PROVIDER
UPDATE
VOLUME 8, NUMBER 4
AUGUST 1991
Recipient Eligibility Verification System
We would like to encourage providers to use our new
computerized Recipient Eligibility Verification System.
To access the system, providers must telephone (800)
776-6323 and have their seven-digit Provider I.D. number, as well as the
appropriate thirteen-digit recipient number and date of service, available.
Procedural instructions will be given via voice response prompt messages.
Those providers who are familiar with the procedures for entering
information need not wait for the voice response prompt messages; instead, they
may begin entering information as soon as they have accessed the system.
To discontinue the service, providers must press *9
on their touch-tone telephones. Otherwise,
the service will be continued for another 90 seconds, even if the provider has
already hung up the telephone.
Recipient Telephone Inquiries
The Provider Relations telephone unit is setup to receive
telephone inquiries from providers, not recipients. We do not have access to any information that could benefit
recipients. Therefore, we ask that
providers not issue our telephone number to their Medicaid patients.
Recipient inquiries tie up our lines disproportionately so that we are
unable to process provider inquiries in an efficient and timely manner.
If recipients have problems with eligibility, it is
appropriate to refer them to their eligibility worker at the parish office.
If providers have difficulties with filing claims, they should call
Provider Relations for assistance.
Claims Processing Reminder
To allow up to process provider's claims more efficiently,
we would like to request that providers "burst" pin-feed claims before
they mail them to Unisys. In
addition, we request that providers remove all side tabs from their claims.
If the tabs are perforated, they should be torn off.
If the tabs are not perforated, they should be cut off.
If the tabs are not removed of if the claims are not burst, we will
return the claims before they can be processed.
Using the RA to Reconcile Accounts
Some providers call Provider Relations frequently to ask
questions that could be answered if they reviewed the RAs more carefully.
Thus, we would like to encourage providers to call Provider Relations
only to obtain assistance with billing and eligibility problems.
If a provider loses his RA, he may purchase another copy.
Correspondence Research Problem
Frequently, we receive a copy of a claim or claims without
the applicable supporting documentation, e.g., copies of RAs or previous
correspondence. In addition, we
receive RAs with not claims, invoices with no claims or explanations attached,
operative reports with no claims attached, and EOB crossovers and collection
notices without explanations attached. However,
all such correspondence cannot be processed unless we receive the supporting
documentation. In addition, all
such documentation must be attached directly behind the claim or other document
to which it pertains.
Provider/Recipient Review by SURS
To avoid excessive payments and to assess the quality of
services being provided, current federal regulations require that the state
Medicaid agency maintain a statewide surveillance and utilization control
program to safeguard against unnecessary and inappropriate use of Medicaid
services. In addition such a
program must include a postpayment review process utilizing recipient profiles,
provider profiles, and exceptions criteria.
The fiscal intermediary's computer system generates profile
reports on providers and recipient which can identify potential fraud and abuse
situations. A profile report is a
computer-generated document which is produced from data gathered in the state's
claims payment operation. Participants
are classified into peer groups according to geographic location, medical
specialties, or categories of assistance:
A statistical profile of each peer
group classification to be used as a baseline for evaluation is developed.
A statistical profile of each
individual participant, which is compatible with the peer group profile, is
developed.
Each individual participant
profile is evaluated against its appropriate group profile.
All individual participants who
deviate significantly from their group norm are reported as exceptional and
flagged for analysis.
To determine the cause of exceptions, each exceptional
profile is subject to review and analysis by trained staff assisted by medical
consultants. The analysis may
include a review of the provider's paid claims, a review of the provider's reply
to the agency's written request for information, a review of hospital charts and
patient records obtained in field reviews, and a review of other relevant
documents. The review is not
necessarily limited to exceptional areas identified on the profile report.
Access to Providers' Records
All providers who bill and receive payment from Medicaid of
Louisiana must maintain medical records as are necessary to document and support
the delivery of services rendered to recipients.
Records which may be requested include patient office charts, billing
statements and/or ledger cards, laboratory test results, hospital charts
(inpatient, outpatient, and emergency room), doctors' and nurses' notes,
operative reports, and any other pertinent medical and/or billing information.
