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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.

38 policies name 99291, those listing the fewest codes first. A policy that names a code may also list it as excluded.

Optimum Healthcare policies
PolicyDetailsCodesSource
Trauma Activation - FacilityC-24003 · Effective Mar 1, 2025 · Commercial · CO, CT, GA, IN, ME, MO, NH, NV, OH, WI3Original policy ↗
Trauma Activation - FacilityC-24003 · Effective Apr 1, 2026 · Commercial · CA3Original 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 ↗
KENTUCKY PROVIDER MANUALEffective Jul 1, 2017 · Commercial · KY10Original policy ↗
KENTUCKY PROVIDER MANUALEffective Jul 1, 2018 · Commercial · KY10Original policy ↗
Modifier Rules - ProfessionalC-08010 · Effective Jul 1, 2024 · Commercial · CA11Original policy ↗
Modifier Usage - ProfessionalC-08010 · Effective Jan 1, 2027 · Commercial · CA11Original policy ↗
Modifier Usage – ProfessionalC-08010 · Effective Mar 1, 2025 · Commercial · VA12Original policy ↗
Modifier Usage – ProfessionalC-08010 · Effective Jun 3, 2025 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI12Original 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 ↗
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 ↗
Colorado • Commercial HEDIS measurement year 2023–2024Commercial · CO451Original policy ↗
HEDIS measurement year 2023–2024Commercial, Medicaid · CA451Original policy ↗
HEDIS measurement year 2023–2024Commercial · CT451Original policy ↗
HEDIS measurement year 2023–2024Commercial · GA451Original policy ↗
HEDIS measurement year 2023–2024Commercial, Medicaid · IN451Original policy ↗
HEDIS measurement year 2023–2024Commercial · ME451Original policy ↗
HEDIS measurement year 2023–2024Commercial · MO451Original policy ↗
HEDIS measurement year 2023–2024Commercial, Medicaid · NV451Original policy ↗
HEDIS measurement year 2023–2024Commercial · NH451Original policy ↗
HEDIS measurement year 2023–2024Commercial, Medicaid · VA451Original policy ↗
HEDIS measurement year 2023–2024Commercial, Medicaid · WI451Original policy ↗
HEDIS Measurement Year (MY) 2020 Physician documentation guidelines and administrative codesOH567Original 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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