Update to Second-Quarter Procedure Code Review Updates

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1 Update to Second-Quarter Procedure Review Updates Information posted September 11, 2009 This is an update to an article posted on this website on the TMHP Updates Procedure Review web page on May 15, 2009, titled, Second-Quarter Procedure Review Updates. Effective for dates of service on or after July 1, 2009, procedure codes 31075, 31205, and did not become payable as assistant surgery benefits, and surgery procedure code became payable. Additionally, provider type and place of surgery changes were applied to some surgery and radiology procedure codes. Reminder: To align with Centers for Medicare & Medicaid Services (CMS) requirements for easy access to all Texas Medicaid fees, TMHP completed the second-quarter procedure code review. Effective for dates of service on or after July 1, 2009, provider type, place of service (POS), and type-of-service (TOS) changes were applied to some procedure codes. Providers are encouraged to refer to the TMHP fee schedules available on this website to confirm coverage before submitting claims. Effective for dates of service on or after July 1, 2009, the following changes were applied to the procedure codes indicated: Procedure Are not reimbursed as assistant surgery benefits. These procedure codes did not become payable as assistant surgery May be reimbursed to physicians in the office, inpatient hospital, or outpatient hospital Radiology Procedures: Magnetic Resonance Imaging (MRI) Total component: Is not reimbursed to nurse practitioners (NPs), clinical nurse specialists (CNSs), physician assistant (PAs), and radiation treatment centers in the office Is not reimbursed to radiation treatment centers and hospital-based rural health clinics (RHCs) in the outpatient hospital Is not reimbursed in the inpatient hospital or independent laboratory Professional interpretation component: Is not reimbursed to NPs, CNSs, and PAs in the office or outpatient hospital Is not reimbursed to NPs, CNSs, PAs, and hospitals in the inpatient hospital Is not reimbursed in the independent laboratory Technical component: Is not reimbursed to NPs, CNSs, PAs, and radiation treatment centers in the office Is not reimbursed in the home, skilled nursing facility (SNF), intermediary care facility (ICF), outpatient hospital, independent laboratory, or extended care facility (ECF)

2 77059 Total component: Is not reimbursed to NPs, CNSs, PAs, radiologists, and radiation treatment centers in the office Is not reimbursed to radiation treatment centers and hospital-based RHCs in the outpatient hospital Professional interpretation component: Is not reimbursed to NPs, CNSs, and PAs in the office or outpatient hospital Is not reimbursed to NPs, CNSs, PAs, and hospitals in the inpatient hospital Technical component: Is not reimbursed to NPs, CNSs, PAs, and radiation treatment centers in the office Is not reimbursed in the home, SNF, ICF, outpatient hospital, independent laboratory, or ECF Radiology Procedures: Radiation Oncology Total component: May be reimbursed to physicians in the inpatient or outpatient hospital Total component: May be reimbursed to physicians in the inpatient or outpatient hospital Total component: May be reimbursed to physicians in the inpatient or outpatient hospital Total component: May be reimbursed to physicians in the inpatient hospital Professional interpretation component: Technical component: Total component: May be reimbursed to physicians in the inpatient hospital Professional interpretation component: Technical component:

3 77290 Total component: May be reimbursed to physicians in the inpatient hospital Professional interpretation component: Technical component: Total component: May be reimbursed to physicians in the inpatient hospital Professional interpretation component: Technical component: Total component: May be reimbursed to physicians in the inpatient hospital Professional interpretation component: Technical component: Total component: radiological and physiological laboratories in the inpatient hospital physiological laboratories in the outpatient hospital Professional interpretation component: Technical component: Total component: Is not reimbursed to hospitals and hospital-based RHCs in the office May be reimbursed to physicians in the inpatient hospital Is not reimbursed to radiation treatment centers in the outpatient hospital Technical component:

4 77305 Total component: radiological and physiological laboratories in the inpatient hospital physiological laboratories in the outpatient hospital Professional interpretation component: Technical component: Total component: Is not reimbursed radiation treatment centers, hospitals, and radiological and physiological laboratories in the inpatient hospital Is not reimbursed radiation treatment centers and radiological and physiological laboratories in the outpatient hospital Professional interpretation component: Technical component: Total component: radiological and physiological laboratories in the inpatient hospital physiological laboratories in the outpatient hospital Professional interpretation component: Technical component: Total component: radiological and physiological laboratories in the inpatient hospital physiological laboratories in the outpatient hospital Professional interpretation component: Technical component: Total component: radiological and physiological laboratories in the inpatient hospital Is not reimbursed to PT radiation treatment centers and radiological and physiological laboratories in the outpatient hospital

5 77327 Professional interpretation component: Technical component: Total component: radiological and physiological laboratories in the inpatient hospital physiological laboratories in the outpatient hospital Professional interpretation component: Technical component: Total component: radiological and physiological laboratories in the inpatient hospital physiological laboratories in the outpatient hospital Professional interpretation component: Technical component: Total component: Is not reimbursed to radiation treatment centers, hospitals, radiological and physiological laboratories in the inpatient hospital physiological laboratories in the outpatient hospital Professional interpretation component: Technical component: Total component: Is not reimbursed to radiation treatment centers, hospitals, radiological and physiological laboratories in the inpatient hospital physiological laboratories in the outpatient hospital Professional interpretation component: Technical component:

6 77373 Total component: Is not reimbursed to hospital-based RHCs in the office Is not reimbursed in the inpatient hospital Is not reimbursed to physicians, radiation treatment centers, freestanding RHCs, and hospital-based RHCs in the outpatient hospital Total component: Is not reimbursed in the inpatient hospital Is not reimbursed to physicians, radiation treatment centers, and radiological and physiological laboratories in the outpatient hospital Surgery Procedures: Digestive Is not reimbursed in the office Is not reimbursed to NPs, CNSs, PAs, and nurse midwives (CNMs) in the inpatient hospital or outpatient hospital May be reimbursed to dentistry group in the inpatient hospital or outpatient hospital Is not reimbursed in the office Is not reimbursed to NPs, CNSs, PAs, and CNMs in the inpatient hospital or outpatient hospital Is not reimbursed to NPs, CNSs, PAs, and CNMs in the office, inpatient hospital, or outpatient hospital Is not reimbursed to NPs, CNSs, PAs, and CNMs in the inpatient hospital or outpatient hospital Is not reimbursed in the office Is not reimbursed to NPs, CNSs, PAs, and CNMs in the inpatient hospital or outpatient hospital Is not reimbursed to NPs, CNSs, PAs, and CNMs in the office, inpatient hospital, or outpatient hospital Is not reimbursed to NPs, CNSs, PAs, and CNMs in the office, inpatient hospital, or outpatient hospital Is not reimbursed to NPs, CNSs, PAs, and CNMs in the office, inpatient hospital, or outpatient hospital Is not reimbursed to NPs, CNSs, PAs, and CNMs in the inpatient hospital or outpatient hospital Is not reimbursed in the office

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