CommercialReimbursementMedium impact
Reimbursement Policy Updates
EmblemHealth·Provider News
Effective date
Oct 1, 2022
We identified it
Jun 20, 2026
Summary
EmblemHealth and ConnectiCare updated reimbursement policies for hospital treatment room services, requiring specific identifiable procedures unrelated to inpatient/outpatient global periods. The policies also updated ASC grouper requirements for revenue codes 360/490 and expanded experimental/investigational service definitions.
Action Required
By October 1, 2022: Billing team must ensure treatment room services are only billed when specific identifiable procedures are performed outside global periods. Use revenue codes 360 or 490 for ambulatory surgical services to receive surgical contracted rates. Stop billing treatment room services for laboratory, radiology, or diagnostic tests only. Review claims for experimental/investigational services under updated definitions.