Providers must also maintain information regarding payments claimed for
services rendered. Records must be
retained for a period of three years, and they must be furnished upon request to
the Office of Family Support, its authorized representatives, representatives of
the Department of Health and Human Services, or the State Attorney General's
Medicaid Fraud Control Unit.
Foster Care Children in State-Funded Programs
Foster care children in state-funded programs are not
eligible for the unlimited office and/or hospital visits available to other
recipients under the age of 21. These
foster care children have a 1 and a 5 as third and fourth digits of their
Medicaid I.D. numbers, e.g., XX15XXXXXXXXX.
Medicaid Determination of Infants
Effective October 1, 1991, the BHSF will implement
procedures to ease the process of acquiring a Medicaid identification number for
those eligible infants born to a mother who is eligible for and who is receiving
Medicaid on the child's date of birth. Providers should refer to the Attachments section for an explanation of these procedures.
EMC Submitters
The Backslash Character
As of August 2, 1991, any use of a backslash character will
result in the rejection of the entire submission from processing.
Providers should contact their submitters or the Unisys EMC department
for further details or for answers to any questions they may have.
Physicians and CRNAs
Maternity-Related Anesthesia Policy Revisions and Fee Increases
The Bureau of Health Services Financing is pleased to
announce an increases in fees and revisions to policy for maternity-related
anesthesia effective with date of service April 19, 1991.
This increase and the revisions apply only to OB-related
anesthesia procedures. The rules
and regulations currently in effect for surgery-related anesthesia procedures
remain the same.
Concurrence rules and regulations apply only to
surgery-related anesthesia procedures. In
other words, effective with date of service April 19, 1991, concurrence is not
to be considered in OB-related anesthesia cases, nor are maternity-related
anesthesia procedures to be included in determining concurrence in
surgery-related anesthesia procedures.
The anesthesia modifiers listed in the following column
should be used in billing for both vaginal and Cesarean delivery anesthesia:
AA - Anesthesiologist who provides anesthesia for the total
service
AI - Non-anesthesiologist-directed CRNA who provides anesthesia for the total
service
AE - Anesthesiologist who introduces and manages the anesthesia service
24 - Delivering physician who introduces and manages the anesthesia service
25 - Anesthesiologist or CRNA who monitors the client through delivery
The correct modifier must be used when billing in order for
correct reimbursement to be made. Modifiers
AB, AC, AD, and AH should no longer be used for either vaginal or Cesarean
delivery. Claims must be billed
without minutes except for claims for general anesthesia for vaginal delivery.
Modifier 47 should not be used with CPT-4 codes 59410 or 59515.
Vaginal Delivery
Flat fees will continue to be paid for epidurals (CPT-4
code 62279) and saddleblocks (CPT-4 codes 62276 and 62278) anesthesia for
vaginal delivery. However, general
anesthesia for vaginal delivery will be reimbursed according to base and time
units.
The appropriate ICD-9-CM diagnosis code within the range of
650-659 must be used when billing for vaginal delivery.
The fees for epidural anesthesia for vaginal delivery are listed as
follows:
1.
$341.00 for the total anesthetic service, payable to the
anesthesiologist, the non-anesthesiologist-directed CRNA, or the delivering
physician. This professional, who
will bill code 62279 with modifier AA if he is the anesthesiologist, modifier AI
if he is the non-anesthesiologist-directed CRNA, or no modifier if he is the
delivering physician, should provide for the client's anesthetic needs from
introduction of the anesthesia through delivery.
2.
$188.00 for introduction and management of the epidural, payable to the
anesthesiologist or to the delivering physician.
Only one professional will be paid for this service.
The delivering physician should bill code 62279 with modifier 24 and the
anesthesiologist should bill code 62279 with modifier AE.
3.
$153.00 for monitoring the patient through delivery, after introduction
of the epidural catheter by the delivering physician or the anesthesiologist,
payable to either the anesthesiologist or the CRNA.
The professional should bill code 62279 with modifier 25 for this
service.
The fee for saddleblocks (CPT-4 codes 62276 and 62278)
should remain $75.00 for the AA, the AI, or the delivering physician.
The AB, AC, AD, and AH modifiers for codes 62276 and 62278 have been
placed in non-pay status effective with date of service April 19, 1991.
Cesarean Delivery
Flat fees for anesthesia for Cesarean delivery will
continue to be paid regardless of the type, or combination of types, of
anesthesia given.
