Optimum Healthcare policies, page 19
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.
| Policy | Details | Codes | Source |
|---|---|---|---|
| Modifier 22 – Professional | C-12003 · Effective May 6, 2025 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI | — | Original policy ↗ |
| Modifier 22 – Professional | C-12003 · Effective Jan 1, 2026 · Commercial · CA | — | Original policy ↗ |
| Modifier 24 | G-06011 · Effective Jun 11, 2025 · Medicaid · OH | — | Original policy ↗ |
| Modifier 24 | G-06011 · Effective Dec 27, 2022 · Medicaid · IN | — | Original policy ↗ |
| Modifier 24 | G-06011 · Effective Jun 11, 2025 · Medicaid · NV | — | Original policy ↗ |
| Modifier 25 and 57: Evaluation and Management with Global Procedures | C-09011 · Effective Jan 1, 2026 · Commercial · CA | 8 | Original policy ↗ |
| Modifier 26 and TC: Professional and Technical Component | C-20004 · Effective Jan 1, 2026 · Commercial · CA | — | Original policy ↗ |
| Modifier 26 and TC: Professional and Technical Component - Professional | C-20004 · Effective Oct 1, 2021 · Commercial · VA | — | Original policy ↗ |
| Modifier 50 and 51: Multiple and Bilateral Surgery | G-06010 · Effective Dec 18, 2025 · Medicaid · OH | — | Original policy ↗ |
| Modifier 50 and 51: Multiple and Bilateral Surgery | G-06010 · Effective Dec 18, 2025 · Medicaid · NV | — | Original policy ↗ |
| Modifier 50 and 51: Multiple and Bilateral Surgery – Professional | C-08004 · Effective Jul 1, 2026 · Commercial · CA | 61 | Original policy ↗ |
| Modifier 62 | G-06027 · ME | — | Original policy ↗ |
| Modifier 62 | G-06027 · Effective Mar 26, 2026 · Medicaid · OH | — | Original policy ↗ |
| Modifier 62 | G-06027 · Effective Mar 26, 2026 · Medicaid · NV | — | Original policy ↗ |
| Modifier 62 - Professional | C-21005 · Effective Apr 1, 2026 · Commercial · CA | — | Original policy ↗ |
| Modifier 62 – Professional | C-21005 · Effective Nov 17, 2023 · Commercial · CO, CT, GA, IN, KY, MO, NH, NV, OH, WI | — | Original policy ↗ |
| Modifier 62 – Professional | C-21005 · Effective Mar 1, 2025 · Commercial · VA | — | Original policy ↗ |
| Modifier 62: Co-Surgeons | G-06027 · Effective Aug 7, 2020 · Medicaid · IN | — | Original policy ↗ |
| Modifier 63 | G-06015 · Effective Aug 28, 2020 · Medicaid · NV | — | Original policy ↗ |
| Modifier 63: Procedure Performed on Infants less than 4 kg | G-06015 · Effective Feb 1, 2023 · Medicaid · OH | — | Original policy ↗ |
| Modifier 66 | G-06039 · Effective Aug 7, 2020 · Medicaid · NV | — | Original policy ↗ |
| Modifier 66 - Professional | C-21006 · Effective Mar 1, 2025 · Commercial · VA | — | Original policy ↗ |
| Modifier 66 - Professional | C-21006 · Effective Jan 1, 2027 · Commercial · CA | — | Original policy ↗ |
| Modifier 66 – Professional | C-21006 · Effective Nov 17, 2023 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI | — | Original policy ↗ |
| Modifier 66: Surgical Teams – Professional | C-21006 · Effective Jul 1, 2024 · Commercial · CA | — | Original policy ↗ |
| Modifier 76 | G-06018 · Effective Jan 26, 2026 · Medicaid · IN | — | Original policy ↗ |
| Modifier 76 | G-06018 · Effective Jan 26, 2026 · Medicaid · NV | — | Original policy ↗ |
| Modifier 77 | G-06019 · Effective Jan 26, 2026 · Medicaid · IN | — | Original policy ↗ |
| Modifier 77 | G-06019 · Effective Jan 26, 2026 · Medicaid · NV | — | Original policy ↗ |
| Modifier 78 | G-13001 · Effective Sep 11, 2025 · Medicaid · OH | — | Original policy ↗ |
| Modifier 78 | G-13001 · Effective Sep 11, 2025 · Medicaid · IN | — | Original policy ↗ |
| Modifier 78 | G-13001 · Effective Sep 11, 2025 · Medicaid · NV | — | Original policy ↗ |
| Modifier 90 | G-20001 · Effective Jul 21, 2025 · Medicaid · IN | — | Original policy ↗ |
| Modifier FB - Professional and Facility | C-22003 · Effective Mar 1, 2023 · Commercial · VA | — | Original policy ↗ |
| Modifier FB – Professional and Facility | C-22003 · Effective Oct 1, 2022 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI | — | Original policy ↗ |
| Modifier FB – Professional and Facility | C-22003 · Effective Jul 1, 2024 · Commercial · CA | — | Original policy ↗ |
| Modifier Rules - Professional | C-08010 · Effective Jul 1, 2024 · Commercial · CA | 11 | Original policy ↗ |
| Modifier Usage | G-06006 · Effective Jan 16, 2024 · Medicaid · OH | — | Original policy ↗ |
| Modifier Usage | G-06006 · Effective Jan 16, 2024 · Medicaid · NV | — | Original policy ↗ |
| Modifier Usage - Facility | C-23005 · Effective Apr 1, 2026 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI | — | Original policy ↗ |
| Modifier Usage - Facility | C-23005 · Effective Jul 1, 2026 · Commercial · CA | — | Original policy ↗ |
| Modifier Usage - Professional | C-08010 · Effective Jan 1, 2027 · Commercial · CA | 11 | Original policy ↗ |
| Modifier Usage – Professional | C-08010 · Effective Mar 1, 2025 · Commercial · VA | 12 | Original policy ↗ |
| Modifier Usage – Professional | C-08010 · Effective Jun 3, 2025 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI | 12 | Original policy ↗ |
| Modifiers 25 and 57: Evaluation and Management Services with Global Procedures - Professional | C- 09011 · Effective Mar 1, 2025 · Commercial · VA | 8 | Original policy ↗ |
| Modifiers 25 and 57: Evaluation and Management with Global Procedures | C-09011 · Effective Nov 23, 2022 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI | 8 | Original policy ↗ |
| Modifiers 25 and 57: Evaluation and Management with Global Procedures | G-06003 · Effective May 22, 2024 · Medicaid · OH | 1 | Original policy ↗ |
| Modifiers 25 and 57: Evaluation and Management with Global Procedures | G-06003 · Effective May 22, 2024 · Medicaid · NV | 1 | Original policy ↗ |
| Modifiers 26 and TC | G-15004 · Effective Oct 30, 2023 · Medicaid · OH | — | Original policy ↗ |
| Modifiers 26 and TC | G-15004 · Effective May 20, 2024 · Medicaid · NV | — | Original policy ↗ |