Passport by Molina Healthcare policies, page 3

Search Passport by Molina 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.

379 public policies Substrate tracks for Passport by Molina Healthcare, by title.

Passport by Molina Healthcare policies
PolicyDetailsCodesSource
Enteral NutritionCommercial, Medicaid28Original policy ↗
EPAP for Obstructive Sleep ApneaCommercial, Medicaid2Original policy ↗
Epidural Steroid Injections For Pain ManagementCommercial, Medicaid7Original policy ↗
ESRD 90999 No Modifier Weekly and Monthly LimitsCommercial, Medicaid1Original policy ↗
ESRD Billing for J0406 or J0606 with Modifier AXCommercial, Medicaid3Original policy ↗
Evaluation of New TechnologyCommercial, Medicaid—Original policy ↗
Excludes 1 Note—Original policy ↗
Experimental and Investigational ServicesCommercial, Medicaid—Original policy ↗
Facility Bilateral or Anatomical Modifier UseCommercial—Original policy ↗
Facility Emergency Department Evaluation and Management levelingCommercial, Medicaid3Original policy ↗
Facility Emergency Department Evaluation and Management LevelingMedicaid · KY14Original policy ↗
Fee ScheduleEffective Aug 19, 2025 · Commercial, Medicaid—Original policy ↗
Foot Surgery BunionectomyCommercial, Medicaid13Original policy ↗
Foot Surgery Hallux RigidusCommercial, Medicaid7Original policy ↗
Foot Surgery Lesser Toe Deformities Hammer Mallet and Claw ToeCommercial7Original policy ↗
Fractional CO2 Laser Treatment for Traumatic and Burn ScarsCommercial2Original policy ↗
Functional Electrical Stimulation for Spinal Cord InjuryCommercial, Medicaid2Original policy ↗
Gastric Electrical Stimulation414 · Commercial14Original policy ↗
Gastric Electrical Stimulation KY Effective Date February 16, 2026Effective Feb 16, 2026 · Medicaid · KY14Original policy ↗
Gastroesophageal Reflux Disease GERD Treatment337 · Commercial12Original policy ↗
General Billing and Coding PolicyCommercial, Medicaid—Original policy ↗
Genetic TestingCommercial, Medicaid697Original policy ↗
Genetic Testing KY Effective Date May 24, 2026Effective May 24, 2026 · Medicaid · KY702Original policy ↗
Genicular Artery Embolization of the Knee for Osteoarthritis410 · Commercial, Medicaid1Original policy ↗
Genicular Radiofrequency Ablation RFA and Genicular Nerve Blocks for Chronic Knee PainCommercial5Original policy ↗
Global Surgical Packages for Professional ProvidersEffective Aug 8, 2025 · Commercial, Medicaid—Original policy ↗
H2027 Psychoeducational Service Effective Date September 1, 2025Effective Sep 1, 2025 · Medicaid · KY2Original policy ↗
Heart Transplantation and Heart Transplantation with a Total Artificial HeartCommercial11Original policy ↗
Heart Transplantation with a Total Artificial Heart KY Effective Date February 16, 2026Effective Feb 16, 2026 · Medicaid · KY4Original policy ↗
Hematopoietic Stem Cell Transplantation for Hematologic CancersCommercial, Medicaid26Original policy ↗
Hematopoietic Stem Cell Transplantation for Hematologic DisordersCommercial, Medicaid23Original policy ↗
Hematopoietic Stem Cell Transplantation for Non - Cancerous Diseases454 · Commercial24Original policy ↗
Hematopoietic Stem Cell Transplantation for Solid Tumors457 · Commercial, Medicaid21Original policy ↗
Hemgenix (etranacogene dezaparvovec-drlb)429 · Commercial, Medicaid3Original policy ↗
High Dollar PharmacyCommercial—Original policy ↗
High Level E/M with Preventive Medicine PolicyMedicaid · KY10Original policy ↗
High Level Evaluation and Management with Preventive MedicineCommercial10Original policy ↗
High-Level Evaluation and Management with Preventive Medicine10Original policy ↗
HospiceEffective Feb 19, 2025 · Commercial, Medicaid—Original policy ↗
Hospice Value Code 61Effective Aug 4, 2025 · Commercial, Medicaid—Original policy ↗
Hospital Readmission ReviewCommercial, Medicaid—Original policy ↗
Hospital Routine Supplies ServicesCommercial—Original policy ↗
Hospital Routine Supplies Services ReimbursementMedicaid · KY—Original policy ↗
Hyaluronic Acid InjectionsMedicaid13Original policy ↗
Hydrolyzed Enteral Formula DiagnosisCommercial30Original policy ↗
Hydrolyzed Enteral Formula DiagnosisMedicaid · KY3Original policy ↗
Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea (OSA)363 · Effective Apr 8, 2026 · Commercial, Medicaid9Original policy ↗
ICD-10 First Listed Diagnosis Coding PolicyCommercial, Medicaid—Original policy ↗
ICD-10 First Listed Diagnosis Coding Policy—Original policy ↗
ICD-10 SpecificityCommercial, Medicaid2Original 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.