When claims submitted on the CMS-1500 claim form or through the 837P transaction are processed by AmeriHealth, various edits are used to appropriately adjudicate claims. One such edit is procedure code combinations. Based on code terminology and/or guidelines from the applicable governing entity*, some codes represent a combination of two or more ?components.? These components may also be represented by individual codes. If component codes are reported separately, they may be combined into the combination or ?total? procedure code.

The list of the procedure codes with applicable component codes has been updated and can be downloaded from the Clinical Relationship Logic (Code-to-Code Edits) page in the Claims and Billing section of the AmeriHealth New Jersey and AmeriHealth Pennsylvania websites.

*Procedure codes may be governed by the American Medical Association or the Centers for Medicare & Medicaid Services.