ICD-10 Diagnosis Coding Specificity Requirements for Reimbursement
Governs Molina Healthcare reimbursement expectations for ICD-10-CM diagnosis coding specificity on claims. Applies to providers submitting claims to Molina and clarifies that diagnosis codes must be reported to the highest level of specificity supported by documentation and at least as specific as the billed procedure code.
Policy created 2020-11-20 and subsequently updated on 2022-10-19, 2023-08-16, and 2024-12-12 for code/link verification and template updates.
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