Connecticut Medical Assistance Program Provider Bulletin Policy Transmittal December 2017

Transcription

1 Connecticut Medical Assistance Program Provider Bulletin Policy Transmittal December 2017 TO: Effective Date: January 1, 2018 Roderick L. Bremby, Commissioner Contact: Dana Physicians, Physician Assistants, Advanced Practice Registered Nurses, Certified Nurse Midwives, and Independent Radiologists RE: 1) 2018 Independent Radiology and Physician-Radiology Fee Schedules - HIPAA Compliant Update 2) Updates to Independent Radiology and Physician-Radiology Fee Schedules HIPAA Compliant Update: Effective for dates of service January 1, 2018 and forward, the Department of Social Services (DSS) is incorporating the 2018 Healthcare Common Procedure Coding System (HCPCS) changes (additions, deletions and description changes) to the fee schedules for independent radiology and physician-radiology services. DSS is making these changes to ensure that both fee schedules remain compliant with the Health Insurance Portability and Accountability Act (HIPAA). The changes apply to services reimbursed under all the HUSKY Health programs. Updates to Existing Services on the Fee Schedules: Effective for dates of service February 1, 2018 and forward, DSS is updating the rates for a select set of current services on the independent radiology and/or physician-radiology fee schedules to ensure the rates are consistent with the standard reimbursement methodology of 57.5% of the Medicare fee schedule. CPT Codes Modifier Description of tear duct of tear duct of tear duct Rate Type Rates $35.52 $9.13 $ Fmri brain by phys/psych Fmri brain by phys/psych w/o dye w/o dye w/o dye w/o & w/o & w/o & spine spine $76.88 $ $ $ $ $ $96.76 $ $ $96.98 $ $ $51.87

2 Policy Transmittal December 2017 Page spine upr extr upr extr upr extr of peritoneum of peritoneum of peritoneum Remove esophagus obstruction Remove esophagus obstruction Remove esophagus obstruction bile ducts/pancre as bile ducts/pancre as bile ducts/pancre as s at surgery addon s at surgery addon $ $ $49.59 $ $50.42 $14.27 $36.14 $ $39.93 $64.22 $28.95 $10.76 $18.19 $17.01 $ s at surgery addon bile duct bile duct bile duct for pancreas for pancreas for pancreas bile/panc bile/panc bile/panc guide for gi guide for gi guide for gi guide intestinal guide intestinal guide intestinal $10.56 $ $21.31 $87.20 $98.20 $21.53 $76.68 $ $27.32 $87.20 $88.68 $16.13 $72.55 $95.55 $22.99 $72.55

3 Policy Transmittal December 2017 Page 3 guide gi dilation $ of kidney lesion guide gi dilation guide gi dilation bile duct dilation bile duct dilation bile duct dilation of penis of penis of penis urethra/blad der urethra/blad der urethra/blad der $17.22 $87.20 $ $.08 $ $83.31 $10.76 $72.55 $46.68 $10.54 $36.14 $65.11 $33.94 $31.17 $50.27 $9.94 $ of kidney lesion of kidney lesion fallopian fallopian fallopian of perineum of perineum of perineum arm/leg arm/leg arm/leg arms/legs arms/legs arms/legs $50.46 $15.91 $34.55 $95.46 $18.42 $77.04 $58.95 $18.62 $40.32 $ $27.53 $ $ $35.19 $ $ $24.43

4 Policy Transmittal December 2017 Page $ Vein x-ray spleen/liver Vein x-ray spleen/liver Vein x-ray spleen/liver s transcath therapy s transcath therapy s transcath therapy Follow-up angiography Follow-up angiography Follow-up angiography $184. $35.19 $ $ $34.16 $ $ $37.89 $ $79.75 $51.01 $29.05 $ $ $ $ place prox ext thor ao place prox ext thor ao place prox ext thor ao place dist ext thor ao place dist ext thor ao place dist ext thor ao Vascular Vascular Vascular Fluoroscope exam extensive Fluoroscope exam extensive Fluoroscope exam extensive x-rays x-rays $ $ $ $ $ $ $ $ $343. $24.40 $ $93.99 $21.44 $72.55 $43.46 $11.40

