This webpage lists all former available versions of Neighborhood Health Plan of Rhode Island payment policies.  Active current payment policies are available on the Billing Guidelines and Payment Policies webpage.  Other documents listed below, such as coverage summaries and billing guidelines, are no longer maintained.  Information regarding covered benefits and services can be found in the applicable Member Handbook or Certificate of Coverage.   

A

• Acupuncture Services Payment Policy – Archive 1 (Effective 2/1/2022 through 3/28/2023)
• Adult Day Health Services Payment Policy – Archive 1 (Effective  9/01/2013 through 9/13/2020)
• Adult Day Health Services Payment Policy – Archive 2 (Effective  9/14/2020 through 9/28/2021)
• Adult Day Health Payment Policy – Archive 3 (Effective 9/29/2021 through 9/30/2022)
• Adult Day Health Payment Policy – Archive 4 (Effective 10/01/2022 through 11/27/2023)
• Anesthesia Billing and Reimbursement Policy (Effective 6/1/2014 through 12/31/2022)
• Anesthesia Services Payment Policy – Archive 1 (Effective 01/01/2023 through 11/27/2023)
• Annual GYN Exams CHC Billing Guidelines (Effective 9/1/2013 through 5/01/22; Replaced with Physician Services Payment Policy, effective May 2, 2022)
• Assisted Living Payment Policy – Archive 1 (Effective 3/01/2018 through 3/15/2022)
• Assisted Living Payment Policy – Archive 2 (Effective 3/16/2022 through 3/28/2023)

 

B

—

C

• Chemotherapy Billing Guidelines (Effective 9/1/2010 through 6/30/2022; Replaced with Medically Administered Medication Payment Policy on 7/01/2022)
• Chiropractic Services Payment Policy– Archive 1 (Effective 11/30/2021 through 12/31/2022)
• Chiropractic Services Payment Policy – Archive 2 (Effective 1/1/2023 through 3/10/2024)
• Children’s Care Services Benefit Coverage Summary (Effective 9/24/2012 through 11/30/2021; Replaced with Children’s Care Services Payment Policy on 12/01/2021)
• Children’s Care Services Payment Policy – Archive 1 (Effective 12/01/2021 through 12/02/2021)
• Children’s Care Services Payment Policy – Archive 2 (Effective 12/3/2021 through 9/30/2022)
• Children’s Care Services Payment Policy – Archive 3 (Effective 10/01/2022 through 12/31/2022)
• Clinical Trials Payment Policy – Archive 1 (Effective 11/15/2022 through 9/04/2023)
• Complementary and Alternative Medicine (CAM) Services Payment Policy – Archive 1 (Effective 7/01/2018 through 9/28/2021)
• Complementary and Alternative Medicine (CAM) Services Payment Policy – Archive 2 (Effective 9/29/2021 through 11/01/2021)
• Complementary Alternative Medicine (CAM) Services Payment Policy – Archive 3 (Effective 11/2/2021 through 12/31/2022)
• Complementary Alternative Medicine (CAM) Services Payment Policy – Archive 4 (Effective 1/1/2023 through 3/10/2024)
• COVID-19 Vaccine Payment Policy – Archive 1 (Effective  12/11/2020 through 3/02/2021)
• COVID-19 Vaccine Payment Policy – Archive 2 (Effective  3/03/2021 through 6/14/2021)
• COVID-19 Vaccine Payment Policy – Archive 3 (Effective 6/15/2021 through 8/16/2021)
• COVID-19 Vaccine Payment Policy – Archive 4 (Effective 8/17/2021 through 9/26/2021)
• COVID-19 Vaccine Payment Policy – Archive 5 (Effective 9/27/2021 through 11/11/2021; Replaced with Immunization and Vaccine Payment Policy, effective 11/12/2021)
• Critical Care Billing Guidelines (Effective 9/01/2010 through 4/30/2021; Replaced with Physician Services Payment Policy on 5/01/2021)

