Archived SECTION 19 - PROCEDURE CODES. Section 19 - Procedure Codes
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1 SECTION 19 - EDURE S 19.1 EDURE S HOME HEALTH SERVICES FOR CHILDREN THOUGH HEALTHY CHILDREN AND YOUTH (HCY) A EDURES REQUIRING COPAY (TEXT DEL. 5/08) HOME HEALTH SUPPLIES THERAPY SERVICES INCLUDED IN AN IEP
2 SECTION 19-EDURE S 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 EDURE S All procedure codes listed in this section are effective January 1, The following procedure codes require the attachment of a Plan of Care (HCFA-485 and HCFA- 486) when billing through paper submission (UB-04). For the X12N 837 Health Care Claim electronic transaction (837 Institutional claim), all applicable home health segments of the 2300, 2305 and 2310a loops are required. Information regarding the home health segments can be found in the National Electronic Data Interchange Transaction Set Implementation Guide, Health Care Claim: ASC X12N 837 Institutional and the Missouri Medicaid X12N Version 4010A1 Companion Guide, 837 Institutional Specific Information. G Skilled Nursing Services (includes psychiatric nursing services) G Home Health Aide Services Maternity Post-Discharge Home Visit The following codes require attachment of the HCFA-485 and HCFA-486 when billing through paper submission (UB-04), or the home health loops of the 837 Institutional claim must be populated when billing through electronic submission. A provider may only bill these procedure codes for one certification period (62 days) if the certification period begins within 60 days of onset of condition or 60 days of discharge. 2
3 G Physical Therapy G Occupational Therapy G Speech Therapy The following codes must be prior authorized. They must be billed through the UB-04 claim form or the 837 institutional transaction and do not require any attachments or home health loops populated when billing. G0151SC...Physical Therapy G0152SC...Occupational Therapy G0153SC...Speech Therapy 19.2 HOME HEALTH SERVICES FOR CHILDREN THOUGH HEALTHY CHILDREN AND YOUTH (HCY) The following codes do not require prior authorization. Evaluation visits are limited to two per year. Therapy service may be billed to Medicaid without prior authorization and without any attachment or home health loops populated. T1001EP...Skilled Nurse Evaluation Visit through HCY 97003EP...Occupational Therapy Evaluation Visit through HCY 97001EP...Physical Therapy Evaluation Visit through HCY 92506EP...Speech Therapy Evaluation Visit through HCY G0151EP...Physical Therapy through HCY G0152EP...Occupational Therapy through HCY G0153EP...Speech Therapy through HCY 3
4 The following codes must be prior authorized before they are delivered and must not be billed on the same claim as the services that are not prior authorized, which are listed in Section The following codes are valid only for Medicaid recipients ages G0154EP...Skilled Nurse Visit through HCY G0156EP...Home Health Aide through HCY 19.2.A EDURES REQUIRING COPAY (text del. 5/08) 19.3 HOME HEALTH SUPPLIES Home health agencies must bill HCPCS procedure codes for non-routine medical supplies utilized during home health visits (effective January 1, 2004). When billing supplies for patients for whom the Bureau of Special Health Care Needs has authorized services, attachments or population of home health segments are not required THERAPY SERVICES INCLUDED IN AN IEP The following codes do not require prior authorization. They must be billed through the UB-04 claim form or the 837 institutional transaction and do not require any attachments or home health segments populated when billing. G0151TM...Physical Therapy, IEP G0151TR...Physical Therapy, IEP, Outside Responsible District G0152TM...Occupational Therapy, IEP G0152TR...Occupational Therapy, IEP, Outside Responsible District G0153TM...Speech/Language Therapy, IEP G0153TR...Speech/Language Therapy, IEP, Outside Responsible District 97001TM...Physical Therapy Evaluation, IEP 97001TR...Physical Therapy Evaluation, IEP, Outside Responsible District 4
5 97003TM...Occupational Therapy Evaluation, IEP 97003TR...Occupational Therapy Evaluation, IEP, Outside Responsible District 92506TM...Speech/Language Therapy Evaluation, IEP 92506TR...Speech/Language Therapy Evaluation, IEP, Outside Responsible District END OF SECTION TOP OF PAGE 5
Archived SECTION 19 - PROCEDURE CODES. Section 19 - Procedure Codes
SECTION 19 - S 19.1 PRIOR CONTENTS NO LONGER APPLICABLE...2 19.2 S...2 19.2.A BASIC LIFE SUPPORT (BLS) BASE RATE...2 19.2.B ADVANCED LIFE SUPPORT (ALS) BASE RATE...3 19.2.C SPECIALIZED TESTING AND TREATMENT...3
Archived SECTION 19 - PROCEDURE CODES. Section 19 - Procedure Codes
SECTION 19 - S 19.1 PRIOR CONTENTS NO LONGER APPLICABLE... 2 19.2 S... 2 19.2.A BASIC LIFE SUPPORT (BLS) BASE RATE... 2 19.2.B ADVANCED LIFE SUPPORT (ALS) BASE RATE... 3 19.2.C SPECIALIZED TESTING AND
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