Notification



Notification Issue Date:



Policy Attachment


Attachment to Policy # 00.03.07x


Attachment:B1

Policy #:00.03.07x

Description:SERVICES ELIGIBLE FOR REIMBURSEMENT WHEN PERFORMED
IN THE SPECIALIST OFFICE (THIS INCLUDES THE CERTIFIED REGISTERED NURSE PRACTITIONER (CRNP) AND PHYSICIAN ASSISTANT (PA) PRACTICING WITHIN THE SCOPE OF THEIR SPECIALTY)

Title:Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products


Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.


SERVICES ELIGIBLE FOR REIMBURSEMENT WHEN PERFORMED
IN THE SPECIALIST OFFICE (THIS INCLUDES CERTIFIED REGISTERED NURSE PRACTITIONERS (CRNPs) AND PHYSICIAN ASSISTANTS (PAs) PRACTICING WITHIN THESE SPECIALTY GROUPS)


NOTES:
  • The Effective Date indicates either the effective date of the code and/or the date the code became eligible for fee-for-service reimbursement consideration.
  • The Delete Date indicates either the date the code becomes invalid and/or the date the code is no longer eligible for fee-for-service reimbursement consideration.
All Non-Capitated Professional Providers
Procedure Code
Effective Date
Delete Date
86580
07/31/2013
12/31/2015

Allergy and Immunology
Procedure Code
Effective Date
Delete Date
89190
10/01/2011

Cardiology and Interventional Cardiology
Procedure Code
Effective Date
Delete Date
83880
12/10/2014

Dermatology
Procedure Code
Effective Date
Delete Date
87220
10/01/2011
88331-59
07/31/2013
Q0112
10/01/2011

General Surgery
Procedure Code
Effective Date
Delete Date
82270
10/01/2011

Hematology Oncology and Medical Oncology
Procedure Code
Effective Date
Delete Date
85007
10/01/2011
85008
10/01/2011
85009
10/01/2011
85013
10/01/2011
85014
10/01/2011
85018
10/01/2011
85025
10/01/2011
85027
10/01/2011
85032
10/01/2011
85044
10/01/2011
85048
10/01/2011

Nephrology
Procedure Code
Effective Date
Delete Date
81000
10/01/2011
81005
10/01/2011
81007
10/01/2011
81015
10/01/2011

Obstetrics-Gynecology
Procedure Code
Effective Date
Delete Date
87210
10/01/2011


Ophthalmology, Pediatric Ophthalmology and Optometry
Procedure Code
Effective Date
Delete Date
83861
02/01/2014
Orthopedic Surgery
Procedure Code
Effective Date
Delete Date
83872
10/01/2011
89050
10/01/2011
89051
10/01/2011
89060
10/01/2011

Reproductive Endocrinology and Infertility
Procedure Code
Effective Date
Delete Date
82670
10/01/2011
83001
10/01/2011
83002
10/01/2011
84144
10/01/2011
84702
10/01/2011
84703
10/01/2011
87210
10/01/2011
89250
10/01/2011
89251
10/01/2011
89253
10/01/2011
89254
10/01/2011
89255
10/01/2011
89257
10/01/2011
89300
10/01/2011
89310
10/01/2011
89320
10/01/2011
89321
10/01/2011
89322
10/01/2011
89329
10/01/2011
89330
10/01/2011
89331
10/01/2011
G0027
10/01/2011

Rheumatology and Pediatric Rheumatology
Procedure Code
Effective Date
Delete Date
83872
10/01/2011
85810
10/01/2011
89050
10/01/2011
89051
10/01/2011
89055
10/01/2011
89060
10/01/2011

Urology
Procedure Code
Effective Date
Delete Date
81000
10/01/2011
81005
10/01/2011
81007
10/01/2011
81015
10/01/2011
81020
10/01/2011
87205
10/01/2011
89300
10/01/2011
89310
10/01/2011
89320
10/01/2011
G0027
10/01/2011



Version Effective Date: 10/01/2019
Version Issued Date: 10/24/2019
Version Reissued Date: N/A

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