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Archived Payment Reimbursement Policies (PRP)

Attention - Physicians Health Plan (PHP) is now University of Michigan Health Plan (UM Health Plan). Documents published before this change may still have references to the PHP brand.
Archived

Archived PHP Payment Reimbursement Policies (PRP)

340B Drug and Biological Discount Program (Modifiers JG and TB)

(

PRP-20

)
Effective Date:
6/22/2021

Advanced Practice Providers and Mid-Level Practitioners

(

PRP-09

)
Effective Date:
5/18/2021

Advanced Practice Providers and Mid-Level Practitioners

(

PRP-09

)
Effective Date:
5/18/2021

Advanced Practice Providers and Mid-Level Practitioners

(

PRP-09

)
Effective Date:
7/2/2020

Advanced Practice Providers and Mid-Level Practitioners

(

PRP-09

)
Effective Date:
7/2/2020

Advanced Practice Providers and Mid-Level Practitioners

(

PRP-09

)
Effective Date:
6/1/2019

Advanced Practice Providers and Mid-Level Practitioners

(

PRP-09

)
Effective Date:
6/1/2019

Behavioral Health Facility Services

(

PRP-21

)
Effective Date:
12/28/2022

Behavioral Health Facility Services

(

PRP-21

)
Effective Date:
2/17/2022

Bilateral and Multiple Procedures

(

PRP-16

)
Effective Date:
8/1/2023

Bilateral and Multiple Procedures

(

PRP-16

)
Effective Date:
7/27/2022

Bilateral and Multiple Procedures

(

PRP-16

)
Effective Date:
8/27/2021

Bilateral and Multiple Procedures

(

PRP-16

)
Effective Date:
3/22/2021

Bilateral and Multiple Procedures

(

PRP-16

)
Effective Date:
2/1/2020

COVID-19 Testing and Treatment

(

PRP-17

)
Effective Date:
4/19/2023

COVID-19 Testing and Treatment

(

PRP-17

)
Effective Date:
4/19/2023

COVID-19 Testing and Treatment

(

PRP-17

)
Effective Date:
2/28/2023

COVID-19 Testing and Treatment

(

PRP-17

)
Effective Date:
7/27/2022

COVID-19 Testing and Treatment

(

PRP-17

)
Effective Date:
10/26/2021

Drug Testing in Pain Management and Substance Use Disorders Treatment

(

PRP-02

)
Effective Date:
4/14/2023

Drug Testing in Pain Management and Substance Use Disorders Treatment

(

PRP-02

)
Effective Date:
10/25/2021

Drugs and Biologicals

(

PRP-11

)
Effective Date:
3/27/2023

Drugs and Biologicals

(

PRP-11

)
Effective Date:
4/15/2022

Drugs and Biologicals

(

PRP-11

)
Effective Date:
5/19/2021

Drugs and Biologicals

(

PRP-11

)
Effective Date:
7/2/2020

Drugs and Biologicals

(

PRP-11

)
Effective Date:
8/22/2019

Evaluation and Management Services

(

PRP-18

)
Effective Date:
1/1/2023

Evaluation and Management Services

(

PRP-18

)
Effective Date:
3/2/2022

Evaluation and Management Services

(

PRP-18

)
Effective Date:
1/28/2021

Hearing Aids and Services

(

PRP-10

)
Effective Date:
12/1/2020

Hearing Aids and Services

(

PRP-10

)
Effective Date:
8/22/2019

Hospice Services

(

PRP-04

)
Effective Date:
4/14/2023

Hospice Services

(

PRP-04

)
Effective Date:
12/6/2022

Hospice Services

(

PRP-04

)
Effective Date:
8/31/2021

Hospice Services

(

PRP-04

)
Effective Date:
10/1/2020

Hospice Services

(

PRP-04

)
Effective Date:
1/1/2019

Inpatient Rehabilitation

(

PRP-14

)
Effective Date:
1/28/2021

Inpatient Rehabilitation (IPR) Facility Services

(

PRP-14

)
Effective Date:
12/6/2022

Inpatient Rehabilitation (IPR) Facility Services

(

PRP-14

)
Effective Date:
8/31/2021

Medical Record Request Standard

(

PRP-05

)
Effective Date:
12/6/2022

Medical Record Request Standard

(

PRP-05

)
Effective Date:
12/7/2021

Observation Care Facility Charges

(

PRP-01

)
Effective Date:
12/6/2022

Observation Care Facility Charges

(

PRP-01

)
Effective Date:
1/12/2022

Observation Care Facility Charges

(

PRP-01

)
Effective Date:
9/3/2019

Observation Care Facility Charges

(

PRP-01

)
Effective Date:
1/1/2019

Oral Sleep Apnea Device

(

PRP-13

)
Effective Date:
10/11/2019

Oral Sleep Apnea Device E0485 E0486

(

PRP-13

)
Effective Date:
4/1/2022

Oral Sleep Apnea Device E0485 E0486

(

PRP-13

)
Effective Date:
7/8/2021

Oral Sleep Apnea Device E0485 E0486

(

PRP-13

)
Effective Date:
8/12/2020

Professional Laboratory Services

(

PRP-19

)
Effective Date:
4/14/2023

Professional Laboratory Services

(

PRP-19

)
Effective Date:
12/6/2022

Professional Laboratory Services

(

PRP-19

)
Effective Date:
12/17/2021

Professional Laboratory Services

(

PRP-19

)
Effective Date:
2/15/2021

Spravato Nasal Spray Esketamine

(

PRP-20

)
Effective Date:
12/6/2022

Sub-Acute Rehabilitation

(

PRP-12

)
Effective Date:
1/28/2021

Sub-Acute Rehabilitation (SAR) Skilled Nursing Facility (SNF) Charges

(

PRP-12

)
Effective Date:
8/31/2021

Telemedicine Services

(

PRP-15

)
Effective Date:
3/27/2023

Telemedicine Services

(

PRP-15

)
Effective Date:
2/16/2022

Telemedicine Services

(

PRP-15

)
Effective Date:
10/25/2021

Telemedicine Services

(

PRP-15

)
Effective Date:
2/15/2021

Telemedicine Services

(

PRP-15

)
Effective Date:
4/15/2020

Unlisted CPT-HCPCS Codes

(

PRP-03

)
Effective Date:
10/16/2023

Unlisted CPT-HCPCS Codes

(

PRP-03

)
Effective Date:
12/6/2022

Unlisted CPT-HCPCS Codes

(

PRP-03

)
Effective Date:
10/26/2021

Unlisted CPT-HCPCS Codes

(

PRP-03

)
Effective Date:
1/1/2020

Unlisted CPT-HCPCS Codes

(

PRP-03

)
Effective Date:
1/1/2019

Unspecified Diagnosis Codes

(

PRP-06

)
Effective Date:
12/28/2022

Unspecified Diagnosis Codes

(

PRP-06

)
Effective Date:
2/17/2022

Unspecified Diagnosis Codes

(

PRP-06

)
Effective Date:
4/16/2021

Unspecified Diagnosis Codes

(

PRP-06

)
Effective Date:
7/2/2020
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