CommercialReimbursementMedium impact
Reimbursement Policy Updates
EmblemHealth·Cardiology, Ophthalmology, General Surgery·Provider News
Effective date
Oct 1, 2023
We identified it
Jun 20, 2026
Summary
EmblemHealth and ConnectiCare have formalized their Multiple Procedure Payment Reduction policy for Cardiology/Ophthalmology and updated ASC Grouper payment rules for ambulatory surgical services. Multiple Laboratory Benefit Management policies have also been revised with new testing guidelines.
Action Required
Immediately: Review and implement the updated Laboratory Benefit Management policies for affected testing services. Billing team must ensure ambulatory surgical services are billed with revenue codes 360 or 490 to receive surgical contracted rates. Review the revision histories for all updated Coding Edits and Preventive Services Lists policies to identify specific changes affecting your practice.