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.

(RPC.025) Evaluation and Management (E/M) Services, Professional
(RPC.017) Bilateral Procedures
(PRC.001) Split-Care Procedures
(RPC.027) Injections and Infusions, Professional
(RPC.031) Two Surgeons/Co-Surgeons (Modifier 62)
(RPC.032) Anatomic Modifiers
Anesthesia Policy
Applied Behavior Analysis (ABA)
Assistant-at-Surgery: Modifiers 80, 81, 82 or AS
Discontinued Procedures: Modifiers 73 and 74
DME Rent-to-Own
Gap Fill Fee Schedule
Increased Procedures: Modifier 22
Infants less than 4kg: Modifier 63
Multiple Procedures: Modifier 51
NCCI and MUE Edits
Non-Payment of Preventable Adverse Events (PAE)
National Provider Identifier (NPI)
Non-Reimbursable Codes
Nurse Practitioner Reimbursement
Observation
Obstetric Ultrasound
Physician Assistant Reimbursement
Reduced Procedures: Modifier 52
Routine Venipuncture and/or Collection of Specimens, Professional
Scope of Practice
Staged, Related, & Unrelated Procedures: Modifiers 58, 78 and 79
Supply Codes Professional
Telemedicine Procedures
Therapy Modifiers
Unlisted Codes

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