Medicine and Surgery Section - Wisconsin.gov

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Appendix Other Services Appendix 1 (Continued) Service HCPCS Procedure Codes Allowable Modifier(s) Dental Procedures D1203 Procedures/Professional Services G0000-G0201 G0202-G0230 TC, 26 G0231-G0234 G0237-G0239 26 G0242-G0243, G0251-G0256, G0261 G0265-G0267, G0269 TC, 26 G0275-G0278 TC, 26 Drugs Administered Other Than Oral Method Medical Services M0064 G0279-G0280, G0281-G0289, G0290-G0291, G0297- G0300, G0307-G0309 G0336, G0341-G0343 TC, 26 G0345-G0365 Wisconsin Medicaid reimburses the physician-administered drug codes ("J," “Q,” and “S” codes) listed in the Physician Services Maximum Allowable Fee Schedule. Q Codes (Temporary) Q0035 TC, 26 Temporary National Codes (Non- Medicare) Q0081-Q0085, Q0111-Q0137, Q0163-Q0187, Q2001- Q2022, Q3001-Q3012, Q3025-Q3031, Q4001-Q4077, Q9941-Q9957 S0017-S0088, S0091-S0093, S0114-S0132, S0155-S0191 S0820 TC, 26 S1040, S2053-S2055, S2065, S2090, S2091, S2112- S2115, S2120, S2140, S2250, S2300, S2341, S2350- S2361, S2360-S2361, S2400-S2411, S3645-S3650 S3708, S8030-S8049, S8080-S8092 TC, 26 S8225, S8262, S8950, S9022-S9024, S9034 72 Wisconsin Medicaid and BadgerCare dhfs.wisconsin.gov/medicaid/ December 2005
Appendix 2 Allowable Modifiers for Physician Evaluation and Management, Medicine, and Surgery Services Wisconsin Medicaid accepts nationally recognized modifiers on claims and other forms, when applicable. The following table lists Medicaid-allowable modifiers for physician evaluation and management, medicine, and surgery services providers. Note: Wisconsin Medicaid accepts all valid modifiers; however, not all modifiers are allowed by Wisconsin Medicaid’s claims processing system. Modifier Description Notes 26 Professional component 50 Bilateral procedure 54 Surgical care only 55 Postoperative management only 80 Assistant surgeon AQ Physician providing service in a HPSA TC Technical component TH TJ Obstetrical treatment/ services, prenatal or postpartum Program group, child and/or adolescent Refer to Appendix 1 of this section for procedure codes for which modifier “26” is allowable. Use of modifier "50" is allowed for those procedures for which the concept is considered appropriate according to standard coding protocols and Healthcare Procedure Coding System or Current Procedural Terminology definitions. Refer to the physician maximum allowable fee schedule for procedures in which this modifier is allowable. Use of modifier “54” is allowed only for cataract surgery procedure codes 66820-66821, 66830-66984 for preoperative care and surgery when postoperative care is performed by an optometrist. The surgeon is reimbursed at 90 percent of global maximum allowable fee for preoperative care and minor surgery or 80 percent for preoperative care and major surgery. Use of modifier “55” is allowed only for cataract surgery procedure codes 66820-66821, 66830-66984 for postoperative care when performed by an optometrist. Use of modifier "80" is allowed for those surgery procedures recognized as accepted medical practice. Modifier “80” should be used regardless of the type of performing provider. Refer to the physician fee schedule for procedures for which this modifier is allowable. Providers receive enhanced reimbursement when services are performed in a Health Professional Shortage Area (HPSA). Refer to Appendix 25 of this section for a list of HPSA-eligible procedure codes. Refer to Appendix 1 of this section for procedure codes for which modifier “TC” is allowable. Providers are required to use modifier "TH" with procedure codes 99204 and 99213 only when those codes are used to indicate the first three antepartum care visits. Providers are required to use both modifiers "TH" and “AQ” when these prenatal services are HPSA eligible. Providers may use modifier "TJ" with procedure codes 99201-99215 and 99281-99285 only for recipients 18 years of age and younger. Providers should not bill the HPSA modifier with modifier “TJ.” Physician Services Handbook — Medicine and Surgery December 2005 73 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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Appendix 122 Wisconsin Medicaid and
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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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