Provider Guide - the Culinary Health Fund
Provider Guide - the Culinary Health Fund
Provider Guide - the Culinary Health Fund
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October 2012<br />
<strong>Provider</strong> <strong>Guide</strong><br />
Frequently Asked Questions<br />
Q: How are assistant surgeons reimbursed?<br />
AA:<br />
Assistant surgeons are reimbursed at 16% of <strong>the</strong> surgical allowable. If <strong>the</strong> assistant surgeon is a<br />
physician’s assistant, <strong>the</strong> reimbursement is 14% of <strong>the</strong> surgical allowable (80% of <strong>the</strong> 16% for a<br />
medical doctor).<br />
Q: What is <strong>Culinary</strong> <strong>Health</strong> <strong>Fund</strong> Administrative Services, LLC policy on<br />
Physician Extenders?<br />
AA:<br />
All Physician Assistants (PA/PAC) and Advanced Practice Nurses (APN), including Certified Nurse<br />
Midwives (CNM), Clinical Nurse Specialists (CNS) and Certified Registered Nurse Anes<strong>the</strong>tists<br />
(CRNA) must successfully complete credentialing. In addition, <strong>the</strong>se providers must be added<br />
under <strong>the</strong> <strong>Culinary</strong> Preferred <strong>Provider</strong> Agreement in order for claims submitted under <strong>the</strong>ir name<br />
to be processed and paid at PPO rates.<br />
Q: How does <strong>Culinary</strong> <strong>Health</strong> <strong>Fund</strong> reimburse for immunization<br />
administrations?<br />
AA:<br />
The <strong>Culinary</strong> <strong>Health</strong> <strong>Fund</strong> does not recognize CPT codes 90460 and 90461 and requires that<br />
providers use CPT codes 90471 – 90474 for immunization administration reimbursement.<br />
Q: What immunizations are covered by <strong>the</strong> <strong>Culinary</strong> <strong>Health</strong> <strong>Fund</strong>?<br />
AA:<br />
A list of immunizations that are covered by <strong>the</strong> <strong>Culinary</strong> <strong>Health</strong> <strong>Fund</strong> and <strong>the</strong> corresponding<br />
allowables are listed below. The <strong>Culinary</strong> <strong>Health</strong> <strong>Fund</strong> establishes reimbursement for<br />
immunizations based on Center for Disease Control (CDC) allowables. If your office participates<br />
in <strong>the</strong> Delegation of Authority Program offered by <strong>the</strong> Nevada State <strong>Health</strong> Division you may<br />
choose to administer vaccines that do not have allowables set by <strong>the</strong> <strong>Culinary</strong> <strong>Health</strong> <strong>Fund</strong> in<br />
your office. Administration codes will be reimbursable on all currently recommended childhood<br />
immunizations; however, <strong>the</strong> <strong>Culinary</strong> <strong>Health</strong> <strong>Fund</strong> has only set allowables for <strong>the</strong> vaccinations<br />
outlined below.<br />
Vaccine<br />
Allowable<br />
Hepatitis A $35.00<br />
Hepatitis A $61.01<br />
HPV (Quadrivalent) Female &<br />
Male<br />
$130.00<br />
HPV (Bivalent) $128.25<br />
Pneumococcal (7 valent) $83.88<br />
Pneumococcal (13 valent) $120.95<br />
Rotavirus (Rotateq) $73.00<br />
Rotarix $106.57<br />
Meningococcal $106.49<br />
If your office does not participate in <strong>the</strong> Delegation of Authority Program, you can refer your<br />
patients to <strong>the</strong> Sou<strong>the</strong>rn Nevada <strong>Health</strong> District for all <strong>the</strong>ir immunizations. Please call Sou<strong>the</strong>rn<br />
Nevada <strong>Health</strong> District at 702-759-0850 for hours and locations.<br />
<strong>Culinary</strong> <strong>Health</strong> <strong>Fund</strong> Administrative Services, LLC<br />
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