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Freedom Health policies, page 3

Search Freedom Health's public medical, payment and drug policies by CPT or HCPCS code, keyword or policy number, with links to the payer's own documents. Links open the payer's own document; check its current version before relying on it.

149 policies name 96365, those listing the fewest codes first. A policy that names a code may also list it as excluded.

Freedom Health policies
PolicyDetailsCodesSource
VIRGINIA FACILITY PROVIDER MANUALEffective Aug 23, 2019 · Commercial · VA58Original policy ↗
CG-ADMIN-01 Clinical Utilization Management (UM) Guideline for Pre-Payment Review Medical Necessity Determinations When No Other Clinical UM Guideline ExistsCG-ADMIN-01 · Commercial62Original policy ↗
Anthem Blue Cross Facility and Professional Provider Manual – 01/01/20Effective Jan 1, 2020 · Commercial · CA66Original policy ↗
Anthem Blue Cross and Blue Shield Nevada Provider and Facility ManualEffective Oct 1, 2021 · Commercial · NV69Original policy ↗
Anthem Blue Cross and Blue Shield Nevada Provider and Facility ManualEffective Jul 1, 2021 · Commercial · NV69Original policy ↗
Anthem Blue Cross and Blue Shield Colorado Provider and Facility ManualEffective Jul 1, 2021 · Commercial · CO70Original policy ↗
Anthem Blue Cross and Blue Shield Colorado Provider and Facility ManualEffective Oct 1, 2021 · Commercial · CO70Original policy ↗
Anthem Blue Cross and Blue Shield Nevada Provider and Facility ManualEffective Nov 1, 2022 · Commercial · NV70Original policy ↗
Anthem Blue Cross and Blue Shield Colorado Provider and Facility ManualEffective Dec 1, 2022 · Commercial · CO71Original policy ↗
Anthem Blue Cross and Blue Shield Colorado Provider and Facility ManualEffective Mar 1, 2024 · Commercial · CO71Original policy ↗
Anthem Blue Cross and Blue Shield Colorado Provider and Facility Manualv2.080124 · Effective Nov 1, 2024 · Commercial · CO71Original policy ↗
Anthem Blue Cross and Blue Shield Nevada Provider and Facility ManualEffective Dec 1, 2023 · Commercial · NV71Original policy ↗
Anthem Blue Cross and Blue Shield Nevada Provider and Facility ManualNVBCBS-CM-PM-068896-24 · Effective Jan 1, 2025 · Commercial · NV80Original policy ↗
Nevada Provider and Facility ManualNVBCBS-CM-PM-091235-25 · Effective Jan 1, 2026 · Commercial · NV80Original policy ↗
Nevada Provider and Facility ManualNVBCBS-CM-PM-091235-25 · Effective Oct 1, 2026 · Commercial · NV80Original policy ↗
Anthem Blue Cross and Blue Shield Provider and Facility ManualEffective Nov 1, 2020 · Commercial · CO81Original policy ↗
Colorado Provider and Facility ManualCOBCBS-CM-PM-091234-25 · Effective Jan 1, 2026 · Commercial · CO81Original policy ↗
Colorado Provider and Facility ManualCOBCBS-CM-PM-068897-24 · Effective Jan 1, 2025 · Commercial · CO81Original policy ↗
Anthem Blue Cross and Blue Shield Provider and Facility ManualEffective Nov 1, 2020 · Commercial · NV83Original policy ↗
Anthem Blue Cross and Blue Shield New Hampshire Provider ManualEffective Jan 26, 2023 · Commercial · NH88Original policy ↗
Anthem Blue Cross and Blue Shield Virginia Facility Provider ManualEffective Jun 1, 2022 · Commercial · VA90Original policy ↗
Anthem Blue Cross and Blue Shield Virginia Facility Provider ManualVABCBS-CM-PM-061543-24 · Effective Oct 1, 2024 · Commercial · VA90Original policy ↗
Anthem Blue Cross and Blue Shield Virginia Facility Provider ManualEffective Jul 1, 2023 · Commercial · VA90Original policy ↗
