Medicare Reimbursement Policies

We want to assist physicians, facilities and other providers in accurate claims submissions and to outline the basis for reimbursement if the service is covered by a member’s Healthy Blue Dual Advantage benefit plan. Keep in mind that determination of coverage under a member’s benefit plan does not necessarily ensure reimbursement. These policies may be superseded by provider or State contract language, or State, Federal requirements or mandates. Providers and facilities are required to use industry standard codes for claim submissions. Services should be billed with CPT codes, HCPCS codes and/or revenue codes. The billed code(s) should be fully supported in the medical record and/or office notes. Industry practices are constantly changing and Healthy Blue Dual Advantage reserves the right to review and revise its policies periodically.

Anesthesia
Coding
DME and Supplies
Drugs
Evaluation and Management
Facilities
Laboratory
Prosthetics and Orthotics
Radiology
Reimbursement Administration - General
Surgery
Transportation