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Optum Reimbursement Policies

Add-on Codes - Anniversary Review  Approved 5-23-22 

Behavioral Health Services Documentation - Updated 1-24-2022

Bundle Codes Reimbursement Policy - Updated 10-18-2021

Consultation Services Reimbursement Policy

Drug Testing Reimbursement Policy - Anniversary Review  Approved 5-23-22

Duplication of Claims Reimbursement Policy - Retired 5-24-2021

Electroconvulsive Therapy Reimbursement Policy - Updated 10-18-2021

Facility-Based Behavioral Health Program Professional Fees Reimbursement Policy - Updated 4-1-2022

Facility-Based Behavioral Health Program Reimbursement Policy - Updated 4-1-2022

Health and Behavior Assessment and Intervention Reimbursement Policy Commercial & Medicare - Updated 4-1-2022

Inappropriate Primary Diagnosis Codes Reimbursement Policy - Updated 12-14-2021

Incident to Billing Reimbursement Policy - Retired 5-24-2021

License Level Reimbursement Policy - Updated 9-16-2021

Maximum Frequency Per Day - Anniversary Review  Approved 5-23-22

Medicare Incident to Bill - Updated 4-1-2022

National Correct Coding Initiative Reimbursement Policy - Anniversary Review  Approved 5-23-22

Non-Emergent Transport and Lodging - Anniversary Review  Approved 5-23-22

Non-Reimbursable HCPCS Codes

Non-Covered HCPCS Codes

Opioid Treatment Program Reimbursement Policy - Updated effective 1-1-2022

Outpatient Family Therapy Reimbursement Policy - Updated 8-21-2021

Outpatient Service Clean Claim Form Submission - Updated 10-18-21

Outpatient Services Outside A Program Reimbursement Policy - Updated 8-21-2021

Procedure and Place of Service Reimbursement Policy - Updated 4-1-2022

Professional Technical Component Reimbursement Policy - Anniversary Review  Approved 5-23-22

Prolonged Services Reimbursement Policy - Commercial and Medicare - New 4-1-2022

Psychological and Neuropsychological Testing Reimbursement Policy - Updated 12-14-2021

Same Day Same Service Reimbursement PolicyNew Policy 9-1-2021 

Specimen Validity Testing Reimbursement Policy (Retired)

Spravato Reimbursement Policy - Updated 4-1-2022

Telemental Health Services Reimbursement Policy - Commercial - Updated 1-1-2022

Telemental Health Services Reimbursement Policy – Medicaid  - Updated 3-25-2022

Telemental Health Services Reimbursement Policy – Medicare   - Updated 1-1-2022