DC Reimbursement Policies | Providers - Amerigroup | Providers – Amerigroup

District of Columbia Reimbursement Policies

We want to assist physicians, facilities and other providers in accurate claims submissions and to outline the basis for reimbursement if the service is covered by a member’s Amerigroup District of Columbia, Inc. benefit plan. Keep in mind that determination of coverage under a member’s benefit plan does not necessarily ensure reimbursement. These policies may be superseded by state, federal or CMS requirements. Providers and facilities are required to use industry standard codes for claim submissions. Services should be billed with CPT codes, HCPCS codes and/or revenue codes. The billed code(s) should be fully supported in the medical record and/or office notes. Industry practices are constantly changing and Amerigroup reserves the right to review and revise its policies periodically.

expand Anesthesia
expand Coding
Split-Care Surgical Modifiers
Unlisted, Unspecified or Miscellaneous Codes
Modifier 24: Unrelated Evaluation and Management Service by the Same Physician during the Postoperative Period
Modifier 62: Co-Surgeons
Diagnoses Used in DRG Computation
DME Modifiers for New, Rented and Used Equipment
Preadmission Services for Inpatient Stays
Modifier Usage
Reimbursement of Services with Obsolete Codes
Modifier 26 and TC: Professional and Technical Component
Modifier 91: Repeat Clinical Diagnostic Laboratory Test
Modifier 76: Repeat Procedure by the Same Physician
expand DME and Supplies
DME (Rent to Purchase)
expand Drugs
Drugs and Injectable Limits
expand Evaluation and Medicine
expand Facilities
Inpatient Readmissions
expand Prevention
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)
expand Prosthetics and Orthotics
expand Radiology
Multiple Radiology Payment Reduction
expand Reimbursement Administration - General
Requirements for Documentation of Proof of Timely Filing
Reimbursement of Claims with Charge Discrepancies
Corrected Claims
DRG Inpatient Facility Transfers
Reimbursement for Eligible Billed Charges
Claims Submission – Required Information for Facilities
Locum Tenens Physicians/Fee-for-Time Compensation
Medical Recalls
Present on Admission Indicator for Health Care-Acquired Conditions
Reimbursement of Sanctioned and Opt-Out Providers
Site of Service Payment Differential — Professional
expand Surgery
Abortion (Termination of Pregnancy)
Multiple Delivery Services
expand Transportation
Transportation Services: Ambulance and Nonemergent Transport