End-Stage Renal Disease capitation payment
Monthly capitation payment for physician services furnished to beneficiariesFirst Coast Service Options Inc. (First Coast) recently1 identified the billing of both the monthly capitation payment (MCP)...
View ArticleCPT code 97375, 93976, 93978 - Non invasive vascular studies
IndicationsThis procedure is indicated in the evaluation and/or management of vascular disease involving vessels of the abdominal, pelvic, scrotal contents, and/or retroperitoneal...
View ArticleCPT 22612, 22633, 22558, 22614 - LUMBAR SPINE
Procedure Codes and DescriptionGroup 1 Codes:22533ARTHRODESIS, LATERAL EXTRACAVITARY TECHNIQUE, INCLUDING MINIMAL DISCECTOMY TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION);...
View ArticleCPT code 83880 - Natriuretic peptide
Procedure Codes And DescriptionGroup 1 Codes:83880NATRIURETIC PEPTIDECoverage Indications, Limitations, and/or Medical NecessityAbstract:B-type natriuretic peptide (BNP) is a cardiac neurohormone...
View ArticleCPT code 81479 - Molecular pathology procedure
Procedure Code and DescripitonGroup 1 Codes:81479UNLISTED MOLECULAR PATHOLOGY PROCEDURECoverage Indications, Limitations, and/or Medical NecessityThis LCD provides limited coverage for the GeneSight®...
View ArticleCPT 81206, 81270, 81403, 81450 - BCR / ABL negative MYELOPROLIFERATIVE
Procedure codes and DescriptionGroup 1 Codes:81206BCR/ABL1 (T(9;22)) (EG, CHRONIC MYELOGENOUS LEUKEMIA) TRANSLOCATION ANALYSIS; MAJOR BREAKPOINT, QUALITATIVE OR QUANTITATIVE81207BCR/ABL1 (T(9;22)) (EG,...
View Articlecpt code 88341, 88342, 88360
Procedure code and Description88312SPECIAL STAIN INCLUDING INTERPRETATION AND REPORT; GROUP I FOR MICROORGANISMS (EG, ACID FAST, METHENAMINE SILVER)88313SPECIAL STAIN INCLUDING INTERPRETATION AND...
View Articlewhat is cost outlier - occurrence code OC 47, 70, 61
Definitions• Cost outlier -- an inpatient hospital discharge that is extraordinarily costly. Hospitals may be eligible to receive additional payment for the discharge. Section 1886(d)(5)(A) of the...
View ArticleCPT code 92133, 92134 - SCODI
Procedure code and DescriptionGroup 1 Paragraph: N/AGroup 1 Codes:92132SCANNING COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGING, ANTERIOR SEGMENT, WITH INTERPRETATION AND REPORT, UNILATERAL OR...
View ArticleCPT code for SNF in home health or hospice setting
CPT/HCPCS CodesGroup 1 Paragraph: N/AGroup 1 Codes:G0299DIRECT SKILLED NURSING SERVICES OF A REGISTERED NURSE (RN) IN THE HOME HEALTH OR HOSPICE SETTING, EACH 15 MINUTESG0300DIRECT SKILLED NURSING...
View ArticleCPT 96150, 96152 - Health and behavior assessment
CPT/HCPCS CodesGroup 1 Paragraph: N/AGroup 1 Codes:96150Assess hlth/behave init96151Assess hlth/behave subseq96152Intervene hlth/behave indiv96153Intervene hlth/behave group96154Interv hlth/behav fam...
View ArticleOccurrence Code 32 , Condition Codes 20 and 21
Condition Codes 20 and 21, Occurrence Code 32If an FI receives a completely non-covered claim with either a condition code 20 or a condition code 21, process the claim through all systems.Beneficiaries...
View ArticleWhat is the new Therapy Cap process
New Therapy Cap Process: Frequently Asked QuestionsWhat is the new Therapy Cap process? Answer:Starting October 1, 2012, claims for patients who meet or exceed $3,700 in therapy expenditures will be...
View ArticleMedicare Regulatory Terms and abbreviations
V. Regulatory Impact Analysis Regulations Text AcronymsIn addition, because of the many organizations and terms to which we refer by acronym in this final rule, we are listing these acronyms and their...
View ArticleCPT 64727, 69990 - Microsurgery procedures
CPT Code Description64727 Internal neurolysis, requiring use of operating microscope (List separately in addition to code for neuroplasty) (Neuroplasty includes external...
View ArticleCPT 59400, 59510 - obstetrical policy
REIMBURSEMENT GUIDELINESGlobal Obstetrical (OB) CareAs defined by the American Medical Association (AMA), "the total obstetric package includes the provision of antepartum care, delivery, and...
View ArticleIn house laboratory CPT code list
All In-Office Laboratory Testing and Procedures: Marked with *, **, ***, ****, and ***** will be limited to one procedure within the same family of asterisks, per visit.Example: All laboratory...
View ArticleCPT CODE 80091, 84443, 80092, 84436, 84479 - Thyroid tes
Frequency Limitations:Testing may be covered up to two times a year in clinically stable patients; more frequent testing may be reasonable and necessary for patients whose thyroid therapy has been...
View ArticleDefinition of Incidental, Mutually exclusive, integral procedure with Example
Claims are reviewed to determine eligibility for payment. Services considered incidental, mutually exclusive, integral to the primary service rendered, or part of a global allowance, are not eligible...
View ArticleFQHC cpt g0466, g0467, g0468, g0469, g0470
Specific Payment Codes for the Federally Qualified Health CenterIn accordance with Section 1834(o)(1)(A) and 1834(o)(2)(C) of the Social Security Act, we established specific payment codes that FQHCs...
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