EmblemHealth Coding Edit Rules

Payment Policy: Coding Edit Rules (Commercial, Medicare & Medicaid) Proprietary inf ormation of EmblemHealth . 2022 EmblemHealth & Af f iliates Page 1 of 142 Review Date: 11/09/2022 Number: RP20210017 Reimbursement Guideline Disclaimer: EmblemHealth has policies in place that reflect billing or claims payment processes unique to our health plans. Current billing and claims payment policies apply to all our products, unless otherwise noted. EmblemHealth will inform you of new policies or changes in policies through updates to the Provider Manual and/or provider news. The information presented in this policy is accurate and current as of the date of this publication.

P Anesthesia Policy Daily hospital management of epidural or subarachnoid continuous drug administration (01996) is not payable when billed with physical status modifiers P1-P6. 1/01/2018 ASO, HMOC, PPOC P Anesthesia Policy Anesthesia and moderate sedation services (00300, 00400, 00600, 01935-01936, 01991-01992, 99152-99153, 99156-99157)

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  Physical, Status, Modifiers, Anesthesia, Emblemhealth, Physical status modifiers

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