Optimum Healthcare policies, page 14

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
Facility Emergency DepartmentC-13001 · Effective Jun 1, 2013 · Commercial · NH10Original policy ↗
Facility Global Surgery - FacilityC-17003 · Effective Jul 1, 2024 · Commercial · CA—Original policy ↗
Facility Guidelines for Claims Related to Professional Services - FacilityC-15004 · Effective Dec 1, 2026 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI19Original policy ↗
Facility Guidelines for Claims Related to Professional Services - FacilityC-15004 · Effective Jan 1, 2027 · Commercial · CA17Original policy ↗
Facility Guidelines for Claims Related to Professional Services – FacilityC-15004 · Effective Apr 1, 2026 · Commercial · CA10Original policy ↗
Facility Take-Home DME and Medical SuppliesG-06081 · Effective May 24, 2024 · Medicaid · OH—Original policy ↗
Facility Take-Home DME and Medical SuppliesG-06081 · Effective May 22, 2024 · Medicaid · NV—Original policy ↗
Facility Take-Home DrugsANV-RP-0078-18 · Effective Aug 31, 2006 · Medicaid · NV—Original policy ↗
Facility UB Billers Remittance Advice Overview - FEP Institutional Commercial · NH—Original policy ↗
Facility UB Billers Remittance Advice Overview - Local Institutional2636 · Commercial · NH—Original policy ↗
Formal AuditCommercial · NH—Original policy ↗
Frequency Editing - ProfessionalC-08012 · Effective Mar 1, 2025 · Commercial · VA214Original policy ↗
Frequency Editing - ProfessionalC-08012 · Effective Jun 11, 2025 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI215Original policy ↗
Frequency Editing - ProfessionalC-08012 · Effective Apr 1, 2026 · Commercial · CA194Original policy ↗
Gene Therapy for Duchenne Muscular DystrophyMED.00144 · Commercial1Original policy ↗
Genetic Testing FAQsCommercial · GA—Original policy ↗
Genetic Testing: Once per LifetimeG-23002 · Effective Jul 1, 2026 · Medicaid · OH—Original policy ↗
Genetic Testing: Once per LifetimeG-23002 · Effective Nov 1, 2026 · Medicaid · IN—Original policy ↗
Genetic Testing: Once per LifetimeG-23002 · Effective Jul 1, 2026 · Medicaid · NV—Original policy ↗
Georgia Facility and Professional Provider ManualGABCBS-CM-PM-063065-24 · Effective Jan 1, 2025 · Commercial · GA30Original policy ↗
Georgia Facility and Professional Provider ManualEffective Oct 1, 2022 · Commercial · GA27Original policy ↗
Georgia Facility and Professional Provider ManualGABCBS-CM-PM-091749-25 · Effective Jan 1, 2026 · Commercial · GA30Original policy ↗
Georgia Facility and Professional Provider ManualEffective Oct 1, 2023 · Commercial · GA30Original policy ↗
Georgia Facility and Professional Provider ManualEffective Nov 1, 2023 · Commercial · GA30Original policy ↗
Georgia Facility and Professional Provider ManualEffective Jan 1, 2024 · Commercial · GA30Original policy ↗
Georgia Facility and Professional Provider ManualEffective Aug 1, 2021 · Commercial · GA30Original policy ↗
Georgia Facility and Professional Provider Manual (For Commercial Products)Commercial · GA45Original policy ↗
Georgia Facility and Professional Provider Manual (For Commercial Products)Commercial · GA11Original policy ↗
Georgia Facility and Professional Provider Manual (For Commercial Products)Effective Jan 1, 2021 · Commercial · GA45Original policy ↗
Georgia Facility and Professional Provider Manual (For Commercial Products)Commercial · GA46Original policy ↗
Global Surgery -FacilityC-17003 · Effective Apr 22, 2020 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI—Original policy ↗
Global Surgical PackageG-06041 · Effective Jan 30, 2023 · Medicaid · OH—Original policy ↗
Global Surgical PackageG-06041 · Effective Jun 3, 2025 · Medicaid · IN—Original policy ↗
Global Surgical PackageG-06041 · Effective Jan 30, 2023 · Medicaid · NV—Original policy ↗
Global Surgical Package - ProfessionalC-08007 · Effective Dec 1, 2023 · Commercial · VA158Original policy ↗
Global Surgical Package - ProfessionalC-08007 · Effective Jun 14, 2023 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI159Original policy ↗
Global Surgical Package- ProfessionalC-08007 · Effective Jul 1, 2024 · Commercial · CA159Original policy ↗
Glossary of BlueCard TermsCommercial · GA—Original policy ↗
Guide to Provider Complaints and AppealsCommercial · KY, MO, WI—Original policy ↗
Guidelines for Reporting Timed Units for Physical Medicine and Rehabilitation Services (Rule of 8) - ProfessionalC-07002 · Effective Mar 1, 2023 · Commercial · VA1Original policy ↗
Guidelines for Reporting Timed Units for Physical Medicine and Rehabilitation Services - ProfessionalC-07002 · Effective Aug 13, 2025 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI1Original policy ↗
Guidelines for Reporting Timed Units for Physical Medicine and Rehabilitation Services - ProfessionalC-07002 · Effective Jul 1, 2026 · Commercial · CA1Original policy ↗
Half-Tablet ProgramCommercial · CT, GA, NH, VA—Original policy ↗
Hand TransplantationTRANS.00040 · Commercial1Original policy ↗
HCPCS and CPT Coding Requirements for Outpatient ClaimsCommercial · CT—Original policy ↗
HCPCS and CPT Coding Requirements for Outpatient ClaimsCommercial · NH—Original policy ↗
Health and Behavior Assessment and Intervention – ProfessionalC-11003 · Effective May 8, 2024 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI11Original policy ↗
Health and Behavior Assessment and Intervention – ProfessionalC-11003 · Effective Mar 1, 2025 · Commercial · VA11Original policy ↗
Health and Behavior Assessment and Intervention – ProfessionalC-11003 · Effective Apr 1, 2026 · Commercial · CA11Original policy ↗
Health Insurance Exchange Quick Reference Guide Commercial · IN—Original 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.