Optimum Healthcare policies, page 17

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
LAB.00044 Saliva-based Testing to Determine Drug-Metabolizer StatusLAB.00044 · Commercial1Original policy ↗
LAB.00045 Selected Tests for the Evaluation and Management of InfertilityLAB.00045 · Commercial5Original policy ↗
LAB.00046 Testing for Biochemical Markers for Alzheimer’s DiseaseLAB.00046 · Commercial19Original policy ↗
LAB.00048 Analysis of Urine Biomarkers for Chronic Pain ManagementLAB.00048 · Commercial1Original policy ↗
LAB.00049 Artificial Intelligence-Based Software for Prostate Cancer DetectionLAB.00049 · Commercial1Original policy ↗
LAB.00050 Metagenomic Sequencing for Infectious Disease in the Outpatient SettingLAB.00050 · Commercial8Original policy ↗
LAB.00051 Per- and Polyfluoroalkyl Substances (PFAS) TestingLAB.00051 · Commercial7Original policy ↗
Laboratory and Venipuncture Services - Professional and FacilityC-21010 · Effective Mar 1, 2025 · Commercial · VA24Original policy ↗
Laboratory and Venipuncture Services - Professional and FacilityC-21010 · Effective Apr 1, 2026 · Commercial · CA24Original policy ↗
Laboratory and Venipuncture Services – Professional and FacilityC-21010 · Effective Aug 6, 2024 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI32Original policy ↗
Learn How to Confirm Your Participation Status with Member PlansNVBCBS-CDCRCM-054471-24-SRS53654 · Commercial, Medicaid · NV—Original policy ↗
Learn how to request an appeal66998MUSENMUB · CA—Original policy ↗
Liver TransplantationTRANS.00008 · Commercial11Original policy ↗
Local Self-Funded Groups Standard Precertification List 2019Commercial · IN, KY, MO, OH, WI—Original policy ↗
Local WI Member ID Card ExamplesCommercial · WI—Original policy ↗
Locum TenensCRHPAP - 005 · Effective Feb 14, 2019 · Commercial · IN, KY, MO, OH, WI—Original policy ↗
Low-Frequency Ultrasound Therapy for Wound ManagementMED.00096 · Commercial1Original policy ↗
Lower Extremity Pressure Gradient Compression StockingsCG-DME-57 · Commercial23Original policy ↗
Mailing Addresses for Paper Claims and Claims Related CorrespondenceCommercial · IN—Original policy ↗
Maine Provider ManualMEBCBS-CM-PM-082442-25 · Effective Jan 1, 2026 · Commercial · ME24Original policy ↗
Maternal Cardiovascular Health FlierNYBCBS-CDCM-043164-23 · Commercial, Medicaid · NY—Original policy ↗
Maternity ServicesG-14001 · Effective Jan 1, 2027 · Medicaid · OH34Original policy ↗
Maternity ServicesG-14001 · Effective Oct 23, 2025 · Medicaid · IN—Original policy ↗
Maternity ServicesG-14001 · Effective Jan 1, 2027 · Medicaid · NV34Original policy ↗
Maternity Services -ProfessionalC-19004 · Effective Mar 1, 2023 · Commercial · VA3Original policy ↗
Maternity Services – ProfessionalC-19004 · Effective Jan 1, 2027 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI35Original policy ↗
Maternity Services – ProfessionalC-19004 · Effective Jan 1, 2026 · Commercial · CA3Original policy ↗
Maximum Units Per DayG-15003 · Effective Dec 2, 2025 · Medicaid · OH—Original policy ↗
Maximum Units Per DayG-15003 · Effective Dec 2, 2025 · Medicaid · IN—Original policy ↗
Maximum Units Per DayG-15003 · Effective Dec 2, 2025 · Medicaid · NV—Original policy ↗
MED.00004 Noninvasive Imaging Technologies for the Evaluation of Skin LesionsMED.00004 · Commercial12Original policy ↗
MED.00011 Sensory Stimulation for Brain-Injured Individuals in Coma or Vegetative StateMED.00011 · Commercial3Original policy ↗
MED.00053 Non-Invasive Measurement of Left Ventricular End Diastolic Pressure in the Outpatient SettingMED.00053 · Commercial1Original policy ↗
MED.00059 Idiopathic Environmental Illness (IEI)MED.00059 · Commercial1Original policy ↗
MED.00087 Optical Detection for Screening and Identification of Cervical CancerMED.00087 · Commercial1Original policy ↗
MED.00090 Wireless Capsule for the Evaluation of Suspected Gastric and Intestinal Motility DisordersMED.00090 · Commercial1Original policy ↗
MED.00092 Automated Nerve Conduction TestingMED.00092 · Commercial3Original policy ↗
MED.00098 Hyperoxemic Reperfusion TherapyMED.00098 · Commercial1Original policy ↗
MED.00101 Physiologic Recording of Tremor using Accelerometer(s) and Gyroscope(s)MED.00101 · Commercial2Original policy ↗
MED.00102 Ultrafiltration in Decompensated Heart FailureMED.00102 · Commercial1Original policy ↗
MED.00110 Silver-based Products for Wound and Soft Tissue ApplicationsMED.00110 · Commercial1Original policy ↗
MED.00111 Intracardiac Ischemia MonitoringMED.00111 · Commercial9Original policy ↗
MED.00116 Near-Infrared Spectroscopy Scanning for Brain Hematoma ScreeningMED.00116 · Commercial1Original policy ↗
MED.00118 Continuous Monitoring of Intraocular PressureMED.00118 · Commercial1Original policy ↗
MED.00120 Gene Therapy for Ocular ConditionsMED.00120 · Commercial5Original policy ↗
MED.00129 Gene Therapy for Spinal Muscular AtrophyMED.00129 · Commercial2Original policy ↗
MED.00130 Surface Electromyography and Electrodermal Activity Sensor Devices for Seizure MonitoringMED.00130 · Commercial3Original policy ↗
MED.00131 Electronic Home Visual Field Monitoring MED.00131 · Commercial2Original policy ↗
MED.00132 Autologous Adipose-derived Regenerative Cell TherapyMED.00132 · Commercial8Original policy ↗
MED.00133 Ingestion Event MonitorsMED.00133 · Commercial2Original 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.