Medicine and Surgery Section - Wisconsin.gov
Medicine and Surgery Section - Wisconsin.gov
Medicine and Surgery Section - Wisconsin.gov
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Appendix 27<br />
Allowable Temporom<strong>and</strong>ibular Joint <strong>Surgery</strong> <strong>and</strong> Anesthesia Procedure<br />
Codes <strong>and</strong> Temporom<strong>and</strong>ibular Joint Evaluation Programs<br />
Temporom<strong>and</strong>ibular Joint <strong>Surgery</strong> <strong>and</strong> Anesthesia Procedure Codes<br />
Service Codes<br />
<strong>Surgery</strong> services<br />
20910, 20962, 21010, 21050, 21060, 21070, 21240, 21242, 21243,<br />
29800, 29804<br />
Anesthesia services 00190, 00192, 00470, 01250, 01320, 01470, 01610, 01710, 01810<br />
Temporom<strong>and</strong>ibular Joint Evaluation Programs<br />
The following programs have been approved as multidisciplinary temporom<strong>and</strong>ibular joint evaluation programs for<br />
<strong>Wisconsin</strong> Medicaid.<br />
Medical College of <strong>Wisconsin</strong><br />
Oral <strong>and</strong> Maxillofacial <strong>Surgery</strong><br />
9200 W <strong>Wisconsin</strong> Ave<br />
Milwaukee WI 53226<br />
(414) 454-5760<br />
Gundersen Clinic, Ltd.<br />
1836 South Ave<br />
LaCrosse WI 54601<br />
(608) 782-7300, extension 2260<br />
Oral <strong>and</strong> Maxillofacial <strong>Surgery</strong> Associates of Waukesha, Ltd.<br />
1111 Delafield St #321<br />
Waukesha WI 53188<br />
(414) 547-8665<br />
Oral <strong>and</strong> Maxillofacial <strong>Surgery</strong> Associates of Green Bay SC<br />
704 Webster Ave<br />
Green Bay WI 54301<br />
(920) 468-3400<br />
University of <strong>Wisconsin</strong> Hospital <strong>and</strong> Clinics<br />
600 Highl<strong>and</strong> Ave<br />
Madison WI 53792<br />
(608) 263-7502<br />
Physician Services H<strong>and</strong>book — <strong>Medicine</strong> <strong>and</strong> <strong>Surgery</strong> December 2005 159<br />
Appendix