Passport Health Plan by Molina Healthcare policies, page 2

Search Passport Health Plan 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 Health Plan by Molina Healthcare, by title.

Passport Health Plan by Molina Healthcare policies
PolicyDetailsCodesSource
Category III CPT CodesCommercial, Medicaid214Original policy ↗
Clinical Determinations of Appropriate Level of CareMHI-Healthcare Services-394 · Effective May 2, 2016 · Commercial, Medicaid—Original policy ↗
Clinical Diagnostic Laboratory ServicesCommercial211Original policy ↗
Clinical Diagnostic Laboratory Services212Original policy ↗
Clinical Trials and Rare Disease PolicyCommercial, Medicaid9Original policy ↗
CMS Replacement CodesCommercial, Medicaid—Original policy ↗
Co Surgeon Team Surgeon ProfessionalCommercial, Medicaid2Original policy ↗
Colonoscopy and SigmoidoscopyCommercial35Original policy ↗
Comprehensive Community Support Services (CCSS) (H2015)Medicaid · KY4Original policy ↗
Condition Codes 49, 50, and 53Commercial, Medicaid—Original policy ↗
Cooled Radiofrequency Ablation (CRFA) for the Management of Chronic Pain386 · Commercial, Medicaid7Original policy ↗
Corneal Collagen Cross-Linking (CXL)328 · Effective Aug 12, 2026 · Commercial, Medicaid3Original policy ↗
Corrected ClaimsCommercial—Original policy ↗
Corrected ClaimsMedicaid · KY—Original policy ↗
Cranial Orthotic DevicesCommercial3Original policy ↗
Criteria for Cast Crowns Policy Effective Date January 1, 2026Effective Jan 1, 2026 · Medicaid · KY17Original policy ↗
Criteria for Fixed Prosthodontics Policy Effective Date January 1, 2026Effective Jan 1, 2026 · Medicaid · KY9Original policy ↗
Criteria for General Anesthesia and IV Sedation Policy Effective Date January 1, 2026Effective Jan 1, 2026 · Medicaid · KY8Original policy ↗
Criteria for Maxillofacial Prosthetics Policy Effective Date January 1, 2026Effective Jan 1, 2026 · Medicaid · KY11Original policy ↗
Criteria for Occlusal Guards Policy Effective Date January 1, 2026Effective Jan 1, 2026 · Medicaid · KY3Original policy ↗
Criteria for Oral and Maxillofacial Surgery Effective Date June 8, 2026Effective Jun 8, 2026 · Medicaid · KY7Original policy ↗
Critical Care Codes when Discharged to HomeMedicaid · KY2Original policy ↗
Critical Care Codes when Discharging Home from the Emergency DepartmentCommercial2Original policy ↗
Cross-Departmental Recovery PolicyMedicaid—Original policy ↗
CT Computed Tomography of the Abdomen and PelvisCommercial—Original policy ↗
D M E Place of Service 31 or 32Effective Aug 6, 2025 · Medicaid—Original policy ↗
D R G (DRG) Clinical ValidationEffective Aug 1, 2025 · Commercial, Medicaid—Original policy ↗
Decision for Surgery Modifier 57Commercial, Medicaid—Original policy ↗
Developmental TestingCommercial, Medicaid3Original policy ↗
Diagnosis Code CodingCommercial, Medicaid—Original policy ↗
Diagnosis Code Y65 XXCommercial, Medicaid—Original policy ↗
Discontinued ProceduresEffective Aug 4, 2025 · Commercial, Medicaid4Original policy ↗
DME Non Invasive Ventilator SettingsCommercial, Medicaid6Original policy ↗
DME Place of Service Separately ReimbursableCommercial, Medicaid9Original policy ↗
DME Rental Vs PurchaseCommercial629Original policy ↗
Donor Lymphocyte Infusion and Hematopoietic Stem Cell BoostsCommercial, Medicaid3Original policy ↗
DRG Clinical ValidationMedicaid · KY—Original policy ↗
Duplicate Claim Reimbursement PolicyMedicaid · KY2Original policy ↗
Duplicate ClaimsEffective Aug 19, 2025 · Commercial, Medicaid—Original policy ↗
Durable Medical Equipment K F (KF)F ModifierCommercial, Medicaid14Original policy ↗
Dynamic Exoskeletal Orthoses for Lower Extremity InjuriesCommercial, Medicaid3Original policy ↗
Early Elective Delivery Payment PolicyMedicaid · KY—Original policy ↗
Electric Tumor Treatment Fields for Glioblastoma353 · Commercial, Medicaid3Original policy ↗
Electrocardiographic EKG or ECG Monitoring Holter or Real Time MonitoringCommercial, Medicaid—Original policy ↗
Electrostimulation and Electromagnetic Therapy for Wound Care399 · Effective Aug 12, 2026 · Commercial, Medicaid6Original policy ↗
Elevidys (delandistrogene moxeparvovec-rokl)Commercial, Medicaid3Original policy ↗
Emergency Service E&M Codes and Place of Service 23Commercial5Original policy ↗
Encelto (revakinagene tororetcel)Commercial2Original policy ↗
Enclosed Bed Systems329 · Commercial, Medicaid5Original policy ↗
End Stage Renal Disease (ESRD) Consolidated Billing PolicyEffective Aug 4, 2025 · Commercial, Medicaid29Original 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.