Tuesday, August 30, 2016

Cost share and Collection process

What is Cost Sharing?
Cost sharing is the patient balance that remains after the insurance plan has applied payment for  covered services according to the benefit plan.


What does it include?
Cost Sharing includes:
 
Copay
Deductible
Coinsurance

COPAY
A fixed amount you pay for a covered health care service , to be paid when you receive the service

The amount can vary by the type of covered health care service.
$15 primary care
$25 specialist

Deductible
The amount the patient owes for healthcare services before your health insurance plan begins to pay
Deductible may not apply to all services
Deductibles are applied annually

Coinsurance
Your share of the costs of a covered health care service, calculated as a percent of the allowed amount for the service
Co-insurance plus deductible may apply in some cases


Cost Sharing Tools

Most commercial Health Insurance carriers have cost estimators on their websites to help you estimate your out-of-pocket expense.

Calculate your estimated costs for procedures, office visits, lab tests, and surgeries.
Compare what your cost sharing will be at different providers and locations.

Medicare Cost Comparison

Medicare also provides transparency into healthcare costs on their website You can compare hospital pricing for hospital inpatient and outpatient care The annual Medicare and You booklet also provides insight into Medicare covered benefits

Visit the Medicare website: www.medicare.gov


Pre-Collection Process

You will receive 3 statements before balances are flagged at collect status

Statement messages indicate the aging of your statement balance

Statement Messages

Second Statement:
Your account is overdue; please pay this balance immediately.

Third Statement:
Your account is in collections status; please contact the office immediately.

Collection Letters
You will receive a separate letter from Insurance company when your balance is billed on a second and third statement.

The letter is to remind you that your account is in collect status and if the balance is not paid it will go to our outside collection agency.

Collection Policy
Insurance company  does send aged balances to a collection agency.

Insurance company  has contracted with Collection Agency to help us recover unpaid patient balances.

Account balances are sent to the collection agency after you receive 3 statements and you do not make a payment.

What to Expect from the Collection Agency

Patient receives automated and live calls from the agency. Collection balance is not reported to the credit bureau until 90 days after placement with the agency.
Payments can be made directly to Agency or to Insurance company . Agency will update Insurance company records to show your payment was made and clear your balance.



Sunday, August 28, 2016

Billing Clinical Consultation Services - 80500, 80502


Clinical consultations are paid under the physician fee schedule only if they:

a. Are requested by the patient’s attending physician;

b. Relate to a test result that lies outside the clinically significant normal or expected range in view of the condition of the patient;

c. Result in a written narrative report included in the patient’s medical record; and

d. Require the exercise of medical judgment by the consultant physician.

Clinical consultations are professional component services only, i.e., there is no TC service. The clinical consultation codes are 80500 and 80502.

Routine conversations held between a laboratory director and an attending physician about test orders or results do not qualify as consultations unless all four requirements are met. Laboratory personnel, including the director, may from time to time contact attending physicians to report test results or to suggest additional testing or be contacted by attending physicians on similar matters. These contacts do not constitute clinical consultations. However, if in the course of such a contact, the attending physician requests a consultation from the pathologist, and if that consultation meets the other criteria and is properly documented, it is paid under the fee schedule.

EXAMPLE: A pathologist telephones a surgeon about a patient’s suitability for surgery based on the results of clinical laboratory test results. During the course of their conversation, the surgeon asks the pathologist whether, based on test results, patient history and medical records, the patient is a candidate for surgery. The surgeon’s request requires the pathologist to render a medical judgment and provide a consultation. The pathologist follows up his/her oral advice with a written report and the surgeon notes in the patient’s medical record that he/she requested a consultation. This consultation is paid under the fee schedule.

In any case, if the information could ordinarily be furnished by a nonphysician laboratory specialist, the service of the physician is not a consultation payable under the fee schedule.

See the Program Integrity Manual for guidelines for related data analysis to identify inappropriate patterns of billing for consultations.

