Archived 19.1 CPT CODES PROCEDURE CODES HCY PROCEDURE CODES FOR PARTICIPANTS 20 YEARS OLD AND UNDER... 12

Size: px

Start display at page:

Download "Archived 19.1 CPT CODES PROCEDURE CODES HCY PROCEDURE CODES FOR PARTICIPANTS 20 YEARS OLD AND UNDER... 12"

Blake James
6 years ago
Views:

1 SECTION 19 - PROCEDURE CODES 19.1 CPT CODES PROCEDURE CODES HCY PROCEDURE CODES FOR PARTICIPANTS 20 YEARS OLD AND UNDER Hing Aid Manual 1-01##2009

2 SECTION 19-PROCEDURE CODES Procedure codes used by Medicaid are identified as HCPCS codes (Health Care Procedure Coding System). The HCPCS is divided into three subsystems, referred to as level I, level II and level III. 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. Level III codes have been developed by Medicaid State agencies for use in specific programs. NOTE: Replacement of level III codes is required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Providers should reference bulletins for code replacement information. The CPT and HCPCS books may be purchased at any medical bookstore CPT CODES A copy of the Physicians' Current Procedural Terminology (CPT) may be purchased by writing to the following address: Order Department American Medical Association P.O. Box 7046 Dover, DE Telephone Number: (800) Fax Orders: (312) PROCEDURE CODES PROC CODE Exams DESCRIPTION Basic comprehensive audiometry hing exam, including the measuring of hing acuity and tests relating to air conduction, bone conduction, speech reception threshold, and speech discrimination. (The procedure must be ordered by a qualified physician and the diagnosis must be related to disease or trauma. Supporting documentation must be Hing Aid Manual AGE LIMIT 21 and over REQUIRED ATTACHMENTS RHAE # $20.00 REIMBURSEMENT AMOUNT 2-01##2009

3 retained in the patient's file) Basic comprehensive audiometry hing exam, including the measuring of hing acuity and tests relating to air conduction, bone conduction, speech reception threshold, and speech discrimination (in a nursing home). (The procedure must be ordered by a qualified physician and the diagnosis must be related to disease or trauma. Supporting documentation must be retained in the patient's file) Hing Aids/Services V5011RT V5011LT Fitting/orientation/checking of hing aid, right Fitting/orientation/checking of hing aid, left V5011RT22 Post fitting evaluation, right (used to bill for the post fitting evaluation). (Refer to Section 13.9.D(1) and Section 13.9.D(2) for special billing instructions.) V5011LT22 Post fitting evaluation, left (used to bill for the post fitting evaluation). Refer to Section 13.9.D(1) and Section 13.9.D(2) for special billing instructions.) V5030RT V5030LT V5040RT V5040LT Hing aid, monaural; body worn, air conduction, right Hing aid, monaural; body worn, air conduction, left Hing aid, monaural; body worn, bone conduction, right Hing aid, monaural; body worn, bone conduction, left 21 and over PA/RHAE $20.00 $10.00 $10.00 $25.00 $25.00 V5050RT Hing aid, monaural; in the, right V5050LT Hing aid, monaural; in the, left V5060RT Hing aid, monaural; behind the, right Hing Aid Manual - 01##2009 3

4 V5060LT V5090RT V5090LT Hing aid, monaural; behind the, left Dispensing fee, unspecified hing aid, right (refer to Section 13.9.C(1) for special billing instructions.) Dispensing fee, unspecified hing aid, left (refer to Section 13.9.C(1) for special billing instructions.) None PA/RHAE $95.00 None PA/RHAE $95.00 V5100RT Hing aid, bilateral, body worn, right V5100LT Hing aid, bilateral, body worn, left V5110RT Dispensing fee, bilateral, right None PA/RHAE $95.00 V5110LT Dispensing fee, bilateral, left None PA/RHAE $95.00 V5120RT Binaural; body, right V5120LT Binaural; body. left V5130RT Binaural; in the, right V5130LT Binaural; in the, left V5140RT Binaural; behind the, right V5140LT Binaural; behind the, left V5160RT Dispensing fee, binaural, right None PA/RHAE $95.00 V5160LT Dispensing fee, binaural, left None PA/RHAE $95.00 V5170RT Hing aid, CROS; in the, right V5170LT Hing aid, CROS; in the, left V5180RT Hing aid, CROS; behind the, right V5180LT Hing aid, CROS; behind the, left V5200RT Dispensing fee, CROS, right None PA/RHAE $95.00 V5200LT Dispensing fee, CROS, left None PA/RHAE $95.00 V5210RT Hing aid, bicros; in the, right V5210LT Hing aid, bicros; in the, left V5220RT Hing aid, bicros; behind the, right V5220LT Hing aid, bicros; behind the, left Hing Aid Manual - 01##2009 4

