Clinical Payment and Coding Policy - Archived Documents

Observation Services Policy	Policy Number	Effective Date	End Date
Observation Services Policy	CPCP001	06/22/2023	07/12/2023
Inpatient/Outpatient Unbundling Policy	Policy Number	Effective Date	End Date
Inpatient/Outpatient Unbundling Policy	CPCP002	04/01/2019	09/29/2019
Inpatient/Outpatient Unbundling Policy V6	CPCP002	09/30/2019	12/04/2020
Inpatient/Outpatient Unbundling Policy	CPCP002	12/16/2021	01/03/2024
Home Health Care/Private Duty Nursing Policy	Policy Number	Effective Date	End Date
Coordinated Home Care/Private Duty Nursing Policy	CPCP005	08/08/2021	11/12/2023
Preventive Services Policy	Policy Number	Effective Date	End Date
Preventive Services Policy	CPCP006	01/01/2024	03/31/2024
Preventive Services Policy	CPCP006	11/01/2023	12/31/2023
Preventive Services Policy	CPCP006	10/01/2023	10/31/2023
Preventive Services Policy	CPCP006	07/01/2023	09/30/2023
Preventive Services Policy	CPCP006	04/01/2023	06/30/2023
Preventive Services Policy	CPCP006	03/01/2023	03/30/2023
Preventive Services Policy V1	CPCP006	01/01/2023	02/28/2023
Preventive Services Policy V1	CPCP006	10/01/2022	12/31/2022
Preventive Services Policy V1	CPCP006	09/01/2022	09/30/2022
Preventive Services Policy V1	CPCP006	07/01/2022	08/31/2022
Preventive Services Policy V1	CPCP006	03/01/2022	06/30/2022
Preventive Services Policy V1	CPCP006	01/01/2022	03/31/2022
Preventive Services Policy V2	CPCP006	07/01/2021	09/30/2021
Preventive Services Policy V2	CPCP006	04/01/2021	07/01/2021
Preventive Services Policy V2	CPCP006	01/15/2021	04/01/2021
Preventive Services Policy V2	CPCP006	01/01/2021	01/15/2021
Preventive Services Policy V2	CPCP006	07/01/2020	09/30/2020
Preventive Services Policy V 2.0	CPCP006	10/15/2019	01/01/2020
Preventive Services Policy V 1.0	CPCP006	04/01/2020
Preventive Services Policy V 6.0	CPCP006	01/01/2020	N/A
Preventive Services Policy V1	CPCP006	10/01/2020	01/01/20
Psychological and Neuropsychological Testing	Policy Number	Effective Date	End Date
Psychological and Neuropsychological Testing V1	CPCP008	12/16/2022	12/04/2023
Psychological and Neuropsychological Testing V1	CPCP008	03/31/2021	12/16/2022
Psychological and Neuropsychological Testing V2	CPCP008	03/04/2020	03/31/2021
Psychological and Neuropsychological Testing V5	ECPCP008	3/01/2018	3/4/2020
Co-Surgeon/Team Surgeon Modifiers	Policy Number	Effective Date	End Date
Co-Surgeon/Team Surgeon Modifiers	CPCP009	09/26/2023	01/25/2024
Co-Surgeon/Team Surgeon Modifiers V1	CPCP009	09/16/2020	09/25/2023
Co-Surgeon/Team Surgeon Modifiers V1	CPCP009	09/16/2020	10/04/2021
Co-Surgeon/Team Surgeon Modifiers V4	CPCP009	01/01/2019	09/16/2020
Anesthesia Information	Policy Number	Effective Date	End Date
Anesthesia Information	CPCP010	03/30/2023	06/01/2024
Anesthesia Information	CPCP010	10/01/2022	03/30/2023
Anesthesia Clinical Payment and Coding Information	CPCP010	10/13/2021	9/30/2020
Applied Behavior Analysis	Policy Number	Effective Date	End Date
Applied Behavior Analysis V9	CPCP011	02/22/2019	3/6/2020
Applied Behavior Analysis V1	CPCP011	03/28/2020	11/25/2020
Applied Behavior Analysis V2	CPCP011	11/25/2020	12/18/2020
Applied Behavior Analysis V1	CPCP011	11/09/2021	06/12/2023
Hernia Repair	Policy Number	Effective Date	End Date
Hernia Repair	CPCP012	06/18/2021	04/22/2022
Hernia Repair	CPCP012	04/28/2022	05/17/2023
Increased Procedural Services (Modifier 22)	Policy Number	Effective Date	End Date
Increased Procedural Services (Modifier 22)	CPCP013	05/17/2023	01/25/2024
Increased Procedural Services (Modifier 22)	CPCP013	02/24/2022	05/17/2023
Global Surgical Package	Policy Number	Effective Date	End Date
Global Surgical Package	CPCP014	01/25/2019	04/30/2020
Global Surgical Package	CPCP014	04/30/2020	05/11/2021
Global Surgical Package	CPCP014	05/11/2021	08/02/2022
Global Surgical Package	CPCP014	08/02/2022	06/26/2023