Thursday, August 25, 2016

CPT CODE P3000, P3001 , 85060, 38220, 85097 AND 86078

Specific Hematology, Cytopathology and Blood Banking Services

Cytopathology services include the examination of cells from fluids, washings, brushings or smears, but generally excluding hematology. Examining cervical and vaginal smears are the most common service in cytopathology. Cervical and vaginal smears do not require interpretation by a physician unless the results are or appear to be abnormal. In such cases, a physician personally conducts a separate microscopic evaluation to determine the nature of an abnormality. This microscopic evaluation ordinarily does require performance by a physician. When medically necessary and when furnished by a physician, it is paid under the fee schedule.


For services furnished prior to January 1, 1999, contractors pay separately under the physician fee schedule for the interpretation of an abnormal pap smear furnished to a hospital inpatient by a physician. They must pay under the clinical laboratory fee schedule for pap smears furnished in all other situations. This policy also applies to screening pap smears requiring a physician interpretation. For services furnished on or after January 1, 1999, contractors allow separate payment for a physician’s interpretation of a pap smear to any patient (i.e., hospital or non-hospital) as long as: (1) the laboratory’s screening personnel suspect an abnormality; and (2) the physician reviews and interprets the pap smear.

These services are reported under codes P3000 or P3001.

Physician hematology services include microscopic evaluation of bone marrow aspirations and biopsies. It also includes those limited number of peripheral blood smears which need to be referred to a physician to evaluate the nature of an apparent abnormality identified by the technologist. These codes include 85060, 38220, 85097, and 38221.

Contractors pay the PC for the interpretation of an abnormal blood smear (code 85060) furnished to a hospital inpatient by a hospital physician or an independent laboratory.

For other hematology codes, payment may be made for the PC component if the service is furnished to a patient by a hospital physician or independent laboratory. In addition, payment may be made for these services furnished to patients by an independent laboratory.

Blood banking services of hematologists and pathologists are paid under the physician fee schedule when analyses are performed on donor and/or patient blood to determine compatible donor units for transfusion where cross matching is difficult or where contamination with transmissible disease of donor is suspected.

The blood banking codes are 86077, 86078, and 86079 and represent professional component only services.


Friday, August 19, 2016

Policy guideline for CPT CODE G0372 & 99360


Power Mobility Devices (PMDs)


Section 302(a)(2)(E)(iv) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) sets forth revised conditions for Medicare payment of Power Mobility Devices (PMDs). This section of the MMA states that payment for motorized or power wheelchairs may not be made unless a physician (as defined in §1861(r)(1) of the Act), a physician assistant, nurse practitioner, or a clinical nurse specialist (as those terms are defined in §1861(aa)(5)) has conducted a face-to-face examination of the beneficiary and written a prescription for the PMD.


Payment for the history and physical examination will be made through the appropriate evaluation and management (E&M) code corresponding to the history and physical examination of the patient. Due to the MMA requirement that the physician or treating practitioner create a written prescription and a regulatory requirement that the physician or treating practitioner prepare pertinent parts of the medical record for submission to the durable medical equipment supplier, code G0372 (physician service required to establish and document the need for a power mobility device) has been established to recognize additional physician services and resources required to establish and document the need for the PMD.


The G code indicates that all of the information necessary to document the PMD prescription is included in the medical record, and the prescription and supporting documentation is delivered to the PMD supplier within 30 days after the face-to-face examination.


Effective October 25, 2005, G0372 will be used to recognize additional physician services and resources required to establish and document the need for the PMD and will be added to the Medicare physician fee schedule.

Physician Standby Service (Code 99360)

Standby services are not payable to physicians. Physicians may not bill Medicare or beneficiaries for standby services. Payment for standby services is included in the Part A payment to the facility. Such services are a part of hospital costs to provide quality care. If hospitals pay physicians for standby services, such services are part of hospital costs to provide quality care.

Wednesday, August 17, 2016

Example of billable and non billable prolonged service - CPT CODE 99358 & 99359

Examples of Billable Prolonged Services

EXAMPLE 1

A physician performed a visit that met the definition of an office visit code 99213 and the total duration of the direct face-to-face services (including the visit) was 65 minutes. The physician bills code 99213 and one unit of code 99354.


