| Anesthesia Information | Policy Number | Effective Date | End Date |
|---|---|---|---|
| Anesthesia Information | CPCP010 | 03/30/2023 | 08/13/2024 |
| Anesthesia Information | CPCP010 | 10/01/2022 | 03/29/2023 |
| Applied Behavior Analysis | Policy Number | Effective Date | End Date |
| Applied Behavior Analysis | CPCP011 | 06/12/2023 | 11/05/2024 |
| Applied Behavior Analysis V1 | CPCP011 | 11/09/2021 | 06/11/2023 |
| Chiropractic Care Services | Policy Number | Effective Date | End Date |
| Chiropractic Care Services | CPCP016 | 01/25/2024 | 06/19/2025 |
| Chiropractic Care Services | CPCP016 | 03/28/2023 | 01/24/2024 |
| Chiropractic Care Services | CPCP016 | 12/16/2021 | 03/27/2023 |
| Corrected Claim Submissions | Policy Number | Effective Date | End Date |
| Corrected Claim Submissions | CPCP025 | 07/01/2024 | 01/01/2025 |
| Corrected Claim Submissions | CPCP025 | 04/30/2020 | 06/30/2024 |
| Co-Surgeon/Team Surgeon Modifiers | Policy Number | Effective Date | End Date |
| Co-Surgeon/Team Surgeon Modifiers | CPCP009 | 01/25/2024 | 04/17/2025 |
| Co-Surgeon/Team Surgeon Modifiers | CPCP009 | 09/26/2023 | 01/24/2024 |
| Co-Surgeon/Team Surgeon Modifiers V1 | CPCP009 | 09/16/2020 | 09/25/2023 |
| Drug Testing | Policy Number | Effective Date | End Date |
| Drug Testing Clinical Payment and Coding Policy | CPCP020 | 12/04/2023 | 11/13/2024 |
| Drug Testing Clinical Payment and Coding Policy | CPCP020 | 03/30/2023 | 12/03/2023 |
| Drug Testing Clinical Payment and Coding Policy | CPCP020 | 01/14/2022 | 03/29/2023 |
| Emergency Department Evaluation and Management (E/M) Services Coding - Professional Services | Policy Number | Effective Date | End Date |
| Emergency Department Evaluation and Management (E/M) Services Coding - Professional Services | CPCP042 | 08/01/2023 | 10/02/2024 |
| Evaluation and Management (E/M) Coding – Professional Provider Services | Policy Number | Effective Date | End Date |
| Evaluation and Management (E/M) Coding – Professional Provider Services | CPCP024 | 12/04/2023 | 11/17/2024 |
| Evaluation and Management (E/M) Coding – Professional Provider Services | CPCP024 | 06/22/2023 | 12/03/2023 |
| Evaluation and Management (E/M) Coding – Professional Provider Services V3 | CPCP024 | 12/07/2020 | 06/21/2023 |
| Global Surgical Package-Professional Provider | Policy Number | Effective Date | End Date |
| Global Surgical Package-Professional Provider | CPCP014 | 01/25/2024 | 04/14/2025 |
| Global Surgical Package-Professional Provider | CPCP014 | 06/26/2023 | 01/24/2024 |
| Global Surgical Package-Professional Provider | CPCP014 | 08/02/2022 | 06/25/2023 |
| Hernia Repair | Policy Number | Effective Date | End Date |
| Hernia Repair | CPCP012 | 05/17/2023 | 07/09/2024 |
| Hernia Repair | CPCP012 | 04/28/2022 | 05/16/2023 |
| Home Health Care/Private Duty Nursing Policy | Policy Number | Effective Date | End Date |
| Home Health Care/Private Duty Nursing Policy | CPCP005 | 11/13/2023 | 03/20/2025 |
| Coordinated Home Care/Private Duty Nursing Policy | CPCP005 | 08/08/2021 | 11/12/2023 |
| Increased Procedural Services (Modifier 22) | Policy Number | Effective Date | End Date |
| Increased Procedural Services (Modifier 22) | CPCP013 | 01/25/2024 | 04/14/2025 |
| Increased Procedural Services (Modifier 22) | CPCP013 | 05/17/2023 | 01/24/2024 |
| Increased Procedural Services (Modifier 22) | CPCP013 | 02/24/2022 | 05/16/2023 |
| Infusion Services | Policy Number | Effective Date | End Date |
| Infusion Services | CPCP019 | 07/18/2025 | 07/18/2025 |
| Home Infusion | CPCP019 | 11/13/2023 | 07/17/2025 |
| Home Infusion | CPCP019 | 01/03/2023 | 11/12/2023 |
| Home Infusion v3 | CPCP019 | 09/07/2021 | 01/02/2023 |
| Inpatient Readmissions | Policy Number | Effective Date | End Date |
| Inpatient Readmissions | CPCP027 | 07/01/2023 | 12/12/2024 |
| Inpatient Readmissions | CPCP027 | 03/01/2023 | 06/30/2023 |
| Inpatient/Outpatient Unbundling Policy | Policy Number | Effective Date | End Date |
| Inpatient/Outpatient Unbundling Policy | CPCP002 | 12/16/2021 | 01/03/2024 |
| Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Guideline | Policy Number | Effective Date | End Date |
| Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Guideline | CPCP032 | 09/26/2023 | 10/02/2024 |
| Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Guideline | CPCP032 | 04/22/2022 | 09/25/2023 |
| Laboratory Panel Billing | Policy Number | Effective Date | End Date |
| Laboratory Panel Billing | CPCP021 | 07/10/2024 | 09/21/2025 |
| Laboratory Panel Billing | CPCP021 | 06/26/2023 | 07/09/2024 |
| Laboratory Panel Billing | CPCP021 | 04/06/2022 | 06/25/2023 |
| Medical Record Documentation | Policy Number | Effective Date | End Date |
| Medical Record Documentation | CPCP029 | 11/13/2023 | 11/13/2024 |
| Medical Record Documentation | CPCP029 | 09/16/2022 | 11/12/2023 |
| Modifier Reference Policy | Policy Number | Effective Date | End Date |
| Modifier Reference Policy | CPCP023 | 11/13/2023 | 01/24/2024 |
| Modifier Reference Policy | CPCP023 | 03/30/2023 | 11/12/2023 |
| Modifier Reference Guideline | CPCP023 | 05/13/2022 | 03/29/2023 |
| Multiple Surgical Procedures - Professional Provider Services | Policy Number | Effective Date | End Date |
| Multiple Surgical Procedures - Professional Provider Services | CPCP015 | 01/25/2024 | 04/22/2025 |
| Multiple Surgical Procedures - Professional Provider Services | CPCP015 | 09/26/2023 | 01/24/2024 |
| Multiple Surgical Procedures - Professional Provider Services | CPCP015 | 06/24/2022 | 09/25/2023 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) | Policy Number | Effective Date | End Date |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) | CPCP028 | 10/01/2024 | 05/14/2025 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) | CPCP028 | 07/01/2024 | 09/30/2024 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) | CPCP028 | 07/01/2024 | 07/01/2024 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) | CPCP028 | 05/15/2024 | 06/30/2024 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) | CPCP028 | 04/01/2024 | 05/15/2024 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) | CPCP028 | 01/15/2024 | 05/14/2024 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) | CPCP028 | 12/01/2023 | 01/15/2024 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) | CPCP028 | 10/01/2023 | 11/30/2023 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) | CPCP028 | 09/01/2023 | 09/30/2023 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) | CPCP028 | 06/01/2023 | 08/31/2023 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) V3 | CPCP028 | 03/27/2023 | 05/31/2023 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) V3 | CPCP028 | 12/07/2022 | 06/31/2023 |
| Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) V3 | CPCP028 | 10/07/2022 | 03/31/2023 |
| Observation Services Policy | Policy Number | Effective Date | End Date |
| Observation Services Policy | CPCP001 | 07/12/2023 | 08/28/2024 |
| Observation Services Policy | CPCP001 | 06/22/2023 | 07/11/2023 |
| Outpatient Facility Service(s) Overlapping During an Inpatient Stay | Policy Number | Effective Date | End Date |
| Outpatient Facility Service(s) Overlapping During an Inpatient Stay | CPCP039 | 07/10/2024 | 06/19/2025 |
| Outpatient Facility Service(s) Overlapping During an Inpatient Stay | CPCP039 | 08/01/2023 | 07/09/2024 |
| Outpatient Services Prior to an Inpatient Admission | Policy Number | Effective Date | End Date |
| Outpatient Services Prior to an Inpatient Admission | CPCP038 | 02/16/2024 | 06/19/2025 |
| Outpatient Services Prior to an Inpatient Admission | CPCP038 | 07/01/2023 | 02/15/2024 |
| Paravertebral Facet Injection Procedure Coding & Billing Policy | Policy Number | Effective Date | End Date |
| Paravertebral Facet Injection Procedure Coding & Billing Policy | CPCP036 | 11/13/2023 | 11/13/2024 |
| Paravertebral Facet Injection Procedure Coding & Billing Policy | CPCP036 | 01/03/2023 | 11/12/2023 |
| Paravertebral Facet Injection Procedure V1 | CPCP036 | 01/14/2022 | 01/02/2023 |
