Johns Hopkins Health Plans reimbursement policies are available for providers. Please see the list below for the most recent updates to our reimbursement policies.

If you have questions, please contact Provider Relations at (888) 895-4998.

Add-on Codes
Advanced Laboratory Testing
Age and Gender/Sex Based Codes
Assistant-at-Surgery: Modifiers 80, 81, 82 or AS
Bilateral Procedures
Devices, Implants and Skin Substitutes
Discontinued Procedures: Modifiers 73 and 74
Durable Medical Equipment Capped Rental Items
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)
EHP Applied Behavior Analysis
Evaluation and Management Services
Gap Fill Fee Schedule
Global Surgical Services
Laboratory Services
Multiple Procedures
National Drug Code Reporting Guidelines
NCCI and MUE Edits
Non-Payment of Preventable Adverse Events (PAE)
Non-Reimbursable Codes
Observation Care Services
Once in a Lifetime Procedures and Services
Preventive and Screening Services
Priority Partners (PPMCO) Ambulance and Medical Transportation Services
Priority Partners (PPMCO) Supplemental UB04 Billing Guide for Transportation Services
Priority Partners (PPMCO) Obstetrical Services
Priority Partners (PPMCO) Telemedicine and Telehealth Services
Priority Partners (PPMCO) Trauma Activation and Critical Care Services
Reduced Procedures: Modifier 52
Reimbursement Policy Reference Guide
Routine Venipuncture and/or Collection of Specimens
Scope of Practice
Telemedicine Procedures
Therapy Modifiers- Rehabilitative and Habilitative Care (PT, OT, ST, SLP)
Trauma Activation and Critical Care Services
Unlisted Codes
USFHP Applied Behavior Analysis
USFHP ESRD & Related Services

Please continue to check back. Policies are being added quarterly.