Optimum Healthcare policies, page 23

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
Preadmission Services for Inpatient StaysG-01017 · Effective Sep 11, 2025 · Medicaid · NV—Original policy ↗
Preferred Glucometer ProgramCommercial · CT, GA, NH, VA—Original policy ↗
Prefix Reference ListCommercial · CO3Original policy ↗
Pregnancy: Your Birth Options After CesareanCommercial · CA, CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, VA, WI—Original policy ↗
Preoperative Testing for Low Risk Invasive Procedures and SurgeriesCG-MED-61 · Commercial16Original policy ↗
PresentationCommercial · CT, GA, NH, VA—Original policy ↗
PresentationCommercial · CT, GA, NH, VA—Original policy ↗
PresentationCommercial · CT, GA, NH, VA—Original policy ↗
PresentationCommercial · CT, GA, NH, VA—Original policy ↗
Preventable Adverse Events - FacilityC-10002 · Effective May 27, 2020 · Commercial · ME—Original policy ↗
Preventive Care Services Covered with No Member Cost-shareCommercial · CA—Original policy ↗
Preventive Care Services Covered with No Member Cost-shareCommercial · CO—Original policy ↗
Preventive Care Services Covered with No Member Cost-shareCommercial · CT, ME, NH—Original policy ↗
Preventive Care Services Covered with No Member Cost-shareCommercial · GA—Original policy ↗
Preventive Care Services Covered with No Member Cost-share Commercial · NV—Original policy ↗
Preventive Care Services Covered with No Member Cost-shareCommercial · NY—Original policy ↗
Preventive Care Services Covered with No Member Cost-shareCommercial · VA—Original policy ↗
Preventive Care Services Covered with No Member Cost-share (updated December 2021)Commercial · IN, KY, MO, OH, WI—Original policy ↗
Preventive Health GuidelinesCommercial · VA—Original policy ↗
Preventive Medicine and Other Visits on the Same DayG-05016 · Effective Jul 1, 2026 · Medicaid · NV—Original policy ↗
Preventive Medicine and Sick Visits on the Same DayG-05016 · Effective Aug 1, 2026 · Medicaid · OH—Original policy ↗
Preventive Medicine and Sick Visits on the Same DayEffective Sep 1, 2018 · Medicaid · NV—Original policy ↗
Preventive Medicine Services with Screening and other Evaluation and Management Services – ProfessionalC-12002 · Effective Apr 1, 2026 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI54Original policy ↗
Preventive Medicine Services with Screening and other Evaluation and Management Services – ProfessionalC-12002 · Effective Jan 1, 2027 · Commercial · CA54Original policy ↗
Prior Authorization ListCommercial · CT—Original policy ↗
Prior Authorization ListCommercial · ME—Original policy ↗
Prior Authorization ListCommercial · NV3,304Original policy ↗
Prior Authorization ListEffective Sep 1, 2024 · Commercial · NH—Original policy ↗
Prior Authorization Request: Inpatient or OutpatientCommercial · CT, NH—Original policy ↗
Prior Authorization Requirements for City of New York EmployeesCommercial · NY—Original policy ↗
Professional Anesthesia ServicesG-07018 · Effective Nov 14, 2025 · Medicaid · OH—Original policy ↗
Professional Anesthesia ServicesG-07018 · Effective Nov 14, 2025 · Medicaid · IN2Original policy ↗
Professional Anesthesia ServicesG-07018 · Effective Nov 14, 2025 · Medicaid · NV—Original policy ↗
Professional CMS 1500 Billers Remittance Advice Overview - FEP Professional Commercial · NH—Original policy ↗
Professional CMS 1500 Billers Remittance Advice Overview - Local Professional 2637 · Commercial · NH—Original policy ↗
Professional Provider Billing GuidelinesCommercial · NH—Original policy ↗
Professional Provider ManualEffective Dec 9, 2019 · Commercial · VA17Original policy ↗
Professional Provider ManualEffective Nov 1, 2019 · Commercial · VA17Original policy ↗
Professional Provider ManualEffective Sep 1, 2019 · Commercial · VA17Original policy ↗
Prolonged Services – ProfessionalC-08011 · Effective Jun 3, 2025 · Commercial · CO, CT, GA, IN, KY, MO, NH, NV, OH, WI12Original policy ↗
Prolonged Services – ProfessionalC-08011 · Effective Jun 3, 2025 · Commercial · ME12Original policy ↗
Prolonged Services – ProfessionalC-08011 · Effective Dec 1, 2025 · Commercial · VA12Original policy ↗
Prolonged Services – ProfessionalC-08011 · Effective Jan 1, 2026 · Commercial · CA12Original policy ↗
Proof of Timely FilingG-06133 · Effective Oct 23, 2025 · Medicaid · OH—Original policy ↗
Proof of Timely FilingG-06133 · Effective Oct 23, 2025 · Medicaid · IN—Original policy ↗
Proof of Timely FilingG-06133 · Effective Oct 23, 2025 · Medicaid · NV—Original policy ↗
Prosthetic and Orthotic DevicesG-06084 · Effective Oct 14, 2024 · Medicaid · OH—Original policy ↗
Prosthetic and Orthotic DevicesG-06084 · Effective Oct 14, 2024 · Medicaid · NV—Original policy ↗
Provider Agreement Affiliates ListCommercial, Medicaid · CO, CT, GA, IN, KY, ME, MO, NH, NV, NY, OH, WI—Original policy ↗
Provider Appeal Policy and ProcedureCommercial · VA—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.