Policy Bulletins
The Policy Bulletins listed below represent our catalogue of medical and claim payment policies. If you are looking for a specific type of policy, choose a category from the menu on the right. You may also use the search function in the top menu to search for policies by word or phrase.
 
   

Policy #
Policy Bulletin Title
MA03.009d
Modifier 24: Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period
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MA03.003g
Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service
MA03.003g
Attachment A (E&M codes appended with modifier 25 should be reimbursed at 50 percent of the applicable fee schedule amount when submitted on the same date of service, by the same professional provider or other qualified health care provider, as a minor procedure. ) to MA03.003g Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service
MA03.003g
Attachment B (Problem-focused E&M codes appended with modifier 25 should be reimbursed at 50 percent of the applicable fee schedule amount when submitted on the same date of service, by the same professional provider or other qualified health care provider, as a preventive E&M.) to MA03.003g Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service
MA03.002c
Modifier 50: Bilateral Procedure
MA03.014a
Modifier 52 Reduced Services
MA03.018a
Modifier 53 Discontinued Procedure
MA03.010d
Modifier 57 Decision for Surgery
ma03.001a
Modifier 76: Repeat Procedure or Service by Same Physican or Qualified Health Professional
MA03.007a
Modifier 77: Repeat Procedure or Service by Another Physician or Other Qualified Health Care Professional
MA03.008b
Modifier 78 Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following the Initial Procedure for a Related Procedure During the Postoperative Period
MA03.012c
Modifier 79 Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
MA03.011d
Modifiers 26 (Professional Component) and TC (Technical Component)
MA03.017b
Modifiers for Shared or Split Surgical Services (Modifiers 54, 55, 56)
MA03.005b
Modifiers XE, XS, XP, XU, and 59









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