CommercialReimbursementHigh impact
Reimbursement Policies
EmblemHealth·General Surgery, Orthopedics, Ophthalmology +3 more·Provider News
Effective date
Apr 1, 2024
We identified it
Jun 20, 2026
Summary
Starting April 1, 2024, EmblemHealth and ConnectiCare updated their ASC Grouper 2024 reimbursement policy for ambulatory surgical centers. Claims will be paid at surgical contracted rates when billed with revenue codes 360 or 490, or when other revenue codes include anesthesia/recovery room charges unless otherwise negotiated.
Action Required
Effective April 1, 2024: Billing team must ensure all ambulatory surgical center claims are billed with revenue codes 360 or 490 to receive surgical contracted rates. If using other revenue codes, verify that anesthesia and/or recovery room charges are included to maintain surgical rate reimbursement. Update billing system rules and train staff on proper ASC revenue code selection for EmblemHealth and ConnectiCare claims.