CPT CODE and description
99080 – Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form – average fee amount – $0.00
99090 – Analysis of clinical data stored in computers (eg, ECGs, blood pressures, hematologic data
99091 – Collection and interpretation of physiologic data (eg, ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time
Use Current Procedural Terminology (CPT®) code 99080 for additional diagnoses
BlueCross BlueShield of Western New York encourages claim submissions containing the maximum number of diagnosis codes along with CPT code 99080, which allows multiple ICD-9/ICD-10 diagnosis codes.
• Code 99080 can be used with Evaluation and Management (E/M) codes when a patient has multiple medical conditions, but only one procedure was performed in your office on the date of service.
• If you already use 99080 for other reasons, such as medical records or workers’ compensation, your practice management system should be updated to use this code for reporting additional diagnoses also.
• Some EMRs require every diagnosis code to point to a CPT code, while other EMRs do not; therefore, there will be occasional discrepancies between the number of diagnosis codes providers believe they are sending and what we actually receive.
• Some practice management systems limit the number of diagnosis codes that can be submitted with a claim. Provider offices experiencing system limitations are encouraged to contact their software vendor for assistance.
• The examples provided show how to best use this code.
MEDENT Users Only: Use EXTDX or 99080 ANSI 5010 guidelines specify a maximum of 12 diagnosis codes can be sent at the claim level; however, charges can only have a total of 4 diagnosis pointers in MEDENT software.
To allow additional diagnosis codes to be sent on claims, MEDENT programmed a special house code – EXTDX – that can be entered at charge entry for the additional diagnosis codes.
How does this work?
MEDENT looks for any EXTDX code with a matching doctor, location, and date of service for the charge being billed.
The diagnosis codes listed on the charge activity of the matching EXTDX charge will be added to the claim. Up to 12 diagnosis codes can be sent.
Diagnosis codes beyond the maximum allowed per claim will not be sent.
MEDENT will not send duplicate diagnosis codes on the same claim. The EXTDX feature will automatically work with any electronic or printed insurance claim.
Development of an updated treatment plan will be billed using Current Procedural Terminology (CPT) code 99080, “Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form.”
FEES FOR REPORTS/COPIES
1. Health care providers may charge for completing an initial diagnostic medical report (Form M-1) or other supplemental report. The charge is to be identified by billing CPT® Code 99080.
2. The maximum fee for completing an initial M-1 form or other supplemental report is: Each 10 minutes: $30.00
3. Health care providers may charge for copies of the health care records required to accompany the bill. The charge is to be identified by billing CPT® Code S9981 (units equal total number of pages). The maximum fee for copies is $5 for the first page and 45¢ for each additional page, up to a maximum of $250.00.
4. Health care providers must at the written request of the employer/insurer or the employer/insurer’s representative furnish copies of the health care records to the employer/insurer or the employer/insurer’s representative and to the employee’s representative (if none, to the employee) within 10 business days from receipt of a properly completed Form 220. An itemized invoice must accompany the copies sent to the employer/insurer. The maximum fee for copies is $5 for the first page and 45¢ for each additional page, up to a maximum of $250.00. The copying charge must be paid by the party requesting the records. Health care providers shall not require payment prior to responding to the request. Health care providers shall not charge a fee for postage/ shipping, sales tax, or a fee for researching a request that results in no records.
5. Health care providers must at the written request of the employee or the employee’s representative furnish copies of any written information (may include billing records) pertaining to a claimed workers’ compensation injury or disease regardless of whether the claimed injury or disease is denied by the employer/insurer. Copies must be furnished within 10 business days from receipt of the written request. An itemized invoice must accompany the copies. The maximum fee for copies is $5 for the first page and 45¢ for each additional page, up to a maximum of $250.00. The copying charge must be paid by the party requesting the records. Health care providers shall not require payment prior to responding to the request. Health care providers shall not charge a fee for postage/ shipping, sales tax, or a fee for researching a request that results in no records.
