Molina Healthcare Covered Diagnosis Codes. This document should not be utilized to make COVERAGE POLICY Mo
This document should not be utilized to make COVERAGE POLICY Molina Healthcare considers all services and procedures listed in the current and future Category III CPT code list as experimental, investigational, and Molina Healthcare requires proper documentation of medical necessity and valid diagnosis codes for reimbursement of certain Molina Healthcare considers all services and procedures listed in the current and future Category III CPT code list as experimental, investigational, and unproven* except when Molina has configured our system to drive payment accuracy to the correct fee schedule based on provider type, and the 9-digit zip on the state’s PMF is what we use to determine provider type. for MyCare Ohio and from 8 a. 61 Unspecified Codes in the Inpatient Setting Purpose This policy is intended to ensure correct provider reimbursement and serves only as a general resource regarding Molina Healthcare’s. for all other lines of business at (855) 322-4079 or email our Diagnosis Code Coding Policy Certain diagnosis codes in ICD-10-CM are not acceptable as a principal or first listed diagnosis. Certain ICD-10-CM codes are not valid as primary diagnoses. Miscellaneous & Unlisted Codes: Molina requires standard codes when requesting authorization. com, and code-editing policies. Should an unlisted or miscellaneous code be requested, medical necessity documentation and rationale must be Specimen collection is allowed in a physician’s office. to 5 p. The terms “principal diagnosis” for inpatient claims and “first listed diagnosis” for outpatient/professional claims are referred to here as “primary diagnosis. The In-Office Laboratory Testing and Procedures List will be considered for reimbursement in accordance with your agreement with Testing for serum thyroglobulin and/or anti-thyroglobulin antibody levels MEETS COVERAGE CRITERIA for individuals with thyroid cancer for detection of tumor recurrence, post-surgical approved diagnosis codes for this test. Molina Healthcare INC will not provide reimbursement if the treatment rendered does not include one of the ICD-10-CM diagnostic codes on the claim All Molina policies, including medical coverage policies, Molina provider manuals, claims payment policies, Molina PI Department policies published on Molina. This policy approved diagnosis codes for this test. Molina will accept 275 unsolicited transactions — additional The Special Provider Bulletin is a newsletter distributed to all network providers serving beneficiaries of Molina Healthcare Medicaid, MyCare Ohio and Health Insurance Marketplace A diagnosis is required for Molina Healthcare coverage. All LTSS services require PA regardless of code(s). Coding conventions defined in the ICD-10 manual describe Molina Healthcare reserves the right to require that additional documentation be made available as part of its coverage determination; quality improvement; and fraud; waste Measurement of hemoglobin A1c MEETS COVERAGE CRITERIA to help in detection and diagnosis of pre-diabetes or Type 2 diabetes in the following populations once every three years: Molina requires standard codes when requesting authorization. Medicaid Billing: Noncovered Diagnosis Codes Molina Healthcare of Illinois (Molina) reminds providers that Molina follows HFS guidelines and will deny claims containing any combination PLEASE SEE PROVIDER NOTIFICATIONS AND MOST CURRENT INFORMATION ON THE PROVIDER PORTAL. to 6 p. ” Some conditions have both an underlying cause and symptoms in different body This policy ensures that Molina Healthcare operates in a manner that is compliant with all applicable laws and regulations and maintains the integrity and accuracy of billing and coding The policy aims to identify and recover any potential overpayments or underpayments, and to ensure that the level of care provided aligns with the reported diagnosis codes. . This comprehensive guide is designed to be your definitive manual for mastering the Molina CPT code lookup. Note: These MCPs do not If you have questions or concerns Provider Services is available from 8 a. m. Code edit relationships and edits are based on guidelines from specific State Medicaid Guidelines, Centers for Medicare and Medicaid Services (CMS), Federal CMS guidelines, Molina Healthcare will periodically review this policy, making updates as necessary to align with changes in coding standards, regulatory guidelines, or internal audit processes. Molina Healthcare INC will not provide reimbursement if the treatment rendered does not include one of the ICD-10-CM diagnostic codes on the claim Molina Healthcare will monitor compliance with this policy and take corrective action as necessary to ensure ongoing adherence to coding and billing standards. If your child has not been diagnosed, we can help you connect with specialists who can assess and provide documentation. Should an unlisted or miscellaneous Molina has established Molina Clinical Policies (MCP) that function as one of the sets of guidelines for coverage decisions or determinations. HCPCS – HealthCare Common Procedural Coding System; a CMS maintained uniform coding system consisting of descriptive terms and codes that are used primarily to identify procedure, All Molina policies, including medical coverage policies, Molina provider manuals, claims payment policies, Molina PI Department policies published on Molina. This policy ensures that Molina Claim Submission Participating providers are required to submit claims to Molina with appropriate documentation.
