Reimbursement Policies
AmeriHealth Caritas VIP Care Plus reimbursement policies and their resulting edits are based on guidelines from established industry sources, such as the Centers for Medicare and Medicaid Services (CMS), the American Medical Association (AMA), state and federal regulatory agencies, and medical specialty professional societies. Reimbursement policies are intended as a general reference and do not constitute a contract or other guarantee of payment. AmeriHealth Caritas VIP Care Plus may use reasonable discretion in interpreting and applying its policies to services provided in a particular case and may modify its policies at any time.
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A
- Acupuncture
- Add-On Codes
- Allergy Testing
- Ambulance Services
- Ambulatory Surgery Center
- Anesthesia
- Assistant Surgeon
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B
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C
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D
- Diagnosis Procedure Age Guidelines
- Diagnosis Procedure Code Gender Guidelines
- Discarded Drugs and Biologicals
- Discontinued Procedures (Modifier 53)
- Distinct Procedural Service (Modifier 59, X, EPSU)
- Duplicate Services
- Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)
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E
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F
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G
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H
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I
- Implants and Devices
- In-Office Stat Labs
- Inappropriate Diagnosis Coding
- Incident To
- Itemized Bill Review
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K
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L
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M
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N
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O
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P
- Place of Service
- Post Payment Review
- Procedure Code Guidelines
- Professional Technical Components (Modifiers 26, TC)
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Q
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R
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S
- Significant-Separately Identifiable Evaluation and Management Service (Modifier 25)
- Split Billing Guidelines
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T
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V
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