Medicare Advantage Preferred Provider Organization (MA PPO)

Applicable to enrollees from other Blue Cross Blue Shield Medicare Advantage Plans who obtain health care services within the 5-county Philadelphia service area.

Notification

Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus

Notification Issued Date: N/A

This policy update becomes effective 01/13/2020. The policy update reaffirms the Company's continuing position on Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus. However, the following five consultation codes will be removed from Attachment A because they are not eligible for reimbursement at all: 99241, 99242, 99243, 99244, 99245.

Policy Attachment

Attachment to Policy #

MA00.037m

Attachment:

Policy #:

MA00.037m

Description:

Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus - CPT/HCPCS Codes

Title:

Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus

This attachment lists Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) codes that represent office visits and outpatient consultations that are considered to be office-based services. This list may not be all-inclusive and does not contain minor office procedures or any related items or services that are included in the payment of an office visit or outpatient consultation.

Table I: CPT CODES

CPT Codes Representing Office Visits and Outpatient Consultations

0405T
0464T
34839
92002
92004
92012
92014
92015
92071
92072
92081
92082
92083
92265
92270
92273
92274
92283
92284
92310
92311
92312
92313
92314
92315
92316
92317
92340
92341
92342
92352
92353
92354
92355
92358
92370
92371
93010
93016
93018
93042
93227
93228
93272
93293
93294
93295
93297
93298
93790
93792
93793
94016
94777
95249
95251
96004
96127
96160
96161
98000
98001
98002
98003
98004
98005
98006
98007
98008
98009
98010
98011
98012
98013
98014
98015
98016
98960
98961
98962
99172
99173
99174
99177
99188
99201
99202
99203
99204
99205
99211
99212
99213
99214
99215
99358
99359
99366
99367
99368
99381
99382
99383
99384
99385
99386
99387
99391
99392
99393
99394
99395
99396
99397
99401
99402
99403
99404
99406
99407
99408
99409
99411
99412
99415
99416
99417
99421
99422
99423
99429
99439
99450
99455
99456
99461
99473
99474
99483
99484
99490
99492
99493
99494
99497
99498

TABLE II: HCPCS CODES

HCPCS Codes Representing Office Visits and Outpatient Consultations

D0120

D0140

D0150

D0160

D0170

D0180

D9311

G0175

G0250

G0296

G0323

G0379

G0402

G0405

G0436

G0437

G0438

G0439

G0442

G0443

G0444

G0445

G0446

G0447

G0463

G0473

G0501

G0505

G0506

G0508

G0509

G0511

G0512

G0513

G0514

G2011

G2061

G2062

G2063

G2211

G2212

G2214

H0004

S0220

S0221

S0260

S0302

S0610

S0612

S0613

S0620

S0621

S0622

S9117

S9150

T1001

Version Effective Date:

01/01/2025

Version Issued Date:

01/27/2025

Version Reissued Date:

N/A