| Common terms: |
|
|---|---|
| Category: | V Visit |
| Base rate: | $80.00 |
| Type | Code | # of calls | Explicit | Action | Amount |
|---|---|---|---|---|---|
| SKLL | ANES | Replace Base | $121.39 | ||
| SKLL | ANPA | Replace Base | $175.59 | ||
| SKLL | CARD | Replace Base | $175.00 | ||
| SKLL | CLIM | Replace Base | $202.94 | ||
| SKLL | CMSP | Replace Base | $202.94 | ||
| SKLL | CRCM | Replace Base | $165.67 | ||
| SKLL | CRSG | Replace Base | $161.95 | ||
| SKLL | CTSG | Replace Base | $161.95 | ||
| SKLL | DERM | Replace Base | $80.00 | ||
| SKLL | E/M | Replace Base | $195.12 | ||
| SKLL | EMSP | Replace Base | $122.55 | ||
| SKLL | FTER | Replace Base | $122.55 | ||
| SKLL | GAST | Replace Base | $186.95 | ||
| SKLL | GNSG | Replace Base | $154.07 | ||
| SKLL | GP | Replace Base | $129.01 | ||
| SKLL | HEM | Replace Base | $202.94 | ||
| SKLL | HEPA | Replace Base | $175.59 | ||
| SKLL | IDIS | Replace Base | $201.13 | ||
| SKLL | INMD | Replace Base | $202.94 | ||
| SKLL | MDBI | Replace Base | $175.59 | ||
| SKLL | MDGN | Replace Base | $204.52 | ||
| SKLL | MDMI | Replace Base | $175.59 | ||
| SKLL | MDON | Replace Base | $202.94 | ||
| SKLL | NEPH | Replace Base | $210.92 | ||
| SKLL | NEUR | Replace Base | $197.86 | ||
| SKLL | NPM | Replace Base | $204.52 | ||
| SKLL | NUPA | Replace Base | $175.59 | ||
| SKLL | NUSG | Replace Base | $131.52 | ||
| SKLL | OBGY | Replace Base | $115.01 | ||
| SKLL | OCMD | Replace Base | $202.94 | ||
| SKLL | OPHT | Replace Base | $121.58 | ||
| SKLL | ORTH | Replace Base | $109.88 | ||
| SKLL | OTOL | Replace Base | $102.89 | ||
| SKLL | PATH | Replace Base | $175.59 | ||
| SKLL | PDGE | Replace Base | $204.52 | ||
| SKLL | PDNR | Replace Base | $204.52 | ||
| SKLL | PDSG | Replace Base | $204.52 | ||
| SKLL | PED | Replace Base | $204.52 | ||
| SKLL | PEDC | Replace Base | $204.52 | ||
| SKLL | PEDN | Replace Base | $210.92 | ||
| SKLL | PHMD | Replace Base | $204.69 | ||
| SKLL | PLAS | Replace Base | $103.80 | ||
| SKLL | RHEU | Replace Base | $198.38 | ||
| SKLL | ROSP | Replace Base | $129.01 | ||
| SKLL | RSMD | Replace Base | $207.31 | ||
| SKLL | THOR | Replace Base | $193.46 | ||
| SKLL | UROL | Replace Base | $95.33 | ||
| SKLL | VSSG | Replace Base | $160.56 | ||
| CARE | CMXC30 | Yes | Increase Base By | $31.51 |
When a claim is submitted for the following HSCs, the referring practitioner field must be completed with a valid referring practitioner number.
HSCs in the following list marked with an asterisk(*) cannot be self-referred. Self-referred means the physician is providing the diagnostic service and treating the patient.
HSCs in Section E (Lab and Pathology) and X (Diagnostic Radiology) require a valid referring practitioner number with the following exceptions: HSC X27D does not require a referral and HSC X27F may be self-referred. HSC 03.03D requires a valid referring physician, chiropractor, midwife, podiatrist, dentist, optometrist, physical therapist or nurse practitioner number when it is a visit to a referred patient.
| 01.01A | 01.01B | 01.03 | 01.04A | 01.05A | 01.09 |
| 01.12A | 01.12B | 01.14 | 01.16A | 01.16B | 01.16C |
| 01.22 | 01.22A | 01.22B | 01.22C | 01.24A | 01.24B |
| 01.24BA | 01.24BB | 01.32 | 01.34 | 02.82A | 02.84A |
| 02.84B |
| 03.01O* | 03.01LJ* 03.01LK* 03.01LL* 03.03D* | 03.03F* | ||
| 03.03FA* | 03.03FT* 03.03FV* 03.03FZ* 03.04Q* | 03.05B* | ||
| 03.07A* | 03.07AZ* 03.07B* | 03.07C* | 03.08A* | 03.08AZ* |
| 03.08B* | 03.08BZ* 03.08C* | *03.08CV 03.08F* | 03.08H* | |
| 03.08K* | 03.08L* | 03.08M* |
| 10.04 | 10.08A | 10.33B | 13.99CC 13.99GA* | 14.49A | |
| 14.82 | 14.85B | 14.88A | 14.88B | 15.94A | 16.83A |
| 16.83B | 16.83C | 16.89A | 16.92B | 17.81B | 19.81 |
| 22.81 | 24.89A | 24.89B | 28.8 A | 28.81A | 29.0 A |
| 30.81A | 33.22B | 37.81 | 37.82A | 37.82B | 38.89A |
| 38.89B | 39.21A | 39.62A | 39.83A |
| 40.92A | 41.29A | 41.29B | 42.09B | 43.81 | 43.82 |
| 44.3 B | 45.81A | 45.83 | 45.84B | 45.86A | 46.5 A |
| 46.81A | 46.82 | 46.84A | 46.88A | 48.92A | 48.98A |
| 48.98B | 49.93A | 49.95A | 49.96A | 49.96B | 49.98B |
| 49.98C | 49.98D |
| 60.82C | 60.89A | 62.12A | 62.12B | 62.81A | 63.86A |
| 63.96B | 64.95A | 64.97A | 66.19A | 66.3 C | 66.83 |
| 66.89A | 66.89B | 66.89C | 67.81 | 67.86 | 67.87A |
| 67.89A | 68.95 | 69.83A | 69.83B | 72.91 | 72.92A |
| 74.82A | 75.83A | 76.89A | 78.7 A | 79.29E |
| F7 |
Comprehensive visits and/or comprehensive/major consultations may only be claimed once every 365 days per patient by the same physician. Comprehensive visit and consultation services are defined as HSCs 03.04A, 03.04AZ, 03.08A, 03.08AZ, 03.08B, 03.08BZ, 03.08C, 03.08CV, 03.08F, 03.08H, 03.08K, 08.11A, 08.11C, 08.19A, 08.19AZ, 08.19AA, and 08.19CX.
HSC 03.09B is defined as comprehensive and may not be billed more frequently than once every 180 days by the same physician.
HSCs 03.04O and 03.04P are defined as comprehensive services and may not be billed more frequently than four times per year as indicated or within 180 days of a comprehensive service or consultation by the same physician.
