Medicine and Surgery Section - Wisconsin.gov

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Appendix Medicine Services (Continued) Appendix 1 (Continued) Service CPT Procedure Code(s) Allowable Modifier(s) Special Otorhinolaryngologic Services 92617 TC, 26 (Continued) 92620-92625 Cardiovascular 92950-92977 92700 TC, 26 92978-92979 TC, 26 92980-93018 93024-93025 TC, 26 93040-93272 93278-93312 TC, 26 93313 93314, 93315 TC, 26 93316 93317-93318 26 93320-93501 TC, 26 93503 93505-93533 TC, 26 93539-93545 93555-93572 TC, 26 93580, 93581 93600-93612 TC, 26 93613 93615-93619 TC, 26 93620 26 93621-93642 TC, 26 93650-93652 93660 TC, 26 93662 26 93701 TC, 26 93720-93722 93724 TC, 26 93727 93731-93744 TC, 26 93745 93760, 93762, 93770 TC, 26 93784-93798 93799 TC, 26 70 Wisconsin Medicaid and BadgerCare dhfs.wisconsin.gov/medicaid/ December 2005
Medicine Services (Continued) Appendix 1 (Continued) Service CPT Procedure Code(s) Allowable Modifier(s) Pulmonary 94010 94014-94016 TC, 26 94060-94621 94640-94668 TC, 26 94680-94750 94760 TC, 26 94770-94772, 94799 TC, 26 Allergy and Clinical Immunology 95004-95199 Neurology and Neuromuscular Procedures 95805-95829 95830-95857 TC, 26 95858-95962 TC, 26 95965-95967 95970-95991 26 95999 96000-96004 TC, 26 Central Nervous System Assessments/Tests 96100-96117 Chemotherapy Administration 96400-96542, 96549 Photodynamic Therapy 96567-96571 Special Dermatological Procedures 96900, 96910-96999 Physicial Medicine and Rehabilitation 97001-97004, 97010-97542 Osteopathic Manipulative Treatment 98925-98929 Special Services Procedures and Reports 99000-99001 99070 Other Services Procedures 99170, 99173, 99183-99199 Category II Codes Refer to the physician fee schedule for Category II Performance Measurement CPT codes. Category II codes consist of four numbers followed by the letter “F.” Category III Codes Refer to the physician fee schedule for Category III Emerging Technology CPT codes. Category III codes consist of four numbers followed by the letter “T.” Physician Services Handbook — Medicine and Surgery December 2005 71 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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Page 26 and 27: Medicine Services System [HCPCS] co
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Page 32 and 33: Medicine Services Providers of ment
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Page 36 and 37: Surgery Services Appendix 10 of thi
Page 38 and 39: Surgery Services Cataract Surgery W
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Page 44 and 45: Surgery Services • Sterilization.
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Page 48 and 49: Surgery Services by a multi-discipl
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Page 52 and 53: Prescription Requirements Approval
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Page 60 and 61: Claims Submission 58 Wisconsin Medi
Page 62 and 63: Reimbursement • Confirming or rev
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Page 68 and 69: Appendix 66 Wisconsin Medicaid and
Page 70 and 71: Appendix Surgery Services Appendix
Page 74 and 75: Appendix Other Services Appendix 1
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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
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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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