Reimbursements

Category:

Services Not Separately Reimbursed

Reimbursement Policy: NDRP-GC-012
Section: General Coding
Effective Date: January 1, 2019
Last Reviewed:
March 1, 2019

Description:

The purpose of this policy to provide direction on procedure codes the Plan will not separately reimburse.

Policy:

The procedure codes listed below are considered not separately reimbursed by The Plan.

Reimbursement for these services is inherently included in the global allowance for other services not specified. If submitted, these services will be rejected and non-billable to the Member.

15850 20936 22841 36000 36416 69209 69210 90863 90887 92260
92531 92532 92533 92921 92925 92929 92934 92938 92944 92971
93770 94005 94150 94760 94761 96902 97010 97602 99000 99001
99002 99024 99070 99078 99090 99172 99173 99340 99374 99377
99378 99379 99380 99483 99484 99487 99489 99490 99491 99492
99493 99494 A4220 A4262 A4263 A4270 A4300 A4550 A4556 A4557
A4558 A4565 A4570 A4580 A4590 G0269 Q4001 Q4002 Q4003 Q4004
Q4005 Q4006 Q4007 Q4008 Q4009 Q4010 Q4011 Q4012 Q4013 Q4014
Q4015 Q4016 Q4017 Q4018 Q4019 Q4020 Q4021 Q4022 Q4023 Q4024
Q4025 Q4026 Q4027 Q4028 Q4029 Q4030 Q4031 Q4032 Q4033 Q4034
Q4035 Q4036 Q4037 Q4038 Q4039 Q4040 Q4041 Q4042 Q4043 Q4044
Q4045 Q4046 Q4047 Q4048 Q4049 Q4050 Q4051 S0395 S3600 S3601
S8450 S8451 S8452 S9110