EXAMPLE 2

A physician performed a visit that met the definition of a domiciliary, rest home care visit code 99327 and the total duration of the direct face-to-face contact (including the visit) was 140 minutes. The physician bills codes 99327, 99354, and one unit of code 99355.


EXAMPLE 3

A physician performed an office visit to an established patient that was predominantly counseling, spending 75 minutes (direct face-to-face) with the patient. The physician should report CPT code 99215 and one unit of code 99354.



J. Examples of Nonbillable Prolonged Services

EXAMPLE 1

A physician performed a visit that met the definition of visit code 99212 and the total duration of the direct face-to-face contact (including the visit) was 35 minutes. The physician cannot bill prolonged services because the total duration of direct face-to-face service did not meet the threshold time for billing prolonged services.


EXAMPLE 2

A physician performed a visit that met the definition of code 99213 and, while the patient was in the office receiving treatment for 4 hours, the total duration of the direct face-to-face service of the physician was 40 minutes. The physician cannot bill prolonged services because the total duration of direct face-to-face service did not meet the threshold time for billing prolonged services.


EXAMPLE 3

A physician provided a subsequent office visit that was predominantly counseling, spending 60 minutes (face-to-face) with the patient. The physician cannot code 99214, which has a typical time of 25 minutes, and one unit of code 99354. The physician must bill the highest level code in the code family (99215 which has 40 minutes typical/average time units associated with it). The additional time spent beyond this code is 20 minutes and does not meet the threshold time for billing prolonged services.

Prolonged Services Without Direct Face-to-Face Patient Contact Service (Codes 99358 - 99359)

Contractors may not pay prolonged services codes 99358 and 99359, which do not require any direct patient face-to-face contact (e.g., telephone calls). Payment for these services is included in the payment for direct face-to-face services that physicians bill. The physician cannot bill the patient for these services since they are Medicare covered services and payment is included in the payment for other billable services.

ICD 10 code for osteopenia

Provider Action Needed

The Centers for Medicare & Medicaid Services (CMS) will implement Change Request (CR) 9252 on January 4, 2016, effective October 1, 2015. (See related MLN Matters® article MM9252.) This CR establishes the list of covered conditions and corresponding ICD-10-CM diagnosis codes approved for Bone Mass Measurement studies according to the requirements set forth in National Coverage Determination (NCD) 150.3. CR9252 and accompanying spreadsheet inadvertently omitted the condition of osteopenia and the ICD- 10-CM codes that describe it which are classified to subcategory M85.8- Other specified disorders of bone density and structure. The codes and conditions identified within this subcategory are considered covered indications for bone mass measurement under NCD 150.3 and providers should report these appropriately according to medical documentation.


Additional guidance and education as to the updated complete list of covered indications will be forthcoming as CMS continues to review this issue and the systems updates required. Under ICD-9-CM, the term “Osteopenia” was indexed to ICD-9-CM diagnosis code 733.90 (Disorder of bone and cartilage). This code was listed as a covered condition under the Business requirement 5521.1.1 for CR 5521/NCD 150.3, dated May 11, 2007, when reported with CPT code 77080. (See related MLN Matters article MM552


Under ICD-10-CM, the term “Osteopenia” is indexed to ICD-10-CM subcategory M85.8- Other specified disorders of bone density and structure, within the ICD-10-CM Alphabetic Index. The codes within this subcategory were inadvertently omitted from the CMS spreadsheet that accompanied CR 9252 containing the list of covered conditions and corresponding diagnosis codes. These are considered covered for NCD 150.3 indications.

Below is the list of ICD-10-CM diagnosis codes within subcategory M85.8- that providers may report as covered indications in addition to the current list provided in CR 9252 and its accompanying CMS spreadsheet.

