September 2008 Medicare Bulletin - Idaho Insert
Posted September 5, 2008
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of this issue 
Table of Contents
- 2008 Idaho Medicare Clinical Social Worker Fee Schedule Revised Fees for selected Mental Health Codes. Note: Bolded codes received an increase Effective for DOS July 1, 2008
- 2008 Idaho Medicare Clinical Psychologist Fee Schedule Revised Fees for selected Mental Health Codes. Note: Bolded codes received an increase Effective for DOS July 1, 2008
- ID Revised fees for selected Mental Health codes.
- July 2008 Update to the ASC Payment System; Summary of Payment Policy Changes – CR6095
Top2008 Idaho Medicare Clinical Social Worker Fee Schedule Revised Fees for selected Mental Health Codes. Note: Bolded codes received an increase Effective for DOS July 1, 2008
Procedure Code |
Non-Facility Fee |
Facility Fee |
|
|---|---|---|---|
|
90801AJ |
$104.69 |
$90.43 |
|
90802AJ |
$110.98 |
$97.47 |
* |
90804AJ |
$46.20 |
$40.43 |
* |
90806AJ |
$65.82 |
$61.88 |
* |
90808AJ |
$97.28 |
$93.08 |
* |
90810AJ |
$49.05 |
$44.06 |
* |
90812AJ |
$71.40 |
$65.36 |
* |
90814AJ |
$102.35 |
$97.09 |
* |
90816AJ |
$43.69 |
$43.69 |
* |
90818AJ |
$65.10 |
$65.10 |
* |
90821AJ |
$96.60 |
$96.60 |
* |
90823AJ |
$47.22 |
$47.22 |
* |
90826AJ |
$69.34 |
$69.34 |
* |
90828AJ |
$100.65 |
$100.65 |
* |
90845AJ |
$57.71 |
$56.47 |
*# |
90846AJ |
$61.07 |
$60.08 |
*# |
90847AJ |
$75.94 |
$72.18 |
*# |
90849AJ |
$22.65 |
$20.65 |
* |
90853AJ |
$21.50 |
$20.25 |
* |
90857AJ |
$24.11 |
$21.61 |
* |
90880AJ |
$76.12 |
$69.36 |
|
96102AJ |
$34.73 |
$15.97 |
|
96103AJ |
$27.15 |
$16.64 |
|
96105AJ |
$45.36 |
$45.36 |
|
96110AJ |
$7.07 |
$7.07 |
|
96111AJ |
$89.75 |
$88.25 |
|
96119AJ |
$48.06 |
$19.79 |
|
96120AJ |
$43.42 |
$16.40 |
|
96125AJ |
$64.15 |
$54.39 |
* The procedure code is subject to the 62.5% outpatient psychiatric payment limitation (i.e., the allowed amount is reduced to 62.5% of the allowable amount).
# The procedure code has a restricted coverage status. Documentation must be included in order to review for coverage.
© All Current Procedural Terminology (CPT) codes and descriptors are copyrighted 2007 by the American Medical Association.
2008 Idaho Medicare Clinical Psychologist Fee Schedule Revised Fees for selected Mental Health Codes. Note: Bolded codes received an increase Effective for DOS July 1, 2008
x |
Procedure Code |
Non-Facility Fee |
Facility Fee |
|---|---|---|---|
x |
90801AH |
$139.59 |
$120.57 |
x |
90802AH |
$147.97 |
$129.96 |
* |
90804AH |
$61.60 |
$53.90 |
* |
90806AH |
$87.76 |
$82.50 |
* |
90808AH |
$129.71 |
$124.10 |
* |
90810AH |
$65.40 |
$58.75 |
* |
90812AH |
$95.20 |
$87.15 |
* |
90814AH |
$136.46 |
$129.45 |
* |
90816AH |
$58.25 |
$58.25 |
* |
90818AH |
$86.80 |
$86.80 |
* |
90821AH |
$128.80 |
$128.80 |
* |
90823AH |
$62.96 |
$62.96 |
* |
90826AH |
$92.45 |
$92.45 |
* |
90828AH |
$134.20 |
$134.20 |
* |
90845AH |
$76.95 |
$75.29 |
*# |
90846AH |
$81.43 |
$80.10 |
*# |
90847AH |
$101.25 |
$96.24 |
*# |
90849AH |
$30.20 |
$27.53 |
* |
90853AH |
$28.67 |
$27.00 |
* |
90857AH |
$32.15 |
$28.81 |
* |
90880AH |
$101.49 |
$92.48 |
x |
96101AH |
$80.10 |
$79.43 |
x |
96102AH |
$46.31 |
$21.29 |
x |
96103AH |
$36.20 |
$22.19 |
x |
96105AH |
$60.48 |
$60.48 |
x |
96110AH |
$9.43 |
$9.43 |
x |
96111AH |
$119.67 |
$117.67 |
x |
96116AH |
$88.58 |
$83.24 |
x |
96118AH |
$102.92 |
$81.91 |
x |
96119AH |
$64.08 |
$26.38 |
x |
96120AH |
$57.89 |
$21.86 |
x |
96125AH |
$85.53 |
$72.52 |
* The procedure code is subject to the 62.5% outpatient psychiatric payment limitation (i.e., the allowed amount is reduced to 62.5% of the allowable amount).
