August 2004 Medicare Bulletin - Idaho Insert

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2004 Idaho Ambulance Fee Schedule/Prevailing Charges (11-South / 12 North)
Idaho Health Professional Shortage Areas (HPSAs)
Mental Health Professional Shortage Areas
Updated Surgical Add-On Code(s) Listing - Idaho

2004 IDAHO AMBULANCE FEE SCHEDULE / PREVAILING CHARGES (11-SOUTH)

PROCEDURE	URBAN RATE	URBAN RATE JULY '04	RURAL RATE	RURAL RATE JULY '04	IIC
A0425	5.65	5.71	.00	5.76	0.00
A0426M2	193.65	215.04	193.65	217.17	156.45
A0426M4	193.65	215.04	193.65	217.17	130.50
A0427M2	306.61	340.04	306.61	343.85	211.58
A0427M4	306.61	340.04	306.61	343.85	185.65
A0428M2	161.38	179.20	161.38	180.98	144.45
A0428M4	161.38	179.20	161.38	180.98	118.51
A0429M2	258.20	286.72	258.20	289.56	178.52
A0429M4	258.20	286.72	258.20	289.56	152.49
A0430	2246.96	2246.96	3370.44	3370.44	2492.57
A0431	2612.42	2612.42	3918.63	3918.63	1490.20
A0432	282.41	313.60	282.41	316.71	~
A0433M2	443.78	492.80	443.78	497.68	211.58
A0433M4	443.78	492.80	443.78	497.68	185.65
A0434M2	524.47	582.41	524.47	588.17	211.58
A0434M4	524.47	582.41	524.47	588.17	185.65
A0435	6.78	6.78	10.17	10.17	32.00
A0436	18.07	18.07	27.11	27.11	32.00
Q3019	258.20	286.72	258.20	289.56	211.58
Q3020	161.38	179.20	161.38	180.98	156.45
A0382	~		~		7.06
A0384	~		~		9.79
A0392	~		~		9.15
A0394	-		-		4.72
A0396	~		~		12.11
A0422	~		~		12.06

2004 IDAHO AMBULANCE FEE SCHEDULE / PREVAILING CHARGES (12-NORTH)

PR0CEDURE	URBAN RATE	URBAN RATE JULY'04	RURAL RATE JULY '04	RURAL RATE JULY '04	IIC
A0425	5.65	5.71	.00	5.76	0.00
A0426M2	193.65	215.04	193.65	217.17	156.45
A0426M4	193.65	215.04	193.65	217.17	130.61
A0427M2	306.61	340.48	306.61	343.85	227.61
A0427M4	306.61	340.48	306.61	343.85	201.67
A0428M2	161.38	179.20	161.38	180.98	144.45
A0428M4	161.38	179.20	161.38	180.98	118.51
A0429M2	258.20	286.72	258.20	289.56	202.60
A0429M4	258.20	286.72	258.20	289.56	176.65
A0430	2246.96	2246.96	3370.44	3370.44	2492.57
A0431	2612.42	2612.42	3918.63	3918.63	1490.20
A0432	282.41	313.60	282.41	316.71	~
A0433M2	443.78	492.80	443.78	497.68	227.61
A0433M4	443.78	492.80	443.78	497.68	201.67
A0434M2	524.47	582.41	524.47	588.17	227.61
A0434M4	524.47	582.41	524.47	588.17	201.67
A0435	6.78	6.78	10.17	10.17	32.00
A0436	18.07	18.07	27.11	27.11	32.00
Q3019	258.20	286.72	258.20	289.56	227.61
Q3020	161.38	179.20	161.38	180.98	156.45
A0382	~		~		4.50
A0384	~		~		9.79
A0392	~		~		9.15
A0394					4.72
A0396	~		~		12.11
A0422	~		~		25.55

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Updated Surgical Add-On Code(s) Listing - Idaho

Certain surgical procedure codes are add-on codes that are always billed with another service. These add-on codes have a ZZZ indicated in the post-operative period. Post-operative work is not included in the fee schedule payment for the ZZZ codes.

Listed below are the surgical add-on codes and their primary procedure codes. Payment will not be made for these add-on codes unless billed in addition to accompanying primary procedure.

