August 2004 Medicare Bulletin - North Carolina Insert

<< Back to the August 2004 Main Table of Contents

2004 North Carolina Ambulance Fee Schedule / Prevailing Charges
North Carolina Health Professional Shortage Areas (HPSAs)
North Carolina Mental Health Professional Shortage Areas (HPSAs)
Policy Updates
Provider Relations’ Automated Development System (ADS) Letter Initiative
Updated Surgical Add-On Code(s) Listing - North Carolina

2004 NORTH CAROLINA AMBULANCE FEE SCHEDULE / PREVAILING CHARGES

PROCEDURE	URBAN RATE	URBAN RATE JULY '04	RURAL RATE	RURAL RATE JULY '04	IIC
A0425	5.65	5.71	.00	5.75	~
A0426M2	201.04	203.06	201.04	205.07	129.52
A0426M4	201.04	203.06	201.04	205.07	115.48
A0427M2	318.32	321.50	318.32	324.69	199.30
A0427M4	318.32	321.50	318.32	324.69	118.51
A0428M2	167.54	169.21	167.54	170.89	116.68
A0428M4	167.54	169.21	167.54	170.89	115.48
A0429M2	268.06	270.74	268.06	273.42	133.02
A0429M4	268.06	270.74	268.06	273.42	115.48
A0430	2306.69	2306.69	3460.03	3460.03	2492.57
A0431	2681.86	2681.86	4022.79	4022.79	1490.20
A0432	293.19	296.12	293.19	299.05	~
A0433M2	460.73	465.33	460.73	469.94	199.30
A0433M4	460.73	465.33	460.73	469.94	118.51
A0434M2	544.50	549.94	544.50	555.39	199.30
A0434M4	544.50	549.94	544.50	555.39	118.51
A0435	6.78	6.78	10.17	10.17	32.00
A0436	18.07	18.07	27.11	27.11	32.00
Q3019	268.06	270.74	268.06	273.42	199.30
Q3020	167.54	169.21	167.54	170.89	129.52
A0382	~		~		28.57
A0384	~		~		9.04
A0392	~		~		9.15
A0394	~		~		4.43
A0396	~		~		12.11
A0398	~		~		28.20
A0422	~		~		15.86

(04-1051)

Updated Surgical Add-On Code(s) Listing - North Carolina

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
01968 – 01969	01967
11001	11000
11101	11100
11201	11200
11732	11730
11922	11920, 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, 19103
19340	19140-19162, 19180-19240, 19316-19318, 19357, 19364-19369, 19380
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	26121, 26123
26861	26860
26863	26862
27358	27355-27357
27692	27690-27691
31632	31628
31633	31629
32501	32480-32484
33141	33510-33536, 33572
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
34808	34800, 34813, 34825, 34826
34813	34812
34826	34825
35390	35301
35400	35201-35381,35585
35500	33510-33536, 35556, 35566
35572	33510-33523, 34502, 34520, 35001-35002, 35011-35022, 35102-35103, 35121-35152, 35231-35256, 35501-35587, 35879-35907
35600	33533-33536
35682	35501-35587
35683	35501-35587
35697	33877
35700	35556, 35566, 35571, 35583-35587, 35656, 35666-35671
36218	36216-36217
36248	36246-36247
37206	37205
37208	37207
37250	36215-36248, 37200-37208, 61624, 61626
37251	37250
43635	43631-43634
44121	44120
44701	44140, 44145, 44150, 44604
47550	47600-47620
48400	43260-43272
49568	49560-49566
56606	56605
58611	43020-43634, 43638-44010, 44020-44120, 44125-44130, 44140-44950, 44960-47000, 47010-48180, 49500-49566, 49570-49900, 59510-59525
59525	59510-59515, 59618-59622
60512	60500, 60502, 60505, 60212, 60225, 60240, 60252, 60254, 60260, 60270, 60271
61316	61304, 61312-61313, 61322-61323, 61340, 61570-61571, 61680-61705
61517	61510, 61518
61609	61607-61608
61610	61607-61608
61611	61605-61606
61612	61605-61606
61795	61304-61692, 61700-61711, 61855, 63001-63091, 22100-22328, 22548-22851, 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
64443	64442
64472	64470
64476	64475
64480	64479
64484	64483
64623	64622
64727	64702-64726
64778	64776
64783	64782
64787	64774-64786
64832	64831
64837	64834-64836
64859	64856-64858
64872	64831-64870, 64874-64907
64874	64831-64872, 64876
64876	64831-64874
64901	64885-64893
64902	64885, 64886, 64895-64898
66990	65820, 65875, 65920, 66985-66986, 67038-67048
69990	61304-61711, 62010-62100, 63081-63308, 63704-63710, 64831, 64834-64836, 64840-64858, 64861-64870, 64885-64898, 64905-64907
67225	67221
67320	67311-67318
67331	67311-67318
67332	67311-67318
67334	67311-67318
67335	67311-67334
67340	67311-67320, 67331-67334
74301	74300
75774	75600-75790, 36215-36248
75946	75945
75964	75962
75968	75966
75993	75992
75998	36555-36585
75996	75995
76085	76092, G0202
76802	76801
76810	76805
76812	76811
76937	36555-36585
78020	78018
78478	78460-78465
78480	78460-78465
78496	78472
88155	88142-88145, 88150-88154, 88164-88167
90781	90780
92547	92541-92546
92979	92978
92981	92980, G0290
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
93623	93620-93622
93662	93621-93622, 93651-93652, 93580-93581
95920	92585, 95925-95937
95962	95961
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, 99341-99345, 99347-99350
99355	99354
99356	99221-99223, 99231-99233, 99251-99255, 99261-99263, 99301-99303, 99311-99313
99357	99356
G0236	76090, 76091, G0204, G0206
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
G0291	92980, G0290

