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
• Always / sometimes therapy
• Advanced Practice Professional (APP)

B

• Balance billing
• Behavioral health
• Bladder scans

C

• Cardiac rehabilitation
• Cardiology
• Care management services
• Chiropractic services
• Chronic pain management services
• Clinical edit
• Clinical trials
• Compression garments
• Condition codes
• Continuous glucose monitor (CGM) supplies
• Critical access hospital (CAH) method II billing
• Critical care

D

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

E

• ECG interpretation
• E/M services billed with treatment room codes
• Endomyocardial biopsy with right heart catheterization
• Enteral nutrition
• Evaluation and management

F

• Facility modifiers
• Fundus photography

G

• General coding
• Genetic testing coding

H

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

I

• Infusion services supplies
• Inpatient only procedures

L

• Lab and pathology

M

• Malnutrition
• Maternity and prenatal care
• Medicare Annual Wellness Visit (AWV) / preventive care visits
• Miscellaneous DME
• Moh's micrographic surgery
• Musculoskeletal shoulder
• Musculoskeletal spine

N

• Negative pressure wound therapy pumps
• 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
• Skilled nursing facility
• 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
• Unlisted codes
• Urological supplies

W

• Wound care and debridement