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 These policies may be superseded by state, federal or CMS requirements.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
Consultations
expand Facilities
Inpatient Readmissions
expand Prevention
Vaccines for Children (VFC) Program
expand Prosthetics and Orthotics
Prosthetic and Orthotic Devices
expand Radiology
Portable/Mobile/Handheld Radiology Services
expand Reimbursement Administration - General
Claims Requiring Additional Documentation
Code and Clinical Editing Guidelines
Documentation Standards for Episodes of Care
Duplicate or Subsequent Services on the Same Date of Service
Emergency Services: Nonparticipating Providers and Facilities
Reimbursement for Items Under Warranty
Reimbursement for Maximum Units Per Day
Other Provider Preventable Conditions (OPPC)
Claims Submission – Required Information for Professional Providers
Scope of Practice
expand Surgery
Sterilization
Global Surgical Package for Professional Providers
Maternity Services
Robotic Assisted Surgery
expand Transportation