The anesthesia modifiers listed on the preceding page
should be used for Cesarean delivery.
The fees for anesthesia for Cesarean delivery are listed as
follows:
1.
$425.00 for the total anesthetic service, payable to the anesthesiologist
or the non-anesthesiologist-directed CRNA.
This provider, who will bill CPT-4 code 59515 with either modifier AA or
AI, should supply the client's total anesthetic needs from introduction through
delivery.
2.
$227.00 for the introduction and management of the anesthesia service,
payable to either the anesthesiologist or to the delivering physician.
The anesthesiologist should bill CPT-4 code 59515 with modifier AE, and
the delivering physician should bill code 59515 with modifier 24.
3.
$198.00 for monitoring the patient through delivery, after the anesthesia
service has been introduced by the anesthesiologist or delivering physician,
payable to either the anesthesiologist or the CRNA.
CPT-4 code 59515 with modifier 25 should be billed by the provider for
this service.
Procedure code 62279 is not to be billed for Cesarean
delivery anesthesia. The anesthesia
fees listed in this section include the professional's fee for the tubal
ligation performed at the same surgical session as the delivery.
This revision makes obsolete the maternity-related
anesthesia policy printed on pages 3-4 through 3-6 of the October 1990 Provider
Update effective with date of service April 19, 1991.
Providers may void claims paid under the obsolete
guidelines and refile with the modifiers previously listed retroactive to date
of service April 19, 1991. Under no
circumstances are adjustments to be submitted for adjudication.
If questions arise about this new policy, providers should
contact Kandis V. McDaniel, Physician's Program Manager, at (504)
342-9490 or Sandra Victor, Medical Assistance Policy Consultant, at (504)
342-9319.
Physicians
Change in Reimbursement for Coronary Artery Procedures
The Bureau of Health Services Financing will update the
fees for CPT-4 procedure codes 33512, 33513, 33514, and 33516 to those listed
below effective with date of service August 1, 1991:
33512
Coronary artery bypass, autogenous graft, e.g., saphenous vein or
internal mammary artery, three coronary grafts $3,253.00.
33513
Four coronary grafts $3,344.00
33514
Five coronary grafts $3,380.00
33516
Six or more coronary grafts $3,389.00
Surgical Care Billing
Many physicians continue to "split" or to bill
incorrectly the surgical care package, even though a thorough explanation of
services covered by this package is found in the Professional Services Provider Manual on page 4-3a.
Thus, providers should review this information and the clarification of
revised policy, effective January 1, 1989, which is provided below:
The surgical care package consists of routine pre-and
postoperative daily care hospitals visits and postoperative visits.
These visits are included in the surgeon's fee.
Office visits that occur after the surgery that are billed under the same
diagnostic code will be considered as postoperative care.
As such, these visits will be considered as part of the surgical care
package.
The postoperative period for follow-up visits is based on
the same number of days used by Medicare in 1986. For more resent CPT-4 codes, the fiscal intermediary will use
a comparable surgical code to determine the follow-up period.
Procedures identified with an asterisk (*) in the Surgery
Procedures list of the CPT-4 Manual
include certain small surgical services which are not covered by the surgical
care "package" concept because of the indefinite pre- and
postoperative services. For an
explanation of billing for these services, providers should refer to pages 67
and 73 or the 1988 and 1989 CPT-4 Manual
respectively.
Non-starred procedures billed in conjunction with
postoperative office visits or pre- and postoperative hospital visits will be
subject to postpayment review and subsequent recoupment.
Critical Care Code 99160
Effective with the 1991 CPT-4
Manual, the definition of Critical Care (99160) was expanded to include a
number of codes previously billed separately to Medicaid when billing 99160.
Thus, providers should no longer bill any of the procedures currently
listed in the definition when billing critical care.
State staff will be working with a committee to determine a solution to
adequate reimbursement for this code.
Revised 1991 CPT-4 Codes
The 1991 CPT-4 codes have been priced and placed on the
procedure/formulary file effective with date of service June 1, 1991.
Please refer to the list of codes, descriptions, fees, and anesthesia
base unit information provided in the Attachments
section of this issue of the Provider
Update.
