Iowa Reimbursement Policies | Providers – Amerigroup

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 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  These policies may be superseded by State, Federal or Centers for Medicare and Medicaid Services (CMS) requirements.  Providers and facilities are required to use industry standard codes for claim submissions.  Services should be billed with Current Procedure Terminology (CPT) codes, Healthcare Common Procedure Coding System (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.

Policy Disclaimer >>

Policy Definitions >>

expand Coding
Diagnoses Used in DRG Computation
Modifier 22: Increased Procedural Service
Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service
Modifier 62: Co-Surgeons
Modifier 66: Surgical Teams
Modifier 77: Repeat Procedure by Another Physician
Modifiers LT and RT: Left Side/Right Side Procedures
Multiple and Bilateral Surgery: Professional and Facility Reimbursement
DME Modifiers for New, Rented and Used Equipment
Modifier 26 and TC: Professional and Technical Component
Split-Care Surgical Modifier
expand DME and Supplies
Facility Take-Home DME and Medical Supplies
expand Drugs
Facility Take-Home Drugs
expand Evaluation and Management
Preventive Medicine and Sick Visits on the Same Day
expand Facilities
Inpatient Readmissions
Preadmission Services for Inpatient Stays
expand Prevention
Vaccines for Children (VFC) Program
expand Prosthetics and Orthotics
Prosthetic and Orthotic Devices
expand Radiology
Multiple Radiology Payment Reduction
expand Reimbursement Administration - General
Requirements for Documentation of Proof of Timely Filing
Scope of Practice
Claims Timely Filing
Claims Requiring Additional Documentation
Claims Submission – Required Information for Professional Providers
Duplicate or Subsequent Services on the Same Date of Service
Documentation Standards for Episodes of Care
Reimbursement for Items Under Warranty
Other Provider Preventable Conditions (OPPC)
Corrected Claims
expand Surgery
Robotic Assisted Surgery
Global Surgical Package
Maternity Services
Multiple Delivery Services
expand Transportation