Non-Covered Services

PAYMENT POLICIES HARVARD PILGRIM HEALTH CARE-PROVIDER MANUAL September 2022 Non-Covered Services Harvard Pilgrim Does Not Reimburse1 Harvard Pilgrim Health Care does not reimburse for the procedures or categories of codes outlined in this policy. This list is not all-inclusive. Denials include Non-Covered Services defined as exclusions in the members evidence of coverage (EOC), payment included in the allowance of another service ( , global) and procedure codes submitted that are not eligible for payment. Member or provider liability is indicated. Benefits may vary; please call the Provider Service Center at 800-708-4414 for benefit determination including covered benefits selected by the member s employer group and the applicable benefit limitations and cost sharing. Any coverage exceptions are noted in the Comments column. Harvard Pilgrim does not reimburse for the following code categories. Category II CPT Codes (XXXXF) Use of these codes is optional, not required for correct coding, and may not be used as a substitute for Category I codes.

19105 Ablation, cryosurgical, of fibroadenoma, including ultrasound guidance, each fibroadenoma Provider liable — procedure code not eligible for payment 19396 Preparation of moulage for custom breast implant Member liable — not a covered service

Loading..

Tags:

  Ablation

Information