** M85.811 Other specified disorders of bone density and structure, right shoulder

** M85.812 Other specified disorders of bone density and structure, left shoulder

** M85.821 Other specified disorders of bone density and structure, right upper arm

** M85.822 Other specified disorders of bone density and structure, left upper arm

** M85.831 Other specified disorders of bone density and structure, right forearm

** M85.832 Other specified disorders of bone density and structure, left forearm

** M85.841 Other specified disorders of bone density and structure, right hand


** M85.842 Other specified disorders of bone density and structure, left hand

** M85.851 Other specified disorders of bone density and structure, right thigh

** M85.852 Other specified disorders of bone density and structure, left thigh

** M85.861 Other specified disorders of bone density and structure, right lower leg

** M85.862 Other specified disorders of bone density and structure, left lower leg

** M85.871 Other specified disorders of bone density and structure, right ankle and  foot

** M85.872 Other specified disorders of bone density and structure, left ankle and foot

** M85.88 Other specified disorders of bone density and structure, other site

** M85.89 Other specified disorders of bone density and structure, multiple sites



Question 1 When will the LCD be updated to either remove Osteopenia as an indication or include the ICD-10 diagnosis codes for Osteopenia? 

Answer

• The ICD-10 codes that crosswalk with Osteopenia are under subcategory M85.8 and do not refer to Osteopenia. They are a group of very nonspecific disorders of bone density which do NOT justify or qualify for Vitamin D testing. • The specificity of the ICD-10 testing has refined what disorders qualify for coverage of Oncology Cytogenetics and have allowed us to cull out diagnoses that were previously covered but should not have been. We feel at present the appropriate diagnoses are covered and do not plan on developing a LCD that will expand on the covered ICD-10 codes that CMS has established in NCD 190.3


The following two studies are not covered by Medicare:

 78350: Bone density (bone mineral content) study, 1 or more sites; single photon absorptiometry
 78351: Bone density (bone mineral content) study, 1 or more sites; dual photon absorptiometry

ICD-10-CM code Z90.721 or Z90.722 should be reported for women s/p oophorectomy.

ICD-10-CM code Z79.51 or Z79.52 should be reported for an individual on glucocorticoid therapy.

ICD-10-CM code Z79.83 should be reported for DXA testing while taking medicines for osteoporosis/osteopenia.

ICD-10-CM Z09 should be reported for an individual who has COMPLETED drug therapy for osteoporosis and is being monitored for response to the therapy.

Medicare covers a bone mass measurement for a beneficiary once every two years (if at least 23 months have passed since the month the last bone measurement was performed). The criteria for bone mass measurement every two years are listed below:

 It is performed with a bone densitometer, other than dual photon absorptiometry (DPA) or a bone sonometer (e.g., ultrasound) device that has been approved or cleared for marketing by the Food and Drug Administration (FDA).

 It is performed on a qualified individual for the purpose of identifying bone mass, detecting bone loss or determining bone quality. The term “qualified individual” means an individual who meets the medical indications  for at least one of the criteria listed below:

o A woman who has been determined by the physician or qualified non-physician treating her to be estrogendeficient and at clinical risk for osteoporosis, based on her medical history and other indicators

o An individual with vertebral abnormalities as demonstrated by an x-ray to be indicative of osteoporosis, osteopenia (low bone mass), or vertebral fracture

o An individual receiving (or expecting to receive) glucocorticoid (steroid) therapy equivalent to 5 mg of Prednisone, or greater, per day for more than 3 months

o An individual with primary hyperparathyroidism

o An individual being monitored to assess the response to or efficacy of an FDA approved osteoporosis drug therapy. This service must be performed using dual energy x-ray absorptiometry system (axial skeleton) – CPT code 77080 and 77085


Monday, August 15, 2016

MO HealthNet contact information for provider enrollment

PROVIDER COMMUNICATIONS
573-751-2896

MO HealthNet providers can contact the Provider Communications Unit with inquiries, concerns or questions regarding proper claim filing, claims resolution and disposition, and participant eligibility questions and verification. The IVR (Interactive Voice Response) system is accessed by calling the 573-751-2896 number. The IVR system can address participant eligibility, last two check amounts and claim status inquiries. At anytime during the IVR options, providers may select "0" to speak with the next available specialist. Calls are put into a queue and will be answered in the order received. Providers must use a touchtone phone to access the
IVR.