Payment for Specimen Collection Discontinued
Effective July 1, 1983, Medicaid of Louisiana discontinued
payment to physicians for the collection, handling, and/or conveyance of
specimens to the laboratory. The
only exception to this policy is procedure 99004 (Collection of eye culture
specimens), which continues to be payable.
Previous RA messages and newsletter articles instructing providers to
bill for the actual collection of a specimen via venipuncture pertained only to hospitals
and independent laboratories, NOT physicians. Physicians may not
bill for routine specimen collection under procedure codes 36400, 36410, or
36415.
Dentists
Adult Dental Enrollment
Medicaid of Louisiana requests that dentists who wish to
participate only in the Adult Dental Program notify the BHSF Provider Enrollment
Unit so that their name does not appear on any listing of dentists who wish to
participate in the EPSDT/KID-MED Dental Program.
Rehabilitation Providers
Physical Therapy Documentation
Medicaid of Louisiana would like to remind providers to
attach the M.D. prescription and initial evaluation on all initial PA01 and PA02
extensions, providers must remember to attach the Summary and/or Progress notes
to warrant an extension visit. If
all of the pertinent blocks on these forms are not completed and if all of the
pertinent information is not attached, we will not be able to process the
requests.
DME and Rehabilitation Providers
Reconsideration of a Denied Prior Authorization Request
When submitting Prior Authorization request for
reconsideration, providers should follow the procedures listing on the following
page:
1.
Send a copy of the denial letter.
2.
Write "Reconsideration: across the top of the letter.
3.
Write a brief explanation of the reasons for the request at the bottom of
the letter.
4.
Send all documentation that was submitted with the original P.A. request
and any additional information that would support medical necessity.
Following these procedures will expedite Requests for
Reconsideration. Any letters
received without documentation will be returned to the provider.
Additional PA01 Instructions
To help us process PA01s in a more efficient and timely
manner, providers should follow the instructions listed below when they complete
their PA01 forms:
1.
In the Description of Services
section providers should include a complete description of the required
equipment. If specialized or
customized equipment is requested, providers should describe each special
feature or attachment. If medical
supplies are requested, providers should give the brand name, stock number,
number per package, cost per package, and number used per month.
The description and cost of each supply should be for monthly amounts.
2.
Miscellaneous DME procedure codes, e.g., E1399, should be used only when
a more specific code cannot be found to adequately identify a requested item.
When such a miscellaneous code is used, providers should state that the
item is a special item not classified elsewhere by another procedure code in the
Description section of the PA01 form.
3.
Durable Medical Equipment should not be released to the client before
approval is obtained from the Prior Authorization Unit.
If emergency needs exist, the request should be called in to Prior
Authorization, and verbal approval should be obtained by phone before the
equipment is released. Requests,
however, will be accepted as an emergency request by Prior Authorization only
when a delay would prove life threatening to the recipient.
Long Term Care Providers
Billing Reminders
When changing a level of care on the preprinted TAD,
providers must use Action Code C. In
addition, the Adm. Code must be changed to a 6, and a copy of the 51 NH must
always be attached.
When rebilling for a claim that has been denied where the
recipient is on the preprinted TAD, providers must use Action Code A.
Action Code C cannot be used to rebill for a denied claim.
Health Standards
Nurse Aide Training and Certification
The following Training Schools have been approved for Nurse
Aide Training and Certification:
Advanced Training Designs, Inc.
2335 Woodvale Dr.
Baton Rouge, LA 70819
Holistic School of Vocational Technical Training
223 Paul Maillard Rd.
P. O. Box 170
Luling, LA 70070
Louisiana Medicaid Program Reimbursement Procedures
1990 CPT-4 Procedure Code Additions
|
|
|
|
TYPE
OF SERVICE
|
|
|
CODE
|
DESCRIPTION
|
ANESTHESIA
BASE UNITS
|
ASSIST.
SURGERY
|
TOTAL
COMPONENT
|
PROF.
