LEGEND. COLUMN 6. MED REV (Medical Review): Claims with some codes pend to Medical Review for review of the attachments or for manual pricing.

Size: px

Start display at page:

Download "LEGEND. COLUMN 6. MED REV (Medical Review): Claims with some codes pend to Medical Review for review of the attachments or for manual pricing."

Elfrieda Perkins
5 years ago
Views:

1 RUN: 12/31/ :44:06 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: 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 Molina 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 Take Charge Plus. Nurse Practitioners, Clinical Nurse Specialists, and Physician Assistants are paid at 80% of the fee listed for physician services except for physician administered injections, long-acting reversible contraceptive (LARC's), immunizations, and EPSDT preventative medical screenings which are reimbursed at 100% of the physician services fee. 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. BASE UNITS: The base units for anesthesia codes. COLUMN 12. X-OVERS (Only): These codes are payable for Medicare/Medicaid recipients only. COLUMN 13. UVS>001: An 'X' in this column means more than one unit of service per day may be billed.

2 RUN: 12/31/ :44:06 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: 1 58 A4216 STERILE WATER SALINE AND/OR DEXTROSE X X 58 A4266 DIAGPHRAM FOR CONTRACEPTIVE USE F X 58 A4267 CONTRACEP SUPPLY/MALE CONDOM, EACH X X 58 A4268 CONTRACEP SUPPLY/FEMALE CONDOM, EACH X X 58 A4269 CONTRACEPTIVE SUPPLY, SPERMACIDE X X 58 G0123 SCREENING CYTOPATH, CERVICAL OR VAGI F 58 G0141 SCR C/V CYTO,AUTOSYS AND MD F 58 HR250 PHARMACY, GENERAL CLASSIFICATION CCR X X 58 HR258 PHARMACY, IV SOLUTIONS CCR X X 58 HR259 PHARMACY, OTHER PHARMACY CCR X 58 HR260 IV THERAPY CCR X X 58 HR270 MED/SURG SUPPLY/DEVICE-GEN CLS CCR X X 58 HR271 TEMPKIT/PROBE COVERS/SERVICE CCR X X 58 HR272 STERILE SUPPLY CCR X X 58 HR300 LABORATORY-GEN CLASSIFICATION CCR X 58 HR301 CHEMISTRY CCR X X 58 HR302 IMMUNOLOGY CCR X X 58 HR305 HEMATOLOGY CCR X X 58 HR306 LABORATORY-HEMATOLOGY CCR X X 58 HR307 LABORATORY-UROLOGY CCR X X 58 HR309 LABORATORY-OTHER LABORATORY CCR X X 58 HR310 LAB PATHOLOGICAL/GE CLASSIFICATION CCR X X 58 HR311 LABORATROY PATHOLOGIC/CYTOLOGY CCR X X 58 HR312 LAB PATHOLOGIC/HISTOLOGY CCR X X 58 HR320 RADILOLGY-DIAGNOSTIC GEN CLASS CCR X X 58 HR324 CHEST X-RAY CCR X X 58 HR360 OPERATING ROOM SERVICES GN CLA CCR X X 58 HR402 ULTRASOUND CCR F X X 58 HR490 AMBULATORY SURGICAL CARE GENERAL HCPC X X 58 HR510 CLINIC - GENERAL CCR HR514 OB-GYN CLINIC CCR X 58 HR517 FAMILY PRACTICE CLINIC CCR X 58 HR760 TREATMENT/OBSERVATION ROOM CCR X X 58 HR920 OTHER DIAG SERV GEN CLASSIFICATION CCR X X 58 HR925 PREGNANCY TEST CCR F X X 58 J0171 INJECTION ADRENALIN EPINEPHRINE X 58 J0461 INJECTION, ATROPINE SULFATE, 0.01 MG X 58 J0558 INJECTION PENICILLIN G BENZATHINE A X 58 J0561 INJECTION PENICILLIN G BENZATHINE X 58 J0690 CEFAZOLIN SODIUM INJ 500MG X 58 J0694 CEFOXITIN SODIUM, 1GM X

