Archived SECTION 19 - PROCEDURE CODES. Section 19 - Procedure Codes
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1 SECTION 19 - PROCEDURE CODES 19.1 CPT CODES PROCEDURE CODES PROCEDURES REQUIRING A COPAY (TEXT DEL. PRIOR TO 7/08) COVERED AMBULATORY SURGICAL CENTER PROCEDURE CODES...3 Ambulatory Surgical Center 1
2 SECTION 19-PROCEDURE CODES Procedure codes used by MO HealthNet are identified as HCPCS codes (Health Care Procedure Coding System). The HCPCS is divided into three subsystems, referred to as level I, level II and level III. Level I is comprised of Current Procedural Terminology (CPT) codes that are used to identify medical services and procedures furnished by physicians and other health care professionals. Level II is comprised of the HCPCS National Level II codes that are used primarily to identify products, supplies and services not included in the CPT codes. Level III codes have been developed by Medicaid State agencies for use in specific programs. NOTE: Replacement of level III codes is required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Providers should reference bulletins for code replacement information CPT CODES Reference materials regarding the HealthCare Common Procedure Coding System (HCPCS), Current Procedural Terminology (CPT) may be obtained through the American Medical Association at: Order Department American Medical Association P.O. Box Atlanta, GA Telephone Number: (800) AMA Members (800) Fax Orders: (312) PROCEDURE CODES The following list of procedure codes and descriptions are for additional Radiology and EKG services which are performed on-site and which are not included in the ASC MO HealthNet Procedure Reimbursement Schedule. Only these services are considered for separate reimbursement in addition to the surgical procedures listed in Section 19.4 and are subject to limitations expressed in Section 13. Reimbursement for these radiology services is based on a maximum allowable fee for the total service (facility and professional component), or for the facility component only, depending on the facility arrangement with the interpreting radiologist. Only the facility technical component of the EKG service is allowable as a facility charge and is reimbursed accordingly. Ambulatory Surgical Center 2
3 PROC CODE DESCRIPTION Radiologic examination, chest single view, frontal (Total charge facility + professional component) Radiologic examination, chest stereo, frontal (Facility component only) Radiologic examination, chest, two views, frontal and lateral (Total charge facility + professional component) Electrocardiogram, routine EKG with at least 12 leads (facility component only) 19.3 PROCEDURES REQUIRING A COPAY (text del. prior to 7/08) 19.4 COVERED AMBULATORY SURGICAL CENTER PROCEDURE CODES Procedure codes that must have required attachments when submitted on a claim for processing are identified with the following: RESTRICTION DESCRIPTION CODE 1 Prior Authorization Request Required 2 Certificate of Medical Necessity Required 4 (Sterilization) Consent Form Required 8 Acknowledgement of Receipt of Hysterectomy Information Required 9 Second Surgical Opinion Form Required K R Y Certification of Medical Necessity for Abortion Required Invoice Required Operative Report Required MO HealthNet covered procedures that are performed bilaterally and are identified by Medicare as appropriate bilateral procedures, must be billed using the 50 modifier. For bilateral procedures identified by Medicare, please reference Attachment A of the Indicators/Global Surgery Percentages/Endoscopies table located at Missouri Medicare Services. Ambulatory Surgical Center 3
4 The following procedure codes can be billed by Ambulatory Surgical Centers: D7140 D7210 D7220 D7230 D7240 D7241 D9999 G0260 V2630 V2631 V Ambulatory Surgical Center 4
5 Ambulatory Surgical Center 5
6 Ambulatory Surgical Center 6
7 Ambulatory Surgical Center 7
8 Ambulatory Surgical Center 8
9 Ambulatory Surgical Center 9
10 Ambulatory Surgical Center 10
11 Ambulatory Surgical Center 11
12 Y Ambulatory Surgical Center 12
13 Ambulatory Surgical Center 13
14 Ambulatory Surgical Center 14
15 K K Ambulatory Surgical Center 15
16 Ambulatory Surgical Center 16
17 R R R R Ambulatory Surgical Center 17
18 Ambulatory Surgical Center 18
19 Ambulatory Surgical Center 19
20 END OF SECTION TOP OF PAGE Ambulatory Surgical Center 20
Archived SECTION 19 - PROCEDURE CODES. Section 19 - Procedure Codes
SECTION 19 - PROCEDURE CODES 19.1 CPT CODES...2 19.2 PROCEDURE CODES...2 19.3 PROCEDURES REQUIRING A COPAY (TEXT DEL. PRIOR TO 7/08)...3 19.4 COVERED AMBULATORY SURGICAL CENTER PROCEDURE CODES...3 Ambulatory
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