Bold = updates/adds

(04-1063)

Provider Relations’ Automated Development System (ADS) Letter Initiative

Automated Development System (ADS) letters are those letters that are sent to request additional information regarding a claim submission prior to issuing a denial. Once we send one of these letters, we suspend the claim in our system for 30 days, to give the provider an opportunity to supply the requested information. If the requested information is not received within this time period, the claim is ultimately denied for lack of information.

While this process is designed to allow providers an opportunity to supply additional information, it also delays the adjudication of these claims. We have found that in many instances, if the information were included on or with the claim initially, the claim could be processed and paid in a timely manner.

The North Carolina Provider Relations Department currently conducts data analysis to identify providers who receive high volumes of ADS letters as well as those who do not respond to ADS letter requests. Providers identified will receive an informational letter from the Provider Relations Department, for educational purposes only.

We want to ensure that providers have the tools necessary to submit claims for reimbursement and experience lower levels of denials and rejections. We also want to stress the importance of returning documentation anytime it is requested by CIGNA Government Services or the Centers for Medicare & Medicaid Services (CMS).

If you are interested in CIGNA Government Services sponsored workshops or seminars, please refer to the CIGNA Government Services Web site at http://www.cignamedicare.com/wrkshp/nc/index.html.

(04-1086)

POLICY UPDATES

Nerve Conduction Studies (NCS) Electromyography (EMG) (LMRP 97-015)

The following CPT was added to the policy:

95920	Intraop Nerve Test Add On

The following ICD-9 codes were added to those that may support medical necessity:

142.0	Malignant neoplasm of Parotid Gland
170.0	Malignant Neoplasm of Bone of Skull and Face Except Mandible
210.2	Benign Neoplasm of Major Salivary Glands
382.3	Unspecified Chronic Suppurative Otitis Media
383.1	Chronic Mastoiditis

(04-1096)

North Carolina Mental Health Professional Shortage Areas (HPSAs)

