Chiropractic Modalities
• Physical Medicine and Rehabilitation• CPT Code DescriptionThe application of a modality that does not require direct (one-on-one) patient contact by the provider is as follows:• 64550 Application of...
View ArticleTherapy and Acupuncture CPT code list
Therapeutic ProceduresPhysician or therapist required to have direct (one-on-one) patient contact. The therapeutic procedures, for one or more areas, each 15 minutes interval is as follows:• 97110...
View ArticleCPT code 10060 , 10061 With ICD code
Coverage Indications, Limitations, and/or Medical NecessityAn abscess is a cavity containing pus surrounded by inflamed tissue. It is generally associated with pain, swelling and erythema. An abscess...
View ArticleBilling Guidelines for Dialysis center
Dialysis CentersOutlined below are generally accepted billing guidelines. This is intended to be illustrative and is not an all-inclusive list.• Indicate “72X” type of bill. The third digit is based on...
View ArticleBILLING Guideline for home health - 0571, 0572 revenue codes
Home Health/Home Infusion AgenciesFlorida Blue defines home health care services as those services rendered to an individual in the home by health care professionals (e.g., nurses, therapists) or...
View ArticleBilling Multiple Infusion Therapies - Revenue code 0640, 0641, 0644
When billing home health services to Florida Blue, revenue codes and CPT/HCPCS should be reported using the most current publications. The matrix below indicates the commonly used the revenue codes to...
View ArticlePulmonary Function Tests CPT code Indication
PFTs measure two components of the respiratory system: the mechanical ability of the respiratory system to move air in and out of the lungs; and the effectiveness of the respiratory system in...
View ArticleLab CPT codes list which can be performed by CLIA certified providers
Providers with a CLIA certificate may conduct the following laboratory tests in their offices:Description Codes Description CodesUrinalysis 81000- 81003Crystal Identification 89060Glucose 82947-...
View ArticlePFT CPT 94010, 94750, 94250, 94200. 94060 AND 94010
CPT/HCPCS CodesGroup 1 Codes94010Breathing capacity test94060Evaluation of wheezing94070Evaluation of wheezing94150Vital capacity test94200Lung function test (MBC/MVV)94250Expired gas...
View ArticleInpatient Care in SNF - Revenue code 0191 - 0194
Type of bill (211-214)Revenue code (0191-0194, 0199)• Level 1 (Revenue Code 0191)• Level 2 (Revenue Code 0192)• Level 3 (Revenue Code 0193)• Level 4 (Revenue Code 0194)• Level 5 (Revenue Code 0199)•...
View ArticleCPT CODE 99183 AND G0277 - COVERAGE AND ICD code
Coverage Indications, Limitations, and/or Medical NecessityNotice: It is not appropriate to bill Medicare for services that are not covered (as described by this entire LCD) as if they are covered....
View ArticleRevenue code list with description
The following chart identifies revenue codes that require a specific CPT/HCPCS code in field 44 of the UB-04.Revenue Code Description CPT/HCPCS Code0300 - 0309 Laboratory –...
View ArticleUrgent Care Centers CPT code list
Urgent Care Centers (UCCs0 are the delivery of ambulatory care in a facility dedicated to unscheduled, walk-in care outside a hospital emergency department.Billing Requirements• Place of service "11"...
View ArticleCPT CODE G0296, G0297 COVERAGE and payment Guide
Health Care Common Procedure Coding System (HCPCS) CodesEffective for claims with dates of service on and after February 5, 2015, the following HCPCS codes are used for lung cancer screening with...
View ArticleBilling Guide for partial hospitalization
Partial Hospitalization• Submit partial hospitalization services with the following revenue codes:• 0912, 0913 or 0915o If a separate contract for the hospital and psych DPU are in effect, submit...
View ArticleDRG Hierarchy and calculation of allowed amount
DRG Hierarchy for a Standard Base AgreementEach inpatient case for a DRG contract is evaluated using the following payment hierarchy:• Low Stay Outlier• High Charge/High Stay Outlier• DRG Value...
View ArticlePer Diem agreement and allowed amount calculation
Per DiemPer Diem is a per day negotiated rate which represents an allowance that includes all services for that day.Per Diem agreements reimburse based on the admission date of the member.The following...
View ArticleWhat is Present on Admission Indicator Reporting ?
A Present on Admission (POA) Indicator is used to identify whether a primary or secondary condition was present at the time the order for inpatient admission occurs. Conditions that develop during an...
View ArticlePresent of Admission (POA) Indicator list on UB 04
The table below outlines the payment implications for each of the different POA Indicator reporting options.POA Indicator Options and Definitions Code DescriptionY Diagnosis was present at time of...
View ArticleWhat is Clinical trials and well child care
Clinical TrialsCMS has specific billing requirements for Clinical Trials. For clinical trials other than IDE A and B devices and Clinical Evidence Development, traditional Medicare A or B will pay...
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