NOTE: ALL CPT CODES AND DESCRIPTIONS ARE COPYRIGHTED BY THE AMERICAN MEDICAL ASSOCIATION.

Transcription

1 RUN: 04/16/14 11:45:23 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: OFFICE,NEW,PROBLEM, STRAIGHTFORWARD OFFICE,NEW,PROBLEM, STRAIGHTFORWARD OFFICE,NEW PT,EXPANDED,STRAIGHTFOWD OFFICE,NEW PT,EXPANDED,STRAIGHTFOWD OFFICE,NEW PT, DETAILED, LOW COMPLEX OFFICE,NEW PT, DETAILED, LOW COMPLEX OFFICE,NEW PT, COMPREHEN, MOD COMPLX OFFICE,NEW PT, COMPREHEN, MOD COMPLX OFFICE,NEW PT, COMPREHEN, HIGH COMPX OFFICE,NEW PT, COMPREHEN, HIGH COMPX OFFICE,EST PT, MINIMAL PROBLEMS 9.09 X OFFICE,EST PT, MINIMAL PROBLEMS X OFFICE,EST PT, PROBLEM,STRAITFORWD X OFFICE,EST PT, PROBLEM,STRAITFORWD X OFFICE,EST PT, EXPANDED, LOW COMPLEX OFFICE,EST PT, EXPANDED, LOW COMPLEX OFFICE,EST PT, DETAILED, MOD COMPLX OFFICE,EST PT, DETAILED, MOD COMPLX OFFICE,EST PT, COMPREHEN,HIGH COMPLX OFFICE,EST PT, COMPREHEN,HIGH COMPLX INITIAL OBSERVATION CARE, PER DAY, F INITIAL OBSERVATION CARE, PER DAY, F INITIAL OBSERVATION CARE, PER DAY, F INITIAL OBSERVATION CARE, PER DAY, F INITIAL OBSERVATION CARE, PER DAY, F INITIAL OBSERVATION CARE, PER DAY, F INITIAL HOSP,COMPRE,STRTFWD,LOCMPLX INITIAL HOSP,COMPRE,STRTFWD,LOCMPLX INITIAL HOSP,COMPRE,MOD CMPLX INITIAL HOSP,COMPRE,MOD CMPLX INITIAL HOSP,COMPRE, HIGH CMPLX INITIAL HOSP,COMPRE, HIGH CMPLX SUBSEQUENT OBSERVATION CARE, PER DAY SUBSEQUENT OBSERVATION CARE, PER DAY SUBSEQUENT OBSERVATION CARE, PER DAY SUBSEQUENT OBSERVATION CARE, PER DAY SUBSEQUENT OBSERVATION CARE, PER DAY SUBSEQUENT OBSERVATION CARE, PER DAY SUBSEQNT HOSP,PRBLM,STRTFWD R LO CLX SUBSEQNT HOSP,PRBLM,STRTFWD R LO CLX SBSQNT HOSP,XPANDED,MOD CMPLXTY SBSQNT HOSP,XPANDED,MOD CMPLXTY SBSQNT HOSP,DETAILED, HIGH CMPLXTY SBSQNT HOSP,DETAILED, HIGH CMPLXTY OBSERV/HOSP SAME DATE X OBSERV/HOSP SAME DATE X

2 RUN: 04/16/14 11:45:23 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: OBSERV/HOSP SAME DATE X OBSERV/HOSP SAME DATE X OBSERV/HOSP SAME DATE X OBSERV/HOSP SAME DATE X HOSPITAL DISCHARGE DAY MANAGEMENT HOSPITAL DISCHARGE DAY MANAGEMENT HOSPITAL DISCHARGE DAY HOSPITAL DISCHARGE DAY EMER DEPT VST,PRBLM,STRTFWD EMER DEPT VST,PRBLM,STRTFWD EMER DEPT VST,PRBLM,LOW CMPLXTY EMER DEPT VST,PRBLM,LOW CMPLXTY EMER DEPT VSTXXPAND,LOW CMPLSTY EMER DEPT VSTXXPAND,LOW CMPLSTY EMER DEPT VST,DETAILED,MOD CMPLXTY EMER DEPT VST,DETAILED,MOD CMPLXTY EMER DEPT VST,COMPHSV,HIGH CMPLXTY EMER DEPT VST,COMPHSV,HIGH CMPLXTY CRITICAL CARE, FIRST HOUR X CRITICAL CARE, FIRST HOUR X CRITICAL CARE, EVALUATION AND MANAGE X X CRITICAL CARE, EVALUATION AND MANAGE X X INITIAL NURSING FACILITY CARE, PER D INITIAL NURSING FACILITY CARE, PER D INITIAL NURSING FACILITY CARE, PER D INITIAL NURSING FACILITY CARE, PER D INITIAL NURSING FACILITY CARE, PER D INITIAL NURSING FACILITY CARE, PER D SUBSEQUENT NURSING FACILITY CARE, PE SUBSEQUENT NURSING FACILITY CARE, PE SUBSEQUENT NURSING FACILITY CARE, PE SUBSEQUENT NURSING FACILITY CARE, PE SUBSEQUENT NURSING FACILTIY CARE, PR SUBSEQUENT NURSING FACILTIY CARE, PR SEBSEQUENT NURSING FACILITY CARE, PE SEBSEQUENT NURSING FACILITY CARE, PE NURSING FAC DISCHARGE DAY NURSING FAC DISCHARGE DAY NURSING FAC DISCHARGE DAY NURSING FAC DISCHARGE DAY DOMICIL/R-HOME VISIT NEW PAT DOMICIL/R-HOME VISIT NEW PAT DOMICIL/R-HOME VISIT NEW PAT DOMICIL/R-HOME VISIT NEW PAT DOMICIL/R-HOME VISIT NEW PAT DOMICIL/R-HOME VISIT NEW PAT

