Medicine and Surgery Section - Wisconsin.gov

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Appendix Surgery Services Appendix 1 (Continued) Service CPT Procedure Code(s) Allowable Modifier(s) General 10021-10022 Integumentary System 10040-19499 Musculoskeletal System 20000-29999 Respiratory System 30000-32999 Cardiovascular System 33010-37799 Hemic and Lymphatic Systems 38100-38999 Mediastinum and Diaphragm 39000-39599 Digestive System 40490-49999 Urinary System 50010-51720 51725-51797 51798-53899 TC, 26 Male Genital System 54000-54235 54240, 54250 54300-55899 TC, 26 Female Genital System 56405-58999 Maternity Care and Delivery 59000-59899 Endocrine System 60000-60699 Nervous System 61000-62230 62252 62256-62365 TC, 26 62367, 62368 63001-64999 26 Eye and Ocular Adnexa 65091-66983 66820-66821, 66830-66984 66985-68899 54, 55 Auditory System 69000-69979 Radiology Services Refer to the Laboratory and Radiology section of this handbook for Medicaid-covered radiology services (CPT codes 70010- 79999 and HCPCS codes). Laboratory Services Refer to the Laboratory and Radiology section of this handbook for Medicaid-covered laboratory services (CPT codes 80048- 89356 and HCPCS). 68 Wisconsin Medicaid and BadgerCare dhfs.wisconsin.gov/medicaid/ December 2005
Medicine Services Appendix 1 (Continued) Service CPT Procedure Code(s) Immune Globulins 90281-90399 Vaccines, Toxoids 90476-90749 Therapeutic or Diagnostic Infusions 90780-90781 Therapeutic, Prophylactic or Diagnostic Injections 90782-90799 Psychiatry 90862 Biofeedback 90901-90911 Dialysis 90935-90999 Refer to the mental health and substance abuse publications for covered services and related limitations for information on other psychiatric services coverage. Allowable Modifier(s) Gastroenterology 91000-91122 TC, 26 91123 91132, 91133, 91299 TC, 26 Ophthalmology Refer to the vision care services publications for more information about covered services and related limitations. Special Otorhinolaryngologic Services 92002-92020 92060-92065 TC, 26 92070 92081-92083 TC, 26 92100, 92120, 92130 92135-92136 TC, 26 92140-92230 92235-92250 TC, 26 92260 92265-92286 TC, 26 92287 92499 TC, 26 92502-92526 92531-92548 TC, 26 92551-92584 92585-92588 TC, 26 92590-92593 92601-92606 TC, 26 92607-92611 92612-92615 TC, 26 92616 Physician Services Handbook — Medicine and Surgery December 2005 69 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
Page 20 and 21: Evaluation and Management reimburse
Page 22 and 23: Evaluation and Management in an out
Page 24 and 25: Evaluation and Management 22 Wiscon
Page 26 and 27: Medicine Services System [HCPCS] co
Page 28 and 29: Medicine Services In cases where mo
Page 30 and 31: Medicine Services documentation in
Page 32 and 33: Medicine Services Providers of ment
Page 34 and 35: Medicine Services Substance Abuse S
Page 36 and 37: Surgery Services Appendix 10 of thi
Page 38 and 39: Surgery Services Cataract Surgery W
Page 40 and 41: Surgery Services and the insertion
Page 42 and 43: Surgery Services Note: A telephone
Page 44 and 45: Surgery Services • Sterilization.
Page 46 and 47: Surgery Services live with her sinc
Page 48 and 49: Surgery Services by a multi-discipl
Page 50 and 51: Prescription Requirements Prescribe
Page 52 and 53: Prescription Requirements Approval
Page 54 and 55: Prescription Requirements prescribe
Page 56 and 57: Prescription Requirements 54 Wiscon
Page 58 and 59: Claims Submission adjustment reques
Page 60 and 61: Claims Submission 58 Wisconsin Medi
Page 62 and 63: Reimbursement • Confirming or rev
Page 64 and 65: Reimbursement about whether a speci
Page 66 and 67: Reimbursement 64 Wisconsin Medicaid
Page 68 and 69: Appendix 66 Wisconsin Medicaid and
Page 72 and 73: Appendix Medicine Services (Continu
Page 74 and 75: Appendix Other Services Appendix 1
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Page 82 and 83: Appendix Appendix 4 (Continued) Ele
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Page 98 and 99: ABORTION CERTIFICATION STATEMENTS P
Page 102 and 103: STERILIZATION INFORMED CONSENT FORM
Page 104 and 105: DEPARTMENT OF HEALTH AND FAMILY SER
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Page 116 and 117: Appendix Category Musculoskeletal S
Page 118 and 119: Appendix Category Musculoskeletal S
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Appendix Category Female Genital Sy
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Appendix SECTION II — RECIPIENT I
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Appendix 122 Wisconsin Medicaid and
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Appendix (This page was intentional
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Appendix PRIOR AUTHORIZATION / PHYS
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PRIOR AUTHORIZATION / PHYSICIAN ATT
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PRIOR AUTHORIZATION / “J” CODE
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PRIOR AUTHORIZATION / “J” CODE
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PRIOR AUTHORIZATION / PHYSICIAN OTO
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DEPARTMENT OF HEALTH AND FAMILY SER
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Appendix Health Professional Shorta
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Appendix HPSA Name County ZIP Codes
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Appendix Appendix 26 (Continued) ma
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Appendix The following table lists
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DECLARATION OF SUPERVISION FOR NONB
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Appendix HCPCS Code* Drug Name Diag
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Index Organ Transplants, 44 Provide
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