Medicine and Surgery Section - Wisconsin.gov

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Appendix The following table lists the allowable place of service codes that providers of clozapine management services are required to use when submitting claims. POS Code Description 03 School 04 Homeless Shelter 05 Indian Health Service Free-Standing Facility 06 Indian Health Service Provider-Based Facility 07 Tribal 638 Free-Standing Facility 08 Tribal 638 Provider-Based Facility 11 Office 12 Home 22 Outpatient Hospital 34 Hospice Appendix 26 (Continued) 71 State or Local Public Health Clinic 99 Other Place of Service 158 Wisconsin Medicaid and BadgerCare dhfs.wisconsin.gov/medicaid/ December 2005
Appendix 27 Allowable Temporomandibular Joint Surgery and Anesthesia Procedure Codes and Temporomandibular Joint Evaluation Programs Temporomandibular Joint Surgery and Anesthesia Procedure Codes Service Codes Surgery services 20910, 20962, 21010, 21050, 21060, 21070, 21240, 21242, 21243, 29800, 29804 Anesthesia services 00190, 00192, 00470, 01250, 01320, 01470, 01610, 01710, 01810 Temporomandibular Joint Evaluation Programs The following programs have been approved as multidisciplinary temporomandibular joint evaluation programs for Wisconsin Medicaid. Medical College of Wisconsin Oral and Maxillofacial Surgery 9200 W Wisconsin Ave Milwaukee WI 53226 (414) 454-5760 Gundersen Clinic, Ltd. 1836 South Ave LaCrosse WI 54601 (608) 782-7300, extension 2260 Oral and Maxillofacial Surgery Associates of Waukesha, Ltd. 1111 Delafield St #321 Waukesha WI 53188 (414) 547-8665 Oral and Maxillofacial Surgery Associates of Green Bay SC 704 Webster Ave Green Bay WI 54301 (920) 468-3400 University of Wisconsin Hospital and Clinics 600 Highland Ave Madison WI 53792 (608) 263-7502 Physician Services Handbook — Medicine and Surgery December 2005 159 Appendix
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Physician Services Medicine and Sur
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T Table of Contents Preface .......
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Telemedicine ......................
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Health Professional Shortage Areas
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Legal Framework The following laws
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General Information Treatment (EPSD
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General Information Category III Co
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General Information collecting the
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General Information • The current
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Evaluation and Management reimburse
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Evaluation and Management in an out
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Evaluation and Management 22 Wiscon
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Medicine Services System [HCPCS] co
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Medicine Services In cases where mo
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Medicine Services documentation in
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Medicine Services Providers of ment
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Medicine Services Substance Abuse S
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Surgery Services Appendix 10 of thi
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Surgery Services Cataract Surgery W
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Surgery Services and the insertion
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Surgery Services Note: A telephone
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Surgery Services • Sterilization.
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Surgery Services live with her sinc
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Surgery Services by a multi-discipl
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Prescription Requirements Prescribe
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Prescription Requirements Approval
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Prescription Requirements prescribe
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Prescription Requirements 54 Wiscon
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Claims Submission adjustment reques
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Claims Submission 58 Wisconsin Medi
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Reimbursement • Confirming or rev
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Reimbursement about whether a speci
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Reimbursement 64 Wisconsin Medicaid
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Appendix 66 Wisconsin Medicaid and
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Appendix Surgery Services Appendix
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Appendix Medicine Services (Continu
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Appendix Other Services Appendix 1
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Appendix Appendix 4 (Continued) If
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Appendix Appendix 4 (Continued) Ele
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Appendix (This page was intentional
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ABORTION CERTIFICATION STATEMENTS P
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STERILIZATION INFORMED CONSENT FORM
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DEPARTMENT OF HEALTH AND FAMILY SER
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DEPARTMENT OF HEALTH AND FAMILY SER
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Medicine and Surgery Section - Wisconsin.gov

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