Global Surgical Package	CPCP014	06/26/2023	01/25/2024
Multiple Surgical Procedures	Policy Number	Effective Date	End Date
Multiple Surgical Procedures v1	CPCP015	09/26/2023	01/25/2024
Multiple Surgical Procedures v1	CPCP015	06/24/2022	09/26/2023
Multiple Surgical Procedures v1	CPCP015	08/24/2021	06/24/2022
Multiple Surgical Procedures V1	CPCP015	07/07/2020	08/24/2021
Multiple Surgical Procedures V6	CPCP015	02/22/2019	07/07/2020
Chiropractic Services	Policy Number	Effective Date	End Date
Chiropractic Services	CPCP016	08/15/2019	09/25/2020
Chiropractic Services	CPCP016	12/16/2021	03/28/2023
Chiropractic Services	CPCP016	03/28/2023	01/25/2024
Wasted/Discarded Drugs and Biologicals Guideline	Policy Number	Effective Date	End Date
Wasted/Discarded Drugs and Biologicals Guideline	CPCP017	02/13/2023	02/28/2024
Wasted/Discarded Drugs and Biologicals Guideline V4	CPCP017	10/26/2021	02/13/2023
Wasted/Discarded Drugs and Biologicals Guideline V3	CPCP017	09/11/2020	10/26/2021
Wasted/Discarded Drugs and Biologicals Guideline V5	CPCP017	06/26/2019	09/11/2020
Home Infusion	Policy Number	Effective Date	End Date
Home Infusion	CPCP019	01/03/2023	11/12/2023
Home Infusion V 3.0	CPCP019	09/07/2021	01/03/2023
Home Infusion V 2.0	CPCP019	6/17/2020	09/07/2021
Home Infusion V 2.0	CPCP019	06/30/2020	04/30/2020
Drug Testing	Policy Number	Effective Date	End Date
Drug Testing Clinical Payment and Coding Policy	CPCP020	03/30/2023	12/04/2023
Drug Testing Clinical Payment and Coding Policy	CPCP020	01/14/2022	03/30/2023
Drug Testing Clinical Payment and Coding Policy (Retired 12/31/2021)	CPCP020	10/22/2021	12/31/2021
Drug Testing Policy	CPCP020	09/04/2020	10/21/2021
Drug Testing Policy	CPCP020	12/20/2020	09/04/2020
Laboratory Panel Billing	Policy Number	Effective Date	End Date
Laboratory Panel Billing	CPCP021	06/04/2021	07/30/2021
Laboratory Panel Billing	CPCP021	07/30/21	04/06/22
Laboratory Panel Billing	CPCP021	04/06/22	06/26/23
Pneumatic Compression Devices – Outpatient Use	Policy Number	Effective Date	End Date
Pneumatic Compression Devices – Outpatient Use	CPCP022	02/13/2023	02/16/2024
Pneumatic Compression Devices – Outpatient Use	CPCP022	01/14/2022	02/13/2023
Pneumatic Compression Devices – Outpatient Use	CPCP022	07/01/2019	08/31/2020
Modifier Reference Policy	Policy Number	Effective Date	End Date
Modifier Reference Policy	CPCP023	11/13/23	01/25/24
Modifier Reference Policy	CPCP023	03/30/23	11/12/23
Modifier Reference Guideline V1	CPCP023	05/13/22	03/30/23
Modifier Reference Guideline V1	CPCP023	04/08/22	05/13/22
Modifier Reference Guideline V2	CPCP023	03/31/21	04/08/22
Evaluation and Management (E/M) Coding – Professional Provider Services	Policy Number	Effective Date	End Date
Evaluation and Management (E/M) Coding – Professional Provider Services	CPCP024	06/22/23	12/04/23
Evaluation and Management (E/M) Coding – Professional Provider Services V3	CPCP024	12/07/20	06/22/23
Corrected Claim Submissions	Policy Number	Effective Date	End Date
Corrected Claim Submissions	CPCP025	04/30/20	06/30/24
Therapeutic, Prophylactic and Diagnostic Injection and Infusion Coding	Policy Number	Effective Date	End Date
Therapeutic, Prophylactic and Diagnostic Injection and Infusion Coding V3	CPCP026	10/05/21	01/03/23
Therapeutic, Prophylactic and Diagnostic Injection and Infusion Coding V3	CPCP026	01/03/23	05/17/23
Inpatient Readmissions	Policy Number	Effective Date	End Date
Inpatient Readmissions	CPCP027	03/01/23	06/30/23
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	12/01/23	01/15/24
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU)	CPCP028	10/01/23	11/30/23
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU)	CPCP028	09/01/23	09/30/23
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU)	CPCP028	06/01/23	08/31/23
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) V3	CPCP028	03/27/23	05/31/23
