ICD-9-CM diagnosis codes 151.0 – 151.9 were incorrectly listed as codes to bill in conjunction with CPT code 86304 (immunoassay for tumor antigen, quantitative, CA 125). The correct codes are: 151.0, 151.1, 151.2, 151.3, 151.4, 151.8 and 151.9. CPT code 86304 is reimbursable only when billed in conjunction with ICD-9-CM diagnosis codes listed in the provider manual Pathology: Chemistry section.
Effective for dates of service on or after May 1, 2010, HCPCS code S3820 (complete BRCA1 and BRCA2 gene sequence analysis for susceptibility to breast and ovarian cancer) is a once-in-a-lifetime procedure and requires a Treatment Authorization Request (TAR). A TAR for HCPCS code S3820 requires documentation of one or more of the following numbered criteria....
Gender restrictions for males receiving either gonadotropin follicle stimulating hormone (FSH) (CPT code 83001) or gonadotropin luteinizing hormone (LH) (code 83002) have been updated to include ICD-9-CM codes in the range 752.51 – 752.69 or 752.81 – 752.89.
Effective for dates of service on or after May 1, 2010, the diagnosis code range for CPT code 86304 (immunoassay for tumor antigen, quantitative, CA 125) has been expanded to include ICD-9-CM diagnosis codes 233.0 – 233.39. Providers are reminded to always bill to highest specificity.
Effective for dates of service on or after May 1, 2010, ICD-9-CM diagnosis code ranges for CPT code 82728 (ferritin) have been expanded to include the following codes: 001.0 – 009.3 608.3 010.00 – 018.96 626.0 – 627.9 042.(no change) 648.00 – 648.94 070.0 – 070.9 698.0 – 698.9 (no...
The ICD-9-CM diagnosis code range for CPT code 83001 (gonadotropin; follicle stimulating hormone [FSH]) or 83002 (...luteinizing hormone [LH]) has been expanded to include codes 303.90 – 303.93. This policy is effective for dates of service on or after May 1, 2010.
Effective for dates of service on or after May 1, 2010, CPT code 84146 (prolactin level testing) is reimbursable when billed in conjunction with one of the following updated ICD-9-CM diagnosis codes: 242.90, 242.91, 250.40 – 250.43, 403.00 – 403.91, 404.00 – 404.93, 405.01 – 405.99 and 676.00 – 676.94.
The chart below clarifies ICD-9-CM diagnosis codes allowable on claims for CPT code 83009 (Helicobacter pylori, blood test analysis for urease activity), code 83013 (Helicobacter pylori; breath test analysis for urease activity), code 83014 (Helicobacter pylori; drug administration), code 87338 (infectious agent antigen detection by immunofluorescent technique; Helicobacter pylori; stool)...
Effective for dates of service on or after May 1, 2010, the ICD-9-CM code requirement for billing with CPT code 83876 (myeloperoxidase [MPO]) has been expanded to include 410.00 – 414.9.
Providers are reminded that attachments are required when billing Medi-Cal for CPT codes 86920 (compatibility test each unit; immediate spin technique), 86921 (incubation technique), 86922 (antiglobulin technique) and 86923 (electronic). Codes 86920, 86921, 86922 and 86923 are all “By Report” codes so attachments are necessary in order for the Department of Health Care Services (DHCS) consultant...
Effective retroactively for dates of service on or after February 1, 2010, the following laboratory CPT-4 codes are now split-billable and must be billed with the appropriate modifier 26, 99, TC or ZS. CPT-4 Code Description 80047 – 80076 Organ or Disease-Oriented Panels 80100 – 80103 Drug Testing 80150 – 80299 Therapeutic Drug Assays 80400 – 80440 Evocative/Suppression Testing 81000 – 81099...
Effective for dates of service on or after April 1, 2010, CPT-4 code 87184 (susceptibility studies, antimicrobial agent; disk method, per plate [12 or fewer agents]) is a new Presumptive Eligibility (PE) benefit.
Underpayment/Overpayment Adjustments and Voids A Claims Inquiry Form (CIF) adjustment should be used to correct both underpayments and overpayments. However, this transaction type is different than requesting a full payment recovery, which is a void. A CIF adjustment is a one-step process. If requesting an adjustment for an underpaid or overpaid claim, the adjustment is completed in one...
Effective for dates of service on or after March 1, 2010, CPT code 88305 (Level IV – surgical pathology, gross and microscopic examination; skin, other than cyst/tag/debridement/plastic repair) should be submitted for surgical pathology of biopsies to confirm vulvar, vaginal or genital warts. Code 88304 is no longer reimbursable for this purpose, effective for the same dates of service. When...
Medi-Cal is pleased to announce a new training product, Webinar (Web-based seminar) classes. Beginning May 2010, new training sessions will allow providers to learn from Medi-Cal trainers online. Providers will be able to efficiently communicate with trainers through streaming audio and video in a virtual classroom. Providers will be able to view the material being presented, print documents and...
Effective for dates of service on or after February 1, 2010, CPT code 84155 (protein, total, except by refractometry; serum, plasma or whole blood) is CLIA waived.
Effective for dates of service on or after February 1, 2010, the laboratory procedure codes listed below will no longer be split-billable using modifiers 26, TC and ZS. These modifiers will be end-dated effective January 31, 2010, for all laboratory procedure codes that have been defined as non-split-billable. CPT-4 Codes: 80047 – 80076, 80100 – 80103, 80150 – 80299, 80400 – 80440, 80500 – 80502...
Effective for dates of service on or after October 1, 2009, CPT codes 82040 and 82043 can be billed with modifier QW.
Effective for dates of service on or after October 1, 2009, CPT codes 82040 and 82043 can be billed with modifier QW.
Effective for dates of service on or after August 1, 2009, the following services are new benefits of the program; 88307, 88360. As of August 1, 2009, 88143 is no longer a benefit.