Archived SECTION 19 - PROCEDURE CODES. Section 19 - Procedure Codes

Transcription

1 SECTION 19 - PROCEDURE CODES 19.1 PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY EVALUATION AND TREATMENT CODES A HEALTHY CHILDREN AND YOUTH (HCY) THERAPY PROCEDURE CODES HCY OCCUPATIONAL/PHYSICAL THERAPY SUPPLY CODES SCREENING PROCEDURE CODES AUGMENTATIVE COMMUNICATION DEVICE EVALUATION AND TRAINING CODES...7 1

2 SECTION 19-PROCEDURE CODES Procedure codes used by MO HealthNet are identified as HCPCS codes (Health Care Procedure Coding System). The HCPCS is divided into two subsystems, referred to as level I, and level II. Level I is comprised of Current Procedural Terminology (CPT) codes that are used to identify medical services and procedures furnished by physicians and other health care professionals. Level II is comprised of the HCPCS National Level II codes that are used primarily to identify products, supplies and services not included in the CPT codes. Reference materials regarding the Healthcare Common Procedure Coding System (HCPCS), Current Procedural Terminology (CPT) may be obtained through the American Medical Association at: Order Department American Medical Association P.O. Box Atlanta, GA Telephone Number: (800) AMA Members: (800) Fax Orders: (312) PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY EVALUATION AND TREATMENT CODES 19.1.A HEALTHY CHILDREN AND YOUTH (HCY) THERAPY PROCEDURE CODES Use the appropriate CPT evaluation and therapeutic procedure codes for fee-for-service participants. Services specified in an Individual Education Plan (IEP) require the appropriate modifier. Refer to Section A of the Therapy Provider Manual for appropriate modifier use HCY OCCUPATIONAL/PHYSICAL THERAPY SUPPLY CODES The following are casting supply codes to be used when splinting or casting procedures are required for a participant. PROCEDURE CODE DESCRIPTION ALLOWED PAYMENT Q4001 Cast supplies, body cast adult, with or without head, plaster $

3 Q4002 Q4003 Q4004 Q4005 Q4006 Q4007 Q4008 Q4009 Q4010 Q4011 Q4012 Cast supplies, body cast adult, with or without head, Cast supplies, shoulder cast, adult (11 years +), plaster Cast supplies, shoulder cast, adult (11 years +), pediatric (0-10 years), plaster pediatric (0-10 years), pediatric (0-10 years +), plaster pediatric (0-10 years +), $ $19.81 $68.57 $7.30 $16.46 $3.66 $8.23 $4.88 $10.98 $2.44 $5.49 Q4013 Cast supplies, gauntlet cast hand), Q4014 Cast supplies, gauntlet cast hand), adult (11 years +), $8.88 $

4 Q4015 Cast supplies, gauntlet cast hand), pediatric (0 10 years), plaster Q4016 Cast supplies, gauntlet cast hand), pediatric (0 10 years), $4.44 $7.48 Q4017 Q4018 Q4019 Q4020 Q4021 Q4022 Q4023 Q4024 Q4025 Q4026 pediatric (0-10 years), plaster pediatric (0-10 years), pediatric (0-10 years), plaster pediatric (0-10 years), both legs), adult (11 years +), plaster both legs), adult (11 years +), $5.13 $8.18 $2.57 $4.09 $3.79 $6.85 $1.91 $3.43 $21.29 $

5 Q4027 both legs), pediatric (0-10 years), plaster $10.65 Q4028 both legs), pediatric (0-10 years), $33.24 Q4029 Cast supplies, long leg cast, adult (11 years +), plaster $16.28 Q4030 Cast supplies, long leg cast, adult (11 years +), $42.86 Q4031 Cast supplies, long leg cast, pediatric (0 10 years), plaster $8.14 Q4032 Cast supplies, long leg cast, pediatric (0 10 years), $21.43 Q4033 cast, $15.19 Q4034 cast, $37.78 Q4035 cast, pediatric (0-10 years), plaster $7.59 Q4036 cast, pediatric (0-10 years), $18.89 Q4037 Cast supplies, short leg cast, adult (11 years +), plaster $9.27 Q4038 Cast supplies, short leg cast, adult (11 years +), $23.21 Q4039 Cast supplies, short leg cast, pediatric (0-10 years), plaster $4.64 Q4040 Cast supplies, short leg cast, pediatric (0-10 years), $

6 Q4041 Q4042 Q4043 Q4044 Q4045 Q4046 Q4047 Q4048 pediatric (0-10 years), plaster pediatric (0-10 years), pediatric (0 10 years), plaster pediatric (0 10 years), $11.26 $19.23 $5.64 $9.62 $6.54 $10.52 $3.26 $5.26 Q4049 Finger splint, static $1.19 The following codes must be submitted for the time spent placing the cast/splint. The allowed amount for the procedures listed below is $10 per unit. Each unit billed equals 15 minutes (i.e. 30 minutes=2 units) PROCEDURE CODE DESCRIPTION APPLICATION OF FIGURE EIGHT APPLICATION OF SHOULDER CAST APPLICATION OF SHOULDER CAST APPLICATION OF LONG ARM CAST APPLICATION OF FOREARM CAST APPLY HAND/WRIST CAST APPLY FINGER CAST 6

7 29105 APPLY LONG ARM SPLINT APPLY FOREARM SPLINT APPLY FOREARM SPLINT APPLICATION OF FINGER SPLINT APPLICATION OF FINGER SPLINT APPLICATION OF LONG LEG CAST APPLICATION OF LONG LEG CAST APPLY LONG LEG CAST BRACE APPLICATION OF LONG LEG CAST APPLY SHORT LEG CAST APPLY SHORT LEG CAST APPLY SHORT LEG CAST ADDITION OF WALKER TO CAST APPLY RIGID LEG CAST APPLICATION, LONG LEG SPLINT APPLICATION LOWER LEG SPLINT 19.3 SCREENING PROCEDURE CODES Refer to Section 9 of the Therapy Provider Manual for all HCY/EPSDT screening procedure codes AUGMENTATIVE COMMUNICATION DEVICE EVALUATION AND TRAINING CODES Refer to Section F(10) of the Therapy Provider Manual for procedure codes related to augmentative communication devices. END OF SECTION TOP OF PAGE 7