D

• Date Range Outpatient Billing Guidelines (Effective 9/01/2011 through 9/30/2021)
• Diabetes Prevention Program Coverage Summary and Payment Policy – Archive 1 (Effective  4/01/2018 through 5/24/2021)
• Diabetes Prevention Program Payment Policy – Archive 2 (Effective 5/25/2021 through 9/30/2022)
• Diabetes Prevention Program Payment Policy – Archive 3 (Effective 10/01/2022 through 9/04/2023)
• Dialysis Coverage Summary (Effective 10/03/2013 through 9/30/2021)
• Digestive Coverage Summary (Effective 4/04/2012 through 9/30/2021)
• Drug Testing Payment Policy – Archive 1 (Effective 1/1/2023 through 3/10/2024)
• Durable Medical Equipment (DME) Coverage Summary (Effective 6/10/2013 through 12/31/2022; Replaced with Durable Medical Equipment Payment Policy)
• Durable Medical Equipment (DME) Payment Policy – Archive 1 (Effective 1/1/2023 through 11/27/2023)

E

• Ear Coverage Summary (Effective 8/23/2012 through 9/30/2021)
• EKG Interpretation and Report with Surgeon Billing Guidelines (Effective 9/01/2013 through 9/30/2021)
• Emergency Department Services Evaluation and Management Codes (Effective 9/01/2010 through 4/30/2021; Replaced with Physician Services Payment Policy on 5/01/2021)
• Evaluation and Management Codes (Effective 9/01/2010 through 4/30/2021; Replaced with Physician Services Payment Policy on 5/01/2021)
• Exploratory Surgery Billing Guidelines (Effective 9/01/2013 through 9/30/2021)
• Extended Family Planning Benefit Coverage Summary (Effective 12/11/2019 through 9/27/2020; Replaced with Extended Family Planning Payment Policy on 9/28/2020)
• Extended Family Planning Payment Policy – Archive 1 (Effective 9/28/2020 through 9/28/2021)
• Extended Family Planning Payment Policy – Archive 2 (Effective 9/29/2021 through 9/30/2022)
• Extended Family Planning Payment Policy – Archive 3 (Effective 10/01/2022 through 9/04/2023)

F

• From and To Date Range Billing Guidelines (Effective 09/01/2013 through 9/30/2021)

G

—

H

• Hemic and Lymphatic Coverage Summary (Effective 10/03/2013 through 9/30/2021)
• Home Health Care Services Payment Policy – Archive 1 (Effective 4/08/2020 through 11/02/2020)
• Home Health Care Services Payment Policy – Archive 2 (Effective 11/3/2020 through 12/31/2023)
• Hospice Billing & Reimbursement Guideline and Hospice Coverage Summary (Effective 7/8/2010 through 12/31/2022; Replaced with Hospice Services Payment Policy)
• Hospice Services Payment Policy – Archive 1 (Effective 1/1/2023 through 3/10/2024)
• Hospital Inpatient Billing Guidelines (Effective 9/01/2010 through 4/30/2021; Replaced with Physician Services Payment Policy on 5/01/2021)
• Hospital Readmission Payment Policy – Archive 1 (Effective 12/29/2020 through 9/30/2022)
• Hospital Readmission Payment Policy – Archive 2 (Effective 10/1/2022 through 11/27/2023)

I

• Immunization and Vaccine Payment Policy (Effective May 25, 2021 through 11/01/2021)
• Immunization and Vaccine Payment Policy – Archive 2 (Effective 11/02/2021 through 12/31/2022)
• Immunization and Vaccine Payment Policy – Archive 3 (Effective 01/01/2023 through 03/28/2023)
• Immunization and Vaccine Payment Policy – Archive 4 (Effective 03/29/2023 through 02/29/2024)
• Immunosuppressive Therapy During a Global Period (Effective 9/1/2010 through 12/15/2022; Retired content included in Modifier Payment Policy and Transplant Services Payment Policies)
• Implants Coverage Summary (Effective 10/03/2013 through 9/30/2021)
• In Lieu of Services Payment Policy – Archive 1 (Effective 7/16/20 through 9/28/2021)
• In Lieu of Services Payment Policy – Archive 2 (Effective 9/29/2021 through 11/01/2021)
• In Lieu of Services Payment Policy– Archive 3 (Effective 11/2/2021 through 12/31/2022)
• In Lieu of Services Payment Policy – Archive 4 (Effective 1/1/2023 through 3/10/2024)
• Inpatient Neonatal and Pediatric Critical Care Coverage Summary (Effective 9/01/2010 through 4/30/2021; Replaced with Physician Services Payment Policy on 5/01/2021)
• Integumentary and Musculoskeletal Coverage Summary (Effective 3/09/2011 through 9/30/2021)