3 RUN: 12/31/ :44:06 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: 2 58 J0696 CEFTRIAXONE SODIUM 250MG ROCEPHIN X 58 J0697 STERILE CEFUROXIME SODIUM 750MG X 58 J0698 CEFOTAXIME SODIUM/PER GM X 58 J0710 INJECTION CEPHAPIRIN SODIUM UP TO1GM X 58 J1050 INJECTION, MEDROXYPROGESTERONE ACETA F X 58 J1200 DIPHENHYDRAMINE HCL INJ(BENDARY)50MG X 58 J1840 KANAMYCIN SULFATE, UP TO 500MG X 58 J2460 OXYTETRACYCLINE,UP TO 50MG X 58 J2510 PCN G PROCAINE AQ, UP TO 600,000 U X 58 J2540 PCN G POTASSIUM,UP TO 600,000U X 58 J3000 STREPTOMYCIN, UP TO 1GM X 58 J7120 RINGERS INJ, UP TO 1000 CC X 58 J7300 INTRAUTERINE COPPER DEVICE F X 58 J7301 LEVONORGESTREL-RELEASING INTRAUTERIN F X 58 J7302 MIRENA-LEV-REL INTRA CONT SYS, 52MG F X 58 J7306 LEVONORGESTREL IMPLANT SYS X F 58 J7307 ETONOGESTREL (CONTRACEPTIVE) IMPLANT F X 58 Q0111 WET MOUNTS,PREPARATIONS OF VAGINAL F 58 Q0112 POTASSIUM MYDROXIDE PREPARATIONS S4993 CONTRACEP PILLS/BIRTH CONTROL-1 MTH F X X 58 T1001 NURSING ASSESSMENT X 58 Z5177 PROFIT LOCAL TRIP X X 58 Z5178 PROFIT NEGOTIATED TRIP X X 58 Z5179 CAPITATED REGULAR URBAN X 58 Z5180 CAPITATED REGULAR RURAL X 58 Z5181 FAMILY AND FRIENDS NEGOTIATED X 58 Z5182 ENHANCED CAPITATED >5 TRIPS PER WK X 58 Z5183 CAPITATED REMOTE RURAL X 58 Z5184 CAPITATED WHEELCHAIR RURAL X 58 Z5185 CAPITATED WHEELCHAIR URBAN X 58 Z5186 LOCAL PROFIT WHEELCHAIR X 58 Z5187 LOCAL NONPROFIT WHEELCHAIR X 58 Z5188 CAPITATED-NEGOTIATED NEMT X 58 Z9486 FAMILY AND FRIENDS TWO WAY TRIP X X 58 Z9494 FAMILY AND FRIENDS URBAN X 58 Z9498 NON PROFIT LOCAL TRIP X X 58 Z9500 NON PROFIT NEGOTIATED RATE.00 X ANES; TUBAL LIGATION/TRANSECTION X F X 6 X ANESTHESIA, VASECTOMY, UNILATERAL/BI M 3 X ANESTHESIA, VAGINAL PROC, NOS F 3 X HYSTEROSCOPY/HYSTEROSALPINGOGRAPHY F 4 X

