Billing Guidelines and Payment Policies

The payment policies listed below is not an exhaustive list of all billing, coding and payment guidelines and policies. To inquire about guidelines not listed here, contact Neighborhood Provider Services at 1-800-963-1001.

Guidelines and policies are updated regularly and are subject to change as State, Federal, CMS, AMA, Neighborhood and other industry standards change.  For more information, please refer to Neighborhood’s Provider Manual.

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.

All current payment polices are listed below in alphabetical order (all links will open as a PDF document in a new webpage). Previous versions of all temporary and permanent payment policies, as well as, other documents formerly listed on this webpage, are listed on Billing Guidelines and Payment Policies Archive webpage.  

 

A

• Acupuncture Services Payment Policy – (Effective February 1, 2022)
• Adult Day Health Services Payment Policy (Updated September 29, 2021)
• Anesthesia Billing and Reimbursement Policy 
• Annual GYN Exams CHC Billing Guideline 
• Assisted Living Payment Policy (Updated March 16, 2022)

B

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C

• Chemotherapy Billing Guidelines 
• Children’s Care Services Payment Policy (Effective December 3, 2021)
• Chiropractic Services Payment Policy (Effective December 1, 2021)
• Claim Adjustment Grid Process
• Complementary and Alternative Medicine (CAM) Services Payment Policy (Updated November 2, 2021)
• COVID-19 Vaccine Payment Policy (Replaced with Immunization and Vaccine Payment Policy, effective 11/12/2021)

D

• Diabetes Prevention Program Payment Policy
• Durable Medical Equipment (DME) Coverage Summary 

E

• Extended Family Planning (EFP) Services Payment Policy (Updated September 29, 2021)

F

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G

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H

• Home Health Care Services Payment Policy
• Hospice Coverage Summary 
• Hospice Billing & Reimbursement Guideline
• Hospital Readmission Payment Policy

I

• Immunization and Vaccine Payment Policy (Effective November 12, 2021; combines elements of former COVID-19 Vaccine Payment Policy)
• Immunosuppressive Therapy During a Global Period 
• In Lieu of Services Payment Policy (Updated November 2, 2021)

J

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K

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L

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M

• Mammography Screening Payment Policy (Updated November 30, 2021)
• Modifier Payment Policy – New!
• Multiple Procedures Payment Policy (Updated March 11, 2022)

N

• Non-Covered Services Payment Policy (Updated May 16, 2022)

O

• Obstetrical Services Payment Policy
• Oral Surgery Payment Policy
• Out of Network Payment Policy (Updated May 2, 2022)

P

Pharmaceutical policies and guidance are published on Neighborhood’s Pharmacy webpage.

• Physical and Occupational Rehabilitation Services Payment Policy (Effective April 1, 2022)
• Physician Services Payment Policy (Updated May 2, 2022)
• Provider Preventable Condition Policy
• Psychological Assessment Coverage Summary 

Q

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R

• Reason Codes 

S

• Skilled Nursing Facility Payment Policy
• Speech Therapy Services Payment Policy  (Effective May 1, 2022)
• Surgical Global Fee Period Billing Guidelines 

T

• Temporary COVID-19 Prior Authorization Policy (Updated October 1, 2021)
• Temporary COVID-19 Telemedicine/Telephone-only Services  (Updated April 8, 2022)
• Temporary COVID-19 Telemedicine/Telephone-only Preventive Medicine Visits
• Temporary COVID-19 Testing and Treatment Services Policy
• Telemedicine Services Payment Policy
• Telemedicine/Telephone Services Payment Policy  New! Effective July 1, 2022
• Transplant Coverage Summary 
• Transportation Coverage Summary 

U

• Unlisted Unspecified Procedure Codes Billing Guidelines 

V

• Venipuncture Billing Guidelines 
• Vision Care Services Payment Policy – (Effective March 1, 2022)

W

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X

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Y

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Z

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