Passport by Molina Healthcare policies, page 5

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
Microwave Ablation Thermotherapy for Breast CancerCommercial1Original policy ↗
Minimally Invasive Glaucoma SurgeriesCommercial5Original policy ↗
Minimally Invasive Glaucoma Surgeries KY Effective Date February 16, 2026Effective Feb 16, 2026 · Medicaid · KY5Original policy ↗
Minimally Invasive Sacroiliac Joint FusionCommercial, Medicaid4Original policy ↗
Mobile Cardiac Outpatient Telemetry428 · Commercial, Medicaid2Original policy ↗
Mobile Cardiac Outpatient Telemetry KY Effective Date February 16, 2026Effective Feb 16, 2026 · Medicaid · KY2Original policy ↗
Modifier 25Commercial—Original policy ↗
Modifier 26Commercial, Medicaid—Original policy ↗
Modifier 26—Original policy ↗
Modifier KXCommercial, Medicaid7Original policy ↗
Modifier Technical Component PolicyEffective Aug 21, 2025 · Commercial, Medicaid2Original policy ↗
Modifiers XE XS XP XU and 59 UsageCommercial, Medicaid—Original policy ↗
Modifiers XE XS XP XU and 59 Usage—Original policy ↗
Multiple EM codes for the same provider same date of serviceCommercial, Medicaid2Original policy ↗
Multiple Procedure Payment Reduction PolicyCommercial, Medicaid24Original policy ↗
N C C I (NCCI) Procedure-to-Procedure with ModifiersEffective Aug 5, 2025 · Commercial, Medicaid—Original policy ↗
National Drug CodeCommercial—Original policy ↗
Negative Pressure Wound TherapyCommercial, Medicaid7Original policy ↗
Neuromuscular Electrical Training for the Treatment of OSA or Snoring (eXciteOSA)422 · Commercial, Medicaid2Original policy ↗
Neurostimulation Treatments for EpilepsyCommercial, Medicaid54Original policy ↗
Newborn and Neonatal Intensive Care Unit PolicyEffective Aug 6, 2025 · Commercial, Medicaid—Original policy ↗
Newborn and NICUMedicaid · KY—Original policy ↗
Non-Emergent Air Ambulance TransportCommercial, Medicaid10Original policy ↗
Non-Invasive Abdominal/Visceral Vascular StudiesCommercial, Medicaid—Original policy ↗
Non-Invasive Prenatal TestingEffective Jul 31, 2025 · Commercial, Medicaid7Original policy ↗
Noninvasive Positive Pressure Ventilation275 · Commercial, Medicaid3Original policy ↗
NPFS Status Indicator TMedicaid—Original policy ↗
ObservationCommercial17Original policy ↗
Observation17Original policy ↗
Observation Reimbursement Policy64 · Effective Mar 11, 2024 · Medicaid · KY2Original policy ↗
Occupational Therapy409 · Commercial, Medicaid28Original policy ↗
Omisirge (omidubicel onlv)Commercial, Medicaid5Original policy ↗
Omisirge (omidubicel-onlv)Effective Aug 22, 2026 · Medicaid · KY4Original policy ↗
Opioid Treatment ServiceMedicaid18Original policy ↗
Optum EDC Analyzer - Facility ER E&M Leveling PrepaymentCommercial, Medicaid6Original policy ↗
Optum Pause and PayMedicaid—Original policy ↗
Optum Pause and PayMedicaid · KY—Original policy ↗
Otarmeni (lunsotogene parvec)485 · Commercial3Original policy ↗
Otarmeni (lunsotogene parvec) MEDICARE485b3Original policy ↗
Otarmeni (Lunsotogene Parvec-cwha)Effective Aug 22, 2026 · Medicaid · KY3Original policy ↗
Outpatient Definitive Presumptive Drug Testing Medicaid MedicareMedicaid · KY78Original policy ↗
Overlapping Room and BoardCommercial—Original policy ↗
Packaged and conditionally packaged lab servicesCommercial—Original policy ↗
Paid Amount Exceeded Billed AmountEffective Jul 30, 2025 · Commercial, Medicaid—Original policy ↗
Pancreas TransplantationEffective Apr 23, 2021 · Commercial, Medicaid20Original policy ↗
Papzimeos (zopapogene imadenovec)Commercial, Medicaid1Original policy ↗
Papzimeos (zopapogene imadenovec)Effective Feb 16, 2026 · Medicaid · KY2Original policy ↗
Papzimeos (zopapogene imadenovec) MEDICARE1Original policy ↗
Percutaneous Electrical Nerve Field Stimulation for Abdominal PainCommercial4Original policy ↗
Percutaneous Epidural Adhesiolysis257 · Commercial2Original 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.