WellPoint Medicare Supplement policies, page 5
Search WellPoint Medicare Supplement'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.
422 public policies Substrate tracks for WellPoint Medicare Supplement, by title.
| Policy | Details | Codes | Source |
|---|---|---|---|
| Medical Recalls | G-06111 · Effective May 22, 2024 · Medicaid · WV | — | Original policy ↗ |
| Medicare Advantage Quick Reference Card | Medicaid · TX | — | Original policy ↗ |
| Member Preventative Health Guidelines | Medicaid · WV | — | Original policy ↗ |
| MLTC Provider Manual | NY-WP-CD-PM-003952-25-GRP1355 · Medicaid · NY | — | Original policy ↗ |
| Modifier 22 | G-07020 · Effective Sep 6, 2024 · Medicaid · DC | — | Original policy ↗ |
| Modifier 22 | G-07020 · Effective Sep 6, 2024 · Medicaid · GA, MD, WA | — | Original policy ↗ |
| Modifier 22 | G-07020 · Effective Sep 6, 2024 · AZ, IA, NJ, SC, TN, TX, WA | — | Original policy ↗ |
| Modifier 22 | G-07020 · Effective Sep 6, 2024 · Medicaid · TX | — | Original policy ↗ |
| Modifier 22 | G-07020 · Effective Sep 6, 2024 · Medicaid · TX | — | Original policy ↗ |
| Modifier 22 | G-07020 · Effective Sep 6, 2024 · Medicaid · WV | — | Original policy ↗ |
| Modifier 24 | G-06011 · Effective Jun 11, 2025 · Medicaid · DC | — | Original policy ↗ |
| Modifier 24 | G-06011 · Effective Jun 11, 2025 · Medicaid · MD | — | Original policy ↗ |
| Modifier 24 | G-06011 · Effective Jun 11, 2025 · SC, TX | — | Original policy ↗ |
| Modifier 24 | G-06011 · Effective Jun 11, 2025 · Medicaid · TX | — | Original policy ↗ |
| Modifier 24 | G-06011 · Effective Dec 27, 2022 · Medicaid · TX | — | Original policy ↗ |
| Modifier 24 | G-06011 · Effective Jun 11, 2025 · Medicaid · WV | — | Original policy ↗ |
| Modifier 26 and TC | G-15004 · Effective Oct 30, 2023 · WV | — | Original policy ↗ |
| Modifier 50 and 51: Multiple and Bilateral Surgery | G-06010 · Effective Dec 18, 2025 · Medicaid · WV | — | Original policy ↗ |
| Modifier 62 | G-06027 · Effective Mar 26, 2026 · Medicaid · DC | — | Original policy ↗ |
| Modifier 62 | G-06027 · Effective Mar 26, 2026 · Medicaid · MD | — | Original policy ↗ |
| Modifier 62 | G-06027 · Effective Mar 26, 2026 · AZ, IA, NJ, SC, TN, TX, WA | — | Original policy ↗ |
| Modifier 62 | G-06027 · Effective Mar 26, 2026 · Medicaid · TX | — | Original policy ↗ |
| Modifier 62 | G-06027 · Effective Aug 7, 2020 · Medicaid · TX | — | Original policy ↗ |
| Modifier 62 | G-06027 · Effective Mar 26, 2026 · Medicaid · WV | — | Original policy ↗ |
| Modifier 63 | G-06015 · Effective Apr 1, 2023 · Medicaid · DC | — | Original policy ↗ |
| Modifier 63 | G-06015 · Effective Aug 28, 2020 · Medicaid · MD | — | Original policy ↗ |
| Modifier 63 | G-06015 · Effective Aug 28, 2020 · SC, TX | — | Original policy ↗ |
| Modifier 63 | G-06015 · Effective Nov 16, 2018 · Medicaid | — | Original policy ↗ |
| Modifier 63 | G-06015 · Effective Aug 28, 2020 · Medicaid · TX | — | Original policy ↗ |
| Modifier 63 | G-06015 · Effective Aug 28, 2020 · Medicaid · WV | — | Original policy ↗ |
| Modifier 66 | G-06039 · Effective Aug 7, 2020 · Medicaid · GA, WA | — | Original policy ↗ |
| Modifier 66 | G-06039 · Effective Aug 7, 2020 · AZ, IA, NJ, SC, TN, TX, WA | — | Original policy ↗ |
| Modifier 66 | G-06039 · Effective Aug 7, 2020 · Medicaid · TX | — | Original policy ↗ |
| Modifier 66 | G-06039 · Effective Aug 7, 2020 · Medicaid · WV | — | Original policy ↗ |
| Modifier 66: Surgical Team | G-06039 · Effective Apr 1, 2023 · Medicaid · DC | — | Original policy ↗ |
| Modifier 76 | G-06018 · Effective Jan 26, 2026 · Medicaid · DC | — | Original policy ↗ |
| Modifier 76 | G-06018 · Effective Jan 26, 2026 · Medicaid · MD | — | Original policy ↗ |
| Modifier 76 | G-06018 · Effective Jan 26, 2026 · AZ, IA, NJ, SC, TN, TX, WA, WV | — | Original policy ↗ |
| Modifier 76 | G-06018 · Effective Jan 26, 2026 · Medicaid · TX | — | Original policy ↗ |
| Modifier 76 | G-06018 · Effective Oct 1, 2017 · Medicaid · TX | — | Original policy ↗ |
| Modifier 76 | G-06018 · Effective Jan 26, 2026 · Medicaid · WV | — | Original policy ↗ |
| Modifier 77 | G-06019 · Effective Apr 1, 2023 · Medicaid · DC | — | Original policy ↗ |
| Modifier 77 | G-06019 · Effective Jan 26, 2026 · Medicaid · MD | — | Original policy ↗ |
| Modifier 77 | G-06019 · Effective Jan 26, 2026 · AZ, IA, NJ, SC, TN, TX, WA | — | Original policy ↗ |
| Modifier 77 | G-06019 · Effective Jan 26, 2026 · Medicaid | — | Original policy ↗ |
| Modifier 77 | G-06019 · Effective Oct 1, 2017 · Medicaid · TX | — | Original policy ↗ |
| Modifier 77 | G-06019 · Effective Jan 26, 2026 · Medicaid · WV | — | Original policy ↗ |
| Modifier 78 | G-13001 · Effective Sep 11, 2025 · Medicaid · DC | — | Original policy ↗ |
| Modifier 78 | G-13001 · Effective Sep 11, 2025 · Medicaid · GA, MD, WA | — | Original policy ↗ |
| Modifier 78 | G-06016 · Effective Sep 11, 2025 · AZ, IA, NJ, SC, TN, TX, WA | — | Original policy ↗ |