Medicare CPT 80061, 82465, 83718 & 84478

Cardiovascular Screening Blood Tests

Every year, thousands of Americans die of heart disease and stroke. Millions more currently live with one or more types of cardiovascular disease, including, coronary heart disease, stroke, high blood pressure, congestive heart failure, congenital cardiovascular defects, and hardening of the arteries. Heart disease and stroke are also among the leading causes of disability for both men and women in the United States.

Recognizing the need for early detection to effectively combat the risks of cardiovascular disease, Congress expanded preventive services to include the coverage of cardiovascular screening blood tests. Section 612 of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 established Medicare coverage of cardiovascular screening blood tests.


The cardiovascular screening blood tests covered by Medicare include the following:

Total Cholesterol Test
Cholesterol Test for High Density Lipoproteins
Triglycerides Test

NOTE: The beneficiary must fast for 12 hours prior to testing. Other cardiovascular screening blood tests remain non-covered .


CPT Codes for Cardiovascular Screening Blood Tests

80061 - Lipid Panel This panel must include the following:Cholesterol, serum, total (82465)Lipoprotein, direct measurement, high density cholesterol (HDLcholesterol) (83718)Triglycerides (84478)

82465 - Cholesterol, serum or whole blood, total (For high density lipoprotein HDL,use 83718)

83718 - Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol)

84478 - Triglycerides

Diagnosis covered

Medicare providers must report one or more of the following International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) screening ("V") diagnosis code(s) for cardiovascular screening blood tests:

V81.0 Special screening for ischemic heart disease
V81.1 Special screening for hypertension
V81.2 Special screening for other and unspecified cardiovascular conditions

CPT code G0389 - Ultrasound Screening

An aneurysm is an abnormal bulge or “ballooning” in the wall of an artery. Most aneurysms occur in the aorta, the main artery that carries blood from the heart to the rest of the body. An aneurysm that occurs in the aorta in the abdomen is called an abdominal aortic aneurysm (AAA). Three out of four aortic aneurysms are AAAs.

An AAA occurs when the aorta below the renal arteries expands to a maximal diameter of 3.0 centimeters (cm) or greater. AAAs may be asymptomatic for years, but if left untreated, the continuing extension and thinning of the vessel wall may eventually result in a rupture of the aneurysm. Ultrasound screening of the abdomen has been shown to be a reliable and accurate method for detecting AAAs.

Procedure Codes and Descriptors

G0389 - Ultrasound, B-scan and/or real time with image documentation; for abdominal aortic aneurysm (AAA) ultrasound screening.


Diagnosis Requirements

Although Medicare providers must report a diagnosis code on the claim, there are no specific International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis codes that are required for the AAA ultrasound screening. Providers should choose an appropriate ICD-9-CM diagnosis code. Contact the local Medicare Contractor for further guidance.

CPT codes and HCPCS codes
Medicare J codes
Anesthesia billing CPT codes
What is ICD 9 diagnosis codes
CPT codes G0402 G0403 & G0405

CPT codes G0402 , G0403 G0404 & G0405

HCPCS Codes for the IPPE and Screening EKG

G0402 -Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment
G0403 - Electrocardiogram, routine ECG with 12 leads; performed as a screening for the initial preventative physical examination with interpretation and report
G0404 - Electrocardiogram, routine ECG with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventative physical examination
G0405 - Electrocardiogram, routine ECG with 12 leads; interpretation and report only, performed as a screening for the initial preventative physical examination

The HCPCS codes for the IPPE do not include other preventive services that are currently paid separately under Medicare Part B screening benefits. When Medicare providers perform these other preventive services, they must identify the services using the appropriate existing codes

Diagnosis Requirements

Although Medicare providers must report a diagnosis code on the claim, there are no specific International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis codes that are required for the IPPE and screening EKG. Medicare providers should choose an appropriate ICD-9-CM diagnosis code. Contact the local Medicare Contractor for further guidance.