J

—

K

—

L

• Laboratory Coverage Summary (Effective 7/25/2011 through 9/30/2021)
• Labor Evaluation Billing Guidelines (Effective 9/01/2013 through 9/30/2021)
• Lesion Excision Surgery Billing Guidelines (Effective 9/01/2013 through 9/30/2021)

M

• Male Genital and Urinary System Coverage Summary (Effective 7/08/2010 through 9/30/2021)
• Mammography Screening Billing Guidelines  (Effective 9/01/10 through 11/29/2021; Replaced with Mammography Screening Payment Policy)
• Mammography Screening Payment Policy– Archive 1 (Effective 11/30/2021 through 12/31/2022)
• Mammography Screening Payment Policy – Archive 2 (Effective 1/1/2023 through 3/10/2024)
• Maternity Coverage Summary (Effective 3/12/2010 through 7/31/21; Replaced with Obstetrical Services Payment Policy)
• Mediastinum and Diaphragm Coverage Summary (Effective 10/03/2013 through 9/30/2021)
• Modifier Payment Policy – Archive 1 (Effective 5/16/2022 through 9/04/2023)
• Multiple Procedure Payment Policy – Archive 1 (Effective 11/01/2020 through 9/28/2021)
• Multiple Procedure Payment Policy – Archive 2 (Effective 9/29/2021 through 3/10/2022)
• Multiple Procedure Payment Policy – Archive 3 (Effective 3/11/22 through 9/30/2022)
• Multiple Procedure Payment Policy – Archive 4 (Effective 10/01/2022 through 7/31/2023)

N

• Never Events Billing Guidelines (Effective 3/01/2021 through 7/01/2021; Replaced with Provider Preventable Condition Policy)
• Nervous Endocrine System Coverage Summary (Effective 10/03/2013 through 9/30/2021)
• New Versus Established Patient Billing Guidelines (Effective 9/01/2010 through 4/30/2021; Replaced with Physician Services Payment Policy on 5/01/2021)
• Non-Covered Services Payment Policy – Archive 1 (Effective 2/28/2017 through 2/14/2021)
• Non-Covered Services Payment Policy – Archive 2 (Effective 2/15/2021 through 7/14/2021)
• Non-Covered Services Payment Policy – Archive 3 (Effective 7/15/2021 through 10/14/2021)
• Non-Covered Services Payment Policy – Archive 4 (Effective 10/15/2021 through 1/11/2022)
• Non-Covered Services Payment Policy – Archive 5 (Effective 1/12/2022 through 5/15/2022 – Click here for a summary of updates)
• Non-Covered Services Payment Policy – Archive 6 (Effective 5/16/22 through 7/17/2022)
• Non-Covered Services Payment Policy – Archive 7 (Effective 7/18/2022 through 12/31/2022)
• Non-Covered Services Payment Policy – Archive 8  (Effective 01/01/2023 through 3/28/2023 –  Click here for a summary of changes)
• Non-Covered Services Payment Policy – Archive 9 (Effective 01/01/2023 through 3/28/2023)
• Non-Covered Services Payment Policy – Archive 10 (Effective 03/29/2023 through 9/04/2023)
  • Non-Covered CPT/HCPC Codes (Effective 03/29/2023 through 9/04/2023)
  • Non-Covered ICD-10 Diagnosis Codes (Effective 03/29/2023 through 9/04/2023)
  • Non-Covered Modifiers (Effective 03/29/2023 through 9/04/2023)
• Non-Covered Services Payment Policy – Archive 11 (Effective 09/05/2023 through 11/27/2023)
  • Non-Covered CPT/HCPC Codes (Effective 09/05/2023 through 11/27/2023)
  • Non-Covered ICD-10 Diagnosis Codes (Effective 09/05/2023 through 11/27/2023)
  • Non-Covered Modifiers (Effective 09/05/2023 through 11/27/2023)
• Non-Covered Services Payment Policy – Archive 12 (Effective 11/28/2023 through 3/10/2024)
  • Non-Covered CPT/HCPC Codes (Effective 11/28/2023 through 3/10/2024)
  • Non-Covered ICD-10 Diagnosis Codes (Effective 11/28/2023 through 3/10/2024)
  • Non-Covered Modifiers (Effective 11/28/2023 through 3/10/2024)

