by Medical Billing | Jun 8, 2016 | CPT modifiers
Unclassified Drugs An unclassified drug is defined as a drug that does not have a specific, designated HCPCS/CPT code. Unclassified HCPCS/CPT codes should only be used when a specific HCPCS/CPT code is not available for the drug being billed. Claims being sumitted...
by Medical Billing | Jun 5, 2016 | CPT modifiers
A critical component to filing claims with a NDC Code is to ensure that the appropriate HCPCS/CPT code is billed with the NDC Code. A NDC to HCPCS crosswalk identifies the assigned HCPCS/CPT code(s) for the NDC code associated to the drug service(s) billed based upon...
by Medical Billing | Jun 3, 2016 | CPT modifiers
NDC Code An NDC (National Drug Code) is a unique identifier which identifies a specific drug. Even though an NDC Code is assigned to a drug, the drug may not be approved by the FDA. The NDC code(s) reported by the manufacture is the billable NDC code and is generally...
by Medical Billing | Jun 2, 2016 | CPT modifiers
Payment for Evaluation and Management Services Provided During Global Period of Surgery A. CPT Modifier “-24” – Unrelated Evaluation and Management Service by Same Physician During Postoperative Period Carriers pay for an evaluation and management service other...
by Medical Billing | May 31, 2016 | CPT modifiers
Screening Pap Tests HCPCS/CPT Codes G0123, G0124, G0141, G0143, G0144, G0145, G0147, G0148 – Screening cytopathology, cervical or vaginal G0123 – Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid,...
by Medical Billing | May 28, 2016 | CPT modifiers
Payment of DMEPOS Items Based on Modifiers The following modifiers were added to the HCPCS to identify supplies and equipment that may be covered under more than one DMEPOS benefit category: • AU Item furnished in conjunction with a urological, ostomy, or tracheostomy...
by Medical Billing | May 26, 2016 | CPT modifiers
Effective July 1, 2016, providers are required to: • Use the JW modifier for claims with unused drugs or biologicals from single use vials or single use packages that are appropriately discarded (except those provided under the Competitive Acquisition Program (CAP)...
by Medical Billing | May 22, 2016 | CPT modifiers
Screening for Sexually Transmitted Infections (STIs) and High Intensity Behavioral Counseling (HIBC) to Prevent STIs HCPCS/CPT Codes 86631, 86632, 87110, 87270, 87320, 87490, 87491, 87810 – Chlamydia 87590, 87591, 87850 – Neisseria gonorrhoeae 87800 – Infectious agent...
by Medical Billing | May 18, 2016 | CPT modifiers
Policy Services rendered prior to a related inpatient admission are considered incidental to admission and are included in the inpatient reimbursement rate. Services that are incidental to an admission include: • Surgical day care • Observation stay • Emergency room...
by Medical Billing | May 15, 2016 | CPT modifiers
Clinic/Center-Federally Qualified Health Center (FQHC) Bill the encounter using procedure code T1015 with the appropriate rate on the first detail line. Providers are required to list all the CPT/HCPCS services provided during the encounter priced at zero dollars on...
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