3 RUN: 04/16/14 11:45:23 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: DOMICIL/R-HOME VISIT NEW PAT DOMICIL/R-HOME VISIT NEW PAT DOMICIL/R-HOME VISIT NEW PAT DOMICIL/R-HOME VISIT NEW PAT DOMICIL/R-HOME VISIT EST PAT DOMICIL/R-HOME VISIT EST PAT DOMICIL/R-HOME VISIT EST PAT DOMICIL/R-HOME VISIT EST PAT DOMICIL/R-HOME VISIT EST PAT DOMICIL/R-HOME VISIT EST PAT DOMICIL/R-HOME VISIT EST PAT DOMICIL/R-HOME VISIT EST PAT HOME,NEW PT, PROBLM, STRTFWD R LOCLX HOME,NEW PT, PROBLM, STRTFWD R LOCLX HOME,NEW PT, EXPANDED, MOD COMPLEX HOME,NEW PT, EXPANDED, MOD COMPLEX HOME,NEW PT, DETAILED, HIGH COMPLEX HOME,NEW PT, DETAILED, HIGH COMPLEX HOME VISIT, NEW PATIENT HOME VISIT, NEW PATIENT HOME VISIT, NEW PATIENT HOME VISIT, NEW PATIENT HOME VISIT, ESTAB PATIENT HOME VISIT, ESTAB PATIENT HOME VISIT, ESTAB PATIENT HOME VISIT, ESTAB PATIENT HOME VISIT, ESTAB PATIENT HOME VISIT, ESTAB PATIENT HOME VISIT, ESTAB PATIENT HOME VISIT, ESTAB PATIENT PHYSICIAN STANDBY SERVICE, REQUIRING X PHYSICIAN STANDBY SERVICE, REQUIRING X HOME HEALTH CARE SUPERVISION X HOME HEALTH CARE SUPERVISION X HOSPICE CARE SUPERVISION X HOSPICE CARE SUPERVISION X NURSING FAC CARE SUPERVISION X NURSING FAC CARE SUPERVISION X NURSING FAC CARE SUPERVISION X NURSING FAC CARE SUPERVISION X INIT E&M HEALTHY INDV,NEW PT,TO 1 YR INIT E&M HEALTHY INDV,NEW PT,TO 1 YR INIT E&M HEALTHY INDV,ERLY CHD 1-4YR INIT E&M HEALTHY INDV,ERLY CHD 1-4YR INIT E&M HEALTHY INDV,LTE CHLD INIT E&M HEALTHY INDV,LTE CHLD

