New Payment Policies

Date: 06/01/17

Please read the summarized descriptions of our new Payment Policies below:

• Sleep Studies Place of Service
  This policy defines the appropriate place of service for sleep studies.  The health plan’s code editing software will evaluate claim lines to determine if the place of service submitted for a sleep study is consistent with the definition of the sleep study procedure code billed.  If the place of service is incorrect, the sleep study will be denied. A list of acceptable place of service codes may be found in the Sleep Studies Place of Service payment policy on the California Health & Wellness web site.
  
  
• Status “P” Bundled Services
  This policy defines the payment criteria for covered services designated by CMS as always bundle to another physician’s procedure or service to be used in making payment decisions and administering benefits. If an item or service is considered incidental to a physician’s service and is provided on the same day as a physician’s service; the payment is bundled into the payment for the physician’s service to which it is incidental. A list of codes subject to this bundling logic can be found in the Status “P” Bundled Service payment policy on the California Health & Wellness web site.

For the entirety of these Payment Policies please navigate to our Clinical & Payment Policies page.