Select Health Medical Coding & Reimbursement Policies
Coding & Reimbursement policies are based on a review of coding standards, including:
- Centers for Medicare and Medicaid Services (CMS)
- Current Procedural Terminology (CPT®)
- Specialty societies (e.g., AAOS)
- Other expert sources
Individual coding and reimbursement policies are listed individually in alphabetical order below:
59 Modifier [#05]
After Hours and Urgent Care Charges [#02]
Ambulatory Electroencephalography (EEG) [#89]
Anesthesia (General & Mac) with Colonoscopies and Other Endoscopic Examinations [#51]
Anesthesia Complicated by Emergency Conditions [#62]
Appendectomy [#34]
Arthrodesis with Additional Codes for Decompression [#69]
Assistant Surgeons [#23]
Autograft & Allograft for Spine Surgery [#57]
Binocular Microscopy [#60]
Bone and Tendon Grafts with Knee Surgery [#27]
Breast Reconstruction [#44]
Care Plan Oversight Services [#32]
Cerumen Removal [#01]
Chemotherapy and Other Highly Complex Drug or Biologic Agent Administration (Office Based) [#11]
Comparison Films [#53]
Conscious Sedation with Pain Management Procedures (#80)
Critical Care (Not including Neonatal or Pediatric Critical Care) [#15]
Determining Allowed Amounts for Out-of-Network Claims for Commercial Plans [#96]
Durable Medical Equipment (DME) [#41]
Evaluation Visits for Excluded Medical Diagnosis Codes [#33]
Exploration of Spinal Fusion with Other Surgery [#21]
Facet Injection with Epidural Injection [#39]
Fetal Non-Stress Test with or without Ultrasound [#37]
Formulas and Other Enteral Nutrition [#95]
Global Surgery [#12]
Hierarchy of Sources [#63]
Home Health Aide [#82}
Hospital Beds [#90]
Hydration (Office-Based)*[#09]
"Incident to Physician's Professional Services" and Split/Shared E/M Service [#03]
In-Network Coverage of Medical Services with an Out-of-Network Provider [#88]
In-Office Procedures [#79]
Inpatient Readmissions
Insertion, Non-Biodegradable Drug Delivery Implant to Report Joint or Ophthalmologic Spacers or Prosthesis [#71]
Intraoperative Neurophysiological Monitoring (IONM) [#56]
IV Moderate Conscious Sedation [#07]
Lipoma Removal [#58]
After Hours and Urgent Care Charges [#02]
Ambulatory Electroencephalography (EEG) [#89]
Anesthesia (General & Mac) with Colonoscopies and Other Endoscopic Examinations [#51]
Anesthesia Complicated by Emergency Conditions [#62]
Appendectomy [#34]
Arthrodesis with Additional Codes for Decompression [#69]
Assistant Surgeons [#23]
Autograft & Allograft for Spine Surgery [#57]
Binocular Microscopy [#60]
Bone and Tendon Grafts with Knee Surgery [#27]
Breast Reconstruction [#44]
Care Plan Oversight Services [#32]
Cerumen Removal [#01]
Chemotherapy and Other Highly Complex Drug or Biologic Agent Administration (Office Based) [#11]
Comparison Films [#53]
Conscious Sedation with Pain Management Procedures (#80)
Critical Care (Not including Neonatal or Pediatric Critical Care) [#15]
Determining Allowed Amounts for Out-of-Network Claims for Commercial Plans [#96]
Durable Medical Equipment (DME) [#41]
Evaluation Visits for Excluded Medical Diagnosis Codes [#33]
Exploration of Spinal Fusion with Other Surgery [#21]
Facet Injection with Epidural Injection [#39]
Fetal Non-Stress Test with or without Ultrasound [#37]
Formulas and Other Enteral Nutrition [#95]
Global Surgery [#12]
Hierarchy of Sources [#63]
Home Health Aide [#82}
Hospital Beds [#90]
Hydration (Office-Based)*[#09]
"Incident to Physician's Professional Services" and Split/Shared E/M Service [#03]
In-Network Coverage of Medical Services with an Out-of-Network Provider [#88]
In-Office Procedures [#79]
Inpatient Readmissions
