January 2007Medicare Bulletin - Idaho Insert

Posted January 5, 2007

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Table of Contents

• 2007 Chiropractic Fee Schedule – Idaho
• 2007 Idaho Ambulance Fee Schedule
• 2007 Idaho Medicare Clinical Psychologist Fee Schedule
• 2007 Idaho Medicare Clinical Social Worker Fee Schedule
• Idaho – 2007 OPPS Payment Cap Amounts For The TC And Global Portion Of Imaging Services
• Botulinum Toxin - LCD Revision
• Idaho's ASC Facility Adjusted Rate Effective 01/01/2007
• Idaho Health Professional Shortage Areas (HPSAs)
• Idaho Mental Health Professional Shortage Areas

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Botulinum Toxin – LCD Revision

The Idaho LCD for Botulinum Toxin (L13717) has been revised to include the covered diagnosis code 705.21 effective 12/01/04.

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Idaho’s ASC Facility Adjusted Rate Effective 01/01/2007

The following fees are the Adjusted ASC payment rates for the areas within Idaho. These amounts were developed by following the instructions to carriers for wage adjusting the standard ASC payment rates. These instructions are in the CMS Manual Systems, Pub 100-04, Medicare Claims Processing Manual, Chapter 14, Section 40.2 (the Internet Only Manuals can be accessed at: http://www.cms.hhs.gov/manuals/IOM/list.asp).

The standard ASC payment rates are found on the HCPCS ALL list on the CMS Web site at: http://www.cms.hhs.gov/apps/ama/license.asp?file=/ascpayment/downloads/07asc_hcpcs.zip .

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2007 Idaho Ambulance Fee Schedule

CODE	URBAN RATE	RURAL RATE
A0425	$6.25	$6.25
A0426	$217.19	$217.19
A0427	$343.88	$343.88
A0428	$180.99	$180.99
A0429	$289.58	$289.58
A0430	$2,465.60	$3,698.41
A0431	$2,866.63	$4,299.94
A0432	$316.73	$316.73
A0433	$497.72	$497.72
A0434	$588.21	$588.21
A0435	$7.49	$11.24
A0436	$19.96	$29.94

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2007 Idaho Medicare Clinical Psychologist Fee Schedule

Procedure Code	Non Facility Fee	Facility Fee
90801AH	$137.70	$124.52
90802AH	$146.06	$133.54
* 90804AH	$58.62	$53.02
* 90806AH	$85.71	$81.43
* 90808AH	$127.11	$122.50
* 90810AH	$62.58	$58.30
* 90812AH	$92.46	$86.54
* 90814AH	$133.53	$128.59
* 90816AH	$57.12	$57.12
* 90818AH	$85.86	$85.86
* 90821AH	$127.64	$127.64
* 90823AH	$61.57	$61.57
* 90826AH	$91.19	$91.19
* 90828AH	$132.36	$132.36
* 90845AH	$79.15	$77.84
*# 90846AH	$83.63	$82.98
*# 90847AH	$102.62	$99.00
*# 90849AH	$29.65	$28.00
* 90853AH	$28.82	$27.50
* 90857AH	$31.98	$29.68
* 90880AH	$105.81	$95.93
96101AH	$83.25	$82.59
96102AH	$43.57	$22.17
96103AH	$33.91	$22.72
96105AH	$63.35	$63.35
96110AH	$9.01	$9.01
96111AH	$123.38	$122.06
96116AH	$91.40	$85.80
96118AH	$107.54	$84.81
96119AH	$59.53	$27.25
96120AH	$52.03	$22.72

* The procedure code is subject to the 62.5% outpatient psychiatric payment limitation (i.e., the allowed amount is reduced to 62.5% of the allowable amount).

# The procedure code has a restricted coverage status. Documentation must be included in order to review for coverage.

© All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

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2007 Idaho Medicare Clinical Social Worker Fee Schedule

Procedure Code	Non Facility Fee	Facility Fee
90801AJ	$103.28	$93.39
90802AJ	$109.55	$100.16
* 90804AJ	$43.97	$39.77
* 90806AJ	$64.28	$61.07
* 90808AJ	$95.33	$91.88
* 90810AJ	$46.94	$43.73
* 90812AJ	$69.35	$64.91
* 90814AJ	$100.15	$96.44
* 90816AJ	$42.84	$42.84
* 90818AJ	$64.40	$64.40
* 90821AJ	$95.73	$95.73
* 90823AJ	$46.18	$46.18
* 90826AJ	$68.39	$68.39
* 90828AJ	$99.27	$99.27
* 90845AJ	$59.36	$58.38
*# 90846AJ	$62.72	$62.24
*# 90847AJ	$76.97	$74.25
*# 90849AJ	$22.24	$21.00
* 90853AJ	$21.62	$20.63
* 90857AJ	$23.99	$22.26
* 90880AJ	$79.36	$71.95
96102AJ	$32.68	$16.63
96103AJ	$25.43	$17.04
96105AJ	$47.51	$47.51
96110AJ	$6.76	$6.76
96111AJ	$92.54	$91.55
96119AJ	$44.65	$20.44
96120AJ	$39.02	$17.04

* The procedure code is subject to the 62.5% outpatient psychiatric payment limitation (i.e., the allowed amount is reduced to 62.5% of the allowable amount).

# The procedure code has a restricted coverage status. Documentation must be included in order to review for coverage.

© All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

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2007 Chiropractic Fee Schedule – Idaho

CODE	PAR F/S	NON PAR F/S	LIMITING CHARGE
98940	22.90	21.76	25.02
# 98940	19.28	18.32	21.07
98941	31.70	30.12	34.64
# 98941	27.75	26.36	30.31
98942	41.76	39.67	45.62
# 98942	37.48	35.61	40.95
98943	NC	NC	NC

# These amounts apply when service is performed in a facility setting.

Limiting charge applies to unassigned claims by non-participating providers.

NC indicates that the service is non-covered by Medicare.

© All Current Procedural Terminology (CPT) codes and descriptors are copyrighted by the American Medical Association.

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Idaho – 2007 OPPS Payment Cap Amounts For The TC And Global Portion Of Imaging Services

Idaho – 2007 OPPS Payment Cap Amounts For The TC And Global Portion Of Imaging Services

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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 Lake Caribou/Georgetown Georgetown Division Blaine Carey Carey (CCD) Boise All Bonner2 Priest River Blanchard-Glengary (CCD) Priest River (CCD) Bonneville Swan Valley Division SA Swan Valley Division Boundary All Camas All Caribou1 Caribou/Georgetown SA Caribou Clark All Clearwater Clearwater SA C.T. 9701.00 Elk River Elk River Division Custer5 All Elmore All Franklin All Fremont All Idaho Riggins SA Riggins Division Elk City SA Elk City Division Jefferson1 C.T. 9601.00 Jerome All Lemhi3 All Lewis4 Winchester /Nez Perce/Craigmont Lewis CT 9502.00 CT 9503.00 Lincoln All Owyhee All Payette All Teton All Washington6 All

¹ Classified as HPSA, effective 5/1/04
² No longer classified as a HPSA, effective April 12, 2005
³ No longer classified as a HPSA, effective January 7, 2004
⁴ Classified as a HPSA, effective September 8, 2005
⁵ Classified as a HPSA, effective November 18, 2005
⁶ No longer classified as a HPSA, effective July 5, 2006

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