O

• Observation Evaluation and Management Billing Guidelines (Effective 9/01/2010 through 4/30/2021; Replaced with Physician Services Payment Policy on 5/01/2021)
• Obstetrical Billing Guidelines  – Archive (Effective 9/01/2010 through 7/31/2021; Replaced with Obstetrical Services Payment Policy on 8/01/2021)
• Obstetrical Ultrasounds Clinical Medical Policy (CMP #045) – Archive (Effective 11/10/2021 through 7/31/2021; Replaced with Obstetrical Services Payment Policy on 8/01/2021)
• Obstetrical Services Payment Policy – Archive 1 (Effective 8/1/2021 through 12/31/2022)
• Obstetrical Services Payment Policy – Archive 2 (Effective 1/1/2023 through 11/27/2023)
• Ophthalmology Billing Guidelines (Effective 9/01/2010 through 2/28/2022; Replaced with Vision Care Services Payment Policy)
• Oral Surgery Benefit Coverage Summary (Effective 7/25/2011 through 11/30/2021; Replaced with Oral Surgery Payment Policy on 12/01/2021)
• Oral Surgery Payment Policy – Archive 1 (Effective 12/01/2021 through 9/30/2022)
• Oral Surgery Payment Policy – Archive 2 (Effective 10/01/2022 through 9/04/2023)
• Out of Network Payment Policy – Archive 1 (Effective 12/11/2019 through 5/01/2022)
• Out of Network Payment Policy – Archive 2 (Effective 5/02/2022 through 7/31/2022)

P

• Pain Coverage Summary (Effective 10/03/2013 through 9/30/2021)
• Patient Education Coverage Summary (Effective 9/01/2013 through 9/30/2021)
• Pediatric Critical Care Transport (Effective 9/01/2010 through 4/30/2021; Replaced with Physician Services Payment Policy on 5/01/2021)
• Physician Services Coverage Summary Guidelines (Effective 4/23/2010 through 4/30/2021; Replaced with Physician Services Payment Policy on 5/01/2021)
• Physician Services Payment Policy – Archive 1 (Effective 5/01/2021 through 6/07/2021)
• Physician Services Payment Policy – Archive 2 (Effective 6/08/2021 through 5/01/2022)
• Physician Services Payment Policy – Archive 3 (Effective 5/02/2022 through 9/04/2023)
• Physical and Occupational Rehabilitation Services Payment Policy – Archive 1 (Effective 9/01/2010 through 9/30/2020)
• Physical and Occupational Rehabilitation Services Payment Policy – Archive 2 (Effective 10/01/2020 through 12/31/2020)
• Physical and Occupational Rehabilitation Services Payment Policy – Archive 3 (Effective 1/01/2021 through 3/31/2021)
• Physical and Occupational Rehabilitation Services Payment Policy – Archive 4(Effective 1/01/2021 through 3/31/2022)
• Physical and Occupational Rehabilitation Services Payment Policy – Archive 5 (Effective 4/01/2022 through 12/31/2022)
• Physical and Occupational Rehabilitation Services Payment Policy – Archive 6 (Effective 1/1/2023 through 3/28/2023)
• Physical and Occupational Rehabilitation Services Payment Policy – Archive 7 (Effective 3/29/2023 through 9/30/2023)
• Preventative Medicine Billing Guidelines (Effective 9/01/2010 through 4/30/2021; Replaced with Physician Services Payment Policy on 5/01/2021)
• Provider Preventable Condition Payment Policy – Archive 1 (Effective 07/01/2012 through 9/30/2022)
• Provider Preventable Condition Payment Policy – Archive 2 ( Effective 10/01/2022 through 11/27/2023)
• Psychological Assessment Services Payment Policy (Effective 7/08/2010 through 4/30/2021; Replaced with Physician Services Payment Policy on 5/01/2021)

Q

—

R

• Radiology Services Coverage Summary (Effective 4/06/2011 through 9/30/2021)
• Reason Codes (Claims Adjudication Message Descriptions)