CPT code G9141 , 90655 90656 & 90472

CPT modifier 51 - Multible surgery

cpt code modifiers

CPT billing codes

Billing update from Humana

Please confirm this with Humana for latest update.

• CPT 82565 will not be separately reimbursed when submitted with CPT 80050.
• CPT 11101 will not be separately reimbursed when submitted with CPT 17000.
• CPT 36415 will not be separately reimbursed when submitted with the following CPT codes:
80048 82105 82627 83540 84550 85652
80050 82150 82670 83655 84702 86304
80051 82247 82728 84132 84703 86308
80053 82306 82785 84144 85007 86592
80055 82310 82947 84146 85014 86677
80061 82330 82948 84153 85018 86703
80069 82465 82950 84403 85025
80074 82550 82951 84436 85027
80076 82565 82962 84439 85060
80164 82575 83001 84443 85610
82040 82607 83036 84450 85651
• CPT 36416 will not be separately reimbursed when submitted with the following CPT codes:
80053 82465 82962 83655 85018 85610
80061 82947 83036 85013 85025
82247 82948 83540 85014 85027
• CPT 36540 will not be separately reimbursed when submitted with the following CPT codes:
80053 85025
• CPT 71010 will not be separately reimbursed when submitted with the following CPT codes:
99284 99285
• CPT 71020 will not be separately reimbursed when submitted with the following CPT codes:
99283 99284 99285
*The policies and guidelines addressed above are not an all-inclusive listing.
• CPT 74022 will not be separately reimbursed when submitted with CPT 99285.
• CPT 77417 will not be separately reimbursed when submitted with CPT 77427.
• CPT 78890 will not be separately reimbursed when submitted with CPT 93015.
• CPT 90760 will not be separately reimbursed when submitted with CPT 99291.
• CPT 90765 will not be separately reimbursed when submitted with CPT 99291.
• CPT 93010 will not be separately reimbursed when submitted with the following CPT codes:
92980 99232 99254 99291
99223 99233 99255
• CPT 93041 will not be separately reimbursed when submitted with CPT A0427.
• CPT 93042 will not be separately reimbursed when submitted with the following CPT codes:
99232 99233
• CPT 93508 will not be separately reimbursed when submitted with CPT 92980.
• CPT 94150 will not be separately reimbursed when submitted with the following CPT codes:
94620 95117 99214
• CPT 94760 will not be separately reimbursed when submitted with the following CPT codes:
36415 93010 99212 99215 99284
80051 99203 99213 99244 99285
93005 99204 99214 99283 A0427
*The policies and guidelines addressed above are not an all-inclusive listing.
• CPT 94761 will not be separately reimbursed when submitted with the following CPT codes:
99214 99284 99285
• CPT 96110 will not be separately reimbursed when submitted with the following CPT codes:
99391 99392 99393
• CPT 99000 will not be separately reimbursed when submitted with the following CPT codes:
11100 80050 84443 99204 99385 99395
36410 80053 85018 99211 99386 99396
36415 80061 85025 99212 99387 99397
57454 81002 88142 99213 99392
58100 82948 88175 99214 99393
80048 83036 99203 99215 99394
• CPT 99173 will not be separately reimbursed when submitted with the following CPT codes:
99213 99383 99392 99394
99214 99384 99393 99395
• CPT A4209 will not be separately reimbursed when submitted with CPT 99211.
• CPT A4212 will not be separately reimbursed when submitted with the following CPT codes:
96413 99211 99213 99214
• CPT A4215 will not be separately reimbursed when submitted with CPT 36415.
• CPT A4556 will not be separately reimbursed when submitted with CPT E0730.
• CPT Q0091 will not be separately reimbursed when submitted with the following CPT codes:
99385 99386 99395 99396 99397 G0101
• CPT 94664 will not be separately reimbursed when submitted with the following CPT codes:
99213 99214 99244
*The policies and guidelines addressed above are not an all-inclusive listing.
• CPT 97002 will not be separately reimbursed when submitted with the following CPT codes:
97110 97140
• CPT 97140 will not be separately reimbursed when submitted with CPT 98943.
• CPT 99051 will not be separately reimbursed when submitted with the following CPT codes:
99203 99212 99213 99214
• CPT 99053 will not be separately reimbursed when submitted with the following CPT codes:
99282 99283 99284 99285 99291
• CPT 99070 will not be separately reimbursed when submitted with CPT J7050.
• CPT 99215 will not be separately reimbursed when submitted with CPT 99396.
• CPT 99420 will not be separately reimbursed when submitted with CPT 99395.
• CPT 99215 will not be separately reimbursed when submitted with CPT 28190.
• CPT 11101 will not be separately reimbursed when submitted with CPT 17000.
• CPT 36415 will not be separately reimbursed when submitted with the following CPT codes:
80048 82247 82728 83655 84450 85651
80050 82306 82784 83891 84460 85652
80051 82310 82785 84132 84550 86003
80053 82378 82947 84144 84702 86038
80055 82465 82948 84146 84703 86304
80061 82533 82950 84153 85007 86308
80069 82550 82951 84402 85013 86592
80074 82565 82962 84403 85014 86677
80076 82575 83001 84432 85018 86703
82040 82607 83036 84436 85025 86706
82105 82627 83516 84439 85027 86787
82150 82670 83540 84443 85610
