Hcpcs-all.book

Introduction
ORGANIZATION OF HCPCS
Index
The Ingenix 2009 HCPCS Level II book contains mandated changes and new Because HCPCS is organized by code number rather than by service or supply codes for use as of January 1, 2009. Deleted codes have also been indicated name, the index enables the coder to locate any code without looking through and cross-referenced to active codes when possible. New codes have been individual ranges of codes. Just look up the medical or surgical supply, added to the appropriate sections, eliminating the time-consuming step of service, orthotic, prosthetic, or generic or brand name drug in question to find looking in two places for a code. However, keep in mind that the information the appropriate codes. This index also refers to many of the brand names by in this book is a reproduction of the 2009 HCPCS; additional information on coverage issues may have been provided to Medicare contractors after publication. All contractors periodically update their systems and records Table of Drugs
throughout the year. If this book does not agree with your contractor, it is The brand names of drugs listed are examples only and may not include all either because of a mid-year update or correction or a specific local or products available for that type of drug. Our table of drugs lists HCPCS codes from any available sections including A codes, C codes, J codes, S codes, and Q codes under brand and generic drug names with amount, route of We have included codes noted in addendum B of the 2009 Outpatient administration, and code numbers. While we try to make the table Prospective Payment System (OPPS) update as published in the Federal comprehensive, it is not all-inclusive.
Register and from transmittals through 2008 that include codes not discussed in other Centers for Medicare and Medicaid Services (CMS) Color-coded Coverage Instructions
documents. The sources for these codes are often noted in blue beneath The Ingenix HCPCS Level II book provides colored symbols for each coverage and reimbursement instruction. A legend to these symbols is provided on the bottom of each two-page spread.
HOW TO USE INGENIX HCPCS LEVEL II BOOK
Supplies for self-administered injections
Blue Color Bar—Special Coverage Instructions
A blue bar for “special coverage instructions” over a code means
that special coverage instructions apply to that code. These special
instructions are also typically given in the form of Medicare
Pub.100 reference numbers. The appendixes provide the full text
of the cited Medicare Pub.100 references.
Yellow Color Bar—Contractor Discretion
Chlorhexidine containing antiseptic, 1 ml
Issues that are left to “contractor discretion” are covered with a yellow bar. Contact the contractor for specific coverage information on those codes.
Red Color Bar—Not Covered by or Invalid for Medicare
Syringe with needle for external insulin
Codes that are not covered by or are invalid for Medicare are pump, sterile, 3cc
covered by a red bar. The pertinent Medicare internet-only manuals (Pub. 100) reference numbers are also given explaining why a particular code is not covered. These numbers refer to the appendixes, where we have listed the Medicare references.
Codes in the Ingenix HCPCS Level II follow the AMA CPT book conventions to indicate new, revised, and deleted codes.
Injection, levoleucovorin calcium, 0.5 mg
Collagen based wound filler, dry form,
A black circle (●) precedes a new code.
sterile, per gram of collagen
A black triangle (▲) precedes a code with revised terminology or rules.
Albuterol, inhalation solution,
FDA-approved final product,
A circ le (❍) precedes a reissued code.
noncompounded, administered through
Codes deleted from the 2009 active codes appear with a DME, concentrated form, 1 mg
Palivizumab-RSV-IgM, per 50 mg
@ Quantity Alert
Many codes in HCPCS report quantities that may not coincide with
quantities available in the marketplace. For instance, a HCPCS
code for an ostomy pouch with skin barrier reports each pouch,
but the product is generally sold in a package of 10; “10” must be
indicated in the quantity box on the CMS claim form to ensure
Syringe with needle, sterile 2 cc, each
proper reimbursement. This symbol indicates that care should be taken to verify quantities in this code. These quantity alerts do not represent Medicare Unlikely Edits (MUEs) and should not be used for MUEs. An appendix of the MUE’s can be found in appendix 8 of the HCPCS Level II Expert editions.