S

• Skilled Nursing Facility Payment Policy – Archive 1 (Effective 7/1/2016 through 9/30/2022)
• Skilled Nursing Facility Payment Policy – Archive 2 (Effective 10/01/2022 through 9/4/2023)
• Skilled Nursing Facility Payment Policy – Archives 3 (Effective 9/5/2023 through 3/10/2024)
• Special Services Procedures and Reports Billing Guidelines (Effective 9/01/2010 through 4/30/2021; Replaced with Physician Services Payment Policy on 5/01/2021)
• Speech Therapy Services Payment Policy – Archive 1 (Effective 10/01/2020 through 12/31/2020)
• Speech Therapy Services Payment Policy – Archive 2 (Effective 1/01/2021 through 3/31/2021)
• Speech Therapy Services Payment Policy – Archive 3 (Effective 4/01/2021 through 4/30/2022)
• Speech Therapy Services Payment Policy – Archive 4 (Effective 5/01/2022 through 11/14/2022)
• Speech Therapy Services Payment Policy – Archive 5 (Effective 11/15/2022 through 12/31/2022)
• Speech Therapy Services Payment Policy – Archive 6 (Effective 1/01/2023 through 4/17/2023)
• Speech Therapy Services Payment Policy – Archive 7 (Effective 4/18/2023 through 9/30/2023)
• Surgical Global Fee Period Billing Guidelines (Effective 9/1/2010 through 5/15/2022; Replaced with Modifier Payment Policy on 5/16/2022)

T

• Telemedicine Services Payment Policy – Archive 1 (Effective 12/31/2018 through 4/12/2020)
• Telemedicine Services Payment Policy – Archive 2 (Effective 4/13/2020 through 5/6/2020)
• Telemedicine Services Payment Policy – Archive 3 (Effective 5/7/2020 through 6/30/2022; Replaced with Telemedicine/Telephone Services Payment Policy)
• Telemedicine/Telephone Services Payment Policy – Archive 1 (Effective 7/01/2022 through 01/26/2023)
• Telemedicine/Telephone Services Payment Policy – Archive 2 (Effective 01/27/2023 through 04/17/2023)
• Telemedicine/Telephone Services Payment Policy – Archive 3 (Effective 04/18/2023 through 12/31/2023)
• Telemedicine/Telephone Payment Policy (Effective 1/01/2022 through 1/01/2022; See policy for details)
• Temporary COVID-19 Prior Authorization Payment Policy – Archive 1 (Effective 4/01/2020 through 4/27/2020)
• Temporary COVID-19 Prior Authorization Payment Policy – Archive 2 (Effective 4/28/2020 through 7/12/2020)
• Temporary COVID-19 Prior Authorization Payment Policy – Archive 3 (Effective 7/13/2020 through 7/26/2020)
• Temporary COVID-19 Prior Authorization Payment Policy – Archive 4 (Effective 7/27/2020 through 10/21/2020)
• Temporary COVID-19 Prior Authorization Payment Policy – Archive 5 (Effective 10/22/2020 through 12/01/2020)
• Temporary COVID-19 Prior Authorization Payment Policy – Archive 6 (Effective 12/02/2020 through 2/24/2021)
• Temporary COVID-19 Prior Authorization Payment Policy – Archive 7 (Effective 2/25/2021 through 4/15/2021)
• Temporary COVID-19 Prior Authorization Payment Policy – Archive 8 (Effective 4/16/2021 through 6/09/2021)
• Temporary COVID-19 Prior Authorization Payment Policy – Archive 9 (Effective 6/10/2021 through 8/24/2021)
• Temporary COVID-19 Prior Authorization Payment Policy – Archive 10 (Effective 8/25/2021 through 9/30/2021)
• Temporary COVID-19 Prior Authorization Payment Policy – Archive 11 (Effective 10/01/2021 through 05/01/2023)
• Temporary COVID-19 Telemedicine/Telephone-only Preventive Medicine Visits – Archive 1 (Effective 3/18/2020 through 7/12/2021)
• Temporary COVID-19 Telemedicine/Telephone-only Preventive Medicine Visits – Archive 2 (Effective 7/13/2020 through 7/16/2021)
• Temporary COVID-19 Telemedicine/Telephone-only Preventive Medicine Visits – Archive 3 (Effective 7/17/2020 through 7/26/2020)
• Temporary COVID-19 Telemedicine/Telephone-only Preventive Medicine Visits – Archive 4 (Effective 7/27/2020 through 6/30/22; Replaced with Telemedicine/Telephone Services Payment Policy)
• Temporary COVID-19 Telemedicine/Telephone-only Services – Archive 1 (Effective 3/18/2020 through 3/30/2020)
