Getting Authorization for inpatient hospital visit
INPATIENT HOSPITAL AUTHORIZATION REQUIREMENTSThe information in this section applies to instate and borderland hospitals. Information regarding out-ofstate hospital authorization requirements can be...
View ArticleWheelchair CPT code list
Procedure Code Description RateE1037 TRANSPORT CHAIR, PEDIATRIC SIZEE1038 TRANSPORT CHAIR, ADULT SIZE, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDSE1039 TRANSPORT CHAIR, ADULT SIZE, HEAVY...
View ArticleNebulizer cpt code list - A7017, A7018, A7007
For a DME item to be covered by Medicare, it must 1) be eligible for a defined Medicare benefit category, 2) be reasonable and necessary for the diagnosis or treatment of illness or injury or to...
View ArticleBCBS denial code list
Reason codes, and the text messages that define those codes, are used to explain why a claim may not have been paid in full. For instance, there are reason codes to indicate that a particular service...
View ArticleCigna denial codes list
Insurance Cigna denial codes listCode Description Denial Language1 Services after auth end The services were provided after the authorization was effective and are not covered benefits under this...
View Articleicd 10 code for insomnia F51.02, F51.01
Surgical Treatment of Obstructive Sleep Apnea (OSA) and Upper Airway Resistance Syndrome (UARS) Uvulopalatopharyngoplasty (UPPP) may be considered medically necessary for the treatment of clinically...
View ArticleWhat is content of service
CONTENT OF SERVICEContent of service refers to specific services and/or procedures that are considered to be an integral part of previous or concomitant services or procedures to the extent that...
View ArticleWhat is APG paymnet - how its calculated. type and classification
BACKGROUND AND INTRODUCTION TO AMBULATORY PATIENT GROUPS (APGS)PURPOSE:The purpose of this document is to provide Medicaid policy and billing guidance to Article 28 providers billing under the...
View ArticleAPG payment - part 2 , Grouping and use of modifiers
2.4 GROUPING ELEMENTS OF THE APG PAYMENT SYSTEM:The APG System uses three methods for grouping different services provided into a single payment unit: ancillary packaging, significant procedure...
View ArticleWhat 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...
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