5 V5240RT Dispensing fee, bicros, right None PA/RHAE $95.00 V5240LT Dispensing fee, bicros, left None PA/RHAE $95.00 V5241RT V5241LT V5242RT V5242LT V5243RT V5243LT V5244RT V5244LT Dispensing fee, monaural hing aid, any type, right Dispensing fee, monaural hing aid, any type, left Hing aid, analog, monaural, completely in the canal, right Hing aid, analog, monaural, completely in the canal, left Hing aid, analog, monaural, in the canal, right Hing aid, analog, monaural, in the canal, left Hing aid, digitally programmable analog, monaural, completely in the canal, right Hing aid, digitally programmable analog, monaural, completely in the canal, left V5244RTEP Hing aid, digitally programmable analog, monaural, completely in the canal, right V5244LTEP Hing aid, digitally programmable analog, monaural, completely in the canal, left V5245RT V5245LT Hing aid, digitally programmable analog, monaural, in the canal, right Hing aid, digitally programmable analog, monaural, in the canal, left V5245RTEP Hing aid, digitally programmable analog, monaural, in the canal, right V5245LTEP Hing aid, digitally programmable analog, monaural, in the canal, left Hing Aid Manual - 01##2009 None PA/RHAE $95.00 None PA/RHAE $

6 V5246RT V5246LT Hing aid, digitally programmable analog, monaural, in the, right Hing aid, digitally programmable analog, monaural, in the, left V5246RTEP Hing aid, digitally programmable analog, monaural, in the, right V5246LTEP Hing aid, digitally programmable analog, monaural, in the, left V5247RT V5247LT Hing aid, digitally programmable analog, monaural, behind the, right Hing aid, digitally programmable analog, monaural, behind the, left V5247RTEP Hing aid, digitally programmable analog, monaural, behind the, right V5247LTEP Hing aid, digitally programmable analog, monaural, behind the, left V5248RT V5248LT V5249RT V5249LT V5250RT V5250LT Hing aid, analog, binaural, completely in the canal, right Hing aid, analog, binaural, completely in the canal, left Hing aid, analog, binaural, in the canal, right Hing aid, analog, binaural, in the canal, left Hing aid, digitally programmable analog, binaural, completely in the canal, right Hing aid, digitally programmable analog, binaural, completely in the canal, left V5250RTEP Hing aid, digitally programmable analog, binaural, completely in the canal, right V5250LTEP Hing aid, digitally programmable analog, binaural, completely in the canal, left Hing Aid Manual - 01##2009 None PA/RHAE/IofC $ None PA/RHAE/IofC $ PA/RHAE/IofC MP 0-20 PA/RHAE/IofC MP 6

7 V5251RT V5251LT Hing aid, digitally programmable analog, binaural, in the canal, right Hing aid, digitally programmable analog, binaural, in the canal, left V5251RTEP Hing aid, digitally programmable analog, binaural, in the canal, right V5251LTEP Hing aid, digitally programmable analog, binaural, in the canal, left V5252RT V5252LT Hing aid, digitally programmable, binaural, in the, right Hing aid, digitally programmable, binaural, in the, left V5252RTEP Hing aid, digitally programmable, binaural, in the, right V5252LTEP Hing aid, digitally programmable, binaural, in the, left V5253RT V5253LT Hing aid, digitally programmable, binaural, behind the, right Hing aid, digitally programmable, binaural, behind the, left V5253RTEP Hing aid, digitally programmable, binaural, behind the, right V5253LTEP Hing aid, digitally programmable, binaural, behind the, left V5254RT V5254LT Hing aid, digital, monaural, completely in the canal, right Hing aid, digital, monaural, completely in the canal, left V5254RTEP Hing aid, digital, monaural, completely in the canal, right V5254LTEP Hing aid, digital, monaural, completely in the canal, left 0-20 PA/RHAE/IofC MP 0-20 PA/RHAE/IofC MP V5255RT Hing aid, digital, monaural, in the canal, Hing Aid Manual 7-01##2009

8 V5255LT right Hing aid, digital, monaural, in the canal, left V5255RTEP Hing aid, digital, monaural, in the canal, right V5255LTEP Hing aid, digital, monaural, in the canal, left V5256RT V5256LT Hing aid, digital, monaural, in the, right Hing aid, digital, monaural, in the, left V5256RTEP Hing aid, digital, monaural, in the, right V5256LTEP Hing aid, digital, monaural, in the, left V5257RT V5257LT Hing aid, digital, binaural, behind the, right Hing aid, digital, binaural, behind the, left V5257RTEP Hing aid, digital, binaural, behind the, right V5257LTEP Hing aid, digital, binaural, behind the, left V5258RT V5258LT Hing aid, digital, binaural, completely in the canal, right Hing aid, digital, binaural, completely in the canal, left V5258RTEP Hing aid, digital, binaural, completely in the canal, right V5258LTEP Hing aid, digital, binaural, completely in the canal, left V5259RT Hing aid, digital, binaural, in the canal, right Hing Aid Manual 8-01##2009