CHART FOR ZZZ (ADD-ON) CODES

ZZZ ADD-ON CODE	PRIMARY CODE
G0184	67221
G0236	76090,76091, G0204, G0206
G0241	G0240
G0247	G0245-G0246
G0275	93508, 93510-93511, 93524, 93526-93529, 93531-93533, 93539-93541, 93543-93545
G0278	93508, 93510-93511, 93524, 93526-93529, 93531-93533, 93539-93541, 93543-93545
G0289	29873, 29875, 29880-29889
11001	11000
11101	11100
11201	11200
11732	11730
11922	11921
13102	13101
13122	13121
13133	13132
13153	13152
15001	15000
15101	15100
15121	15120
15201	15200
15221	15220
15241	15240
15261	15260
15343	15342
15351	15350
15401	15400
15787	15786
16036	16035
17003	17000
17310	17304-17307
19001	19000
19126	19125
19291	19290
19295	19102
19340	19140 - 19162 19180 - 19240 19316 - 19318 19357 19364 - 19369 19370 – 19371, 19380
20931	Codes 20930-20938 are reported in addition to codes for the definitive procedure(s) without modifier 51. Report only one bone graft code per operative session
20937	Codes 20930-20938 are reported in addition to codes for the definitive procedure(s) without modifier 51. Report only one bone graft code per operative session
20938	Codes 20930-20938 are reported in addition to codes for the definitive procedure(s) without modifier 51. Report only one bone graft code per operative session
22103	22100 – 22102
22116	22110 – 22112 22114
22216	22210 – 22214
22226	22220 – 22224
22328	22325 – 22327
22522	22520, 22521
22534	22532, 22533
22585	22554 - 22558
22614	22600 – 22612
22632	22630
22840	22325 – 22327 22548 – 22812
22842	22325 – 22327 22548 – 22812
22843	22325 – 22327 22548 – 22812
22844	22325 – 22327 22548 – 22812
22845	22325 – 22327 22548 – 22812
22846	22325 – 22327 22548 – 22812
22847	22325 – 22327 22548 – 22812
22848	22325 – 22327 22548 – 22812
22851	22325 – 22327 22548 – 22812
26125	26123
26861	26860
26863	26862
27358	27355 - 27357
27692	27690 - 27691
31632	31628
31633	31629
32501	32480 – 32484
33141	33400 – 33496, 33510 – 33536
33225	33206-33208, 33212-33214, 33216-33217, 33222, 33233-33235, 33240, 33249
33508	33510-33523
33517	33533 – 33536
33518	33533 – 33536
33519	33533 – 33536
33521	33533 – 33536
33522	33533 – 33536
33523	33533 – 33536
33530	33400 - 33496 33510 - 33536 33863
33572	33510 - 33516 33533 - 33536
33924	33470 – 33475 33600 – 33619 33684 – 33688 33692 – 33697 33735 – 33767 33770 – 33786 33918 – 33922
33961	33960
34808	34800, 34813, 34825, 34826
34813	34812
34826	34825
35390	35301
35400	35201 – 35381, 35585
35500	35501 – 35587
35572	33510-33523, 34502, 34520, 35001-35002, 35011-35022, 35102-35103, 35121-35152, 35231-35256, 35501-35587, 35879-35907
35600	33533 – 33536
35681	List separately in addition to primary procedure
35682	35501 – 35587
35683	35501 – 35587
35685	35656, 35666, 35671
35686	35556, 35566, 35571, 35583-35587, 35623, 35656, 35666, 35671
35697	33877
35700	35556 35566 35571 35583 - 35587 35656,35666 - 35671
36218	36216 or 36217
36248	36246 or 36247
37206	37205
37208	37207
37250	36215 – 36248, 37200 – 37208, 61624, 61626
37251	37250
38102	List separately in addition to primary procedure.
38746	List separately in addition to primary procedure.
38747	List separately in addition to primary procedure.
43635	43631 - 43634
44015	List separately in addition to primary procedure.