# The procedure code has a restricted coverage status. Documentation
must be included in order to review for coverage.
© All Current Procedural Terminology (CPT) codes and descriptors are copyrighted 2007 by the American Medical Association.
ID Revised fees for selected Mental Health codes.
Per JSM/TDL-08410 from CMS selected mental health codes will have an
increase in their fee schedule
amounts. The effective date for the increase for the mental health codes
is for dates of service on or
after July 1, 2008. See codes effective below.
| HCPCS Code | PAR | NON- PAR | Limiting Charge |
|---|---|---|---|
| 90804 | 61.60 | 58.52 | 67.30 |
| # 90804 | 53.90 | 51.21 | 58.89 |
| 90805 | 68.26 | 64.85 | 74.58 |
| # 90805 | 60.55 | 57.52 | 66.15 |
| 90806 | 87.76 | 83.37 | 95.88 |
| # 90806 | 82.50 | 78.38 | 90.14 |
| 90807 | 96.71 | 91.87 | 105.65 |
| # 90807 | 89.36 | 84.89 | 97.62 |
| 90808 | 129.71 | 123.22 | 141.70 |
| # 90808 | 124.10 | 117.90 | 135.59 |
| 90809 | 137.96 | 131.06 | 150.72 |
| # 90809 | 130.60 | 124.07 | 142.68 |
| 90810 | 65.40 | 62.13 | 71.45 |
| # 90810 | 58.75 | 55.81 | 64.18 |
| 90811 | 75.21 | 71.45 | 82.17 |
| # 90811 | 65.40 | 62.13 | 71.45 |
| 90812 | 95.20 | 90.44 | 104.01 |
| # 90812 | 87.15 | 82.79 | 95.21 |
| 90813 | 104.21 | 99.00 | 113.85 |
| # 90813 | 94.41 | 89.69 | 103.14 |
| 90814 | 136.46 | 129.64 | 149.09 |
| # 90814 | 129.45 | 122.98 | 141.43 |
| 90815 | 144.71 | 137.47 | 158.09 |
| # 90815 | 134.90 | 128.16 | 147.38 |
| 90816 | 58.25 | 55.34 | 63.64 |
| 90817 | 64.20 | 60.99 | 70.14 |
| 90818 | 86.80 | 82.46 | 94.83 |
| 90819 | 93.00 | 88.35 | 101.60 |
| 90821 | 128.80 | 122.36 | 140.71 |
| 90822 | 134.45 | 127.73 | 146.89 |
| 90823 | 62.96 | 59.81 | 68.78 |
| 90824 | 69.45 | 65.98 | 75.88 |
| 90826 | 92.45 | 87.83 | 101.00 |
| 90827 | 97.30 | 92.44 | 106.31 |
| 90828 | 134.20 | 127.49 | 146.61 |
| 90829 | 138.96 | 132.01 | 151.81 |
# These amounts apply when service is performed in a facility setting.
July 2008 Update to the ASC Payment System; Summary of Payment Policy Changes – CR6095
A: New HCPCS Drug Codes Separately Payable under the ASC Payment System:
The following CPT codes and descriptors are effective July 1, 2008.
CPT 111Short Description
C9242 – Injection, fosaprepitant
C9356 – TendoGlide Tendon Prot, cm2
C9357 – Flowable Wound Matrix, 1cc
C9358 – SurgiMend, 0.5cm2
B: Updated Payment rates for certain HCPCS codes Effective January 1, 2008: Fees are posted on our website.
CPT 111Short Descriptor
90675 – Rabies vaccine, im
J2820 – Sargramostim
J9010 – Alemtuzumab
J9015 – Aldesleukin/single use vial
J9226 – Supprelin LA implant
C: Updated Payment rates for certain HCPCS codes Effective April 1, 2008: Fees are posted on our website.
CPT ---Short Description
J2323 – Natalizumab inj
J2778 – Ramibizumab inj
J3350 – Urea Injection
J3488 – Reclast injection
D: Category III CPT Codes Implemented as ASC Covered Surgical Procedures
as of July 1, 2008:
Three new category III CPT codes have been determined appropriate for
payment in ASC’s effective for DOS July 1, 2008. Please see new
category III codes 0190T, 0191T and 0192T and payments rates for your
applicable CBSA.
