BILLING NEWS

Diagnosis Restrictions for Gonadotropin Follicle Stimulating and Luteinizing Hormones

Effective for dates of service on or after August 1, 2007, CPT-4 codes 83001 (gonadotropin; follicle stimulating hormone [FSH]) and 83002 (Éluteinizing hormone [LH]) are reimbursable only when billed in conjunction with one of the following ICD-9-CM diagnosis codes:

  • 072.0
  • 147.0
  • 170.0
  • 174.0 - 175.9
  • 183.0 - 183.9
  • 185
  • 186.0 - 186.6
  • 191.0
  • 192.8
  • 194.0 - 194.9
  • 213.0
  • 215.0
  • 220
  • 222.0
  • 225.0 - 225.9
  • 227.0 - 227.9
  • 236.0 - 236.6
  • 237.0 - 239.7
  • 240.0 - 279.9
  • 303.9
  • 307.1
  • 359.0 - 359.9
  • 456.4
  • 606.0 - 606.9
  • 626.0 - 626.9
  • 627.0 - 627.9
  • 628.0 - 628.1
  • 752.0 - 752.9
  • 758.0 - 759.9

Codes 83001 and 83002 should only be ordered when medically indicated, based on patient evaluation. Gonadotropin level tests for screening or non-indicated disease processes are not medically justified, and therefore, not reimbursable. ICD-9-CM codes 403.0 - 403.9, 404.0 - 404.9 and 571.0 - 571.9, that were previously supported in connection with codes 83001 and 83002, have been deleted.


INDUSTRY NEWS TAGS: California Medi-Cal


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