What is CPC+ - General Guide
GENERALQ: Why is CMS testing CPC+?CMS believes that through multi-payer payment reform and practice transformation, primary care practices will be able to build capabilities and care processes to...
View ArticleCPT G9143, 0030U - Genotype-Guided Warfarin Dosing
Code Description CPT 0030U Drug metabolism (warfarin drug response), targeted sequence analysis (ie, CYP2C9, CYP4F2, VKORC1, rs12777823) (new code effective 1/1/18) HCPCS G9143 Warfarin responsiveness...
View ArticleCPT 81225, 81226, 81227, 81599 - Genotype-Guided Tamoxifen Treatment
Policy Coverage Criteria Test Investigational Cytochrome P450 2D6 (CYP2D6) testing Coding Genotyping to determine cytochrome P450 2D6 (CYP2D6) variants is considered investigational for the...
View ArticleCPT 81504, 81540, 81599 - Assays for Cancers of Unknown Primary
Policy Coverage Criteria Type of Test Investigational Gene expression profiling Gene expression profiling is considered investigational to evaluate the site of origin of a tumor of unknown primary, or...
View ArticleCPT 37243, 75894, 79445, S2095 - Radioembolization for Primary and Metastatic...
Code Description CPT 37243 Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the...
View ArticleCPT 11055, 11056, 11057, 11719, 11720, 11721 - Routine Foot Care Services
Coding Code Description CPT 11055 Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion 11056 Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); 2...
View ArticleCPT 81405, 81406, 81407, 81439, s3865, s3866 -Hypertrophic Cardiomyopathy
Code Description CPT 81405 Molecular pathology procedure, Level 6 (eg, analysis of 6-10 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of 11-25 exons, regionally...
View ArticleCPT 99453, 99454, 99447- 99448 - guidelines updates on documentation
CMS is finalizing our proposals to pay separately for two newly defined physicians’ services furnished using communication technology,1. Brief communication technology-based service, e.g. virtual...
View ArticleCPT 48160, G0431, S2102, G0343 -Islet Transplantation
Code Description CPT 48160 Pancreatectomy, total or subtotal, with autologous transplantation of pancreas or pancreatic islet cells HCPCS G0341 Percutaneous islet cell transplant, includes portal vein...
View ArticleCPT 95940, 95941, G0453 -Intraoperative Neurophysiologic Monitoring
Medically Necessary Code Description CPT 95940 Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance, each 15 minutes (List...
View ArticleACES program code list
ACES Program Codes Some provider groups rely on the ACES program codes to help them determine if the client is on a state-only program or is on a Washington Apple Health Medicaid program to identify...
View ArticleMedicare part B basics - covered service and premium
Four categories of Medicare insurance: Parts A, B, C, and D.1. Part A. Provides hospital facilities, nursing facilities, hospices and home health facilities.2. Part B. covers physician services,...
View ArticleCondition code G0 - Billing Guideliens
Condition code G0 Distinct Medical Visit Report this code when multiple medical visits occurred on the same day in the same revenue center. The visits were distinct and constituted independent visits....
View ArticleOccurrence code, special program indicator list
OCCURRENCE CODE/DATE ( Form Field 31a - 34B) – Enter the applicable code and associated date to identify significant events relating to this bill that may affect processing. Dates are entered in an...
View ArticleHospital Acquired conditions (HAC) CATAGORIES AND billing guidelines
OverviewHospital Acquired Conditions (HAC) are serious conditions that patients get during an inpatient hospital stay. If hospitals follow proper procedures, patients are less likely to get these...
View ArticleCPT G0108, G0109 and MODIFIER GQ
HCPCS Code DescriptionG0108 Diabetes outpatient self-management training services, individual, per 30 minutesG0109 Diabetes outpatient self-management training services, group session (2 or more), per...
View ArticleCPT code 93000, 93040, 93041, 93042, 93010 - ECG and EKG codes
CPT® Code Procedure Description 93000 Electrocardiogram Routine ECG with at least 12 leads; with interpretation and report 93005 Electrocardiogram Routine ECG with at least 12 leads; tracing only,...
View ArticleInitial observation code CPT 99217, 99218, 99219, 99220
CPT code and descriptions99217 Observation care discharge day management (This code is to be utilized to report all services provided to a patient on discharge from outpatient hospital "observation...
View ArticleCPT code J1439, L34093, J0887, Q9976
Required Billing and CodingJ Code Product IndicationsJ1439 Injection, ferric carboxymaltose, 1 mg L34093 (Chemotherapy and Biologicals)J0887 - Injection, Epoetin Beta (For ESRD On Dialysis), 1...
View ArticleCPT code G0104, G0105, G0121 - Colorectal cancer screening
CPT code and DescriptionG0105 Colorectal cancer screening; colonoscopy on individual at high riskG0121 Colorectal cancer screening; colonoscopy on individual not meeting criteria for high riskG0104 -...
View ArticleCPT CODE 97597, 97598 - Debridement procedure
CPT CODE AND Description CPT code 97598 (Debridement [eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps], open wound, [eg, fibrin,...
View ArticleCPT 71275 AND 74174
CPT Code Description71275 Computed tomographic angiography, chest (non-coronary), with contrast material(s), including noncontrast images, if performed, and image post-processing CPT Code...
View ArticleCPT 80053, Comprehensive metabolic panel
CODE DESCRIPTION80053 Comprehensive metabolic panel This panel must include the following: Albumin (82040), Bilirubin, total (82247), Calcium, total (82310), Carbon dioxide(bicarbonate) (82374),...
View ArticleVenipuncture CPT codes - 36415, 36416, G0471
CPT Code and Definitions36415 Collection of venous blood by venipuncture36416 Collection of capillary blood specimen (e.g., finger, heel, ear stick)G0471 Collection of venous blood by venipuncture or...
View ArticleMedicaid Guidelines - OCCUPATIONAL THERAPY SERVICES
OCCUPATIONAL THERAPY SERVICESOccupational Therapy is provided by an appropriately licensed occupational therapist who evaluates the student's level of functioning and develops a KPOC. Licensed...
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