9 V5259LT Hing aid, digital, binaural, in the canal, left V5259RTEP Hing aid, digital, binaural, in the canal, right V5259LTEP Hing aid, digital, binaural, in the canal, left V5260RT V5260LT Hing aid, digital, binaural, in the, right Hing aid, digital, binaural, in the, left V5260RTEP Hing aid, digital, binaural, in the, right V5260LTEP Hing aid, digital, binaural, in the, left V5261RT V5261LT Hing aid, digital, binaural, behind the, right Hing aid, digital, binaural, behind the, left V5261RTEP Hing aid, digital, binaural, behind the, right V5261LTEP Hing aid, digital, binaural, behind the, left V5264RT V5264LT Ear mold/insert, not disposable, any type, right (a maximum of 4 may be billed on the same date of service) Ear mold/insert, not disposable, any type, left (a maximum of 4 may be billed on the same date of service) 0-20 PA/RHAE/IofC MP 0-20 PA/RHAE/IofC MP None PA/RHAE $25.00 None PA/RHAE $25.00 V5267 Hing aid supplies/accessories 0-20 I/C MP V5275RT Ear impression, right (a maximum of 4 may be billed on the same date of service) V5275LT Ear impression, left (a maximum of 4 may be billed on the same date of service) None PA/RHAE $5.00 None PA/RHAE $5.00 Hing Aid Manual 9-01##2009

10 Repairs L7510(2) L8619(2) Repair of prosthetic device, repair or replace minor parts Cochl implant external speech processor, replacement V5014RT22 Repair to hing aids which are not covered by the one y warranty. V5014LT22 Repair to hing aids which are not covered by the one y warranty. V5014RT Y5014LT Repair/modification of a hing aid (No longer under warranty Repair/modification of a hing aid (No longer under warranty Special Otorhinolaryngologic Services 92507(2) Treatment of speech, language, voice, communication, and/or auditory disorder includes aural rehabilitation; individual. Maximum quantity per day is 16 units. (a unit is up to 15 minutes) (2) Aural rehabilitation following cochl implant (includes evaluation of aural rehabilitation status and hing, therapeutic services) with or without speech processor programming. Maximum quantity per day is 16 units. (a unit is up to 15 minutes) 92601(3) Diagnostic analysis of cochl implant, patient under 7 ys of age; with programming. Maximum quantity per day is 16 units. (a unit is up to 15 minutes) 92602(3) Diagnostic analysis of cochl implant, patient under 7 ys of age; subsequent reprogramming. Maximum quantity per day is 16 units. (a unit is up to 15 minutes). Do not report in addition to on the same date of service Hing Aid Manual - 01##2009 None MP/IofC None PA MP/IofC None PA MP/IofC None PA MP/IofC None I/C MP None I/C MP None None $10.50 None None $10.50 None None $10.50 None None $

11 92603(3) Diagnostic analysis of cochl implant, patient 7 ys or older; with programming. Maximum quantity per day is 16 units. (a unit is up to 15 minutes) 92604(3) Diagnostic analysis of cochl implant, patient 7 ys or older; subsequent reprogramming. Maximum quantity per day is 16 units. (a unit is up to 15 minutes) Do not report in addition to on the same date of service. None None $10.50 None None $10.50 Special Tests (Covered Only When Prescribed by a Physician) The physician must indicate in Section "B" on the RHAE form, why the tests are being ordered Loudness balance test, alternate binaural or monaural (retrocochl vs. cochl) None $ Tone Decay Test None $ Short Increment Sensitivity Index (SISI) None $ Tympanometry (impedance testing) None $ Acoustic Reflex Testing None $ Acoustic Reflex Decay Test None $5.00 Healthy Children and Youth (HCY) for Recipients 20 and Under Only V5266 Battery for use in hing device (When billing for batteries, list the number of batteries dispensed in Field #24 of the HCFA-1500 claim form.) V5298RT(3) Hing aid, not otherwise classified, right None $1.56 PA/MP MP/IofC V5298LT(3) Hing aid, not otherwise classified, left PA/MP MP/IofC V5299 Hing service, miscellaneous (includes FM Systems, noncovered testing, repair to hing equipment other than hing aids, etc. Not to be used for hing aids. ) PA/MP MP/IofC RHAE, Report of Hing Aid Evaluation; PA, Prior Authorization; PA/RHAE, Procedure requires prior authorization. A completed RHAE form must be sent in with the PA Request; PA/RHAE/IofC, Manufacture's invoice of cost and completed RHAE form must be submitted with PA; I/C, Manufacturer's invoice of cost must be Hing Aid Manual - 01##

