announce additions and changes in our provider manual and/or provider newsletters which are available online and emailed to those with a

current and accurate email address on file. The information presented in this policy is accurate and current as of the date of this publication.

The information provided in our policies is intended to serve only as a general reference resource for services described and is not intended to

address every aspect of a reimbursement situation. Other factors affecting reimbursement may supplement, modify or, in some cases,

supersede this policy. These factors may include, but are not limited to, legislative mandates, physician or other provider contracts, the

member’s benefit coverage documents and/or other reimbursement, and medical or drug policies. Finally, this policy may not be implemented

the same way on the different electronic claims processing systems in use due to programming or other constraints; however, we strive to

minimize these variations.

We follow coding edits that are based on industry sources, including, but not limited to, CPT® guidelines from the American Medical

Association, specialty organizations, and CMS including NCCI and MUE. In coding scenarios where there appears to be conflicts between