New and updated billing policies now available

We publish billing policies to offer transparency and help providers bill claims more accurately to reduce delays in processing claims, as well as avoid rebilling and additional requests for information. 

The following billing policies were recently published to or updated in our Provider Manual.

Note: If the effective date is listed as “N/A”, the policy represents our current system set up and expectations for transparency. There are no changes for providers as the policy is already in effect.

Policy New or updated Description Effective date
Claim submission guidelines Updated

This policy primarily compiles guidelines already present in our online Provider Manual and that are already in effect.

With the publishing of this policy, we added guidelines for taxonomy codes that will go into effect on May 19, 2025.

 May 19, 2025 (taxonomy codes only)
Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring) New This policy defines billing, reimbursement and documentation guidelines for Cardiac Event Detection (CED) and Holter Monitoring (24-hour ECG monitoring). N/A
Flow cytometry New This policy defines our current reimbursable limitations and documentation requirements associated with flow cytometry. N/A
Magnetoencephephalography (MEG) New This policy identifies the billing and documentation requirements associated with Magnetoencephalography (MEG).
 N/A
Miscellaneous DME Updated Added information on seat lift mechanisms N/A
Oxygen and oxygen supplies New This policy identifies the payment and documentation requirements associated with oxygen and oxygen supplies. May 19, 2025
Radiation oncology Updated
  • Treatment stimulation: Added code G0562 and additional information on use and billing for codes 77280, 77285 and 77290
  • Superficial radiation therapy: Added information on use and billing for codes 77280, 77285 and 77290, as well as image guidance reporting with SRT.
  • Stereotactic Body Radiation Therapy (SBRT) and Stereotactic Radiosurgery (SRS): Added code G0563
  • Image guided radiation therapy: Added information on IGRT precise target localization requirements
  • Added to References section
May 19, 2025
Semiprivate vs private room New This policy defines billing, reimbursement and documentation guidelines for semiprivate rooms and private rooms for patients in a hospital setting. N/A