*The policies and guidelines addressed above are not an all-inclusive listing.
• CPT 36416 will not be separately reimbursed when submitted with the following CPT codes:
80061 82947 83036 85014 85027
82247 82948 83655 85018 85610
82465 82962 85013 85025
• CPT 36540 will not be separately reimbursed when submitted with the following CPT codes:
80053 85025
• CPT 69210 will not be separately reimbursed when submitted with CPT 99396.
• CPT 71010 will not be separately reimbursed when submitted with the following CPT codes:
99284 99285
• CPT 71020 will not be separately reimbursed when submitted with the following CPT codes:
99284 99285
• CPT 83891 will not be separately reimbursed when submitted with CPT 87491.
• CPT 83901 will not be separately reimbursed when submitted with CPT 87491.
• CPT 90760 will not be separately reimbursed when submitted with CPT 90774.
• CPT 93010 will not be separately reimbursed when submitted with the following CPT codes:
99213 99214 99223 99232 99254 99291
• CPT 93041 will not be separately reimbursed when submitted with CPT A0427.
• CPT 94150 will not be separately reimbursed when submitted with the following CPT codes:
99213 99214
*The policies and guidelines addressed above are not an all-inclusive listing.
• CPT 94760 will not be separately reimbursed when submitted with the following CPT codes:
36415 99203 99204 99213 99214 99215
• CPT 94761 will not be separately reimbursed when submitted with CPT 99214.
• CPT 96110 will not be separately reimbursed when submitted with the following CPT codes:
99391 99392
• CPT 99000 will not be separately reimbursed when submitted with the following CPT codes:
11100 80053 84439 99204 99215 99394
36415 80055 84443 99205 99385 99395
57454 80061 85025 99211 99386 99396
58100 80076 88175 99212 99391
80048 81002 99202 99213 99392
80050 82947 99203 99214 99393
• CPT 99001 will not be separately reimbursed when submitted with the following CPT codes:
36415 80053
• CPT 99144 will not be separately reimbursed when submitted with CPT 77003.
• CPT 99173 will not be separately reimbursed when submitted with the following CPT codes:
99213 99383 99392 99394
99214 99384 99393 99395
• CPT A0999 will not be separately reimbursed when submitted with CPT A0429.
• CPT A4206 will not be separately reimbursed when submitted with CPT 95117.
• CPT A4208 will not be separately reimbursed when submitted with CPT 99211.
*The policies and guidelines addressed above are not an all-inclusive listing.
• CPT A4212 will not be separately reimbursed when submitted with the following CPT codes:
36415 96413 96523 99211 99213 99214
• CPT A4215 will not be separately reimbursed when submitted with the following CPT codes:
36415 99211
• CPT A4216 will not be separately reimbursed when submitted with the following CPT codes:
90765 96413 96523 99213 99214 S9501
• CPT A4245 will not be separately reimbursed when submitted with the following CPT codes:
36415 99211
• CPT A4263 will not be separately reimbursed when submitted with CPT 68761.
• CPT A4550 will not be separately reimbursed when submitted with the following CPT codes:
99202 99203 99213 99214
• CPT A4556 will not be separately reimbursed when submitted with CPT E0730.
• CPT A4930 will not be separately reimbursed when submitted with CPT 99211.
• CPT Q0091 will not be separately reimbursed when submitted with the following CPT codes:
99385 99386 99395 99396 G0101
• CPT 76857 will not be separately reimbursed when submitted with CPT 76830.
• CPT 82310 will not be separately reimbursed when submitted with CPT 82330.
*The policies and guidelines addressed above are not an all-inclusive listing.
• CPT 85027 will not be separately reimbursed when submitted with CPT 85025.
• CPT 94260 will not be separately reimbursed when submitted with CPT 94240.
• CPT 94664 will not be separately reimbursed when submitted with the following CPT codes:
99204 99213 99214
• CPT 97002 will not be separately reimbursed when submitted with the following CPT codes:
97110 97112 97530
• CPT 99051 will not be separately reimbursed when submitted with the following CPT codes:
99203 99212 99213 99214
• CPT 99053 will not be separately reimbursed when submitted with the following CPT codes:
99282 99283 99284 99285
• CPT 99070 will not be separately reimbursed when submitted with the following CPT codes:
A4550 J1100
• CPT 99213 will not be separately reimbursed when submitted with CPT 99214.
• CPT A4215 will not be separately reimbursed when submitted with CPT A4550.
• CPT G0101 will not be separately reimbursed when submitted with the following CPT codes:
99214 99395 99396
• CPT 99050 will not be separately reimbursed when submitted with CPT 90772.
*The policies and guidelines addressed above are not an all-inclusive listing.
• CPT 99203 will not be separately reimbursed when submitted with CPT 90772.
• CPT 99204 will not be separately reimbursed when submitted with CPT 90772.
• CPT 99212 will not be separately reimbursed when submitted with CPT 90772.
• CPT 99213 will not be separately reimbursed when submitted with CPT 90772.
• CPT 99214 will not be separately reimbursed when submitted with CPT 90772.
• CPT 99395 will not be separately reimbursed when submitted with CPT 90772.