5 Policy Transmittal December 2017 Page x-rays x-rays addon x-rays addon x-rays addon consultation Mr spectroscop y Mr spectroscop y Mr spectroscop y for heart for heart for heart for transfusion for transfusion $32.06 $30.20 $8.52 $21.68 $27.38 $ $ $ $61.91 $19.60 $42.31 $ $62.92 $46.13 $84.05 $41.88 $ for transfusion villus sampling villus sampling villus sampling Gi endoscopic ultrasound Gi endoscopic ultrasound Gi endoscopic ultrasound intraop intraop intraop Ct guide for Ct guide for Ct guide for Mri for Mri for Mri for Respirator motion mgmt simul $42.18 $62.86 $20.69 $42.18 $68.72 $.41 $42.31 $ $39.44 $78.13 $ $ $9.76 $ $ $ $273.94

6 Policy Transmittal December 2017 Page 6 function Respirator motion mgmt simul Design mlc device for imrt Design mlc device for imrt Design mlc device for imrt Hepatobiliar y system Hepatobiliar y system Hepatobiliar y system Breath test analysis c- 14 Breath test analysis c- 14 Breath test analysis c- 14 Gi protein loss exam Gi protein loss exam Gi protein loss exam Non heart function Non heart function Non heart $ $ $ $ $21.23 $ $ MP $29.05 $50.53 $31.07 $11.38 $19.73 $36.63 $13.65 $ Heart muscle Heart muscle Heart muscle single single single multiple multiple multiple Brain Brain Brain $1, $42.45 $1, $ $43.32 $ $ $53.83 $ $1, $42.69 $1,

7 Policy Transmittal December 2017 Page 7 In addition, for dates of service February 1, Radiation tx delivery; and forward, select professional and/or complex technical components of identified Current Procedural Terminology (CPT) codes will be Radiology port deleted from the fee schedules for independent images(s) radiology and/or physician-radiology. These revisions will ensure consistency between both of the Medicaid radiology fee schedules and the Medicare fee schedule Neutron beam tx complex Radiation tx mgmt x5 CPT Code Modifier Description stress view Radiation therapy planning Radiation therapy mgmt Stereotactic radiation tx Sbrt mgmt Radiation therapy planning Radiation therapy planning Proton trmt simple w/comp Proton trmt intermediate Proton trmt intermediate Radiation physics consult Radiation physics consult Srs multisource Srs linear based Sbrt delivery Radiation tx delivery Radiation tx delivery; simple Radiation tx delivery; intermedia Platelet survival kinetics Breath tst attain/anal c- 14 Breath test analysis c-14 Electrocardiogram complete Electrocardiogram tracing Cardiovascular stress test Ecg monit/reprt up to 48 hrs Ecg monit/reprt up to 48 hrs

8 Policy Transmittal December 2017 Page Ecg monit/reprt up to 48 hrs 932 Ecg monit/reprt up to 48 hrs Accessing the Fee Schedules: The updated fee schedules can be accessed and downloaded from the Connecticut Medical Assistance Program Web site:. From this Web page, go to "Provider", then to "Provider Fee Schedule Download". Click on the "I accept" button and proceed to click on the appropriate fee schedule. To access the CSV file, press the control key while clicking the CSV link, then select "Open". An Important Message (IM) will be posted and distributed to all providers once the fee schedule has been updated. For questions about billing or if further assistance is needed to access the fee schedule on the Connecticut Medical Assistance Program Web site, please contact the Provider Assistance Center, Monday through Friday from 8:00 a.m. to 5:00 p.m. at Posting Instructions: Policy transmittals can be downloaded from the Web site at. Distribution: This policy transmittal is being distributed to providers of the Connecticut Medical Assistance Program by DXC Technology. Responsible Unit: DSS, Medical Care Administration, Medical Policy and Regulations, Dana Robinson-Rush, Health Policy Consultant, Medical Policy at (860) Date Issued: December 2017