Billing and reimbursement for a Work Status Report is as follows:
Report CPT Code Modifier Reimbursement Required Work Status Report 99080 73 $15.00
Additional report requested by or through the carrier 99080 73 and RR $15.00
Extra copy of a previously filed report requested by or through the carrier 99080 73 and EC $15.00
NOTE: When required by §129.5 to submit a DWC-073, an RME doctor or designated doctor is not reimbursed the $15 for filing the report. Reimbursement to RME doctors and designated doctors for the report is included in the reimbursement for the examination, as outlined in subsections (i) and (k) of §134.204 and addressed above in the Return to Work and Evaluation of Medical Care Exams section of this training module.
ValueOptions – TRICARE South ABA Benefits
Approved Codes
S5108 (Functional Behavioral Assessment, Initial Treatment Plan, and ABA rendered by authorized provider)
S5108 (Initial Functional Behavioral Assessment, Initial Treatment Plan, and ABA reinforcement rendered jointly by Supervisor and Tutor)
Pilot Assessment (OPBH 53)
1181F (Initial assessment by BCBA) with G8539 (Initial assessment & TP per 15 min units); G9165 (patient status code); AND G9166 (initial ABA TP goal); OR if no deficiencies found use G8542 with 1181F
99080 (Treatment plan updates) H2019 (ABA reinforcement rendered directly by Tutor) 96110 & 96111 (psychometric testing)
90887 (Progress meetings w/family) 99080 (Development of progress report and updated BP) Pilot ABA & Reinforcement (OPBH 52)
90887 (Quarterly progress meetings with bene’s caregivers)
S5108 (ABA reinforcement rendered jointly by Supervisor and BCaBA/Tutor)
H2019 (ABA reinforcement rendered directly by BCaBA/Tutor)
S5110 (Family/caregiver training by BCBA)
S5115 (Beneficiary ABA by BCBA)
1450F (Reassessment & TP update by BCBA) with G8539 (repeat assessment & TP per 15 min units); G9165 (patient status code); AND G9166 (ABA TP goal update); OR if discharge is indicated, use G8542 (continued ABA not indicated); and G9167 (discharge from ABA) with 1140F ValueOptions – TRICARE South ABA Benefits Criteria to receive ABA Enrolled in ECHO. Eligibility and registration are prerequisites to ECHO benefits being authorized
Special Services, Procedures and Reports in the Medicine Section of CPT®
(a) Handling and conveyance of specimens in connection with a transfer from an office to a laboratory is a flat rate of $25.00 (CPT® codes 99000 and/or 99001). Any other handling and conveyance in connection with implementation of an order involving devices (such as orthotics) is a flat rate of $13.00 (CPT® code 99002).
(b) Postoperative follow-up visit, CPT® code 99024, is included in the global package and is not separately payable.
(c) Educational supplies are considered “at cost” to the provider and may be billed based upon an agreement between the payer and provider (CPT® codes 99070, 99071 or 99078).
(d) Any stored clinical or physiological data analysis is not recognized unless the provider shows the reasonableness and necessity of these services and obtains prior authorization from the payer (CPT® codes 99090 and 99091).
(e) The charges for services performed after regular business hours, during holidays, or during scheduled disruptions of regular office services are not separately payable unless the provider shows the reasonableness and necessity of these services and obtains prior authorization (CPT® codes 99026, 99027, 99050, 99051, 99053, 99056, 99058, and 99060).
(f) Unusual travel expenses require prior authorization by the payer. The payer and billing provider shall agree upon maximum fees (CPT® code 99082).
(g) Medical testimony is covered under Rule 18-6(D) and special reports are covered under Rule 18-6(G)(3)&(4) (CPT® codes 99075 and 99080).
Parents often bring in forms for the physician to fill out. This is very time consuming, and I was wondering if I could charge for this service.
A. Yes, it is appropriate to report this service. The CPT code 99080 is for special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form. As stated in the code descriptor, this code is used for things such as insurance forms (for life insurance or new health insurance). The most common forms physicians have to fill out are sports and camp forms. You can try reporting 99080, but chances are you will not get reimbursed for this. If the carrier says it is not a covered service, this allows you to be able to charge the patient if the patient filled out a waiver agreeing to pay for this non-covered service. However, most physicians consider sports and camp forms “usual medical communications or standard reporting forms.