Florida Medicaid billing update
Medicare billing update

Billing address update from Sedgwick

Effective immediately please direct all mail, bills and reports for the Sedgwick CMS Oakland and Van Nuys Offices to our new mailing address.

Please note this address change only applies to the Oakland and Van Nuys offices which previously used the following addresses:

P.O. Box 1027
Van Nuys, CA 91408-1027

P.O. Box 2065
Oakland, CA 94604-0064


New Address: Sedgwick CMS -Sedgwick CMS iVOS MCU

P.O. Box 14479
Lexington, KY 40512-4479

Our mailing address has changed; however your claim will continue to be administered from our Oakland and Van Nuys offices by our team of claim professionals. Our phone and fax numbers remain the same.

If you are workins with other clients in Oakland and Van Nuvs not usina the addresses listed above, you should continue to use the address they have provided to vou.

We look forward to providing quality customer service. If you have any questions, please contact our claims professionals in the appropriate office at their regular number.

Medicare billing update

Claims Submission Tips

The Medicare claims department has compiled a list of claims submission tips to address frequent problems they encounter when processing claims.

Medicare Secondary Payer (MSP) Claims

· If you are an electronic biller, please submit MSP claims electronically instead of submitting as paper.
· If you submit MSP claims on the 1500 Claim Form, ensure the correct primary insurance statement is attached and legible.
· When submitting a paper MSP claim, do not highlight the names on the primary insurance statement. It is acceptable to circle the names, but highlighting makes the statement difficult to read.

