October 2004 Medicare Bulletin - Tennessee Insert
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Table of Contents
- Botulinum Toxin (L6102) - LMRP Revision
- Chemotherapy Drugs for Cancer (L61485) - LCD Conversion
- Darbepoetin Alfa (Aranesp) Non-ESRD Use (L17308) - LCD Conversion
- Injection, Tendon Sheath, Ligament, Trigger Points or Ganglion Cyst (L6576) - LMRP Revision
- Interventional Cardiology (L5768) - LMRP Revision
- Lumbar Spine MRI (L5768) - LCD Revision
- Rituximab (Rituxan®) (L5957) - LCD Conversion
- Tennessee Health Professional Shortage Areas
- Tennessee Mental Health Professional Shortage Areas
- Updated Surgical Add-On Code(s) Listing
Rituximab (Rituxan®) (L5957) - LCD Conversion
Rituximab (Rituxan®) (L5957) - LCD Conversion
Chemotherapy Drugs for Cancer (L16485) - LCD
Chemotherapy Drugs for Cancer (L16485) - LCD
Darbepoetin Alfa (Aranesp ® Non-ESRD Use (L17308) - LCD
Darbepoetin Alfa (Aranesp ® Non-ESRD Use (L17308) - LCD
Injection, Tendon Sheath, Ligament, Trigger Points or Ganglion Cyst (L6576) - LMRP Revision
Injection, Tendon Sheath, Ligament, Trigger Points or Ganglion Cyst (L6576) - LMRP Revision
Top
Interventional Cardiology (L6578) - LMRP Revision
Interventional Cardiology (L6578) - LMRP Revision
Lumbar Spine MRI (L5768) - LCD Revision
Lumbar Spine MRI (L5768) - LCD Revision
Botulinum Toxin (L6102) - LMRP Revision
Botulinum Toxin (L6102) - LMRP Revision
Updated Surgical Add-On Code(s) Listing
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 |
| 76082 | 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 |
| ZZZ ADD-ON CODE | PRIMARY CODE |
| 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 |
| ZZZ ADD-ON CODE | PRIMARY CODE |
| 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 |
| ZZZ ADD-ON CODE | PRIMARY CODE |
| 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, 35566, 35556 |
| 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 |
| ZZZ ADD-ON CODE | PRIMARY CODE |
| 35697 | 34800-34805, 34825, 34830, 34832, 35081-35103 |
| 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 |
| ZZZ ADD-ON CODE | PRIMARY CODE |
| 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 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 |
| ZZZ ADD-ON CODE | PRIMARY CODE |
| 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 |
| ZZZ ADD-ON CODE | PRIMARY CODE |
| 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 |
| ZZZ ADD-ON CODE | PRIMARY CODE |
| 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 |
Tennessee Mental Health Professional Shortage Areas (HPSAs)
Designated Geographic Areas
|
(04-1295)
Tennessee Health Professional Shortage Areas (HPSAs)
Designated Geographic Areas
|
1 Classified as a HPSA, effective March 1, 2002.
2 No longer classified as a HPSA, effective March 1, 2002.
3 Classified as a HPSA, effective June 1, 2002.
4 Classified as a HPSA, effective February 1, 2004.
(04-1294)
