Oscar Reimbursement & Payment Policies

Coin falling into a piggy bank

Overview

Below you'll find Oscar's reimbursement policies and guidelines for procedures and correcting coding guidance as well as all relevant updates to Ocsar's reimbursement policies and guidance.Disclaimer: Oscar follows select reimbursement guidelines as provided by, but not limited to, the Centers for Medicare and Medicaid Services, the American Medical Association, specialty organizations, and industry-standard practices. Oscar Reimbursement Policies serve only as reimbursement guidelines and may be superseded by government regulations, provider contracts, or a member’s specific coverage. Policies are not intended to address every reimbursement situation, issue, or question. These policies are not a guarantee of payment or an authorization of services. Oscar reserves the right to interpret and apply policies at our professional discretion.

Summary of Changes

Upcoming Policy Changes

  • Effective 9/1/2026
    • Add-On Codes (Ver. 2)
    • Implants, Devices, and Supplies (Ver. 2)
    • Multiple Surgeons (Ver. 2)
    • Never Events (Ver. 2)
    • Once Per Lifetime (Ver. 2)
  • Effective 10/1/2026
    • Claim Submission Requirements (Ver. 2)
    • Observation (Ver. 2)
    • Radiology (Ver. 2)
  • Effective 11/1/2026
    • Critical Care - Trauma Activation (Ver. 2)
    • Venipuncture (Ver. 2)

Current Policies

        • Place of Service
          • Professional Technical Component

            Laboratory Routine Test Management

            • Effective 10/1/2026
              • G2158 - Testing for Vector-Borne Infections
              • G2156 - Urine Culture Testing for Bacteria

            Archived Policies

            • text