44121	44120
44128	44126 – 44127
44139	44140 – 44147
44203	44202
44955 and 47001	When done for indicated purpose at time of other major procedure (not as separate procedure)
44701	44140, 44145, 44150, 44604
47550	47600 – 47620
48400	43260 - 43272
49568	49560 - 49566
49905	List separately in addition to primary procedure.
56606	56605
58611	43020 - 43634 43638 - 44010 44020 - 44120 44125 - 44130 44140 - 44950 44960 - 47000 47010 - 48180 48500 - 49566 49570 - 49900 59510 - 59515
59525	59510 – 59515 59618 – 59622
60512	60500 - 60505
61316	61304, 61312-61313, 61322-61323, 61340, 61570-61571, 61680-61705
61517	61510, 61518
61609 61610	61607 - 61608
61611 61612	61605 - 61606
61795	61304-61692 61700-61711 63001-63091 22100-22328 22548-22851 61855 31254-31256, 31267, 31276, 31287-31288, 31290-31294
61864	61863
61868	61867
62148	62140-62147
62160	61107, 61210, 62220, 62223, 62225, 62230
63035	63020 - 63030
63043	63040
63044	63042
63048	63045 - 63047
63057	63055 - 63056
63066	63064
63076	63075
63078	63077
63082	63081
63086	63085
63088	63087
63091	63090
63103	63101, 63102
63308	63300 - 63307
64472	64470
64476	64475
64480	64479
64484	64483
64623	64622
64627	64626
64727	64702 - 64726
64778	64776
64783	64782
64787	64774 - 64786
64832	64831
64837	64834 - 64836
64859	64856 - 64857
64872	64831 – 64865
64874	64831 – 64872 64876
64876	64831 - 64865
64901	64885 - 64893
64902	64885, 64886, 64895 - 64898
66990	65820, 65875, 65920, 66985-66986, 67038-67040
67225	67221
67320	67311 – 67318
67331	67311 – 67318
67332	67311 – 67318
67334	67311 – 67318
67335	67311 - 67334
67340	67311 – 67320 67331 – 67334
69990	Surgical procedure not excluded in CPT-4 definition of 69990
74301	74300
75774	75600 – 75790, 36215 – 36248
75946	75945
75964	75962
75968	75966
75993	75992
75996	75995
75998	36555-36585
76085	76092, G0202
76125	Xray procedure where dye or Isotope is used
76802	76801
76810	76805
76812	76811
76937	36555-36585
78020	78018
78478	78460 – 78464, 78465
78480	78460 – 78465
78496	78472
87904	87903
88141	88142 - 88154, 88164 – 88167, 88174-88175, G0123, P3000
88155	88142 – 88145, 88150 – 88154, 88164 – 88167
88311 and 88312	List separately in addition to primary procedure.
90472	90471
90781	90780
92547	92541 – 92546
92973	92980, 92982
92974	92980, 92982, 92995, 93508
92978	During therapeutic intervention including imaging supervision, interpretation and report. List separately in addition to code for primary procedure.
92979	92978
92981	92980
92984	92980,92982,92995,G0290
92996	92980,92982,92995
92998	92997
93320	93303 – 93317 93350
93321	93303 – 93317 93350
93325	76825 – 76828 93303 – 93321 93350
93571	92980-92984, 92995-92996, 93508, 93539-93540, 93545, G0290
93572	93571
93609	93620, 93651 - 93652
93613	93620, 93651 – 93652
93621	93620
93622	93620
93623	93620 – 93622
93662	93621, 93622, 93651, 93652
95920	92585, 95925 – 95937, 95822, 95860 95861, 95867, 95868, 95900, 95904
95962	95961
95967	95966
95973	95972
95975	95974
96412	96410
96423	96422
96570	31641, 43228
96571	31641, 43228
97546	97545
99292	99291
99354	99201-99205, 99212-99215, 99241-99245
99355	99354
99356	99221-99223, 99231-99233 99251-99255, 99261-99263, 99301-99303, 99311-99313
99357	99356

