Reimbursement Policies 

Add-on Codes - Anniversary Review; Updates 6-22-26 Approved

After Hours and Weekend Care - Anniversary Review – Update - Approved 2-23-26

Autism/Applied Behavior Analysis (ABA) Reimbursement Policy – Added 2 Additional Q&As 6-22-26 Approved

Behavioral Health Services Documentation - Retired 10-7-24. Please refer to Documentation Protocols for further guidance. 

Bundle Codes Reimbursement Policy - Anniversary Review  12-2-25

Consultation Services Reimbursement Policy  - Anniversary Review approved 9-25-25

Drug Testing Reimbursement Policy - Anniversary review approved 5-21-25

Electroconvulsive Therapy Reimbursement Policy - Anniversary Review and Updated approved 6-2026

Facility-Based Behavioral Health Program Professional Fees Reimbursement Policy - Update - Approved 2-23-26

Facility-Based Behavioral Health Program Reimbursement Policy - Updates approved 4-20-26

Facility-Based Behavioral Health Program – Medicare – Anniversary Review; No Updates 12-2-25

Health and Behavior Assessment and Intervention Reimbursement Policy Commercial & Medicare - Anniversary Review – No updates - Approved 2-23-26

Diagnosis Codes Requirement Policy(f/ka/ Inappropriate Primary Diagnosis Codes Reimbursement Policy - Update - Approved 2-23-26

License Level Reimbursement Policy - Update 6-22-26 Approved 

Maximum Frequency Per Day - Anniversary Review & Update approved 4-20-26

Medicare Incident to Bill - Anniversary Review – No updates - Approved 2-23-26

Medicare Intensive Outpatient Program (IOP) and Partial Hospitalization Program (PHP) Reimbursement Policy - update 11/1/25

National Correct Coding Initiative Reimbursement Policy - Anniversary Review -No updates approved 4-20-26

New Patient Visit – Anniversary Review; added Q&As 6-22-26 Approved

Non-Emergent Transport and Lodging - Anniversary review approved 5-22-23 (Retired 6-27-24) 

Non-physician Health Care Billing Evaluation and Management Codes Reimbursement Policy  - Anniversary Review & Update approved 4-20-26

Non-Reimbursable HCPCS Codes -  No updates 6-22-26 Approved

Non-Covered HCPCS Codes - added additional codes 6-22-26 Approved

Observation and Discharge Reimbursement Policy  - New Policy approved 4-20-26

Opioid Treatment Program Reimbursement Policy - Anniversary Review & Update approved 4-20-26

Outpatient Family Therapy Reimbursement Policy - Anniversary Review 12/2/25

Outpatient Service Clean Claim Form Submission - Anniversary Review approved 9-25-25

Outpatient Services Outside A Program Reimbursement Policy - Anniversary review approved 8-15-25

Outpatient Services Rendered Under Supervision - Update 6-22-26

Procedure and Place of Service Reimbursement Policy - Anniversary Review – No updates approved 4-20-26

Professional Technical Component Reimbursement Policy Retired Policy 11-20-24 

Prolonged Services Reimbursement Policy - Commercial and Medicare - Anniversary Review – Updates approved 4-20-26

Psychological and Neuropsychological Testing Reimbursement Policy - Anniversary Review approved 5-5-26

Same Day Same Service Reimbursement Policy – Anniversary Review approved 9-25

Spravato Reimbursement Policy - Anniversary Review – No Updates approved 4-20-26

Services Incident to a Supervising Health Care Provider - New Policy Commercial LOB 12-2-25

Telemental Health Services Reimbursement Policy - Commercial - Update 6-22-26 Approved

Telemental Health Services Reimbursement Policy -Medicaid - Update 6-9-26

Telemental Health Services Reimbursement Policy – Medicare - Update 6-22-26 Approved