Balloon Sinuplasty
The guidelines formerly displayed under this policy are now included under revised reimbursement policy Distinct Procedural Service Modifiers (59, XE, XP XS XU).
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- Out-of-Network Referral Policy
- Outlier Audit Programs: Post Payment and Pre-Payment
- Physician and Healthcare Professional Counseling and Termination Policy - Professional Competency
- Participation Status in Products that Utilize Tiering and/or Subset of an Existing Horizon Network
- Practice Locations Limit
- Practitioner Office Site Quality and Medical Record Keeping Standards
- Provider Directory Management
- Retainer Based Medicine
- Standards for All Types of Medical and Dental Diagnostic Radiology and Imaging Facilities
- Tier Awareness Policy
- Use of Horizon Hospital Network Performance Data
- Use of Practitioner Performance Data
- BlueCard Medical Policies
- Reimbursement Policies & Guidelines Reimbursement Policies & Guidelines
- Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005)
- After-hours and Weekend Care
- Ambulance Services
- Ambulatory Electrocardiographic Monitoring
- Anesthesia Reimbursement Guidelines
- ASC Multiple Procedure Methodology
- Assistant at Surgery
- Balloon Sinuplasty
- Bariatric Surgery Billed With Hiatal Hernia Repair
- Bilateral Procedures
- Billing Guidelines for Maternity Services
- Cardiac Event Detection
- Cardiovascular Implant Device Monitoring Services
- Casting, Strapping and Splints
- Chemotherapy Administration
- Chronic Care Management Services
- Claim Editing Policies
- Claims Requiring Additional Documentation
- ClaimsXten Editing Rules
- Clinical Trials Support Program
- Co-Surgeon Reimbursement
- Colonoscopy with Modifier 59
- Conscious Sedation
- Consultation Services Payment
- Consumable Medical Supplies
- Continuous Positive Airway Pressure or Bi-level Positive airway Pressure (CPAP/BiPAP) Supplies
- COVID 19 Antibody Testing
- Daily Management of Epidural or Subarachnoid Continuous Drug Administration
- Daily Maximum Units for Surgical Pathology and Microscopic Examination
- Determination of Refractive State
- Diabetic Screening Services
- Diabetic Supplies
- Distinct Procedural Service Modifiers (59, XE, XP, XS, XU)
- DME Rent to Purchase
- Drug and Immunization Pricing
- Duplex Scanning
- Drug Wastage – Modifier JW
- Duplicate Claim Logic for Independent Laboratory Services
- Enhancement to CMS Always Bundled Edit
- Evaluation and Management Services with Chiropractic Manipulative Treatment
- Evaluation and Management Services with Osteopathic Manipulative Treatment
- Evaluation and Management Services billed with Global Radiology, Stress Test, Stress Echo, Myocardial Profusion Imaging
- Frequency of Care Coordination Services and ESRD Procedures
- Frequency of G0179
- Hip Arthroscopy
- Hospital Non-Patient Laboratory Services Hospital Non-Patient Laboratory Services
- Hot or Cold Pack Therapy
- Inpatient Consultations
- Knee Arthroscopy
- Lab Panel Rebundling
- Laboratory Services Billed by Physicians
- Laser Treatment of Psoriasis or Parapsoriasis
- Maternity Reimbursement
- Maximum Units for Anesthesia
- Medical Nutrition Therapy (MNT)
- Microsurgery and Robotic Surgery
- Modifier 25
- Modifier 50 Bilateral Guidelines
- Modifier 52
- Modifier 53
- Modifier 54
- Modifier 55
- Modifier 56
- Modifier 57
- Modifier 76
- Modifier 77
- Modifier 78
- Modifier SU
- Multiple Procedure Reductions
- Mutually and Non-Mutually Exclusive NCCI Supplemental Edits
- Non-ESRD ESA Level Reporting
- Noncovered Related Services
- Outpatient Consultations
- Outpatient Laboratory Claims: Referring Practitioner Required
- Outpatient Therapy Daily Maximum
- Physician Extenders Non-Surgical Services
- Pre-Admission Testing
- Pre-Payment Documentation Requests: Facility Claims
- Post Payment Documentation Requests: Facility Claims
- Pulmonary Diagnostic Procedures when billed with E&M Codes
- Radiology, Preliminary and Double Reads
- Radiopharmaceuticals
- Reimbursement and Billing Guidelines for Anesthesia Claims
- Removal of Impacted Cerumen Requiring Instrumentation
- Screening and Diagnostic Mammography & 3D Tomosynthesis
- Site of Service Differential
- Smoking Cessation
- Status N Codes
- Telemedicine Services Telemedicine Services
- Telemedicine Services Reimbursement Policy: Temporary Addendum for Horizon BCBSNJ Commercial/ASO plans and products
- Telemedicine Services Reimbursement Policy: Temporary Addendum for Horizon Medicare Advantage
- Ulcer Debridement and Ulcer Stages
- Urinalysis with Evaluation and Management (E&M) Services
- Urine Drug Screening/Testing
- Vitamin D Testing
- Utilization ManagementUtilization Management
- Clinical Practice Guidelines
- PT/OT Outpatient Prior Authorization for Horizon Medicare Advantage Plans
- Services Requiring Prior Authorization Services Requiring Prior Authorization
- Prior Authorization Procedure Search Tool
- BlueCard Members
- Medicare Advantage
- OMNIA Health Plans
- SHBP/SEHBP
- UNITE HERE HEALTH UNITE HERE HEALTH
- Utilization Management Request Tool
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Applicable Products:
Commercial PPO/EPO &
Exchange POS/EPO
Applicable Products:
Commercial HMO & POS
