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)
- Code Editing Overview, CC.PP.011
- NCCI Unbundling, CC.PP.031
- Intravenous Hydration, CC.PP.012 (PDF)
- Maximum Units of Service, CC.PP.007 (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
- 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)
- Urine Specimen Validity Testing, CC.PP.056 (PDF)
- Optum Comprehensive Payment Integrity (CPI), CC.PP.074 (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.
- Unlisted Procedure Codes, CC.PP.009 (PDF)
- Clinical Validation of Modifier 25, CC.PP.013 (PDF)
- Clinical Validation of Modifier 59, CC.PP.014 (PDF)
- Reporting the Global Maternity Package, CC.PP.016 (PDF)
- Distinct Procedural Modifiers, CC.PP.020 (PDF)
- Professional Component Modifier, CC.PP.027 (PDF)
- Modifier to Procedure Code Validation, CC.PP.028 (PDF)
- Assistant Surgeon, CC.PP.029 (PDF)
- Bilateral Procedures, CC.PP.037 (PDF)
- Place of Service Mismatch, CC.PP.063 (PDF)
- Unlisted Procedure Codes, CC.PP.009 (PDF)