There are a number of procedure codes that do not apply to Mountain State’s commercial products.  These codes are typically, but not always, developed by the Centers for Medicare & Medicaid Services (CMS) for the Medicare Part B program.  Often, the terminology for these codes is specific to a Medicare demonstration project or is limited to the Medicare Program in some fashion.

Unless otherwise specified, these codes are not covered by Mountain State under its commercial products and should not be billed to our members.  A participating, preferred, or network provider cannot bill the member for these non-covered services.

This medical policy may not apply to FEP.  Medical policy is not an authorization, certification, explanation of benefits or a contract.  Benefits are determined by the Federal Employee Program.