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) V3	CPCP028	12/07/22	06/31/23
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) V3	CPCP028	10/07/22	03/31/23
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) V3	CPCP028	08/01/22	12/31/22
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) V3 Effective Date 4/22/22	CPCP028	08/01/22	12/31/22
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) V2 Effective Date 4/15/22	CPCP028	04/15/22	04/15/2022
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) V2	CPCP028	07/01/2021	04/01/2022
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) V10 Effective Date 1/1/21	CPCP028	01/01/2021	03/01/2021
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) V10 Effective Date 3/1/21	CPCP028	03/01/2021	04/01/2021
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) V10 Effective Date 4/1/21	CPCP028	04/01/2021	05/15/2021
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) V1 Effective Date 5/15/21	CPCP028	05/15/2021	07/01/2021
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU)	CPCP028	11/20/2020
Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU)	CPCP028	09/01/2020	12/01/2020
Medical Record Documentation	Policy Number	Effective Date	End Date
Medical Record Documentation	CPCP029	09/16/2022	11/12/2023
Medical Record Documentation Guidelines V5	CPCP029	09/22/2021	09/15/2022
Medical Record Documentation Guidelines V1	CPCP029	03/31/2021	09/21/2021
Medical Record Documentation Guidelines V1	CPCP029	02/06/2020	03/31/2021
Medical Record Documentation	OKCPCP01	09/01/2018	02/05/2020
Trauma Activation- Facility Services	Policy Number	Effective Date	End Date
Trauma Activation- Facility Services V1	CPCP031	02/24/2022	07/12/2023
Trauma Activation- Facility Services V1	CPCP031	05/22/2021	02/24/2022
Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Guideline	Policy Number	Effective Date	End Date
Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Guideline	CPCP032	04/22/2022	09/26/2023
Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Guideline V3	CPCP032	07/30/2021	04/22/2022

Telemedicine and Telehealth/Virtual Health Care Services Policy	Policy Number	Effective Date	End Date
Telemedicine and Telehealth Services V5	CPCP033	02/08/2020	03/18/2021
Telemedicine and Telehealth Services V10	CPCP033	01/01/2021	02/08/2021
Telemedicine and Telehealth Services V9	CPCP033	01/01/2021	01/01/2021
Telemedicine and Telehealth Services V10	CPCP033	03/18/2022	03/28/2022
Telemedicine and Telehealth Services V10	CPCP033	03/18/2021	03/28/2022
Telemedicine and Telehealth Services	CPCP033	03/28/2022	12/05/2023
Telemedicine and Telehealth/Virtual Health Care Services Policy	CPCP033	12/05/2023	02/28/2024
Unbundling Policy-Professional Providers	Policy Number	Effective Date	End Date
Unbundling Policy-Professional Providers V2	CPCP034	08/04/2021	04/05/2022
Unbundling Policy-Professional Providers V1	CPCP034	04/05/2022	05/17/2023
Unlisted/Not Otherwise Classified (NOC) Coding Policy	Policy Number	Effective Date	End Date
Unlisted/Not Otherwise Classified (NOC) Coding Policy v3	CPCP035	05/31/2022	09/02/2022
Paravertebral Facet Injection Procedure Coding & Billing Policy	Policy Number	Effective Date	End Date
Paravertebral Facet Injection Procedure Coding & Billing Policy	CPCP036	01/03/2023	11/12/2023
Paravertebral Facet Injection Procedure V1	CPCP036	01/14/2022	01/03/2023
Lab Management Program	Policy Number	Effective Date	End Date
Lab Management Program V1	CPCP037	12/01/2021	08/24/2021
Outpatient Services Prior to an Inpatient Admission	Policy Number	Effective Date	End Date
Outpatient Services Prior to an Inpatient Admission	CPCP038	07/01/2023	02/16/2024
Physical Medicine and Rehabilitation Services	Policy Number	Effective Date	End Date
Physical Medicine and Rehabilitation Services	CPCP040	03/28/2023	01/25/2024