COMPONENT
|
|
17106
|
Destruction
of cutaneous vascular proliferative lesions
|
|
|
80.00
|
|
|
17107
|
Destruction
of cutaneous vascular proliferative lesions
|
|
|
100.00
|
|
|
17108
|
Destruction
of cutaneous vascular proliferative lesions
|
|
|
120.00
|
|
|
20692
|
Application
of multiplane
|
|
|
450.00
|
|
|
20693
|
Adjustment
or revision of external fixation system
|
03
|
|
300.00
|
|
|
20694
|
Removal,
under anesthesia, of external fixation system
|
03
|
|
70.00
|
|
|
21015
|
Radical
resection of tumor, e.g., malignant neoplasm
|
05
|
118.00
|
590.00
|
|
|
21029
|
Removal
by contouring of benign tumor of facial bone
|
07
|
35.00
|
175.00
|
|
|
21079
|
Impression
and custom preparation; interim obturator pr
|
|
|
1470.00
|
|
|
21080
|
Impression
and custom preparation; def obturator prosthe
|
|
|
1680.00
|
|
|
21081
|
Impression
and custom preparation; mandibular resection
|
|
|
1680.00
|
|
|
21082
|
Impression
and custom preparation; pala augm prosth
|
|
|
1010.00
|
|
|
21083
|
Impression
and custom preparation; palatal lift prosthe
|
|
|
1010.00
|
|
|
21084
|
Impression
and custom preparation; speech aid prosthes
|
|
|
1260.00
|
|
|
21085
|
Impression
of custom preparation; oral surgical splint
|
|
|
210.00
|
|
|
21086
|
Impression
and custom preparation; auricular prosthesis
|
|
|
1260.00
|
|
|
21087
|
Impression
and custom preparation; nasal prosthesis
|
|
|
1260.00
|
|
|
21088
|
Impression
and custom preparation; facial prosthesis
|
|
|
1260.00
|
|
|
21120
|
Genioplasty;
augmentation (autograft, allograft, pros)
|
07
|
119.00
|
595.00
|
|
|
21121
|
Genioplasty,
sliding osteotomy, single piece
|
07
|
127.00
|
635.00
|
|
|
21122
|
Genioplasty;
sliding osteotomies, two or more osteotomi
|
07
|
165.00
|
825.00
|
|
|
21123
|
Genioplasty;
sliding, augmentation with interpositional
|
07
|
118.00
|
590.00
|
|
|
21125
|
Augmentation,
mandibular body or angle; prosthetic mate
|
07
|
95.00
|
475.00
|
|
|
21127
|
Augmentation,
mandibular body or angle; with bone graft
|
07
|
119.00
|
595.00
|
|
|
21137
|
Reduction
forehead; contouring only
|
07
|
43.00
|
215.00
|
|
|
21138
|
Reduction
forehead, contouring and application of pros
|
07
|
119.00
|
595.00
|
|
|
21139
|
Reduction
forehead; contouring and setback of anterior
|
07
|
130.00
|
650.00
|
|
|
21144
|
Reconstruction
midface, Lefort I, intrusion, single piece
|
07
|
130.00
|
650.00
|
|
|
21145
|
Reconstruction
midface, Lefort I; single piece, any direct
|
07
|
190.00
|
950.00
|
|
|
21146
|
Reconstruction
midface, Lefort I; two pieces, any direct
|
07
|
247.00
|
1235.00
|
|
|
21147
|
Reconstruction
midface, Lefort I; three or more pieces
|
07
|
266.00
|
1330.00
|
|
|
21150
|
Reconstruction
midface, Lefort II; anterior intrusion
|
07
|
190.00
|
950.00
|
|
|
21151
|
Reconstruction
midface, Lefort II; any direction
|
07
|
209.00
|
1045.00
|
|
|
21154
|
Reconstruction
midface, Lefort III (Extracranial), any
|
07
|
251.00
|
1254.00
|
|
|
21155
|
Reconstruction
midface, Lefort III (Extracranial), any
|
07
|
292.00
|
1460.00
|
|
|
21159
|
Reconstruction
midface, Lefort III (Extra and Intra)
|
07
|
220.00
|
1100.00
|
|
|
21160
|
Reconstruction
midface, Lefort III (Extra and Intra)
|
07
|
264.00
|
1320.00
|
|
|
21172
|
Reconstruction