4 RUN: 12/31/ :44:06 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: DRAINAGE OF SKIN ABSCESS INCISE/DRAIN SIMPLE HEMATOMA EXCISE BENIGN LESION TO 0.5 CM X EXCISE BENIGN LESION 0.6 TO 1 CM X REMOVAL WITHOUT REINSERTION, IMPLANT F INSERTION,NON-BIODEGRADABLE DRUG DEL F REMOVAL,NON-BIODEGRADABLE DRUG DELIV F REMOVAL WITH REINSERTION,NON BIODEGR F DESTROY FLAT WARTS,ANY METHOD,T DESTRUCT LESION, 15 OR MORE VENIPUNCTURE MULTIPLE PATIENTS X X CAPILLARY BLOOD DRAW X REMOVAL OF ANAL LESION REMOVAL OF ANAL LESION CRYSOSURGERY-ANAL LESIONS, X DESTROY ANAL LESION(S)-SURG EXCISION DESTROY ANAL LESIONS,ANY METH,EXTEN TREATMENT OF PENIS LESION M DESTROY PENILE LESION;CRYOSURGERY M BIOPSY OF PENIS M VASECTOMY, UNILATERAL OR BILATERAL X M LIGATION OF VAS DEFERENS X M INCISION AND DRAINAGE OF VULVA OR PE F INCISION AND DRAINAGE OF FEMALE GENI F X DESTROY VULVA LESION(S);SIMPLE F BIOPSY OF VULVA OR PERINEUM (SEPARAT F DESTROY VAGINAL LESIONS;SIMPLE F TREAT VAGINA INFECTION F X DIAPHRAGM FITTING WITH INSTRUCTIONS F EXAMINATION OF VAGINA F VAGINA EXAMINATION & BIOPSY F BIOPSY OF CERVIX W/SCOPE F ENDOCERV CURETTAGE W/SCOPE F COLPOSCOPY (VAGINOSCOPY); F CONZ OF CERVIX W/SCOPE,LEEP F ENDOCERVICAL CURETTAGE F CAUTERIZATION OF CERVIX F CRYOCAUTERY OF CERVIX F LASER SURGERY REVISION OF CERVIX F DILATION OF CERVICAL CANAL F

5 RUN: 12/31/ :44:06 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: BIOPSY OF UTERUS LINING F BX DONE W/COLPOSCOPY ADD-ON F INSERT INTRAUTERINE DEVICE F REMOVE INTRAUTERINE DEVICE F INJECT FOR UTERUS/TUBE X-RAY X F X HYSTEROSCOPY, REMOVE FB X F HYSTEROSCOPY, STERILIZATION 1, X F X DIVISION OF FALLOPIAN TUBE X F DIVISION OF FALLOPIAN TUBE X F LIG/TRANSEC FALLOP TUBE NOT SEP PROC X F X OCCLUSION OF FALLOPIAN TUBE, DEVICE X F LAPAROSCOPY, LYSIS X F LAPAROSCOPY, TUBAL CAUTERY X F LAPAROSCOPY, TUBAL BLOCK X F INJECTION(S), OF DIAGNOSTIC OR THERA INJECTION(S), INCLUDING INDWELLING C INJECTION FOR NERVE BLOCK X X X-RAY CHEST;POSTEROANTERIOR X X-RAY CHEST;TWO VIEWS X X-RAY EXAM OF PELVIS X-RAY EXAM OF ABDOMEN X X-RAY EXAM OF ABDOMEN X HYSTEROSALPINGOGRAPHY F ECHOGRAPHY, TRANSVAGINAL F ECHO EXAM, UTERUS F ECHOGRAPHY, PELVIC, REAL TIME F X ECHOGRAPHY, PELVIC,LIMITED OR FOLLOW US BONE DENSITY MEASURE COMPUTED TOMOGRAPHY, BONE MINERAL DE DUAL-ENERGY X-RAY ABSORPTIOMETRY (DX DUAL-ENERGY X-RAY ABSORPTIOMETRY (DX DUAL-ENERGY X-RAY ABSORPTIOMETRY (DX X BLOOD TEST, BASIC GROUP OF BLOOD CHE BLOOD TEST, BASIC GROUP OF BLOOD CHE GENERAL HEALTH PANEL BLOOD TEST PANEL FOR ELECTROLYTES (S BLOOD TEST, COMPREHENSIVE GROUP OF B BLOOD TEST, LIPIDS (CHOLESTEROL AND KIDNEY FUNCTION BLOOD TEST PANEL ACUTE HEPATITIS PANEL LIVER FUNCTION BLOOD TEST PANEL