Anthem Blue Cross and Blue Shield Virginia Facility Provider ManualEffective Dec 1, 2023 · Commercial · VA90Original policy ↗
Anthem Blue Cross and Blue Shield Virginia Facility Provider ManualVABCBS-CM-PM-061543-24 v1.07012024 · Effective Jul 1, 2024 · Commercial · VA90Original policy ↗
Virginia Facility Provider ManualVABCBS-CM-PM-086206-25 · Effective Aug 1, 2025 · Commercial · VA90Original policy ↗
Virginia Facility Provider Manual Revised August 1, 2024VABCBS-CM-PM-061543-24 v2A.08152024 · Effective Aug 1, 2024 · Commercial · VA90Original policy ↗
2026 Virginia Facility Commercial Provider ManualVA-BCBS-CM-PM-013594-26-S3776 · Effective Jul 1, 2026 · Commercial · VA91Original policy ↗
Anthem Blue Cross and Blue Shield New Hampshire Provider ManualNHBCBS-CM-PM-056380-24 · Effective Jan 1, 2025 · Commercial · NH91Original policy ↗
Anthem Blue Cross and Blue Shield New Hampshire Provider ManualEffective Jul 1, 2023 · Commercial · NH91Original policy ↗
Anthem Blue Cross and Blue Shield New Hampshire Provider ManualNHBCBS-CM-056434-24 v1.050124 · Effective Jul 1, 2024 · Commercial · NH91Original policy ↗
New Hampshire Provider ManualNHBCBS-CM-PM-056380-24 v2.080124 · Effective Aug 1, 2024 · Commercial · NH91Original policy ↗
Anthem Blue Cross and Blue Shield Virginia Facility Provider ManualEffective Jul 1, 2021 · Commercial · VA93Original policy ↗
New Hampshire Provider ManualNHBCBS-CM-PM-082435-25 · Effective Jul 1, 2025 · Commercial · NH110Original policy ↗
New Hampshire Provider ManualNHBCBS-CM-PM-082435-25 · Effective Jan 1, 2026 · Commercial · NH110Original policy ↗
New Hampshire Provider ManualNHBCBS-CM-PM-082435-25 · Effective Sep 1, 2025 · Commercial · NH110Original policy ↗
2026 New Hampshire Commercial Provider ManualNH-BCBS-CM-PM-008213-26-S2536 · Effective Jul 1, 2026 · Commercial · NH111Original policy ↗
Modifiers 59 and XE, XP, XS, & XU: Distinct Procedural Service - ProfessionalC-09006 · Effective Mar 1, 2025 · Commercial · VA113Original policy ↗
Anthem Blue Cross Facility Provider ManualEffective Mar 1, 2017 · Commercial, Medicaid · CA121Original policy ↗
Modifiers 59 and XE, XP, XS, and XU: Distinct Procedural Service - ProfessionalC-09006 · Effective Jul 1, 2026 · Commercial · CA130Original policy ↗
Modifiers 59 and XE, XP, XS, and XU: Distinct Procedural Service - ProfessionalC-09006 · Effective Mar 15, 2026 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI187Original policy ↗
Bundled Services and Supplies - ProfessionalC-08003 · Effective Dec 1, 2025 · Commercial · VA341Original policy ↗
Bundled Services and Supplies - ProfessionalC-08003 · Effective Jul 1, 2026 · Commercial · CA341Original policy ↗
Bundled Services and Supplies - ProfessionalC-08003 · Effective Jan 1, 2027 · Commercial · CA360Original policy ↗
Bundled Services and Supplies - ProfessionalC-08003 · Effective Jun 24, 2026 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI390Original policy ↗
Standard Local Prior Authorization Code ListCommercial · GA3,068Original policy ↗
Colorado Prior Authorization ListCommercial · CO3,281Original policy ↗
Prior Authorization ListCommercial · NV3,304Original policy ↗
California PPO Prior Authorization ListCommercial · CA3,545Original policy ↗

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Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.

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