Policy Name Effective Date Revision Date Next Review Date
Reimbursement
Reimb-020 Custom Diabetic Shoes December 16, 2020 December 16, 2020 December 16, 2021
Reimb-016 Intrathecal or Epidural Pump Refill May 27, 2020 May 27, 2020 May 27, 2021
Reimb-014 Modifier -25 February 24, 2021 February 24, 2021 February 24, 2022
reimb-006 Modifier -78 January 30, 2021 November 30, 2020 November 30, 2021
Reimb-022 Modifier -90 Reference (Outside) Laboratory June 12, 2020 August 12, 2020 June 12, 2021
Reimb-025 OB Anesthesia November 09, 2020 September 03, 2020 September 03, 2021
Reimb-024 Non-residential Opioid Treatment Facility (Place of Service 58) September 22, 2020 July 22, 2020 July 22, 2021
Reimb-015 Oral Appliances for Obstructive Sleep Apnea July 01, 2020 December 02, 2019 December 02, 2020
Reimb-011 Routine Foot Care May 27, 2020 May 27, 2020 May 27, 2021
Reimb-012 Sources for Coding Determinations August 26, 2020 August 26, 2020 August 26, 2021
Reimb-002 Urine Drug Screen Testing In the Outpatient Setting June 24, 2020 June 24, 2020 June 24, 2021