6 RUN: 12/31/ :44:06 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: DRUG, SCREEN; X X DRUG, SCREEN; X X DRUG, CONFIRMATION, EACH PROCEDURE X X URINALYSIS WITH MICROSCOPY X URINALYSIS, AUTO, W/SCOPE ROUTINE URINE ANALYSIS X URINALYSIS, BY DIP STICK OR TABLET R URINALYSIS X BACTERIA SCREEN B NON-CULT TECH COMM MICROSCOPIC EXAM OF URINE X URINALYSIS, GLASS TEST URINE PREGNANCY TEST, BY VISUAL COLO F X ASSAY SERUM ALBUMIN ASSAY URINE ALBUMIN ALBUMIN; AMINES, VAGINAL FLUID QUAL ASSAY OF SERUM AMYLASE X BILIRUBIN TOTAL ASSAY CALCIUM IN BLOOD X ASSAY CALCIUM IN BLOOD ASSAY BLOOD CHLORIDES X ASSAY SERUM CHOLESTEROL ASSAY CPK IN BLOOD X ASSAY CPK IN BLOOD X ASSAY BLOOD CREATININE X ASSAY URINE CREATININE CREATININE CLEARANCE TEST RIA ASSAY FOR VITAMIN B RIA ASSAY OF ESTRADIOL ESTROGENS ASSAY ESTROGEN ASSAY RIA ASSAY OF ESTRIOL RIA ASSAY OF ESTRONE FERRITIN, SPECIFY METHOD BLOOD FOLIC ACID RIA ASSAY BODY FLUID, GLUCOSE X STICK ASSAY OF BLOOD GLUCOSE X GLUCOSE TEST GLUCOSE, BLOOD, BY GLUCOSE MONITORIN X PITUITARY GONADOTROPIN RIA PITUITARY GONADOTROPINS RIA

7 RUN: 12/31/ :44:06 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: ASSAY HEMOGLOBIN X ASSAY BLOOD LIPASE PH; BODY FLUID, NOT OTHERWISE SPECIF X ASSAY ALKALINE PHOSPHATASE ASSAY BLOOD POTASSIUM X ASSAY PROGESTERONE RIA ASSAY FOR PROLACTIN ASSAY SERUM PROTEIN ASSAY OF PROTEIN, OTHER ASSAY VITAMIN B RECEPTOR ASSAY; ESTROGEN(ESTRADIOL) RECEPTOR ASSAY; PROGESTERONE ASSAY VITAMIN B ASSAY BLOOD SODIUM X TESTOSTERONE; ASSAY VITAMIN B RIA ASSAY OF TS HORMONE ASSAY BUN X ASSAY BLOOD URIC ACID GONADOTROPIN,CHORIONIC;QUANTITATIVE GONADOTROPIN,CHORIONIC;QUALITATIVE AUTOMATED DIFF WBC COUNT DIFFERENTIAL WBC COUNT X BLOOD COUNT; DIFFERENTIAL WBC COUNT X BLOOD COUNT; BLOOD COUNT OTHER THAN SPUN HEMATOCR X HEMOGLOBIN, COLORIMETRIC X BLOOD COUNT;HEMO.PLAT.COUNT,AUTO/AMT X HEMOGRAM,AUTOMATED W/PLATELET COUNT X MANUAL CELL COUNT, EACH X RED BLOOD CELL (RBC) COUNT X RETICULOCYTE COUNT FLOW CYTOMETRY WHITE BLOOD CELL (WBC) COUNT PROTHROMBIN TIME X RBC SEDIMENTATION RATE RBC SED RATE, AUTO THROMBOPLASTIN TIME, PARTIAL X FLUORESCENT ANTIBODY; SCREEN IMMUNOASSAY FOR CHEM. CONSTITUENT NEUTRALIZATION TEST, VIRAL

