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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.

Providers billing with a time-based code must document the amount of time spent for the code being billed. For time-based codes, if no amount of time is documented, the claim is not eligible for payment.

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

Policies

Date: 12/9/2019 10:29:02 PM Version: 4.0.30319.42000 Machine Name: PWIVE-CDWEB01