superior-lateral orbital rim
|
07
|
220.00
|
1100.00
|
|
|
21175
|
Reconstruction,
bifrontal, superior-lateral orbital
|
07
|
264.00
|
1320.00
|
|
|
21179
|
Reconstruction,
entire or majority of forehead
|
07
|
140.00
|
700.00
|
|
|
21180
|
Reconstruction,
entire or majority of forehead
|
07
|
168.00
|
840.00
|
|
|
21181
|
Removal
by contouring of benign tumor or cranial bones
|
05
|
35.00
|
175.00
|
|
|
21182
|
Reconstruction
of orbital walls, rims, forehead
|
07
|
191.00
|
955.00
|
|
|
21183
|
Reconstruction
of orbital walls, rims, forehead
|
07
|
229.00
|
1145.00
|
|
|
21184
|
Reconstruction
of orbital walls, rims, forehead
|
07
|
268.00
|
1340.00
|
|
|
21188
|
Reconstruction
midface, osteotomies (other than Lefort)
|
07
|
191.00
|
955.00
|
|
|
21193
|
Reconstruction
of mandibular ramus, horizontal
|
05
|
106.00
|
530.00
|
|
|
21194
|
Reconstruction
of mandibular ramus, horizontal
|
05
|
126.00
|
630.00
|
|
|
21195
|
Reconstruction
of mandibular ramus, sagittal split
|
05
|
106.00
|
530.00
|
|
|
21196
|
Reconstruction
of mandibular ramus, sagittal split
|
05
|
116.00
|
580.00
|
|
|
21198
|
Osteomy,
mandible, segmental
|
05
|
53.00
|
265.00
|
|
|
21247
|
Reconstruction
of mandibular condyle with bone
|
07
|
102.00
|
510.00
|
|
|
21255
|
Reconstruction
of zygomatic arch and glenoid fossa
|
07
|
127.00
|
635.00
|
|
|
21256
|
Reconstruction
of orbit with osteotomies (extracranial)
|
07
|
191.00
|
955.00
|
|
|
29800
|
Arthroscopy,
temporormandibular joint, diagnostic
|
03
|
|
325.00
|
|
|
29804
|
Arthroscopy,
temporormandibular joint, surgical
|
03
|
71.00
|
355.00
|
|
|
31502
|
Tracheotomy
tube change prior to establishment of fistu
|
03
|
20.00
|
102.00
|
|
|
33530
|
Reoperation,
coronary artery bypass procedure, more
|
25
|
800.00
|
4000.00
|
|
|
43326
|
Esophagogastric
fundoplasty; with gastroplasty
|
08
|
160.00
|
800.00
|
|
|
49310
|
Laparoscopy,
surgical; cholecystectomy (any method)
|
08
|
119.00
|
594.00
|
|
|
43911
|
Laparoscopy,
surgical; cholecystectomy w/cholangiography
|
08
|
135.00
|
674.00
|
|
|
56441
|
Lysis
of labial adhesions
|
|
|
38.00
|
|
|
58996
|
Hysteroscopy;
with endometrial ablation (any method)
|
05
|
|
395.00
|
|
|
61556
|
Craniotomy
for craniosynostosis; frontal or parietal
|
09
|
160.00
|
800.00
|
|
|
61557
|
Craniotomy
for craniosynostosis; bifrontal bone flap
|
09
|
225.00
|
1125.00
|
|
|
61558
|
Extensive
craniectomy for multiple cranial suture
|
09
|
394.00
|
1970.00
|
|
|
61559
|
Extensive
craniectomy for multiple cranial suture
|
09
|
394.00
|
1970.00
|
|
|
61563
|
Excision,
intra and extracranial, benign tumor
|
09
|
264.00
|
1320.00
|
|
|
61564
|
Excision,
intra and extracranial, benign tumor
|
09
|
240.00
|
1200.00
|
|
|
62121
|
Craniotomy
with repair of encephalocele, skull base
|
09
|
211.00
|
1055.00
|
|
|
62146
|
Cranioplasty
with autograft; up to 5 cm diameter
|
09
|
182.00
|
910.00
|
|
|
62147
|
Cranioplasty
with autograft; larger than 5 cm diameter
|
09
|
214.00
|
1070.00
|
|
|
62287
|
Aspiration
procedure, percutaneous, or nucleus pulposus
|
07
|
196.00
|
980.00
|
|
|
63012
|
Laminectomy
with removal of abnormal facets and/or pars
|
07
|
251.00
|
1255.00
|
|
|
63690
|
Electronic
analysis of implanted neurostimulator pulse
|
|
|
