Optimum Healthcare policies, page 13

Search Optimum Healthcare'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.

1,402 public policies Substrate tracks for Optimum Healthcare, by title.

Optimum Healthcare policies
PolicyDetailsCodesSource
DRG Newborn Inpatient Stays – FacilityC-18002 · Effective Dec 18, 2025 · Commercial · GA, IN, KY, WI—Original policy ↗
Drug Screen TestingG-19001 · Effective Nov 14, 2025 · Medicaid · OH—Original policy ↗
Drug Screen TestingG-19001 · Effective Dec 1, 2026 · Medicaid · IN—Original policy ↗
Drug Screen TestingG-19001 · Effective Nov 14, 2025 · Medicaid · NV—Original policy ↗
Drug Screen Testing - ProfessionalC-12004 · Effective Oct 1, 2026 · Commercial · CA17Original policy ↗
Drug Screen Testing – ProfessionalC-12004 · Effective Oct 23, 2025 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI17Original policy ↗
Drug Screen Testing – ProfessionalC-12004 · Effective Mar 1, 2025 · Commercial · VA17Original policy ↗
Drugs and Devices Requiring Procedures – FacilityC-26001 · Effective Jul 1, 2026 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI—Original policy ↗
Drugs and Devices Requiring Procedures – FacilityC-26001 · Effective Oct 1, 2026 · Commercial · CA—Original policy ↗
Duplicate or Subsequent Services on the Same Date of ServiceG-06032 · Effective May 22, 2024 · Medicaid · OH—Original policy ↗
Duplicate or Subsequent Services on the Same Date of ServiceG-06032 · Effective May 22, 2024 · Medicaid · IN—Original policy ↗
Duplicate or Subsequent Services on the Same Date of ServiceG-06032 · Effective May 22, 2024 · Medicaid · NV—Original policy ↗
Durable Medical Equipment (Rent to Purchase)G-06052 · NY—Original policy ↗
Durable Medical Equipment (Rent to Purchase)G-06052 · ME—Original policy ↗
Durable Medical Equipment (Rent to Purchase)G-06052 · Effective Oct 6, 2025 · Medicaid · OH—Original policy ↗
Durable Medical Equipment (Rent to Purchase)G-06052 · Effective Oct 6, 2025 · Medicaid · IN—Original policy ↗
Durable Medical Equipment (Rent to Purchase)G-06052 · Effective Oct 6, 2025 · Medicaid · NV—Original policy ↗
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)G-06049 · Effective Jul 21, 2025 · Medicaid · OH—Original policy ↗
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)G-06049 · Effective Jul 21, 2025 · Medicaid · IN—Original policy ↗
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)G-06049 · Effective Jul 21, 2025 · Medicaid · NV—Original policy ↗
Edinburgh Postnatal Depression Scale (EPDS)Commercial · CA, CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, VA, WI—Original policy ↗
Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous DevicesDME.00011 · Commercial15Original policy ↗
Electronic ID Cards Dental Quick Reference GuideCommercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, VA, WI—Original policy ↗
Electronic Member ID Cards Quick Reference GuideCommercial · CA—Original policy ↗
Electronic Member ID Cards Quick Reference GuideCommercial · CO—Original policy ↗
Electronic Member ID Cards Quick Reference GuideCommercial · CT—Original policy ↗
Electronic Member ID Cards Quick Reference GuideCommercial · ME—Original policy ↗
Electronic Member ID Cards Quick Reference GuideCommercial · NV—Original policy ↗
Electronic Member ID Cards Quick Reference GuideCommercial · NH—Original policy ↗
Electronic Member ID Cards Quick Reference GuideCommercial · VA—Original policy ↗
Electronic Member ID Cards: Dental Quick Reference GuideCommercial · CA—Original policy ↗
Eligible Billed ChargesG-06001 · Effective Nov 4, 2024 · Medicaid · OH—Original policy ↗
Eligible Billed ChargesG-06001 · Effective Nov 4, 2024 · Medicaid · NV—Original policy ↗
Emergency Department Leveling of Evaluation and Management ServicesG-19002 · Effective Jan 16, 2024 · Medicaid · NV—Original policy ↗
Emergency Department Protocol for SIU ReviewCommercial · CA, CO, CT, GA, IN, KY, ME, MO, NH, NV, NY, OH, VA, WI10Original policy ↗
Emergency Department: Leveling of Evaluation and Management ServicesG-19002 · Effective Nov 1, 2026 · Medicaid · OH—Original policy ↗
Emergency Department: Leveling of Evaluation and Management Services – FacilityC-13001 · Effective Jan 1, 2021 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI—Original policy ↗
Emergency Department: Leveling of Evaluation and Management Services- FacilityC-13001 · Effective Jul 1, 2024 · Commercial · CA—Original policy ↗
Emergency Room Transfers – FacilityC-20006 · Effective Jul 17, 2024 · Commercial · CO, CT, GA, IN, KY, MO, NV, OH, WI5Original policy ↗
Emergency Room Transfers – FacilityC-20006 · Effective Jan 1, 2026 · Commercial · CA5Original policy ↗
Emergency Services: Nonparticipating Providers and FacilitiesG-06092 · Effective Apr 29, 2022 · Medicaid · NV—Original policy ↗
Encounter Utilization Quality TrackingCommercial · CA—Original policy ↗
Enhancements made to avoidable ER programCommercial · IN, MO, OH—Original policy ↗
Enrollment and revalidation requirements Medicaid participationMedicaid · NV—Original policy ↗
Escalation Contact ListCommercial · NV—Original policy ↗
Escalation ProcessCommercial · NH—Original policy ↗
Example of Cardiology Referral Preparedness ToolCommercial · CT, GA, NH, VA—Original policy ↗
Example of Endocrinology Referral Preparedness ToolCommercial · CT, GA, NH, VA—Original policy ↗
Example of OB/GYN Referral Preparedness ToolCommercial · CT, GA, NH, VA—Original policy ↗
Facility and Professional Provider Manual (For Commercial Products)Commercial · GA10Original 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.