General Information

· Remember to submit documentation when billing the 22, 52 and 53 modifiers (except when reporting the 52 or 53 modifier on radiology services – a brief statement in Item 19 is acceptable).
· Claims containing the 55 modifier should indicate the range of dates.
· Provider signatures should be included on the claim form. If the signature is on file, "Signature on File" and/or a computer-generated signature are acceptable.
· Include CLIA numbers on the claim form when submitting lab tests.


Medicare billing
Medicare CPT codes
Medicare rates
Medicare as secondary payor
Medicare payment
Hospital getting more Medicare payment

Billing consult and preventive code with office visit

A consultation is an evaluation of a patient provided by a physician at the request of another physician or appropriate source. The consulting physician may order tests or therapeutic services at the time of the visit, and these would be reported separately. The request for the consultation as well as the consultant's opinion must be documented in the patient's chart. A written report must be sent back to the physician requesting the consult. A consultation requested by the patient or family member and not by a physician or appropriate source should not be reported with consultation codes. Report the appropriate evaluation and management (E/M) code for this service.


If an abnormality/ies is encountered or a preexisting problem is addressed in the process of performing this preventive medicine evaluation and management service, and if the problem/abnormality is significant enough to require additional work to perform the key components of a problem-oriented E/M service, then the appropriate office/outpatient code 99201-99215 should also be reported. Modifier -25 should be added to the office/outpatient code to indicate that a significant, separately identifiable evaluation and management service was provided by the same physician on the same day as the preventive medicine service. The appropriate preventive medicine service is additionally reported.

A problem/abnormality encountered in the process of performing the preventive medicine evaluation and management service that does not require additional work and the performance of the key components of a problem-oriented E/M service should not be reported.

CPT G9141, 90655 , 90656, 90466 & 90472 billing update from CIGNA

CIGNA will reimburse health care professionals and facilities for the administration of the H1N1 vaccine to all individuals covered under a fully-insured CIGNA medical benefit plan. CIGNA is strongly recommending all self-funded plans administered by CIGNA – where the employer makes coverage policy decisions – to also provide coverage for the administration of the vaccine.
CIGNA coverage for H1N1 vaccine administration will not be subject to plan deductibles, co-payment or coinsurance. Certain self-insured benefit plans administered by CIGNA may not adhere to this coverage policy.

The U.S. government is making the vaccine available at no cost to you; therefore CIGNA will only provide coverage for the administration of the vaccine, in accordance with the current recommendations of the Center for Disease Control (CDC) Advisory Committee on Immunization Practices (ACIP).

CIGNA has developed the following billing guidelines for the prophylactic administration of the H1N1 vaccine. Facilities should use Rev. Code 771 with G9141 when submitting claims for the H1N1 vaccine administration.

H1N1 Only

When the H1N1 vaccine is administered without the seasonal influenza vaccine, the following coding and billing guidelines should be followed:

1) Bill G9141 -Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family) for the administration of the H1N1 vaccine.

Use G9141 to promote prompt payment as this code will not be subject to the usual copay or deductible and coinsurance.

2) Bill V04.81 - need for prophylactic vaccination and inoculation, influenza, as the appropriate ICD-9 code.

H1N1 and Seasonal Flu VaccineWhen both the seasonal influenza vaccine and the H1N1 vaccine are administered to the same individual on the same date of service, follow these coding guidelines:

1) Include G9141 and V04.81 as indicated above for the H1N1 vaccine administration; and

2) Bill one of the appropriate seasonal flu vaccine codes:

90655-Influenza virus vaccine, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use;
90656-Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use;
90657-Influenza virus vaccine, split virus, when administered to children 6-35 months of age, for intramuscular use;
90658-Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use; or
90660-Influenza virus vaccine, live, for intranasal use.

3) In addition, bill one of the following administration codes for the administration of the seasonal influenza vaccine:

90466- Immunization administration younger than 8 years of age (includes percutaneous, intradermal, subcutaneous, or intramuscular injections) when the physician counsels the patient/family; each additional injection (single or combination vaccine/toxoid), per day (List separately in addition to code for primary procedure);
90468-Immunization administration younger than age 8 years (includes intranasal or oral routes of administration) when the physician counsels the patient/family; each additional administration (single or combination vaccine/toxoid), per day (List separately in addition to code for primary procedure;
90472-Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure); or
90474-Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure).

