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Optimum Healthcare policies

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.

69 policies name 99285, those listing the fewest codes first. A policy that names a code may also list it as excluded.

Optimum Healthcare policies
PolicyDetailsCodesSource
Emergency Room Transfers – FacilityC-20006 · Effective Jul 17, 2024 · Commercial · CO, CT, GA, IN, KY, MO, NV, OH, WI5Original policy ↗
Emergency Room Transfers – FacilityC-20006 · Effective Jan 1, 2026 · Commercial · CA5Original policy ↗
Critical Care to Home – FacilityC-25004 · Effective Apr 1, 2026 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI6Original policy ↗
Critical Care to Home – FacilityC-25004 · Effective Oct 1, 2026 · Commercial · CA6Original policy ↗
Emergency Department Protocol for SIU ReviewCommercial · CA, CO, CT, GA, IN, KY, ME, MO, NH, NV, NY, OH, VA, WI10Original policy ↗
Facility Emergency DepartmentC-13001 · Effective Jun 1, 2013 · Commercial · NH10Original policy ↗
Facility Guidelines for Claims Related to Professional Services – FacilityC-15004 · Effective Apr 1, 2026 · Commercial · CA10Original policy ↗
KENTUCKY PROVIDER MANUALEffective Jul 1, 2017 · Commercial · KY10Original policy ↗
KENTUCKY PROVIDER MANUALEffective Jul 1, 2018 · Commercial · KY10Original policy ↗
Observation Services - FacilityC-11005 · Effective Feb 1, 2026 · Commercial · NH14Original policy ↗
Observation Services - FacilityC-11005 · Effective Feb 1, 2026 · Commercial · CO, CT, GA, IN, KY, MO, NV, OH, WI14Original policy ↗
Observation Services - FacilityC-11005 · Effective Feb 1, 2026 · Commercial · ME14Original policy ↗
Observation Services - FacilityC-11005 · Effective Oct 1, 2026 · Commercial · CA14Original policy ↗
Facility Guidelines for Claims Related to Professional Services - FacilityC-15004 · Effective Jan 1, 2027 · Commercial · CA17Original policy ↗
VIRGINIA FACILITY PROVIDER MANUALEffective Apr 1, 2016 · Commercial · VA18Original policy ↗
VIRGINIA FACILITY PROVIDER MANUALEffective Aug 1, 2015 · Commercial · VA18Original 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 ↗
2026 Kentucky Commercial Provider ManualKY-BCBS-CM-PM-010987-26-S3103 · Effective Sep 1, 2026 · Commercial · KY32Original policy ↗
Anthem Blue Cross and Blue Shield Kentucky Provider ManualKYBCBS-CM-PM-061904-24 v1a.070124 · Effective Oct 1, 2024 · Commercial · KY32Original policy ↗
Anthem Blue Cross and Blue Shield Kentucky Provider ManualEffective Oct 1, 2022 · Commercial · KY32Original policy ↗
Anthem Blue Cross and Blue Shield Kentucky Provider Manualv2.031124 · Effective Oct 1, 2023 · Commercial · KY32Original policy ↗
Anthem Blue Cross and Blue Shield Kentucky Provider ManualEffective Oct 1, 2021 · Commercial · KY32Original policy ↗
Anthem Blue Cross and Blue Shield Kentucky Provider ManualKYBCBS-CM-PM-061904-24 v2b 080124 · Effective Nov 1, 2024 · Commercial · KY32Original policy ↗
Anthem Blue Cross and Blue Shield Kentucky Provider ManualEffective Aug 1, 2021 · Commercial · KY32Original policy ↗
Kentucky Provider ManualKYBCBS-CM-PM-086208-25 · Effective Nov 1, 2025 · Commercial · KY32Original policy ↗
Kentucky Provider ManualKYBCBS-CM-PM-086208-25 · Effective Jan 1, 2026 · Commercial · KY32Original policy ↗
KENTUCKY PROVIDER MANUALEffective Jan 1, 2021 · Commercial · KY32Original policy ↗
KENTUCKY PROVIDER MANUALEffective Sep 1, 2020 · Commercial · KY32Original policy ↗
KENTUCKY PROVIDER MANUALEffective Nov 1, 2019 · Commercial · KY32Original policy ↗
VIRGINIA FACILITY PROVIDER MANUALEffective Sep 21, 2017 · Commercial · VA32Original policy ↗
VIRGINIA FACILITY PROVIDER MANUALEffective May 1, 2017 · Commercial · VA32Original policy ↗
VIRGINIA FACILITY PROVIDER MANUALEffective Feb 1, 2018 · Commercial · VA32Original policy ↗
VIRGINIA FACILITY PROVIDER MANUALEffective Apr 1, 2018 · Commercial · VA33Original policy ↗
Hoosier Care Connect and Healthy Indiana Plan: Health Plan AmendmentEffective Jan 1, 2017 · Medicaid · IN41Original 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 ↗
VIRGINIA FACILITY PROVIDER MANUALEffective Oct 23, 2019 · Commercial · VA58Original policy ↗
VIRGINIA FACILITY PROVIDER MANUALEffective May 1, 2019 · Commercial · VA58Original policy ↗
VIRGINIA FACILITY PROVIDER MANUALEffective Aug 23, 2019 · Commercial · VA58Original policy ↗
Anthem Blue Cross and Blue Shield Virginia Facility Provider ManualEffective Jun 1, 2022 · Commercial · VA90Original policy ↗
Anthem Blue Cross and Blue Shield Virginia Facility Provider ManualVABCBS-CM-PM-061543-24 · Effective Oct 1, 2024 · Commercial · VA90Original policy ↗
Anthem Blue Cross and Blue Shield Virginia Facility Provider ManualEffective Jul 1, 2023 · Commercial · VA90Original policy ↗
Anthem Blue Cross and Blue Shield Virginia Facility Provider ManualEffective Dec 1, 2023 · Commercial · VA90Original policy ↗
Anthem Blue Cross and Blue Shield Virginia Facility Provider ManualVABCBS-CM-PM-061543-24 v1.07012024 · Effective Jul 1, 2024 · Commercial · VA90Original policy ↗
Virginia Facility Provider ManualVABCBS-CM-PM-086206-25 · Effective Aug 1, 2025 · Commercial · VA90Original policy ↗
Virginia Facility Provider Manual Revised August 1, 2024VABCBS-CM-PM-061543-24 v2A.08152024 · Effective Aug 1, 2024 · Commercial · VA90Original policy ↗
2026 Virginia Facility Commercial Provider ManualVA-BCBS-CM-PM-013594-26-S3776 · Effective Jul 1, 2026 · Commercial · VA91Original policy ↗
Anthem Blue Cross and Blue Shield Virginia Facility Provider ManualEffective Jul 1, 2021 · Commercial · VA93Original policy ↗
Modifiers 59 and XE, XP, XS, & XU: Distinct Procedural Service - ProfessionalC-09006 · Effective Mar 1, 2025 · Commercial · VA113Original policy ↗
Anthem Blue Cross and Blue Shield Provider and Facility ManualEffective Aug 1, 2016 · Commercial · CO116Original 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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