Insertion, Non-Biodegradable Drug Delivery Implant to Report Joint or Ophthalmologic Spacers or Prosthesis [#71]
Intraoperative Neurophysiological Monitoring (IONM) [#56]
IV Moderate Conscious Sedation [#07]
Lipoma Removal [#58]
Lysis of Adhesions [#36]
Medical Necessity - Geographic
Considerations [#97]
Medical Record Documentation [#35]
Modifiers [#17]
Molecular Genetic Testing Guidelines [#83]
Multiple Procedure Reduction for Diagnostic Cardiology
Procedures [#73]
Multiple Procedure Reduction for Diagnostic Ophthalmology
Procedures [#74]
Multiple Procedure Reduction for Radiology Procedures [#61]
Multiple Procedure Reduction Therapy [#59]
Multiple Surgeries [#13]
Mumford Procedure [#40]
Obstetrical Services [#16]
Ocular Imaging [#92]
Operating Microscope [#46]
Ophthalmic Biometry [#54]
Postoperative Continuous Local Delivery of Medication for
Pain Control [#48]
Post-Operative Debridement Following FESS [#50]
Preventative and Problem-Oriented Evaluation and Management Services [#42]
Preventive Care and Screening Guidelines [#06]
Pulse Oximetry [#19]
Robotic Assisted Surgery [#66]
Scope Procedures Converted to Open Procedures [#38]
Screening Pap-Smear with a Preventive Eval [#76]
Screening Visual Acuity with E/M Services [#31]
Shoulder Debridement [#72]
Specimen Validity Testing [#65]
Spinal Cord Stimulation-Test Trial Portion [#47]
Spravato (Esketamine) for Treatment Resistant Depression [#91]
State-supplied Immunization [#22]
Supervised Anesthesia [#75]
Supervision for Physical Therapy Services [#52]
Surgical Trays and Supplies [#14]
Telehealth and Telemedicine [#85]
Temporomandibular Joint (TMJ)Disorders (TMD) [#43]
Testing Serum Vitamin D Levels [#77]
Therapeutic, Prophylactic, and Diagnostic and Infusions Policy(Office Based) [#10]
Travel Allowance for Organ Transplants [#86]
Unlisted/Unspecified Codes [#08]
Venipuncture and/or Collection of Specimens [#78]
Considerations [#97]
Medical Record Documentation [#35]
Modifiers [#17]
Molecular Genetic Testing Guidelines [#83]
Multiple Procedure Reduction for Diagnostic Cardiology
Procedures [#73]
Multiple Procedure Reduction for Diagnostic Ophthalmology
Procedures [#74]
Multiple Procedure Reduction for Radiology Procedures [#61]
Multiple Procedure Reduction Therapy [#59]
Multiple Surgeries [#13]
Mumford Procedure [#40]
Obstetrical Services [#16]
Ocular Imaging [#92]
Operating Microscope [#46]
Ophthalmic Biometry [#54]
Postoperative Continuous Local Delivery of Medication for
Pain Control [#48]
Post-Operative Debridement Following FESS [#50]
Preventative and Problem-Oriented Evaluation and Management Services [#42]
Preventive Care and Screening Guidelines [#06]
Pulse Oximetry [#19]
Robotic Assisted Surgery [#66]
Scope Procedures Converted to Open Procedures [#38]
Screening Pap-Smear with a Preventive Eval [#76]
Screening Visual Acuity with E/M Services [#31]
Shoulder Debridement [#72]
Specimen Validity Testing [#65]
Spinal Cord Stimulation-Test Trial Portion [#47]
Spravato (Esketamine) for Treatment Resistant Depression [#91]
State-supplied Immunization [#22]
Supervised Anesthesia [#75]
Supervision for Physical Therapy Services [#52]
Surgical Trays and Supplies [#14]
Telehealth and Telemedicine [#85]
Temporomandibular Joint (TMJ)Disorders (TMD) [#43]
Testing Serum Vitamin D Levels [#77]
Therapeutic, Prophylactic, and Diagnostic and Infusions Policy(Office Based) [#10]
Travel Allowance for Organ Transplants [#86]
Unlisted/Unspecified Codes [#08]
Venipuncture and/or Collection of Specimens [#78]
*See also, Chemotherapy, and Therapeutic, Prophylactic, and Diagnostic Injections and Infusions Policies