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.

Advanced Laboratory Testing
Advanced Practice Providers
Age and Gender/Sex Based Codes
Anatomic Modifiers
Anesthesia Policy
Applied Behavior Analysis (ABA)
Assistant-at-Surgery: Modifiers 80, 81, 82 or AS
Bilateral Procedures
Diagnosis Coding Guidelines
Discontinued Procedures: Modifiers 73 and 74
Durable Medical Equipment Capped Rental Items
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)
Evaluation and Management (E/M) Services, Professional
Gap Fill Fee Schedule
Global Surgical Services
Increased Procedures: Modifier 22
Infants less than 4kg: Modifier 63
Injections and Infusions, Professional
Inpatient Reimbursement Guidelines, Facility
Laboratory Services, Professional
Multiple Procedures: Modifier 51
National Drug Codes
National Provider Identifier
NCCI and MUE Edits
Non-Payment of Preventable Adverse Events (PAE)
Non-Reimbursable Codes
Observation
Obstetrical Services
Once in a Lifetime Procedures and Services
Priority Partners (PPMCO) Ambulance and Medical Transportation Services
Priority Partners (PPMCO) Obstetrical Services
Priority Partners (PPMCO) Psychological Testing and Evaluation Services
Priority Partners (PPMCO) Telemedicine and Telehealth Services
Professional and Technical Components
Psychotherapy Services Billed with Evaluation and Management Codes Reduced Procedures: Modifier 52
Routine Venipuncture and/or Collection of Specimens, Professional
Scope of Practice
Split-Care Procedures
Staged, Related, & Unrelated Procedures: Modifiers 58, 78 and 79
Supply Codes Professional
Telemedicine Procedures
Therapy Modifiers- Rehabilitative and Habilitative Care (PT, OT, ST, SLP)
Two Surgeons/Co-Surgeons (Modifier 62)
Unlisted Codes

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