Payer Guidelines

Commercial Payers

Aetna Polices and Guidelines

Empire Blue Cross Blue Shield Medical Policies and Clinical UM Guidelines

Excellus Medical Guidelines

MPV Health Care Policy Updates - Monthly Updates

Access to current MVP Medical Coverage Policies require a username and password.

Government Payers

Medicare

1995 E&M Documentation Guidelines

1997 E&M Documentation Guidelines

Advance Beneficiary Notice (ABN)

Coverage Determinations

• Local Coverage Determinations (National Government Services)
• National Coverage Determinations (NCDs) - Index

"Incident to"

Locum Tenens

Medicare Learning Network

Internet Only Manuals

Teaching Physician Services - Pages 156-177

• Exception for E/M Services Furnished in Certain Primary Care Centers - Pages 162-164
• Teaching Physician Services - Surgical Procedures - Pages 164-166

Medicaid

New York State Medicaid - Home

Ambulatory Payment Groups (APGs)

eMedNY

• Provider Manuals - the list of all available provider manuals is at the bottom of the page
  • Clinic
  • Inpatient
  • Nurse Practitioner
  • Physician

Locum Tenes

Medicaid Updates - New York State Department of Health

Supervising/Teaching Physicians as of April 2008

• Anesthesia Guideline Updates, New York State Department of Health Medicaid Update, November 2010
• Medical Record Documentation for Supervising/Teaching Physicians - New York State Department of Health Medicaid Update, November 2003
• Primary Care Exception