HealthLink Pricing Policies

These policies serve as a guide to assist providers in accurate claims submissions and to outline the basis for allowed amounts for HealthLink members. The determination that a service, procedure, item, etc. is covered under a member's benefit plan is not a determination that you will be reimbursed. Services must meet authorization and medical necessity guidelines appropriate to the procedure and diagnosis.

Administration
Claims Editing Overview (HLAP-0001)
Duplicate Reporting of Diagnostic Services (HLAP-0002)
Expenses Included in Facility Services (HLAP-0003)
Guidelines Reported Timed Units PT Rehabilitation Services (HLAP-0004)
Professional Pricing Policy Definitions
Urgent Care Coding Bundled Supplies (HLAP-0005)
 
Anesthesia
Anesthesia Services (HLANP-0001)
Moderate Sedation (HLANP-0002)
 
Behavioral Health
Health and Behavior Assessment Intervention (HLBHP-0001)
 
Coding
Assistant Surgeon Services (HLCP-0005)
Bundled Services and Supplies (HLCP-0001)
Cancer Treatment Planning Care Coordination (HLCP-0006)
Co-Surgeon Team Surgeon Services (HLCP-0007)
Distinct Procedural Services Modifiers (HLCP-0002)
Evaluation Management Services Related Modifiers 25 & 57 (HLCP-0009)
Frequency Editing (HLCP-0003)
Modifier 22 Increased Procedural Services (HLCP-0004)
Modifier Rules (HLCP-0008)
Once per Lifetime Procedures (HLCP-0011)
Place of Service (HLCP-0012)
Surgical Pathology and Related Prostate Needle Biopsy (HLCP-0013)
 
Diagnostic
Sleep Studies and Related Bundled Services Supplies (HLDP-0001)
 
Evaluation and Management
Documentation and Reporting for Evaluation and Management (HLEM-0001)
Screening Services with Related Evaluation and Management Services (HLEM-0002)
Standby Services (HLEM-0003)
 
Laboratory
Laboratory Venipuncture (HLLP-0001)
 
Radiology
Intensity Modulated Radiation Therapy Planning and Delivery (HLRP-0001)
Multiple Diagnostic Cardiovascular Procedures (HLRP-0004)
Multiple Diagnostic Imaging Procedures (HLRP-0003)
Multiple Diagnostic Ophthalmology Procedures (HLRP-0005)
Three-Dimensional (3D) Radiology Services (HLRP-0002)
 
Surgery
Global Surgery (HLSP-0002)
Maternity Services (HLSP-0004)
Multiple and Bilateral Surgery Processing (HLSP-0001)
Multiple Delivery Services (HLSP-0003)
Overhead Expenses for Office Based Surgery and Diagnostic Testing (HLSP-0005)
 
Transportation
Ambulance Transportation (HLTP-0001)