Payment Policies
*Note: Tailored Plan Physical Health providers are subject to Payment Policies for Carolina Complete Health below. Behavioral Health (BH) Tailored Plan providers should defer to the Tailored Plan for policy information for BH services.
- Add-on Code Billed w/o Primary Code, CC.PP.030 (PDF)
- Assistant Surgeon, CC.PP.029 (PDF)
- Bilateral Procedures, CC.PP.037 (PDF)
- Clinical Validation of Modifier 25, CC.PP.013 (PDF)
- Clinical Validation of Modifier 59, CC.PP.014 (PDF)
- Code Editing Overview, CC.PP.011 (PDF)
- Concert Laboratory Payment Policy, CG.CC.PP.01 (PDF) - Effective 4/15/25.
- Please refer to the Clinical Policy page to review the Concert Lab Testing Policies.
- Distinct Procedural Modifiers, CC.PP.020 (PDF)
- Intravenous Hydration, CC.PP.012 (PDF)
- Maximum Units of Service, CC.PP.007 (PDF)
- Modifier to Procedure Code Validation, CC.PP.028 (PDF)
- NCCI Unbundling, CC.PP.031 (PDF)
- Non-obstetrical and Obstetrical Transabdominal and Transvaginal Ultrasounds, CC.PP.061 (PDF)
- Please refer to PHP Billing Guidance section 3.4.4 specific to Institutional Claims
- Optum Comprehensive Payment Integrity (CPI), CC.PP.074 (PDF)
- Place of Service Mismatch, CC.PP.063 (PDF)
- Professional Component Modifier, CC.PP.027 (PDF)
- Reporting the Global Maternity Package, CC.PP.016 (PDF)
- Robotic Surgery, CC.PP.050 (PDF)
- Sepsis Diagnosis, CC.PP.073 (PDF) - latest revision effective date 11/26/24
- Severe Malnutrition, NC.CC.PP.145 (PDF)
- Sleep Studies Place of Service, CC.PP.035 (PDF)
- Unbundled Professional Services, CC.PP.043 (PDF)
- Unbundled Surgical Procedures, CC.PP.045 (PDF)
- Unlisted Procedure Codes, CC.PP.009 (PDF)
- Urine Specimen Validity Testing, CC.PP.056 (PDF)