Providers may send and receive secure E-mail inquiries to MO HealthNet Provider Communications and Technical Help Desk Staff. This application is available through the MO HealthNet Web portal at www.emomed.com. Once logged in and on the eProvider page, click on the ‘Provider Communications Management’ icon, this opens the ‘Manage Provider Communications’ page. From here, click on ‘New Request’ to open the ‘Create New Request’ form to enter and submit an inquiry. Providers are limited to one inquiry per E-mail. The user submitting the E-mail inquiry will be notified  via E-mail when they have a response available to their inquiry.
The Provider Communications Unit also responds to written inquiries. Written inquiries should be sent to:

Provider Communications Unit
PO Box 5500
Jefferson City, Missouri 65102

WIPRO INFOCROSSING HEALTHCARE SERVICES, INC. HELP DESK
573-635-3559

Call this number for assistance in establishing the required electronic claims and remittance advice formats, network communication, HIPAA trading partner agreements and assistance with the Wipro Infocrossing Internet billing service.


PROVIDER ENROLLMENT

Providers are required to notify Missouri Medicaid Audit Compliance, Provider Enrollment Section regarding changes to their Provider Master File. Changes include, but are not limited to, physical address, tax identification, ownership, individual's name or practice name, or NPI number. Changes may be reported via E-mail at mmac.providerenrollment@dss.mo.gov or by mail to:

Missouri Medicaid Audit and Compliance
Provider Enrollment Section
PO Box 6500
Jefferson City, Missouri 65102



THIRD PARTY LIABILITY
573-751-2005

Call the Third Party Liability Unit to report injuries sustained by MO HealthNet participants, problems obtaining a response from an insurance carrier, or unusual situations concerning third party insurance coverage for a MO HealthNet participant.


PROVIDER EDUCATION
573-751-6683

Provider Education Unit staff are available to educate providers and other groups on0 proper billing methods and procedures for MO HealthNet claims. Contact the unit for training information and scheduling. Providers may also send E-mails to the unit at
mhd.provtrain@dss.mo.gov.


PARTICIPANT SERVICES
800-392-2161 or 573-751-6527

The Participant Services Unit assists participants regarding access to providers, eligibility, covered and non-covered services and unpaid medical bills.


MO HEALTHNET PHARMACY AND CALL CENTER
800-392-8030

Providers can call this toll free number to:

• Request pre-certification for specific DME items;

• Initiate an emergency request for an essential medical service or an item of equipment that would not normally be covered under the MO HealthNet program;

Providers are encouraged to sign up for the MO HealthNet Web tool – CyberAccessSM – which automates the pre-certification process. To become a CyberAccessSM user, contact the Xerox Care and Quality help desk at 888-581-9797 or 573-632-9797 or
send an E-mail to CyberAccessHelpdesk@xerox.com. The CyberAccessSM tool allows each pre-certification to automatically reference the individual participant's claim history, including ICD-9 diagnosis codes and procedure codes.

• Request information on Medicare Part D,

• Request a drug prior authorization; or,

• Request medical pre-certification for a CT scan or MRI.

Saturday, August 13, 2016

Medicare Coverage Related to Investigational Device Exemption (IDE)

Requesting Coverage

Interested parties with Food and Drug Administration (FDA) approval letters dated January 1, 2015 or later for IDE Category A or Category B studies that are seeking Medicare coverage for Category A or B IDE studies must submit a request packet to CMS that includes the following information:

A. A request letter that describes the scope and nature of the IDE study. For your convenience we created a checklist and sample crosswalk to assist submitters in submitting a complete package. We encourage you to submit this crosswalk along with the request packet to facilitate CMS' review. The letter should focus on how the IDE study meets each of the regulatory Medicare coverage IDE study criteria, which are:

1. The principal purpose of the study is to test whether the device improves health outcomes of appropriately selected patients.
2. The rationale for the study is well supported by available scientific and medical information, or it is intended to clarify or establish the health outcomes of interventions already in common clinical use.
3. The study results are not anticipated to unjustifiably duplicate existing knowledge.
4. The study design is methodologically appropriate and the anticipated number of enrolled subjects is adequate to confidently answer the research question(s) being asked in the study.
5. The study is sponsored by an organization or individual capable of successfully completing the study.
6. The study is in compliance with all applicable Federal regulations concerning the protection of human subjects found at 21 CFR parts 50, 56, and 812, and 45 CFR part 46.
7. Where appropriate, the study is not designed to exclusively test toxicity or disease pathophysiology in healthy individuals.  Studies of all medical technologies measuring therapeutic outcomes as one of the objectives may be exempt from this criterion only if the disease or condition being studied is life threatening and the patient has no other viable treatment options.
8. The study is registered with the National Institutes of Health (NIH) National Library of Medicine’s (NLM) ClinicalTrials.gov.
9. The study protocol describes the method and timing of release of results on all pre-specified outcomes, including release of negative outcomes and that the release should be hastened if the study is terminated early.
10. The study protocol must describe how Medicare beneficiaries may be affected by the device under investigation, and how the study results are or are not expected to be generalizable to the Medicare beneficiary population. Generalizability to populations eligible for Medicare due to age, disability, or other eligibility status must be explicitly described.
B. FDA approval letter of the Category A or Category B IDE. (CMS will review a submission with a conditional FDA approval letter; however, please submit the final FDA approval letter to CMS at clinicalstudynotification@cms.hhs.gov.)
C. IDE study protocol.
D. Institutional Review Board (IRB) approval letter (only submit one IRB approval letter per request).
E. National Clinical Trial (NCT) number (e.g., NCT00000123)
F. Supporting materials, as appropriate.

Claims Submission Related to IDE Studies



Medicare claims for routine care items and services related to Category A or B IDE studies and Category B IDE devices should be submitted to MACs that will identify routine costs for which Medicare payment is made for each related claim.

Wednesday, August 10, 2016

Chemotherapy Administration and Evaluation and Management Services Furnished on the Same Day


For services furnished on or after January 1, 2004, do not allow payment for CPT code 99211, with or without modifier 25, if it is billed with a nonchemotherapy drug infusion code or a chemotherapy administration code. Apply this policy to code 99211 when it is billed with a diagnostic or therapeutic injection code on or after January 1, 2005.

Physicians providing a chemotherapy administration service or a nonchemotherapy drug infusion service and evaluation and management services, other than CPT code 99211, on the same day must bill in accordance with §30.6.6 using modifier 25. The carriers pay for evaluation and management services provided on the same day as the chemotherapy administration services or a nonchemotherapy injection or infusion service if the evaluation and management service meets the requirements of section §30.6.6 even though the underlying codes do not have global periods. If a chemotherapy service and a significant separately identifiable evaluation and management service are provided on the same day, a different diagnosis is not required.

In 2005, the Medicare physician fee schedule status database indicators for therapeutic and diagnostic injections were changed from T to A. Thus, beginning in 2005, the policy on evaluation and management services, other than 99211, that is applicable to a chemotherapy or a nonchemotherapy injection or infusion service applies equally to these codes.

