To inquire on guidelines not listed here, please contact Provider Services. These guidelines are not intended to certify coverage availability. While services or technology may be determined by Neighborhood to be medically necessary, it may not be part of a Member's benefit plan.

For more information please review your Provider Manual or contact Neighborhood Customer Service at 1-800-459-6019 for more information about any of our programs.

Find a Coverage Summary or Billing Guideline from our alphabetical list:

A  B  C  D  E  F  G  H  I  J  K  L  M  N  O  P  Q  R  S  T  U  V  W 
X  Y  Z

A

After Hours Billing Guideline 
Anesthesia Billing Guidelines
Anesthesia Coverage Summary

B

Biopsy Services Lab and Path Billing Guidelines

C

Cardiovascular and Peripheral Vascular Coverage Summary
Chemotherapy Billing Guidelines 
Childrens' Care Coverage Summary 
Consultation Billing Guidelines
Critical Care Billing Guidelines

D

Date Range Outpatient Billing Guideline
Date Range Professional Billing Guideline
Dialysis Coverage Summary
Digestive Coverage Summary
Durable Medical Equipment (DME) Coverage Summary

E

Ear Coverage Summary
Extended Family Planning (EFP) Coverage Summary
EKG Interpretation and Report with Surgeon Billing Guidelines
Emergency Department Services Evaluation and Management Codes Billing Guidelines
Exploratory Surgery Billing Guidelines

H

Hemic Lymphatic Coverage Summary
Home Health Care Coverage Summary
Hospice Coverage Summary
Hospital Inpatient Billing Guidelines

I

Immunization and Vaccine Coverage Summary
Immunosuppressive Therapy During a Global Period 
Implants Coverage Summary
Inpatient Neonatal and Pediatric Critical Care Coverage Summary
Integumentary and Musculoskeletal Coverage Summary

L

Laboratory Coverage Summary
Lesion Excision Surgery Billing Guidelines 

M

Male Genital and Urinary System Coverage Summary 
Mammography Screening Billing Guidelines
Maternity Coverage Summary
Mediastinum and Diaphragm Coverage Summary
Modifier Billing Guidelines
Multiple Evaluation and Management Codes for the Same Date of Service Billing Guidelines

N

Nervous Endocrine Coverage Summary 
New Versus Established Patient Billing Guidelines 
Non-Covered Coverage Summary

O

Observation Evaluation and Management Billing Guidelines
Obstetrical Billing Guidelines
Opthalmology Billing Guidelines
Oral Surgery Coverage Summary
Outpatient Surgery and Procedures Coverage Summary

P

Pain Coverage Summary
Patient Education Coverage Summary
Pediatric Critical Care Transport Billing Guidelines
Pharmaceuticals Coverage Summary 
Pharmaceutical Supplies Billing Guidelines
Physical Medicine and Therapies Billing Guidelines 
Physician Coverage Summary 
Preventative Medicine Billing Guidelines
Psychological Assessment Coverage Summary

R

Radiological Procedures Performed in Facility Setting Billing Guidelines 
Radiology Coverage Summary 

Reason Codes
    Healthedge Reason Code Legend
    ICES Reason Codes
    Neighborhood Legacy Reason Codes

Rehabilitative Therapy Coverage Summary 
Respiratory Coverage Summary

S

Skilled Nursing Facility Coverage Summary
Special Services Procedures and Reports Billing Guidelines
Surgical Global Fee Period Billing Guidelines

T

Transplant Coverage Summary 
Transportation Coverage Summary

U

Unlisted Unspecified Procedure Codes Billing Guidelines

V

Vaccine Billing Guidelines 
Venipuncture Billing Guidelines
Venous Procedures with Surgery Billing Guidelines 
Vision Care Billing Guidelines
Vision Care Coverage Summary

W

Womens' Care Coverage Summary