| Physical Medicine and Rehabilitation Services | Policy Number | Effective Date | End Date |
| Physical Medicine and Rehabilitation Services | CPCP040 | 01/25/2024 | 09/21/2025 |
| Physical Medicine and Rehabilitation Services | CPCP040 | 03/28/2023 | 01/24/2024 |
| Pneumatic Compression Devices – Outpatient Use | Policy Number | Effective Date | End Date |
| Pneumatic Compression Devices – Outpatient Use | CPCP022 | 02/13/2023 | 02/15/2024 |
| Pneumatic Compression Devices – Outpatient Use | CPCP022 | 01/14/2022 | 02/13/2023 |
| Preventive Services Policy | Policy Number | Effective Date | End Date |
| Preventive Services Policy | CPCP006 | 07/01/2025 | 09/30/2025 |
| Preventive Services Policy | CPCP006 | 04/01/2025 | 06/30/2025 |
| Preventive Services Policy | CPCP006 | 02/01/2025 | 03/31/2025 |
| Preventive Services Policy | CPCP006 | 01/01/2025 | 02/01/2025 |
| Preventive Services Policy | CPCP006 | 10/01/2024 | 01/01/2025 |
| Preventive Services Policy | CPCP006 | 07/01/2024 | 09/30/2024 |
| Preventive Services Policy | CPCP006 | 04/01/2024 | 06/30/2024 |
| Preventive Services Policy | CPCP006 | 01/01/2024 | 03/31/2024 |
| Preventive Services Policy | CPCP006 | 11/01/2023 | 12/31/2023 |
| Preventive Services Policy | CPCP006 | 10/01/2023 | 10/31/2023 |
| Preventive Services Policy | CPCP006 | 07/01/2023 | 09/30/2023 |
| Preventive Services Policy | CPCP006 | 04/01/2023 | 06/30/2023 |
| Preventive Services Policy | CPCP006 | 03/01/2023 | 03/30/2023 |
| Preventive Services Policy V1 | CPCP006 | 01/01/2023 | 02/28/2023 |
| Psychological and Neuropsychological Testing | Policy Number | Effective Date | End Date |
| Psychological and Neuropsychological Testing V1 | CPCP008 | 12/04/2023 | 11/13/2024 |
| Psychological and Neuropsychological Testing V1 | CPCP008 | 12/16/2022 | 12/03/2023 |
| Telemedicine and Telehealth/Virtual Health Care Services Policy | Policy Number | Effective Date | End Date |
| Telemedicine and Telehealth/Virtual Health Care Services Policy | CPCP033 | 01/01/2025 | 09/25/2025 |
| Telemedicine and Telehealth/Virtual Health Care Services Policy | CPCP033 | 02/28/2024 | 12/31/2024 |
| Telemedicine and Telehealth/Virtual Health Care Services Policy | CPCP033 | 12/05/2023 | 02/27/2024 |
| Telemedicine and Telehealth Services | CPCP033 | 03/28/2022 | 12/04/2023 |
| Therapeutic, Prophylactic, Diagnostic, Injection and Infusion Administration Coding | Policy Number | Effective Date | End Date |
| Therapeutic, Prophylactic, Diagnostic, Injection and Infusion Administration Coding | CPCP026 | 08/29/2024 | 09/25/2025 |
| Therapeutic, Prophylactic and Diagnostic Injection and Infusion Coding V1 | CPCP026 | 05/17/2023 | 08/28/2024 |
| Therapeutic, Prophylactic and Diagnostic Injection and Infusion Coding V3 | CPCP026 | 01/03/2023 | 05/16/2023 |
| Therapeutic, Prophylactic and Diagnostic Injection and Infusion Coding V3 | CPCP026 | 10/05/2021 | 01/02/2023 |
| Trauma Activation - Facility Services | Policy Number | Effective Date | End Date |
| Trauma Activation - Facility Services V1 | CPCP031 | 07/12/2023 | 07/25/2024 |
| Trauma Activation - Facility Services V1 | CPCP031 | 02/24/2022 | 07/11/2023 |
| Unbundling Policy-Professional Providers | Policy Number | Effective Date | End Date |
| Unbundling Policy-Professional Providers | CPCP034 | 05/17/2023 | 06/30/2024 |
| Unbundling Policy-Professional Providers V1 | CPCP034 | 04/05/2022 | 05/16/2023 |
| Unlisted/Not Otherwise Classified (NOC) Coding Policy | Policy Number | Effective Date | End Date |
| Unlisted/Not Otherwise Classified (NOC) Coding Policy | CPCP035 | 09/17/2024 | 10/16/2025 |
| Unlisted/Not Otherwise Classified (NOC) Coding Policy v1 | CPCP035 | 09/02/2022 | 09/16/2024 |
| Wasted/Discarded Drugs and Biologicals Guideline | Policy Number | Effective Date | End Date |
| Wasted/Discarded Drugs and Biologicals Guideline | CPCP017 | 02/13/2023 | 02/27/2024 |
| Wasted/Discarded Drugs and Biologicals Guideline V4 | CPCP017 | 10/26/2021 | 02/12/2023 |
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