Payment Policy
This notice is to clarify a segment of WellCare's payment policy language applicable to all WellCare Medicaid markets. WellCare's payment policies are based on publicly distributed guidelines from established industry sources such as the Centers for Medicare and Medicaid Services (CMS), the American Medical Association (AMA), state health care agencies and medical specialty professional societies.
If you have questions about this information, please contact your Provider Relations representative.
- Emergency Department Facility Coding: CPP-105 (PDF)
- Optum CPI DRG Analytics: CPP-166 (PDF)
- Scanning Computerized Ophthalmic Diagnostic Imaging: CP.VP.14 (PDF)
- Extended Ophthalmoscopy: CP.VP.26 (PDF)
- Fluorescein Angiography: CP.VP.28 (PDF)
- Fundus Photography: CP.VP.29 (PDF)
- Gonioscopy: CP.VP.31 (PDF)
- External Ocular Photography: CP.VP.43 (PDF)
- Visual Field Testing: CP.VP.63 (PDF)
- Inpatient Readmissions: CPP-124 (PDF)
- Inpatient Notification: CPP-101 (PDF)
- 340B Drug Payment Reduction: CPP-150 (PDF)
- NICU Level of Care Authorization and Reimbursement Matching: CPP-163 (PDF)
- Ultrasound in Pregnancy: CP.MP.38 (PDF)
- Intensity Modulated Radiation Therapy (IMRT): CPP-108 (PDF)
- Maximum Units for Reimbursement: CPP-111 (PDF)
- Allergy Testing and Immunotherapy: CPP-112 (PDF)
- Renal Dialysis: CPP-114 (PDF)
- Procedure to Procedure Associated Modifiers: CPP-127 (PDF)
- Robotic Assisted Surgery: CPP-137 (PDF)
- E/M Overcoding Policy: CPP-143 (PDF)
- Appropriate Place of Service (POS) Billing: CPP-144 (PDF)
- Severe Malnutrition Policy: CPP-145 (PDF)
- Post Payment Review Policy: CPP-148 (PDF)
- Frequency of Comprehensive Ophthalmological Exams: CPP-151 (PDF)
- Pre-Payment Clinical Validations: CPP-152 (PDF)
- E/M Visits Bundled with Dipsticks Venipuncture Catheter Services: CPP-158 (PDF)
- Comprehensive Payment Integrity (CPI): CPP-160 (PDF)