Reimbursement policies

Reimbursement of covered services

Updated June 2024

Wellpoint’s reimbursement policies outline the basis for Wellpoint’s reimbursement of covered services. These policies are meant to help providers submit claims correctly, in accordance with the policies described.

Reimbursement policies by category

After Hours, Emergency, and Miscellaneous E/M Services
Claims Requiring Additional Documentation
Code and Clinical Editing Guidelines
Documentation and Reporting Guidelines for Evaluation and Management Services
Documentation Guidelines for Psychotherapy Services
Documentation Standards for Episodes of Care
Incident to Services and Billing
Nurse Practitioner and Physician Assistant Services
Provider Preventable Conditions
Scope of License
Virtual Visits

Modifiers 80, 81, 82, and AS: Assistant at Surgery
Bundled Services and Supplies
Modifiers 59 and XE, XP, XS, & XU: Distinct Procedural Service
Frequency Editing
Modifier 22
Modifier 62
Modifier 66
Modifier FB
Modifier Usage
Modifiers 25 and 57: Evaluation and Management with Global Procedures
Modifiers 26 and TC
Modifiers 50 and 51: Multiple and Bilateral Surgery
Office Place of Service
Once Per Lifetime Procedures
Place of Service
Prolonged Services
Split Care Surgical Modifiers

Reimbursement policies

Reimbursement of covered services

Updated June 2024

Reimbursement policies by category

Administration

Anesthesia

Coding

Durable Medical Equipment (DME)

Drugs

Evaluation and Management

Facilities

Laboratory

Medicine

Radiology

Surgery

Transportation

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