8 RUN: 12/31/ :44:06 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: PRECIPITIN (EG, LATEX BEAD) OR AGGLU SYPHILIS TEST(S),QUALITATIVE SYPHILIS TEST, QUANTITATIVE ANTIBODY; ANTIBODY; ANTIBODY; ANTIBODY; HTLVI, ANTIBODY DETECTION;IMMUNOASSA ANTIBODY; CONFIRMATORY TEST ANTIBODY; ANTIBODY; HERPES SIMPLEX TYPE ANTIBODY; ANTIBODY; ANTIBODY; ANTIBODY; HIV-1 AND HIV-2, SINGLE RE HEP B CORE AB TEST, IGG & M HEP B CORE AB TEST, IGM HEPATITIS B SURFACE AB TEST HEPATITIS BE AB TEST ANTIBODY; ANTIBODY; HEPATITIS C AB TEST HEP C AB TEST, CONFIRM BLOOD TYPING; BLOOD TYPING; BLOOD TYPING; X BLOOD TYPING; X SPECIMEN CONCENTRATION X BLOOD CULTURE FOR BACTERIA X CULTURE SPECIMEN, BACTERIA X CULTURE BACTERI AEROBIC OTHR CULTURE BACTERIA ANAEROBIC CULTURE SPECIMEN, BACTERIA X BACTERIA IDENTIFICATION CULTURE AEROBIC IDENTIFY X BACTERIA CULTURE SCREEN URINE CULTURE, COLONY COUNT URINE BACTERIA CULTURE FUNGUS ISOLATION CULTURE

9 RUN: 12/31/ :44:06 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: CULTURE,CHLAMYDIA CULTURE TYPING, SEROLOGIC DARK FIELD EXAMINATION ANTIBIOTIC SENSITIVITY, EACH X ANTIBIOTIC SENSITIVITY, MIC SMEAR, STAIN & INTERPRET X SMEAR, STAIN & INTERPRET X SMEAR, STAIN & INTERPRET X SMEAR, STAIN & INTERPRET X TISSUE EXAMINATION FOR FUNGI VIRUS ID;TISSUE CULT.INOCULATION/OBS VIRUS ID;TISS CULT,ADD STDY,@ ISOLAT X VIRUS INOCULATION, SHELL VIA X GENET VIRUS ISOLATE, HSV X CHYLMD TRACH AG, DFA HERPES SIMPLEX 2, AG, IF HERPES SIMPLEX AG, DFA CHYLMD TRACH AG, EIA HEPATITIS B SURFACE AG, EIA HEPATITIS B AG, EIA HIV-1 AG, EIA HIV-2 AG, EIA BARTONELLA, DNA, DIR PROBE CANDIDA, DNA, DIR PROBE CANDIDA, DNA, AMP PROBE CHYLMD PNEUM, DNA, DIR PROBE CHYLMD PNEUM, DNA, AMP PROBE CHYLMD TRACH, DNA, DIR PROBE CHYLMD TRACH, DNA, AMP PROBE X CYTOMEG, DNA, DIR PROBE CYTOMEG, DNA, AMP PROBE CYTOMEG, DNA, QUANT GARDNER VAG, DNA, DIR PROBE F GARDNER VAG, DNA, AMP PROBE F HSV, DNA, DIR PROBE HSV, DNA, AMP PROBE HSV, DNA, QUANT HHV-6, DNA, DIR PROBE HHV-6, DNA, AMP PROBE HHV-6, DNA, QUANT HIV-1, DNA, DIR PROBE

