Use of CMS NPFS status codes for reimbursement
Governs Molina Healthcare's reimbursement treatment tied to CMS National Physician Fee Schedule status codes and coding practices; affects Molina providers submitting claims for services listed in the NPFS.
No material clinical or coverage changes in this revision.
Reimbursement and Coverage Determinations
Reimbursement coding and coverage rules
Coverage determination follows CMS NPFS status codes and the member's benefit plan; services marked with exclusion or noncovered status are not payable under the physician fee schedule.
Status code determinations
- E — Excluded from Physician Fee Schedule: services or items not covered under the physician fee schedule.
- N — Noncovered service: services or items the insurance does not cover.
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