250.00
|
|
|
63691
|
Electronic
analysis of implanted neurostimulator pulse
|
|
|
750.00
|
|
|
63741
|
Creation
of shunt, lumbar, subarachnoid-peritoneal
|
07
|
134.00
|
670.00
|
|
|
65755
|
Keratoplasty
(corneal transplant); penetrating
|
08
|
|
1410.00
|
|
|
65771
|
Radial
keratotomy
|
08
|
|
900.00
|
|
|
66180
|
Aqueous
shunt to extraocular reservoir
|
06
|
|
670.00
|
|
|
66185
|
Revision
to aqueous shunt to extraocular reservoir
|
06
|
|
450.00
|
|
|
66702
|
Ciliary
body destruction, any method
|
05
|
|
400.00
|
|
|
66852
|
Removal
of lens material; pars plana approach
|
08
|
|
823.00
|
|
|
67028
|
Intravitreal
injection of a pharmacologic agent
|
06
|
|
225.00
|
|
|
67039
|
Vitrectomy,
mechanical, pars plana approach
|
08
|
|
1400.00
|
|
|
67110
|
Repair
of retinal detachment, one or more sessions
|
08
|
|
825.00
|
|
|
67314
|
Strabismus
surgery, recession or resection procedure
|
05
|
|
575.00
|
|
|
67316
|
Strabismus
surgery, recession or resection procedure
|
05
|
|
625.00
|
|
|
67318
|
Strabismus
surgery, any procedure, superior oblique
|
05
|
|
575.00
|
|
|
67334
|
Strabismus
surgery by posterior fixation suture tech
|
05
|
|
625.00
|
|
|
67340
|
Strabismus
surgery involving exploration and/or repair
|
05
|
|
800.00
|
|
|
67343
|
Release
of extensive scar tissue without detaching
|
05
|
|
450.00
|
|
|
67875
|
Temporary
closure of eyelids by suture
|
05
|
|
250.00
|
|
|
72069
|
Radiologic
examination, spine, thoracolumbar, standing
|
|
|
52.00
|
21.00
|
|
73565
|
Radiologic
examination, knee; both knees, standing
|
|
|
42.00
|
17.00
|
|
74363
|
Percutaneous
transhepatic dilatation of biliary duct
|
|
|
440.00
|
176.00
|
|
77431
|
Radiation
therapy management with complete course
|
|
|
50.00
|
|
|
77781
|
Remote
afterloading high intensity brachytherapy
|
|
|
285.00
|
|
|
77782
|
Remote
afterloading high intensity brachytherapy
|
|
|
355.00
|
|
|
77783
|
Remote
afterloading high intensity brachytherapy
|
|
|
435.00
|
|
|
77784
|
Remote
afterloading high intensity brachytherapy
|
|
|
535.00
|
|
|
78190
|
Kinetics,
study of platelet survival, with or without
|
|
|
53.00
|
|
|
78596
|
Pulmonary
quantitative differential function
|
|
|
196.00
|
|
|
90989
|
Dialysis
training, patient, including helper
|
|
|
330.00
|
|
|
90993
|
Dialysis
training, patient, including helper
|
|
|
160.00
|
|
|
90995
|
End
stage renal disease (ESRD) related services
|
|
|
159.00
|
|
|
94642
|
Aerosol
inhalation of pentamidine for pneumocystis
|
|
|
7.00
|
|
|
95816
|
Electroencephalogram
(EEG) including recording
|
|
|
80.00
|
39.00
|
|
95817
|
Electroencephalogram
(EEG) including recording
|
|
|
99.00
|
47.00
|
|
95920
|
Intraoperative
neurophysiology testing, per hour
|
|
|
50.00
|
|
|
95961
|
Functional
cortical mapping by stimulation of electrode
|
|
|
340.00
|
|
|
95962
|
Functional
cortical mapping by stimulation of electrode
|
|
|
170.00
|
|
|
96913
|
Photochemotherapy
(Goeckerman and/or Puva)
|
|
|
25.00
|
|
To Be Manually Priced
21089 Unlimited
maxillofacial prosthetic procedure
21299 Unlisted
craniofacial and maxillofacial procedure
The Effective Date for the 1991 Code Additions is June 1, 1991.
TPL Supplementary Carrier Listing
Form 152-N Procedures - Medicaid
Determination of Infants
