Reimbursement Guidelines

We have guidelines available to help you with reimbursement for the following services:

Adolescent Well Care
Annual Preventive Exams for Medicare Patients
Contraception
Childhood Immunizations (Ages 0–18)
Developmental Screenings
Immunizations
Preventive Care Services
SBIRT Services
Telemedicine Services, Telehealth and E-visits
**View temporary expanded guidelines to telemedicine services related to COVID-19
Tobacco Cessation

Usual & Customary Reimbursement Guidelines

For contracted providers without a written contract and non-contracted providers: payment is based on the reasonable and customary value for the health care service rendered based upon statistically credible information that is updated at least annually and takes into consideration: (i) the provider’s training, qualifications; (ii) the nature of the services provided; (iii) the fees usually charged by the provider; (iv) prevailing provider rates charged in the general geographic area in which the services were rendered; (v) other aspects of the economics of the medical provider’s practice that are relevant.