Billing Beat

New Ultrasound Benefit

November 1, 2004

Effective for dates of service on or after December 1, 2004, CPT-4 code 76800 (ultrasound, spinal canal and contents) is a Medi-Cal benefit. Code 76800 is reimbursable for recipients 5 years of age or younger, for up to two procedures per calendar year for the same recipient, any provider. Additionally, code 76800 is reimbursable only when billed in conjunction with one of the following ICD-9 diagnosis codes, which must be documented in the Primary ICD-9-CM field (Box 21):

New Codes

ICD-9 Code Description
324.1 Intraspinal abscess
685.1 Pilondial cyst; without mention of abscess
741.9 Spina bifida; without mention of hydrocephalus
741.93 lumbar region
751.2 Atresia and stenosis of large intestine, rectum, and anal canal
756.13 Anomalies of spine; absence of vertebra, congenital

Reimbursement for additional procedures (more than two per calendar year) requires a Treatment Authorization Request (TAR) with medical justification.

The updated information is reflected on manual replacement pages radi ult 2 (Part 2) and tar and non cd7 2 (Part 2).

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