12 attached to claim; PA/MP, Manufacturer's invoice of cost must be submitted with the Prior Authorization Request; MP, Manually priced; MP/IofC, The manufacturer's invoice of cost must be sent with the Prior Authorization Request. Copay required # A copy of the completed RHAE form must be attached to the claim if it is the only procedure being billed for all recipients aged 21 and over. (1) Not covered for recipients under the age of 13 except for medically necessary reasons, e.g., no external, psychological reasons, etc. (2) Age restriction for this code is 0-20 ys for dates of service prior to 7/1/03. (3) Covered for dates of service on or after 7/1/ HCY PROCEDURE CODES FOR PARTICIPANTS 20 YEARS OLD AND UNDER Many of the HCY procedure codes require a Certificate of Medical Necessity form. For information on medical necessity, including a sample Certificate of Medical Necessity form, reference Section 7. PROC DESCRIPTION CODE Evaluation of speech, language, voice communication, auditory processing and/or aural rehabilitation status. Maximum quantity per day is 16 units (a unit is up to 15 minutes). REQUIRED REIMBURSEMENT ATTACHMENT AMOUNT $ Spontaneous nystagmus, including gaze MN $ Positional nystagmus MN $ Caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes four tests) MN $ Optokinetic nystagmus MN $ Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording Positional nystagmus test, minimum of 4 positions, with recording Caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes four tests), with recording MN $20.00 MN $20.00 MN $ Optokinetic nystagmus test, bidirectional MN $10.00 Hing Aid Manual - 01##

13 foveal or peripheral stimulation, with recording Oscillating tracking test, with recording MN $ Sinusoidal vertical axis rotational testing MN $ Use of vertical electrodes in any or all of above tests counts as one additional test MN $ Screening test, pure tone, air only $ Pure tone audiometry (threshold); air only $ Pure tone audiometry (threshold); air and bone $ Speech audiometry threshold $ Speech audiometry threshold; with speech recognition $ Stenger test, pure tone $ Staggered spondaic word test $ Stenger test, speech $ Visual reinforcement audiometry (VRA) $ Conditioning play audiometry $ Select picture audiometry $ Electrocochleography PA $ Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; limited Evoked otoacoustic emissions; limited (single stimulus level, either transient or distortion products) Evoked otoacoustic emissions; comprehensive or diagnostic evaluation (comparison of transient and/or distortion product otoacoustic emissions at multiple Hing Aid Manual - 01##2009 $ $35.43 $70.00 $

14 levels and frequencies) Central auditory function test(s) (specify) PA MP * RHAE, Report of Hing Aid Evaluation; PA, Prior Authorization; MP, Manually priced; MN, Certificate of Medical Necessity Copay required Participant cost sharing is based on the lower sum that of charges shown on invoice or the MO HealthNet allowable fees for covered service according to the schedule below. The applicable sum is generally more than $50.99, so participant cost sharing for these codes is normally $3.00. Participant cost sharing for these services is based on invoice cost for in-shop repairs; on total of invoice cost plus $20.00 for out-of-shop repairs, according to the schedule below. $10.00 or less $.50 $11.00-$25.99 $1.00 $26.00-$50.99 $2.00 $51.00 or more $3.00 The following participants or conditions are exempt from the cost sharing requirement. Participants under age 18; Foster Care Children up to 21 ys; Hospice Participants; Services to participants residing in a skilled nursing facility, a psychiatric hospital, a residential care facility or an adult boarding home; MO HealthNet for Kids health plan enrollees are exempt from cost sharing amounts for services provided by the health plan; Cost sharing is applicable for participants ages who are not in foster care. END OF SECTION TOP OF PAGE Hing Aid Manual 14-01##2009

Archived 19.1 CPT CODES PROCEDURE CODES HCY PROCEDURE CODES FOR PARTICIPANTS 20 YEARS OLD AND UNDER... 14

Archived 19.1 CPT CODES PROCEDURE CODES HCY PROCEDURE CODES FOR PARTICIPANTS 20 YEARS OLD AND UNDER... 14 SECTION 19 - PROCEDURE CODES 19.1 CPT CODES... 2 19.2 PROCEDURE CODES... 3 19.3 HCY PROCEDURE CODES FOR PARTICIPANTS 20 YEARS OLD AND UNDER... 14 1 SECTION 19-PROCEDURE CODES Procedure codes used by Medicaid