HCPCS 2009
Introduction — i
HCPCS NATIONAL T CODES
National
T1025 Intensive, extended multidisciplinary services provided NATIONAL T CODES ESTABLISHED FOR STATE MEDICAID
in a clinic setting to children with complex medical, AGENCIES T1000-T9999
physical, mental and psychosocial impairments, perdiem The T codes are designed for use by Medicaid state agencies to establish codes T1026 Intensive, extended multidisciplinary services provided for items for which there are no permanent national codes but for which codes in a clinic setting to children with complex medical, are necessary to administer the Medicaid program (T codes are not accepted by physical, medical and psychosocial impairments, per Medicare but can be used by private insurers). This range of codes describes nursing and home health-related services, substance abuse treatment, and certaintraining-related procedures.
T1027 Family training and counseling for child development, T1000 Private duty/independent nursing service(s), licensed, T1028 Assessment of home, physical and family environment, to determine suitability to meet patient's medical T1029 Comprehensive environmental lead investigation, not including laboratory analysis, per dwelling T1004 Services of a qualified nursing aide, up to 15 T1030 Nursing care, in the home, by registered nurse, per T1005 Respite care services, up to 15 minutes T1031 Nursing care, in the home, by licensed practical nurse, T1006 Alcohol and/or substance abuse services, family/couple T1502 Administration of oral, intramuscular and/or T1007 Alcohol and/or substance abuse services, treatment T1503 Administration of medication, other than oral and/or T1009 Child sitting services for children of the individual injectable, by a health care agency/professional, per receiving alcohol and/or substance abuse services T1010 Meals for individuals receiving alcohol and/or substance T1999 Miscellaneous therapeutic items and supplies, retail abuse services (when meals not included in the purchases, not otherwise classified; identify product T1012 Alcohol and/or substance abuse services, skills T2001 Nonemergency transportation; patient T1013 Sign language or oral interpretive services, per 15 T2002 Nonemergency transportation; per diem T2003 Nonemergency transportation; encounter/trip T1014 Telehealth transmission, per minute, professional T2004 Nonemergency transport; commercial carrier, T1015 Clinic visit/encounter, all-inclusive T2005 Nonemergency transportation; stretcher van T2007 Transportation waiting time, air ambulance and T1017 Targeted case management, each 15 minutes nonemergency vehicle, one-half (1/2) hour T1018 School-based individualized education program (IEP) T2010 Preadmission screening and resident review (PASRR) T1019 Personal care services, per 15 minutes, not for an level I identification screening, per screen inpatient or resident of a hospital, nursing facility, T2011 Preadmission screening and resident review (PASRR) ICF/MR or IMD, part of the individualized plan of treatment (code may not be used to identify servicesprovided by home health aide or certified nurse T2012 Habilitation, educational; waiver, per diem T2013 Habilitation, educational, waiver; per hour T1020 Personal care services, per diem, not for an inpatient T2014 Habilitation, prevocational, waiver; per diem or resident of a hospital, nursing facility, ICF/MR orIMD, part of the individualized plan of treatment (code T2015 Habilitation, prevocational, waiver; per hour may not be used to identify services provided by home T2016 Habilitation, residential, waiver; per diem health aide or certified nurse assistant) T2017 Habilitation, residential, waiver; 15 minutes T1021 Home health aide or certified nurse assistant, per T2018 Habilitation, supported employment, waiver; per T1022 Contracted home health agency services, all services T2019 Habilitation, supported employment, waiver; per 15 T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per T2021 Day habilitation, waiver; per 15 minutes T1024 Evaluation and treatment by an integrated, specialty T2023 Targeted case management; per month team contracted to provide coordinated care to multipleor severely handicapped children, per encounter T2024 Service assessment/plan of care development, T2025 Waiver services; not otherwise specified (NOS) MED: Pub 100/NCD References 7 DMEPOS Paid
APPENDIX 7 — NATIONAL AVERAGE PAYMENT TABLE FOR HCPCS
Commercial Medicare
Commercial Medicare
Proc
Modifier Description
Data
Data
Proc
Modifier Description
Data
Data
e Payment T
2009 HCPCS
Appendixes — 117

Source: http://cdn.medical-coding.net/media/samplepages/HS11.pdf