Monday, August 8, 2016

gynaecologist CPT code list

HCPCS Description Place of Service 

36415 Routine venipuncture for collection of specimen(s) 11 – Office, 12 – Home
36416 Collection of capillary blood specimen 11 – Office, 12 – Home
59400 Vaginal delivery w/7 or more antepartum & postpartum 11 – Office, 12 – Home
59409 Vaginal delivery only 11 – Office, 12 – Home
59410 Vaginal delivery; including postpartum care 11 – Office, 12 – Home
59425 Antepartum care only; 4-6 visits 11 – Office, 12 – Home
59426 Antepartum care only; 7 or more visits 11 – Office, 12 – Home
59430 Post-partum care only 11 – Office, 12 – Home
59610 Routine OB care including antepartum, vaginal delivery & postpartum; after previous cesarean 11 – Office, 12 – Home
59612 Vaginal delivery only, after previous cesarean 11 – Office, 12 – Home
59614 Vaginal delivery only after cesarean, including postpartum 11 – Office, 12 – Home
59899 Unlisted maternity procedure (use for labor management in the event of transfer intrapartum) 11 – Office, 12 – Home
90471 Immunization administration, first vaccine. Single or combination vaccine/toxoid (use for injection of vaccination/rhogam injection) 11 – Office, 12 – Home
96360 Intravenous infusion, hydration 11 – Office, 12 – Home
96361 Each additional hour (list separately in addition to code for primary procedure) 11 – Office, 12 – Home
96365 IV for therapy, prophylaxis, or diagnosis (specify substance or drug); initial one (1) hour 11 – Office, 12 – Home
96366 Each additional hour (list separately in addition to code for primary procedure) 11 – Office, 12 – Home
99001 Handling and/or conveyance of specimen for transfer 11 – Office, 12 –
Home EVALUATION AND MANAGEMENT VISITS (99201 – 99348) can be used for initial patient visit
99201 New patient office visit problem focused 11 – Office, 12 – Home
99202 New patient office visit expanded problem 11 – Office, 12 – Home
99203 OV or OP evaluation new patient detailed 30 minutes 11 – Office, 12 – Home
99211 Established patient office visit problem focused 11 – Office, 12 – Home
99212 Established patient office visit expanded problem 11 – Office, 12 – Home
99213 OV or OP evaluation established patient detailed 30 minutes 11 – Office, 12 – Home
99341 Home visit new pt/a problem (low severity) 12 – Home
99342 Home visit new pt/expanded (moderate severity) 12 – Home
99347 Home visit for e/m of established patient; problem focused 12 – Home
99348 Home visit for e/m of established patients; expanded problem focused 12 – Home
99460 Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant 11 – Office
99461 Initial care, per day, for evaluation & management of normal newborn other than hospital or birthing center 12 – Home
99463 Initial hospital or birthing center per day for evaluation & management of normal newborn admit/discharge same day 11 – Office, 12 – Home
99465 Delivery/birthing room resuscitation: provision of positive pressure ventilation and/or chest compressions in presence of acute inadequate ventilation 11 – Office, 12 – Home  A4217 Sterile water/saline, 500 ml 11 – Office, 12 – Home
J0171 Injection, adrenalin, epinephrine, 0.1 mg 11 – Office, 12 – Home
J0290 Injection, ampicillin, up to 500 mg 11 – Office, 12 – Home
J0561 Injection, penicillin g benzathine, per 100,000 units 11 – Office, 12 – Home
J0690 Injection, cefazolin sodium, ancef, kefzol, up to 500 mg 11 – Office, 12 – Home
J2590 Injection, oxytocin, up to 10 units 11 – Office, 12 – Home
J2790 Rho d immune globulin injection 300 mcg 11 – Office, 12 – Home
J3430 Injection, vitamin K, per 1 mg 11 – Office, 12 – Home
J3490 UNCLASSIFIED DRUGS (use for erythromycin ointment, or for lidocaine injection and attach a copy of the invoice to the claim) 11 – Office, 12 – Home
J7040 Infusion, normal saline solution, (500 ml=1 unit) 11 – Office, 12 – Home
J7050 Infusion, normal saline solution, 250 cc 11 – Office, 12 – Home
J7120 Ringers lactate infusion up to 1000 cc 11 – Office, 12 – Home
S0077 Injection, clindamycin phosphate, 300 mg 11 – Office, 12 – Home
S3620 Newborn metabolic screening, includes test kit, postage & lab tests specified
11 – Office, 12 – Home S5011 5% dextrose in lactated ringer’s, 1000 ml 11 – Office, 12 – Home

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