4 RUN: 04/16/14 11:45:23 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: INIT E&M HEALTHY INDV,ADOLS,12-17YRS INIT E&M HEALTHY INDV,ADOLS,12-17YRS INIT COMP PREV MED YRS X INIT COMP PREV MED YRS X INIT COMP PREV MED YRS X INIT COMP PREV MED YRS X INIT COMP PREV MED X INIT COMP PREV MED X PERDC REEVAL &MGT HLTHY INDV,INFANT PERDC REEVAL &MGT HLTHY INDV,INFANT PERDC REEVAL & MGT HLTHY INDV,1-4YRS PERDC REEVAL & MGT HLTHY INDV,1-4YRS PERDC REEVAL & MGT,LTE CHLD 5-11 YRS PERDC REEVAL & MGT,LTE CHLD 5-11 YRS PERDC REEVAL & MGT, ADOLS YRS PERDC REEVAL & MGT, ADOLS YRS PERIODIC COMP PREV MED YRS X PERIODIC COMP PREV MED YRS X PERIODIC COMP PREV MED YRS X PERIODIC COMP PREV MED YRS X PERIODIC COMP PREV MED X PERIODIC COMP PREV MED X UNLISTED PREVENTIVE MEDICINE SERVICE MP X UNLISTED PREVENTIVE MEDICINE SERVICE MP X INITIAL HOSPITAL OR BIRTHING CENTER X INITIAL HOSPITAL OR BIRTHING CENTER X INITIAL CARE, PER DAY, FOR EVALUATIO X INITIAL CARE, PER DAY, FOR EVALUATIO X SUBSEQUENT HOSPITAL CARE, PER DAY, F SUBSEQUENT HOSPITAL CARE, PER DAY, F INITIAL HOSPITAL OR BIRTHING CENTER X INITIAL HOSPITAL OR BIRTHING CENTER X ATTENDANCE AT DELIVERY (WHEN REQUEST ATTENDANCE AT DELIVERY (WHEN REQUEST DELIVERY/BIRTHING ROOM RESUSCITATION DELIVERY/BIRTHING ROOM RESUSCITATION CRITICAL CARE SERVICES DELIVERED BY CRITICAL CARE SERVICES DELIVERED BY CRITICAL CARE SERVICES DELIVERED BY X CRITICAL CARE SERVICES DELIVERED BY X INITIAL INPATIENT NEONATAL CRITICAL INITIAL INPATIENT NEONATAL CRITICAL SUBSEQUENT INPATIENT NEONATAL CRITIC SUBSEQUENT INPATIENT NEONATAL CRITIC INITIAL INPATIENT PEDIATRIC CRITICAL INITIAL INPATIENT PEDIATRIC CRITICAL

5 RUN: 04/16/14 11:45:23 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: SUBSEQUENT INPATIENT PEDIATRIC CRITI SUBSEQUENT INPATIENT PEDIATRIC CRITI INITIAL INPATIENT PEDIATRIC CRITICAL INITIAL INPATIENT PEDIATRIC CRITICAL SUBSEQUENT INPATIENT PEDIATRIC CRITI SUBSEQUENT INPATIENT PEDIATRIC CRITI INITIAL HOSPITAL CARE, PER DAY, FOR INITIAL HOSPITAL CARE, PER DAY, FOR SUBSEQUENT INTENSIVE CARE, PER DAY, SUBSEQUENT INTENSIVE CARE, PER DAY, SUBSEQUENT INTENSIVE CARE, PER DAY, SUBSEQUENT INTENSIVE CARE, PER DAY, SUBSEQUENT INTENSIVE CARE, PER DAY, SUBSEQUENT INTENSIVE CARE, PER DAY, UNLISTED EVALUATION AND MANAGEMENT S MP X UNLISTED EVALUATION AND MANAGEMENT S MP X

6 RUN: 04/16/14 11:45:23 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: 6 LEGEND Listed below are some aids we hope will help you understand this fee schedule. If, after reading the information below, you need further clarification of an item, please call Unisys Provider Relations at COLUMN 1. TS (Type Service): Definition: Files on which codes are loaded and from which claims are paid. The file to which a claim goes for pricing is determined by, among other things, the type of provider who is billing and by the modifier appended to the procedure code. Listed below is an explanation of the types of service found on this schedule Affordable Care Act (ACA) Enhanced rates - Facility 55 - Affordable Care Act (ACA) Enhanced rates - Non-Facility COLUMNS 2, 3 and 4. CODE, DESCRIPTION and FEE. COLUMN 5. AGE MIN and MAX: Codes with minimum or maximum age restrictions. If the recipient's age on the date of service is outside the minimum or maximum age, claims will deny. The fee schedule cannot display age restrictions in days or months; therefore providers should follow Current Procedural Terminology(CPT) coding guidelines based on the age of the recipient on the date of service. COLUMN 6. MED REV (Medical Review): Claims with some codes pend to Medical Review for review of the attachments or for manual pricing. COLUMN 7. PA (Prior Authorization): Some services must be prior authorized before they are rendered. If a PA request is approved, a PA number will be issued for inclusion on the claim. If a PA request is not approved, no payment for the service will be made. COLUMN 8. SEX (Restriction): Some procedure codes are indicated for only one sex. COLUMN 9. PSR (Provider Specialty Restriction): If a code has a provider specialty restriction, reimbursement for its performance will not be made to other specialties. COLUMN 10. SL (Service Limitation): Codes with frequency limitations. For example, this could include yearly or lifetime limits. COLUMN 11. X-OVERS (Only): These codes are payable for Medicare/Medicaid recipients only. COLUMN 12. UVS>001: An 'X' in this column means more than one unit of service per day may be billed.