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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.

9 policies name Q4101, those listing the fewest codes first. A policy that names a code may also list it as excluded.

Optimum Healthcare policies
PolicyDetailsCodesSource
CG-SURG-127 Products for Wound Healing and Soft Tissue Grafting: Medically Necessary UsesCG-SURG-127 · Commercial77Original policy ↗
Frequency Editing - ProfessionalC-08012 · Effective Apr 1, 2026 · Commercial · CA194Original policy ↗
Frequency Editing - ProfessionalC-08012 · Effective Mar 1, 2025 · Commercial · VA214Original policy ↗
Frequency Editing - ProfessionalC-08012 · Effective Jun 11, 2025 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI215Original policy ↗
SHBP Medical Policies & Clinical Guidelines Precertification Code ListEffective Jan 1, 2022 · Commercial · GA2,220Original policy ↗
SHBP Prior Authorization RequirementsCommercial · GA2,569Original policy ↗
Colorado Prior Authorization ListCommercial · CO3,281Original policy ↗
Prior Authorization ListCommercial · NV3,304Original policy ↗
California PPO Prior Authorization ListCommercial · CA3,545Original 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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