February 2005 Medicare Bulletin - Idaho Insert

Posted February 2, 2005

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2005 Idaho Ambulance Fee Schedule / Prevailing Charges (11-SOUTH)
Azacitidine for Injectable Suspension (Vidaza TM) - LCD Revision
ECHOgraphy, Retroperitoneal - LCD Revision
Excision of Nail and Nail Matrix - LCD Revision
Idaho Health Professional Shortage Areas (HPSAs)
Idaho Mental Health Professional Shortage Areas
Lumbar Spine MRI - LCD Revision
Lumbosacral Spine X-Rays - LCD Revision
Myocardial Perfusion Imaging - LCD Revision
Nerve Conduction Studies (NCS) Electomyography (EMG) - LCD Revision
Skin Procedures for Hyperkeratosis - LCD Revision
Transthoracic Echocardiography (TTE) LCD - Revision
Virtual Colonoscopy (CT Colonography) - LCD Revision

2005 IDAHO AMBULANCE FEE SCHEDULE / PREVAILING CHARGES (11-SOUTH)

PROCEDURE	URBAN RATE	RURAL RATE	IIC
A0425	5.90	5.96	0.00
A0426M2	215.96	218.10	161.61
A0426M4	215.96	218.10	134.81
A0427M2	341.94	345.32	218.56
A0427M4	341.94	345.32	191.78
A0428M2	179.97	181.75	149.22
A0428M4	179.97	181.75	122.42
A0429M2	287.95	290.80	184.41
A0429M4	287.95	290.80	157.63
A0430	2312.47	3468.70	2574.82
A0431	2688.58	4032.87	1539.38
A0432	314.94	318.06
A0433M2	494.91	499.81	218.56
A0433M4	494.91	499.81	191.78
A0434M2	584.89	590.68	218.56
A0434M4	584.89	590.68	191.78
A0435	7.00	10.50	33.06
A0436	18.67	28.01	33.06
Q3019	287.95	290.80	191.78
Q3020	179.97	181.75	134.81
A0382			7.29
A0384			10.11
A0392			9.45
A0394			4.88
A0396			12.51
A0422			12.46

2005 IDAHO AMBULANCE FEE SCHEDULE / PREVAILING CHARGES (12-NORTH)

PROCEDURE	URBAN RATE	RURAL RATE	IIC
A0425	5.90	5.96	0.00
A0426M2	215.96	218.10	161.61
A0426M4	215.96	218.10	134.92
A0427M2	341.94	345.32	235.12
A0427M4	341.94	345.32	208.33
A0428M2	179.97	181.75	149.22
A0428M4	179.97	181.75	122.42
A0429M2	287.95	290.80	209.29
A0429M4	287.95	290.80	182.48
A0430	2312.47	3468.70	2574.82
A0431	2688.58	4032.87	1539.38
A0432	314.94	318.06
A0433M2	494.91	499.81	235.12
A0433M4	494.91	499.81	208.33
A0434M2	584.89	590.68	235.12
A0434M4	584.89	590.68	208.33
A0435	7.00	10.50	33.06
A0436	18.67	28.01	33.06
Q3019	287.95	290.80	208.33
Q3020	179.97	181.75	134.92
A0382			4.65
A0384			10.11
A0392			9.45
A0394			4.88
A0396			12.51
A0422			26.39

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Azacitidine for Injectable Suspension (Vidaza TM) - LCD Revision

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ECHOgraphy, Retroperitoneal - LCD Revision

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Excision of Nail and Nail Matrix - LCD Revision

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Lumbar Spine MRI - LCD Revision

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Lumbosacral Spine X-Rays - LCD Revision

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Myocardial Perfusion Imaging - LCD Revision

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Nerve Conduction Studies (NCS) Electomyography (EMG) - LCD Revision

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Skin Procedures for Hyperkeratosis - LCD Revision

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Transthoracic Echocardiography (TTE) LCD - Revision

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Virtual Colonoscopy (CT Colonography) - LCD Revision

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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 VI 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 Lake¹	Caribou/Georgetown Georgetown Division
Blaine	Carey Carey (CCD)
Boise	All
Bonner	Priest River Blanchard-Glengary (CCD) Priest River (CCD)
Bonneville	Swan Valley Division SA Swan Valley Division
Boundary	All
Butte²	Arco/Mackay
Camas	All

Caribou¹	Caribou/Georgetown SA Caribou

Clark	All
Clearwater¹¹	Clearwater SA C.T. 9701.00 Elk River Elk River Division
Custer¹	Stanley Stanley/Challis SA Stanley (CCD) Challis Challis (CCD)
Elmore	All
Franklin	All
Fremont	All

Gooding³	All
Idaho	Riggins SA Riggins Division Elk City SA Elk City Division
Jefferson⁵	C.T. 9601.00
Jerome⁴	All

Lemhi	All
Lewis	Winchester Winchester Division
Lincoln	All

Oneida³	All
Owyhee	All
Payette	All

Teton	All
Washington	All

¹Classified as HPSA, effective 3/1/02
² No longer classified as HPSA, effective 3/1/02
³ No longer classified as HPSA, effective 9/1/03
⁴ Classified as HPSA, effective 9/1/03
⁵ Classified as HPSA, effective 5/1/04

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