10 RUN: 12/31/ :44:06 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: DETECTION TEST FOR HIV-1 VIRUS DETECTION TEST FOR HIV-1 VIRUS HIV-2, DNA, DIR PROBE DETECTION TEST FOR HIV-2 VIRUS N.GONORRHOEAE, DNA, DIR PROB N.GONORRHOEAE, DNA, AMP PROB X HPV, DNA, DIR PROBE X HPV, DNA, AMP PROBE X TRICHOMONAS VAGIN, DIR PROBE F DETECT AGENT NOS, DNA, DIR DETECT AGNT MULT, DNA, DIREC DETECT AGNT MULT, DNA, AMPLI CHYLMD TRACH ASSAY W/OPTIC N. GONORRHOEAE ASSAY W/OPTIC CYTOPATHOLOGY, FLUIDS, WASHINGS OR B CYTOPATH CERV/VAG INTERPRET F CYTOPATH CERV/VAG THIN LAYER F CYTPATH C/VAG T/LAYER REDO F CYTPATH C/VAG AUTOMATED F CYTPATH C/VAG AUTO RESCREEN F CYTOPATHOLOGY, PAP SMEAR F X CYTOPATH CERV/VAG AUTO F CYTPATH C/VAG REDO F CYTPATH C/VAG SELECT F CYTOPATH,(PAP);W/ DEF.HORMONAL EVAL F X CYTOPATHOLOGY CYTOPATH...;PREP,SCREEN,INTERP CYTOPATH..;EXT.STUDY,+5 SLIDES,MULTI CYTPATH TBS C/VAG MANUAL F CYTPATH TBS C/VAG REDO F CYTPATH TBS C/VAG AUTO REDO F CYTPATH TBS C/VAG SELECT F CYTOPATHOLOGY, EVALUATION OF FINE NE FINE NEEDLE ASPIRATE..;INTERP/REPORT CYTOPATHOLOGY,CERVIAL OR VAGINAL COL F CYTOPATHOLOGY WITH SCREENING SURGICAL PATHOLOGY, GROSS X PATHOLOGY EXAMINATION OF TISSUE USIN X PATHOLOGY EXAMINATION OF TISSUE USIN X PATHOLOGY EXAMINATION OF TISSUE USIN SPECIAL STAIN INCLUDING INTERPRETATI

11 RUN: 12/31/ :44:06 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: SPECIAL STAIN INCLUDING INTERPRETATI IMMUNIZATION ADMIN, ONE VACC,(SC/IM) IMMUNIZATION ADMINS, EA ADDL VACCINE X HPV VACCINE 4 VALENT, IM HUMAN PAPILLOMA VIRUS (HPV) VACCINE, ROUTINE ECG W/AT LEAST 12 LEADS X TIME OTHER THAN REG SCHED HRS MODERATE SEDATION SERVICES BY PHYSIC X NEW PATIENT OFFICE OR OTHER OUTPATIE NEW PATIENT OFFICE OR OTHER OUTPATIE NEW PATIENT OFFICE OR OTHER OUTPATIE NEW PATIENT OFFICE OR OTHER OUTPATIE NEW PATIENT OFFICE OR OTHER OUTPATIE OFFICE,EST PT, MINIMAL PROBLEMS X ESTABLISHED PATIENT OFFICE OR OTHER X ESTABLISHED PATIENT OFFICE OR OTHER ESTABLISHED PATIENT OFFICE OR OTHER ESTABLISHED PATIENT OFFICE OR OTHER INITIAL HOSPITAL INPATIENT CARE, TYP INITIAL HOSPITAL INPATIENT CARE, TYP INITIAL HOSPITAL INPATIENT CARE, TYP SUBSEQUENT HOSPITAL INPATIENT CARE, SUBSEQUENT HOSPITAL INPATIENT CARE, SUBSEQUENT HOSPITAL INPATIENT CARE, HOSPITAL DISCHARGE DAY MANAGEMENT HOSPITAL DISCHARGE DAY INIT E&M HEALTHY INDV,LTE CHLD INIT E&M HEALTHY INDV,ADOLS,12-17YRS INIT COMP PREV MED YRS X INIT COMP PREV MED YRS X ESTABLISHED PATIENT PERIODIC PREVENT ESTABLISHED PATIENT PERIODIC PREVENT ESTABLISHED PATIENT PERIODIC PREVENT X ESTABLISHED PATIENT PERIODIC PREVENT X

Listed below is an explanation of the types of service found on this schedule.

Listed below is an explanation of the types of service found on this schedule. RUN: 12/20/16 08:55:28 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: LEGEND ------------------------------------------------------------------------------------------------------------------------------------