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Optimum Healthcare policies, page 20

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
Modifiers 26 and TC: Professional and Technical Component - ProfessionalC-20004 · Effective Dec 2, 2025 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI—Original policy ↗
Modifiers 50 and 51: Multiple and Bilateral Surgery - ProfessionalC-08004 · Effective Oct 30, 2023 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI63Original policy ↗
Modifiers 50 and 51: Multiple and Bilateral Surgery - ProfessionalC-08004 · Effective Mar 1, 2025 · Commercial · VA55Original policy ↗
Modifiers 52, 53, 73, and 74: Reduced and Discontinued ServicesG-10033 · Effective Oct 23, 2025 · Medicaid · OH—Original policy ↗
Modifiers 52, 53, 73, and 74: Reduced and Discontinued ServicesG-10033 · Effective Oct 23, 2025 · Medicaid · IN—Original policy ↗
Modifiers 52, 53, 73, and 74: Reduced and Discontinued ServicesG-10033 · Effective Dec 14, 2023 · Medicaid · NV—Original policy ↗
Modifiers 59 and XE, XP, XS, & XU: Distinct Procedural Service - ProfessionalC-09006 · Effective Mar 1, 2025 · Commercial · VA113Original 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 ↗
Modifiers 59 and XE, XP, XS, and XU: Distinct Procedural Service - ProfessionalC-09006 · Effective Jul 1, 2026 · Commercial · CA130Original policy ↗
Modifiers 59, XE, XP, XS, XU: Distinct Procedural ServicesG-15001 · Effective Apr 12, 2022 · Medicaid · OH—Original policy ↗
Modifiers 59, XE, XP, XS, XU: Distinct Procedural ServicesG-15001 · Effective Apr 12, 2022 · Medicaid · NV—Original policy ↗
Modifiers 80, 81, 82 and AS: Assistant at Surgery - ProfessionalC-08006 · Effective Sep 27, 2023 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI44Original policy ↗
Modifiers 80, 81, 82 and AS: Assistant at Surgery - ProfessionalC-08006 · Effective Apr 1, 2026 · Commercial · CA44Original policy ↗
Modifiers 80, 81, 82 and AS: Assistant at Surgery – ProfessionalC-08006 · Effective Mar 1, 2025 · Commercial · VA42Original policy ↗
Modifiers 80, 81, 82, and AS: Assistant at SurgeryG-06005 · Effective Dec 18, 2025 · Medicaid · OH—Original policy ↗
Modifiers 80, 81, 82, and AS: Assistant at SurgeryG-06005 · Effective Dec 19, 2023 · Medicaid · NV—Original policy ↗
Modifiers 90 and 91: Laboratory ServicesG-20001 · Effective Dec 1, 2026 · Medicaid · OH—Original policy ↗
Modifiers 90 and 91: Laboratory ServicesG-20001 · Effective Dec 1, 2026 · Medicaid · NV—Original policy ↗
Modifiers 90, 91, and 92: Laboratory Services – Professional and FacilityC-26002 · Effective Nov 1, 2026 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI6Original policy ↗
Modifiers 90, 91, and 92: Laboratory Services – Professional and FacilityC-26002 · Effective Jan 1, 2027 · Commercial · CA6Original policy ↗
Modifiers LT and RT: Left-Side and Right-Side ProceduresG-07022 · Effective Jul 21, 2025 · Medicaid · OH—Original policy ↗
Modifiers LT and RT: Left-Side and Right-Side ProceduresG-07022 · Effective Jul 21, 2025 · Medicaid · IN—Original policy ↗
Modifiers LT and RT: Left-Side and Right-Side ProceduresG-07022 · Effective Jul 21, 2025 · Medicaid · NV—Original policy ↗
Modifiers PN and PO: Off-Campus Provider-Based Hospital OutpatientG-26002 · Effective Jan 1, 2027 · Medicaid · NV5Original policy ↗
Module 1 PDSA ExampleCommercial · CT, GA, NH, VA—Original policy ↗
Module 2 PDSA ExampleCommercial · CT, GA, NH, VA—Original policy ↗
Module 3 PDSA ExampleCommercial · CT, GA, NH, VA—Original policy ↗
Molecular Signature Test for Predicting Response to Tumor Necrosis Factor Inhibitor TherapyLAB.00042 · Commercial1Original policy ↗
MRI Guided High Intensity Focused Ultrasound Ablation for Non-Oncologic IndicationsMED.00057 · Commercial6Original policy ↗
Multiple and Bilateral Surgery — Professional and Facility ReimbursementAIN-RP-0214-21 · Effective Nov 25, 2020 · Medicaid · IN—Original policy ↗
Multiple Delivery ServicesG-06044 · Effective Jul 17, 2024 · Medicaid · OH—Original policy ↗
Multiple Delivery ServicesG-06044 · Effective Apr 29, 2022 · Medicaid · NV—Original policy ↗
Multiple Delivery Services - ProfessionalC-19005 · Effective Mar 1, 2023 · Commercial · VA—Original policy ↗
Multiple Delivery Services – ProfessionalC-19005 · Effective Apr 29, 2022 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI—Original policy ↗
Multiple Diagnostic Imaging Procedures – ProfessionalC-11004 · Effective Dec 1, 2023 · Commercial · VA—Original policy ↗
Multiple Diagnostic Imaging Procedures – Professional and FacilityC-25003 · Effective Oct 26, 2025 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI—Original policy ↗
Multiple Diagnostic Imaging Procedures – Professional and FacilityC-25003 · Effective Jul 1, 2026 · Commercial · CA—Original policy ↗
Multiple Procedure Payment Reduction – ProfessionalC-23003 · Effective Dec 1, 2023 · Commercial · VA—Original policy ↗
Multiple Procedure Payment Reduction – ProfessionalC-23003 · Effective Apr 12, 2023 · Commercial · ME—Original policy ↗
Multiple Procedure Payment Reduction – ProfessionalC-23003 · Effective Apr 12, 2023 · Commercial · CO, CT, GA, IN, KY, MO, NH, NV, OH, WI—Original policy ↗
Multiple Procedure Payment Reduction – ProfessionalC-23003 · Effective Oct 1, 2026 · Commercial · CA—Original policy ↗
Multiple Radiology Payment ReductionG-12002 · Effective Dec 10, 2024 · Medicaid · OH—Original policy ↗
Multiple Radiology Payment ReductionG-12002 · Effective Aug 15, 2022 · Medicaid · NV—Original policy ↗
Multiple Surgery - FacilityC-21004 · Effective Jan 1, 2026 · Commercial · CA—Original policy ↗
Multiple Surgery - FacilityC-21004 · Effective Jan 1, 2026 · Commercial · CA—Original policy ↗
Multiple Surgery - FacilityC-21004 · Effective Jan 1, 2027 · Commercial · CA—Original policy ↗
Multiple Surgery – FacilityC-21004 · Effective Jan 1, 2022 · Commercial · WI—Original policy ↗
Multiple Surgery – FacilityC-21004 · Effective Jan 1, 2022 · Commercial · CO, CT, GA, IN, KY, MO, NV, OH—Original policy ↗
Multiplex Autoantigen Microarray Testing for Systemic Lupus ErythematosusLAB.00036 · Commercial2Original policy ↗
National Provider Identifier (NPI) FAQsCommercial · NV—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.

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