No reimbursement will be made for CPT code 90663 or HCPCS code G9142, which both represent the H1N1 vaccine product.

CPT code list
Anesthesia billing CPT codes
Consulation code update from UHC

What is Auto insurance

What is Auto Insurance?

Auto Insurance covers for the loss or damage caused to the automobile or its parts due to natural and man-made calamities. Vehicle insurance (also known as auto insurance, car insurance, or motor insurance) is insurance purchased for cars, trucks, and other vehicles. ... In the event of a car accident or damage, auto insurance will protect the owner from the expensive costs involved in fixing the car and other property.

There are basically 6 types of car insurance coverage:

Bodily Injury Liability

This coverage applies to injuries that you, the designated driver or the policyholder, cause to someone else. You and family members listed on the policy are also covered when driving someone else’s car with their permission. It is important to have enough liability insurance, because if you are involved in a serious accident, you may be sued for a large sum of money. Do consider purchasing an auto insurance policy that is more than the state-required minimum to protect assets such as your home and savings.

Medical Payments or Personal Injury Protection (PIP)

This coverage pays for the treatment of injuries to the driver and passengers of the policyholder's vehicle. At its broadest, PIP can cover medical payments, lost wages and the cost of replacing services normally performed by someone injured in an auto accident. It may also cover funeral costs.

Property Damage Liability

This car insurance coverage pays for damage that you (or someone driving the car with your permission) may cause to someone else's property. Usually, this means damage to someone else’s car, but it also includes damage to lamp posts, fences, buildings or other structural property that your car hit. Collision This coverage pays for damage to your car resulting from a collision with another car, object or as a result of flipping over. It also covers damage caused by potholes. Collision coverage is generally sold with a deductible of $250 to $1,000, and the higher your deductible, the lower your premium. Even if you are at fault for the accident, your collision coverage will reimburse you for the costs of repairing your car, minus the deductible. If you're not at fault, your auto insurance company may try to recover the amount they paid you from the other driver’s car insurance company. If auto insurance company is successful in recovering the amount, you'll also be reimbursed for the deductible as well.

Comprehensive

This car insurance coverage reimburses you for loss due to theft or damage caused by something other than a collision with another car or object, such as falling objects, fire, missiles, explosion, earthquake, vandalism, windstorm, hail, flood, riot, or contact with animals such as birds etc. Comprehensive auto insurance is usually sold with a $100 to $300 deductible, though you may want to opt for a higher deductible as a way of lowering your premium. Comprehensive car insurance will also reimburse you if your windshield is cracked or shattered. Some companies offer glass coverage with or without a deductible.

Uninsured and Underinsured Motorist Coverage

This coverage will reimburse you, a member of your family, or a designated driver if one of you is hit by an uninsured or hit-and-run driver. Underinsured motorist coverage comes into play when an at-fault driver has insufficient auto insurance to pay for your total loss. This coverage will also protect you if you are hit as a pedestrian.

What is worker compensation

What is Workers Compensation Insurance?

WC insurance protects employers and injured workers from financial costs when a worker sustains a work-related injury or disease.

The workplace is the spot where most injuries take place. Each State and Territory has a compulsory insurance scheme. It may be called Workers Compensation, Workhealth, Workcare or some other name. Sometimes, the workers' compensation insurance and the traffic accident insurance have been amalgamated and are run by one authority with almost identical benefits being provided. Workers Compensation is payable for any injury caused by the work environment. The injury can be an injured back caused in an accident. Or it can be an occupational disease like asthma or asbestosis caused by dust or asbestos. It can be RSI, repetitive strain injury. It can be a skin disease caused by chemicals. It can be cancer caused by passive smoking.

Medical billing concept - Worker compensation review
Medical billing concept - worker compensation reveiw part 2