, 2025 |
| Chelation therapy | This new policy explains the billing requirements for Chelation Therapy | N/A |
| External breast protheses | This policy outlines billing criteria, frequency and modifier use | Dec. 16, 2025 |
| Infectious disease panel testing | This new policy outlines billing criteria, frequencies and modifier use. | Dec. 16, 2025 |
| Influenza testing | This new policy explains the billing criteria for influenza. | N/A |
| Patient lifts | This new policy outlines billing criteria, frequencies, modifier use and bundling. | Dec. 16, 2025 |
| Pressure reducing support items | This new policy outlines billing criteria, frequencies, modifier use and bundling. | N/A |
| Somatosensory testing | This new policy provides general documentation, coding and billing instructions to include modifiers. | N/A |
| Suction pumps | This new policy outlines billing criteria, frequencies, modifier use and budling. | N/A |
| Therapeutic shoes | This new policy outlines billing criteria, frequencies, modifier use and bundling. | N/A |
| Transcutaneous electrical joint stimulation devices | This new policy outlines billing criteria, frequencies, modifier use and bundling. | Dec. 16, 2025 |
| Updated policies | ||
| Facility billing | This policy was previously called Condition Code policy, but is now updated to Facility billing. Criteria was also added for bill type 014X. | Dec. 16, 2025 |
| Fundus photography | This policy was updated to include the full code range for Glaucoma and added the related billing policy "General Coding No. 022 and has condensed diagnosis to ranges. | Dec. 16, 2025 |