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Policies and Guidelines

Reimbursement Policies

Medica reimbursement policies provide payment methodology guidelines for medical and surgical services submitted on professional claims (CMS-1500 or its electronic equivalent) and, when specified, for those submitted on facility claims (UB-04 or its electronic equivalent). 

These reimbursement policies are provided in conjunction with other Medica policies, including, but not limited to any applicable participating provider contract, provider administrative manual and credentialing plan. Inclusion of a code in a policy does not guarantee payment of the service. 

Additionally, these policies may not process identically on the different processing systems utilized by Medica. However, Medica makes every effort to minimize these variations.


Date: 12/14/2018 10:45:21 PM Version: 4.0.30319.42000 Machine Name: PWIVE-CMSWEB02