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Mental Health Professional Shortage Areas

Designated Geographic Areas

Effective July 1, 2004

Idaho

County	Area Name/Parts	Rural/Urban
Ada	Mental Hlth Region IV Ada	Rural
Adams	Catchment Area # 3 Adams	Rural
Bannock	Mental Hlth Region VI Bannock	Rural
Bear Lake	Mental Hlth Region VI Bear Lake	Rural
Benewah	Mental Hlth Region I Benewah	Urban
Bingham	Mental Hlth Region VI Bingham	Rural
Blaine	Mental Hlth Region V Blaine	Rural
Boise	Mental Hlth Region IV Boise	Rural
Bonner	Mental Hlth Region I Bonner	Urban
Bonneville	Mental Hlth Region VII Bonneville	Rural
Boundary	Mental Hlth Region I Boundary	Urban
Butte	Mental Hlth Region VII Butte	Rural
Camas	Mental Hlth Region V Camas	Rural
Canyon	Catchment Area # 3 Canyon	Rural
Caribou	Mental Hlth Region VI Caribou	Rural
Cassia	Mental Hlth Region V Cassia	Rural
Clark	Mental Hlth Region VII Clark	Rural
Clearwater	Mental Hlth Region II Clearwater	Rural
Custer	Mental Hlth Region VII Custer	Rural
Elmore	Mental Hlth Region IV Elmore	Rural
Franklin	Mental Hlth Region VI Franklin	Rural
Fremont	Mental Hlth Region VII Fremont	Rural
Gem	Catchment Area # 3 Gem	Rural
Gooding	Mental Hlth Region V Gooding	Rural
Idaho	Mental Hlth Region II Idaho	Rural
Jefferson	Mental Hlth Region VII Jefferson	Rural
Jerome	Mental Hlth Region V Jerome	Rural
Kootenai	Mental Hlth Region I Kootenai	Urban
Latah	Mental Hlth Region II Latah	Rural
Lemhi	Mental Hlth Region VII Lemhi	Rural
Lewis	Mental Hlth Region II Lewis	Rural
Lincoln	Mental Hlth Region V Lincoln	Rural
Madison	Mental Hlth Region VII Madison	Rural
Minidoka	Mental Hlth Region V Minidoka	Rural
Nez Perce	Mental Hlth Region II Nez Perce	Rural
Oneida	Mental Hlth REgion VI Oneida	Rural
Owyhee	Catchment Area #3 Owyhee	Rural
Payette	Catchment Area # 3 Payette	Rural
Power	Mental Hlth Region VII Power	Rural
Shoshone	Mental Hlth Region I Shoshone	Urban
Teton	Mental Hlth Region VII Teton	Rural
Twin Falls	Mental Hlth Region V Twin Falls	Rural
Valley	Mental Hlth Region IV Valley	Rural
Washington	Catchment Area # 3 Washington	Rural

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Idaho Health Professional Shortage Areas (HPSAs)

Designated Geographic Areas

COUNTY	AREA NAME/PARTS
Adams	All
Bannock	South Bannock Division South Bannock Division
Bear Lake⁸	Caribou/Georgetown Georgetown Division
Benewah²	St. Maries
Bingham²	American Falls Aberdeen (CCD)
Blaine	Carey Carey (CCD)
Boise	All
Bonner	Priest River Blanchard-Glengary (CCD) Priest River (CCD)
Bonneville³	Swan Valley Division Swan Valley Division
Boundary	All
Butte⁹	Arco/Mackay
Camas	All
Canyon⁴	Nyssa (OR/ID) Parma (CCD) Wilder (CCD)
Caribou⁸	Caribou/Georgetown
Cassia⁴	Albion/Malta Albion (CCD) Oakley Oakley (CCD)
Clark	All
Clearwater¹¹	Clearwater SA C.T. 9701.00 Elk River Elk River Division
Custer⁸	Stanley Stanley (CCD) Challis Challis (CCD)
Elmore³	All
Franklin	All
Fremont	All
Gem⁴	All
Gooding¹⁰	All
Idaho	Riggins Riggins Division Elk City Elk City Division
Jefferson	C.T. 9601.00
Jerome¹¹	All
Kootenai²	St. Maries Harrison (CCD) Worley (CCD)
Lemhi⁶	All
Lewis	Winchester Winchester Division
Lincoln	All
Minidoka²	Minidoka Minidoka Division
Oneida¹⁰	All
Owyhee	All
Payette	All
Power²	American Falls American Falls (CCD) Rockland (CCD)
Teton⁵	All
Twin Falls²	Buhl Buhl (CCD) W. Salmon Falls (CCD)
Valley¹¹	Cascade C.T. 9701.00
Washington	All

¹ No longer classified as HPSA, effective 3/1/98
² No longer classified as HPSA, effective 10/1/98
³ Classified as HPSA, effective 10/1/98
⁴ No longer classified as HPSA, effective 1/1/99
⁵ Classified as HPSA, effective 10/1/99
⁶ Classified as HPSA, effective 12/1/99
⁷ No longer classified as HPSA, effective 9/1/01
⁸ Classified as HPSA, effective 3/1/02
⁹ No longer classified as HPSA, efective 3/1/02
¹⁰No longer classified as HPSA, efective 9/1/03
¹¹Classified as HPSA, effective 9/1/03

*Note: Ada and Valley Counties were added as geographic areas in error.

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