Medicare Reimbursement Policies | Providers – Amerigroup

Medicare 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  These policies may be superseded by State, Federal or Centers for Medicare and Medicaid Services (CMS) requirements.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.

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Policy Definitions >>

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expand Anesthesia
expand Coding
Assistant at Surgery (Modifiers 80/81/82/AS)
Distinct Procedural Services (Modifiers 59, XE, XP, XS, XU)
Modifier 22: Increased Procedural Service
Modifier 25
Modifier 57: Decision for Surgery
Modifier 63: Procedure Performed on Infants less than 4 kg
Modifier 76: Repeat Procedure by the Same Physician
Modifier 78
Modifier Usage
Split-Care Surgical Modifiers
Modifiers LT and RT: Left-Side/Right-Side Procedures
Multiple and Bilateral Surgery: Professional and Facility Reimbursement
expand DME and Supplies
Facility Take-Home DME and Medical Supplies
expand Drugs
Facility Take-Home Drugs
expand Evaluation and Management
expand Facilities
DRG Inpatient Facility Transfers
Emergency Department: Level of E&M Services
Preadmission Services for Inpatient Stays
expand Laboratory
expand Prosthetics and Orthotics
Prosthetic and Orthotic Devices
expand Radiology
Portable/Mobile/Handheld Radiology Services
expand Reimbursement Administration - General
Claims Submission – Required Information for Facilities
Claims Timely Filing
Duplicate or Subsequent Services on the Same Date of Service
Locum Tenens Physicians/Fee-for-Time Compensation
Reimbursement for Eligible Billed Charges
Reimbursement for Maximum Units Per Day
Reimbursement of Sanctioned and Opt-Out Providers
Scope of Practice
Corrected Claims
Nurse Practitioner and Physician Assistant Services
expand Surgery
Global Surgical Package for Professional Providers
Multiple Delivery Services
expand Transportation
Transportation Services: Ambulance and Nonemergent Transport