Billing & coding policies

Below are Priority Health's medical claims payment policies. This information may help providers bill claims more accurately to reduce delays in processing, as well as avoid rebilling and additional requests for information.

A

• Advance care planning (ACP)
• Allergy injections / immunotherapy
• Advanced Practice Professional (APP)

B

• Balance billing
• Behavioral health

C

• Cardiology
• Care management services
• Chiropractic services
• Chronic pain management services
• Clinical edit
• Clinical trials
• Condition codes
• Continuous glucose monitor (CGM) supplies
• Critical care

D

• Diabetes education
• Distinct unbundled modifiers
• Drug testing
• Duplicate claims
• Durable medical equipment (DME) place of service (POS)

E

• ECG interpretation
• E/M services billed with treatment room codes
• Evaluation and management

F

• Facility modifiers
• Fundus photography

G

• General coding
• Genetic testing coding

H

• High tech radiology services
• HIV prognosis and monitoring
• Home infusion

I

• Infusion services supplies
• Inpatient only procedures

L

• Lab and pathology

M

• Malnutrition
• Miscellaneous DME
• Moh's micrographic surgery
• Musculoskeletal shoulder
• Musculoskeletal spine

N

• Nutrition counseling, education and therapy

O

• Observation stays
• Once per lifetime
• Ophthalmology and vision
• Osteopathic manipulation treatment (OMT)
• Ostomy supplies

P

• Partial Hospitalization Program (PHP)
• Pelvic and transvaginal ultrasound
• Portable radiology services
• Positive airway pressure (PAP) devices for treatment of sleep apnea
• Professional and technical components status indicator
• Professional status indicator
• Prostate biopsy pathology
• Prosthetic orthotics and footwear
• Provider-based billing
• Psychiatry and Psychology services

R

• Radiation oncology
• Radiology PC / TC multiple same-day billing
• Readmissions reimbursement

S

• Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
• Sepsis
• Split billing
• Surgical dressings
• Surgical implants & devices

T

• Three-day window bundling
• Tracheostomy care supplies
• Trauma team activation
• Treatment rooms
• Trigger point injection services

U

• Unbundling, inpatient and outpatient
• Urological supplies

W

• Wound care and debridement