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 31420 did not become payable as assistant surgery benefits, and surgery procedure code 31717 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 31075 31205 31420 Are not reimbursed as assistant surgery benefits. These procedure codes did not become payable as assistant surgery. 31717 May be reimbursed to physicians in the office, inpatient hospital, or outpatient hospital Radiology Procedures: Magnetic Resonance Imaging (MRI) 77058 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)
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 77261 Total component: May be reimbursed to physicians in the inpatient or outpatient hospital 77262 Total component: May be reimbursed to physicians in the inpatient or outpatient hospital 77263 Total component: May be reimbursed to physicians in the inpatient or outpatient hospital 77280 Total component: May be reimbursed to physicians in the inpatient hospital Professional interpretation component: Technical component: 77285 Total component: May be reimbursed to physicians in the inpatient hospital 77285 Professional interpretation component: 77285 Technical component:
77290 Total component: May be reimbursed to physicians in the inpatient hospital 77290 Professional interpretation component: 77290 Technical component: 77295 Total component: May be reimbursed to physicians in the inpatient hospital 77295 Professional interpretation component: 77295 Technical component: 77299 Total component: May be reimbursed to physicians in the inpatient hospital 77299 Professional interpretation component: 77299 Technical component: 77300 Total component: radiological and physiological laboratories in the inpatient hospital physiological laboratories in the outpatient hospital 77300 Professional interpretation component: 77300 Technical component: 77301 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 77301 Technical component:
77305 Total component: radiological and physiological laboratories in the inpatient hospital physiological laboratories in the outpatient hospital 77305 Professional interpretation component: 77305 Technical component: 77310 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 77310 Professional interpretation component: 77310 Technical component: 77315 Total component: radiological and physiological laboratories in the inpatient hospital physiological laboratories in the outpatient hospital 77315 Professional interpretation component: 77315 Technical component: 77326 Total component: radiological and physiological laboratories in the inpatient hospital physiological laboratories in the outpatient hospital 77326 Professional interpretation component: 77326 Technical component: 77327 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
77327 Professional interpretation component: 77327 Technical component: 77328 Total component: radiological and physiological laboratories in the inpatient hospital physiological laboratories in the outpatient hospital 77328 Professional interpretation component: 77328 Technical component: 77332 Total component: radiological and physiological laboratories in the inpatient hospital physiological laboratories in the outpatient hospital 77332 Professional interpretation component: 77332 Technical component: 77333 Total component: Is not reimbursed to radiation treatment centers, hospitals, radiological and physiological laboratories in the inpatient hospital physiological laboratories in the outpatient hospital 77333 Professional interpretation component: 77333 Technical component: 77334 Total component: Is not reimbursed to radiation treatment centers, hospitals, radiological and physiological laboratories in the inpatient hospital physiological laboratories in the outpatient hospital 77334 Professional interpretation component: 77334 Technical component:
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 77399 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 42145 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 42205 Is not reimbursed in the office Is not reimbursed to NPs, CNSs, PAs, and CNMs in the inpatient hospital or outpatient hospital 42665 Is not reimbursed to NPs, CNSs, PAs, and CNMs in the office, inpatient hospital, or outpatient hospital 42960 Is not reimbursed to NPs, CNSs, PAs, and CNMs in the inpatient hospital or outpatient hospital 47630 Is not reimbursed in the office Is not reimbursed to NPs, CNSs, PAs, and CNMs in the inpatient hospital or outpatient hospital 49080 Is not reimbursed to NPs, CNSs, PAs, and CNMs in the office, inpatient hospital, or outpatient hospital 49081 Is not reimbursed to NPs, CNSs, PAs, and CNMs in the office, inpatient hospital, or outpatient hospital 49420 Is not reimbursed to NPs, CNSs, PAs, and CNMs in the office, inpatient hospital, or outpatient hospital 49421 Is not reimbursed to NPs, CNSs, PAs, and CNMs in the inpatient hospital or outpatient hospital Is not reimbursed in the office