• Temporary COVID-19 Telemedicine/Telephone-only Services – Archive 2 (Effective 3/31/2020 through 4/12/2020)
• Temporary COVID-19 Telemedicine/Telephone-only Services – Archive 3 (Effective 4/13/2020 through 5/6/2020)
• Temporary COVID-19 Telemedicine/Telephone-only Services – Archive 4 (Effective 5/7/2020 through 6/3/2020)
• Temporary COVID-19 Telemedicine/Telephone-only Services – Archive 5 (Effective 6/4/2020 through 7/12/2020)
• Temporary COVID-19 Telemedicine/Telephone-only Services – Archive 6 (Effective 7/13/2020 through 7/16/2020)
• Temporary COVID-19 Telemedicine/Telephone-only Services – Archive 7 (Effective 7/17/2020 through 7/26/2020)
• Temporary COVID-19 Telemedicine/Telephone-only Services – Archive 8 (Effective 7/27/2020 through 5/10/2021)
• Temporary COVID-19 Telemedicine/Telephone-only Services – Archive 9 (Effective 5/11/2021 through 4/7/2022)
• Temporary COVID-19 Telemedicine/Telephone-only Services – Archive 10 (Effective 4/8/2022 through 6/30/2022; Replaced with Telemedicine/Telephone Services Payment Policy)
• Temporary COVID-19 Testing and Treatment Services Payment Policy – Archive 1 (Effective 3/25/2020 through 3/30/2020)
• Temporary COVID-19 Testing and Treatment Services Payment Policy – Archive 2 (Effective 3/31/2020 through 4/21/2020)
• Temporary COVID-19 Testing and Treatment Services Payment Policy – Archive 3 (Effective 4/22/2020 through 5/12/2020)
• Temporary COVID-19 Testing and Treatment Services Payment Policy – Archive 4 (Effective 5/13/2020 through 5/20/2020)
• Temporary COVID-19 Testing and Treatment Services Payment Policy – Archive 5 (Effective 5/21/2020 through 6/23/2020)
• Temporary COVID-19 Testing and Treatment Services Payment Policy – Archive 6 (Effective 6/24/2020 through 7/12/2020)
• Temporary COVID-19 Testing and Treatment Services Payment Policy – Archive 7 (Effective 7/13/2020 through 7/26/2020)
• Temporary COVID-19 Testing and Treatment Services Payment Policy – Archive 8 (Effective 7/27/2020 through 8/16/2020)
• Temporary COVID-19 Testing and Treatment Services Payment Policy – Archive 9 (Effective 8/17/2020 through 9/01/2020)
• Temporary COVID-19 Testing and Treatment Services Payment Policy – Archive 10 (Effective 9/02/2020 through 10/14/2020)
• Temporary COVID-19 Testing and Treatment Services Payment Policy – Archive 11 (Effective 10/15/2020 through 1/05/2021)
• Temporary COVID-19 Triage Services Provided Via Telephone Only (Effective 3/09/2020 through 3/18/2020; Replaced with Temporary COVID-19 Telemedicine/Telephone-only Payment Policy)
• Transplant Coverage Summary (Effective 10/3/2013 through 12/31/2022; Replaced with Transplant Services Payment Policy)
• Transplant Services Payment Policy – Archive 1 (Effective 1/1/2023 through 11/27/2023)
• Transportation Coverage Summary (Effective 10/26/2010 through 9/30/2022; Refer to Provider Manual)

U

• UB04 General Claim Submission (Effective 10/03/2013 through 9/30/2021; Refer to Provider Manual)
• Unlisted/Unspecified Procedure Code Billing Guidelines – Archive 1 (Effective 9/1/2013 through 9/30/2022)
• Unlisted/Unspecified Procedure Code Billing Guidelines – Archive 2 (Effective 10/01/2022 through 11/27/2023)
• Urine Toxicology Testing Clinical Medicine Policy (CMP), (Effective 6/1/2016 through 12/31/2022; Replaced with Drug Testing Payment Policy)

V

• Venipuncture Billing Guidelines (Effective 9/1/2010 through 9/30/2022; Retired secondary to updated industry standard billing guidelines)
• Venous Procedure with Surgery Billing Guideline (Effective 9/01/2013 through 9/30/2021)
• Vision Care Services Billing Guidelines (Effective 7/01/2011 through 2/28/2022; Replaced with Vision Care Services Payment Policy)
• Vision Care Services Payment Policy – Archive 1 (Effective 3/01/2022 through 3/28/2023)
• Vision Care Services Payment Policy – Archive 2 (Effective 3/29/2023 through 9/04/2023)

—

X

—

Y

—

Z

—