This policy becomes effective 12/01/2017.
This policy has been expanded to include Physician Assistants (PAs) to be eligible to perform services in a specialty group.
In products where members are able to self-refer to providers for care and services, members are advised to use participating providers in order to receive the highest level of benefits.When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.
For more information on how Claim Payment Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.
Attachment A: Codes eligible for reimbursement when billed by Hand Surgeons, Orthopedic Surgeons, or Sports Medicine Specialists
Attachment B: Codes eligible for reimbursement when billed by Podiatrists
Policy: 00.03.02y:Diagnostic Radiology Services Included in Capitation
Policy: 00.10.15c:Cast and Splint Applications and Associated Supplies Provided in the Office Setting
Policy: 00.10.40b:Reimbursement for Services Performed by Certified Registered Nurse Practitioners (CRNPs) or Physician Assistants (PAs)