Code Coverage Analysis
Coverage by code.
Across every payer that matters.
CPT and HCPCS code coverage by payer, with the criteria, prior authorization requirements, and geographic distribution that determine whether a procedure gets paid. Bring your code set and Polify maps the coverage landscape.
Code types covered
Three code systems. One coverage intelligence layer.
CPT codes
Current Procedural Terminology codes govern how procedures are billed and how payers adjudicate claims. Coverage policy for a CPT code determines whether a procedure is covered, under what criteria, and whether prior authorization is required.
CPT 33274: Transcatheter permanent leadless pacemaker implantation
HCPCS Level II codes
Healthcare Common Procedure Coding System codes cover medical devices, supplies, and services not captured by CPT. HCPCS coverage policy is particularly relevant for durable medical equipment, prosthetics, orthotics, and supplies.
HCPCS E0601: Continuous positive airway pressure device
ICD-10 diagnosis codes
Coverage policy often specifies which diagnosis codes qualify a patient for a covered procedure. Polify maps the diagnosis codes that payers require alongside the procedure codes they govern.
ICD-10 I50.9: Heart failure, unspecified, as qualifying diagnosis for remote monitoring
What code coverage analysis looks like
Bring your codes. Get the coverage picture.
Import a code set from your EHR, billing system, or a manual list. Polify maps each code to the payer policies that govern it and returns a coverage position for every payer in your target market.
For health systems using SNOMED CT, Polify maps clinical terms to procedure codes automatically, so your clinical documentation workflows connect directly to payer coverage intelligence without a separate translation step.
See SNOMED mapping for health systemsCPT 27447
Total knee arthroplasty
Covered with criteria
8 payers
CPT 33361
TAVR, native aortic valve
Covered with criteria
8 payers
CPT 95251
Ambulatory glucose monitoring
Covered, varies by payer
6 payers
HCPCS E2101
Insulin infusion pump
Covered with criteria
5 payers
CPT 0580T
Transcatheter mitral valve repair
Investigational, some payers
4 payers
What a code coverage analysis includes
More than a coverage position. The full picture.
Coverage position by payer
For each code in your set, Polify shows the current coverage position across all major commercial payers, Medicare Administrative Contractors, and Medicaid managed care organizations.
Coverage criteria and conditions
Where coverage exists, Polify surfaces the exact criteria: patient selection requirements, documentation thresholds, step therapy conditions, and any diagnosis code restrictions.
Prior authorization requirements
Which payers require prior authorization for each code, what the PA criteria are, and which review organizations manage the PA process for each payer.
Geographic coverage distribution
For Medicare, coverage varies by MAC jurisdiction. Polify maps which MACs have issued LCDs for your codes and what those LCDs require.
Policy version history
How coverage for each code has changed over time. When criteria were tightened or loosened, when PA requirements were added or removed, and what the trend suggests.
SNOMED mapping for health systems
For health systems using SNOMED CT in clinical documentation, Polify maps SNOMED clinical terms to the CPT and HCPCS codes that govern payer coverage, connecting clinical workflows to policy intelligence.
Start with your code set.
Import CPT codes, HCPCS codes, or SNOMED terms. Polify maps the coverage landscape across your payer mix and returns the criteria, PA requirements, and geographic distribution for each code.