Designated Geographic Areas

COUNTY	AREA NAME/PARTS	RURAL/URBAN
Beaufort	Tideland Beaufort	Rural
Bertie	Roanoke-Chowan Bertie	Rural
Bladen	Southeast Regional Blanden	Rural
Brunswick	Brunswick	Rural
Caldwell	Caldwell	Urban
Camden	Albermarle Chowan	Rural
Cherokee	Smokey Mountain Cherokee	Rural
Chowan	Albermarle Chowan	Rural
Clay	Smokey Mountain Clay	Rural
Columbus	Southeast Regional Columbus	Rural
Currituck	Albermarle Currituck	Rural
Dare	Albermarle Dare	Rural
Duplin	Duplin-Sampson Duplin	Rural
Gates	Roanoke-Chowan Gates	Rural
Graham	Smokye Mountain	Rural
Halifax	Halifax MHCA Halifax	Rural
Haywood	Smokey Mountain Haywood	Rural
Hertford	Roanoke-Chowan Hertford	Rural
Hyde	Tideland Hyde	Rural
Jackson	Smokey Mountain Jackson	Rural

(04-1026)

North Carolina Health Professional Shortage Areas (HPSAs)

Designated Geographic Areas

COUNTY	AREA NAME/PARTS	RURAL/URBAN
Alexander	All	Urban
Anson	All	Rural
Beaufort	Bayboro - Aurora Richland Twp. Belhaven - Swan Quarter Bath Twp., Pantego Twp	Rural
Bertie	All	Rural
Bladen⁵	All	Rural
Brunswick¹	All	Rural
Caldwell	Western Caldwell - Globe Twp., Johns River Twp., Mulberry Twp., Patterson Twp., Wilson Creek Twp.,	Rural
Carteret⁵	Eastern Cateret - Atlantic Twp., Cedar Island Twp., Davis Twp., Harkers Islands Twp., Marshallberg Twp., Merrimon Twp., Portsmouth Twp., Sea Level Twp., Smyrna Twp., Stacy Twp., Strait Twp.	Rural
Caswell	All	Rural
Cherokee³	Andrews Area, Valley Town Twp.	Rural
Clay	All	Rural
Columbus	All	Rural
Currituck	All	Urban
Dare	Hatteras - Ocracoke Hatteras Twp., Kinnakeet Twp.,	Rural
Edgecombe	All	Urban
Franklin	All	Urban
Gates	All	Rural
Graham	All	Rural
Greene⁶	All	Rural
Guilford	Inner City Greensboro - Census Tracts 101, 107.02, 108.01, 110, 111.01, 112, 113, 114, 115	Urban
Harnett⁴	Western Harnett - Anderson Creek Twp., Barbecue Twp., Johnsonville Twp., Lillington Twp., Stewarts Creek Twp., Upper Little River Twp.	Rural
Hoke	All	Rural
Hyde	Belhaven-Swan Quarter Currituck Twp., Fairfield Twp., Lake Landing Twp., Lake Mattamuskeet Unorg., Swan Quarter Twp. Hatteras-Ocracoke Ocracoke Twp.	Rural
Lenoir	East Kinston - Census Tracts 101-105, 107	Urban
Macon⁵	Franklin - Burningtown Twp., Cartoogechaye Twp., Cowee Twp., Ellijay Twp., Flats Twp., Franklin Twp., Millshoal Twp., Nantahala Twp., Smiths Bridge Twp.	Rural
Mecklenburg	Central Charlotte - Census Tracts 1, 4, 5, 6, 7, 8, 36, 37, 38.98, 39.01, 39.02, 41, 42, 45, 46, 47, 48, 49, 50, 51, 51.01, 52	Urban
Montgomery⁵	All	Rural
Northampton	All	Rural
Onslow¹	All	Urban
Pamlico	Bayboro - Aurora	Rural
Pender	All	Rural
Person	All	Rural
Randolph	All	Urban
Robeson	All	Rural
Stokes	Danbury - Census Tracts 701, 702, and 703	Urban
Tyrrell	All	Rural
Warren²	All	Rural
Washington	All	Rural

¹ No longer classified as a HPSA, effective December 1, 1999.
² Classifed as a HPSA, effective March 1, 2001.
³ Classifed as a HPSA, effective July 1, 2001.
⁴ No longer classified as a HPSA, effective September 1, 2001.
⁵ No longer classified as a HPSA, effective August 1, 2002.
⁶ No longer classified as a HPSA, effective June 1, 2004.

(04-1144)

Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material that is copyrighted by the American Medical Association and/or American Dental Association.

Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

You are forbidden to download the files unless you read, agree to, and abide by the provisions of the copyright statement. Read the copyright statement now and you will be linked back to here.