HCPCS |
MOD |
PROC IND |
AMOUNT |
FC MOD AMOUNT |
FB MOD AMOUNT |
CBSA REGION |
|---|---|---|---|---|---|---|
0190T |
|
S |
$1,072.29 |
$0.00 |
$0.00 |
34 |
0190T |
|
S |
$1,105.83 |
$0.00 |
$0.00 |
11700 |
0190T |
|
S |
$1,080.59 |
$0.00 |
$0.00 |
15500 |
0190T |
|
S |
$1,125.14 |
$0.00 |
$0.00 |
16740 |
0190T |
|
S |
$1,142.20 |
$0.00 |
$0.00 |
20500 |
0190T |
|
S |
$1,116.38 |
$0.00 |
$0.00 |
22180 |
0190T |
|
S |
$1,111.77 |
$0.00 |
$0.00 |
24140 |
0190T |
|
S |
$1,095.75 |
$0.00 |
$0.00 |
24660 |
0190T |
|
S |
$1,118.34 |
$0.00 |
$0.00 |
24780 |
0190T |
|
S |
$1,096.78 |
$0.00 |
$0.00 |
25860 |
0190T |
|
S |
$1,042.08 |
$0.00 |
$0.00 |
27340 |
0190T |
|
S |
$1,143.53 |
$0.00 |
$0.00 |
39580 |
0190T |
|
S |
$1,095.23 |
$0.00 |
$0.00 |
40580 |
0190T |
|
S |
$1,084.68 |
$0.00 |
$0.00 |
47260 |
0190T |
|
S |
$1,118.80 |
$0.00 |
$0.00 |
48900 |
0190T |
|
S |
$1,101.97 |
$0.00 |
$0.00 |
49180 |
0191T |
|
S |
$892.48 |
$0.00 |
$0.00 |
34 |
0191T |
|
S |
$920.40 |
$0.00 |
$0.00 |
11700 |
0191T |
|
S |
$899.39 |
$0.00 |
$0.00 |
15500 |
0191T |
|
S |
$936.47 |
$0.00 |
$0.00 |
16740 |
0191T |
|
S |
$950.67 |
$0.00 |
$0.00 |
20500 |
0191T |
|
S |
$929.18 |
$0.00 |
$0.00 |
22180 |
0191T |
|
S |
$925.34 |
$0.00 |
$0.00 |
24140 |
0191T |
|
S |
$912.00 |
$0.00 |
$0.00 |
24660 |
0191T |
|
S |
$930.81 |
$0.00 |
$0.00 |
24780 |
0191T |
|
S |
$912.87 |
$0.00 |
$0.00 |
25860 |
0191T |
|
S |
$867.34 |
$0.00 |
$0.00 |
27340 |
0191T |
|
S |
$951.78 |
$0.00 |
$0.00 |
39580 |
0191T |
|
S |
$911.57 |
$0.00 |
$0.00 |
40580 |
0191T |
|
S |
$902.79 |
$0.00 |
$0.00 |
47260 |
0191T |
|
S |
$931.19 |
$0.00 |
$0.00 |
48900 |
0191T |
|
S |
$917.19 |
$0.00 |
$0.00 |
49180 |
0192T |
|
S |
$892.48 |
$0.00 |
$0.00 |
34 |
0192T |
|
S |
$920.40 |
$0.00 |
$0.00 |
11700 |
0192T |
|
S |
$899.39 |
$0.00 |
$0.00 |
15500 |
0192T |
|
S |
$936.47 |
$0.00 |
$0.00 |
16740 |
0192T |
|
S |
$950.67 |
$0.00 |
$0.00 |
20500 |
0192T |
|
S |
$929.18 |
$0.00 |
$0.00 |
22180 |
0192T |
|
S |
$925.34 |
$0.00 |
$0.00 |
24140 |
0192T |
|
S |
$912.00 |
$0.00 |
$0.00 |
24660 |
0192T |
|
S |
$930.81 |
$0.00 |
$0.00 |
24780 |
0192T |
|
S |
$912.87 |
$0.00 |
$0.00 |
25860 |
0192T |
|
S |
$867.34 |
$0.00 |
$0.00 |
27340 |
0192T |
|
S |
$951.78 |
$0.00 |
$0.00 |
39580 |
0192T |
|
S |
$911.57 |
$0.00 |
$0.00 |
40580 |
0192T |
|
S |
$902.79 |
$0.00 |
$0.00 |
47260 |
0192T |
|
S |
$931.19 |
$0.00 |
$0.00 |
48900 |
0192T |
|
S |
$917.19 |
$0.00 |
$0.00 |
49180 |
