Add-on Codes

Always Bundled Procedure Codes

Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus

Billing Requirements for Multiple Births for Professional Providers

Cast and Splint Applications and Associated Supplies Provided in the Office Setting

Diagnosis Criteria for Reimbursement of Emergency Room Services

Diagnostic Radiology Services Included in Capitation

Direct Access Obstetrics/Gynecology (OB/GYN)

Facility Reporting of Observation Services

Guidelines for Well Mother/Well Baby Visits Under the Mother's Option Program

Home Visits by a Physician

Humanitarian Use Devices (HUD) and the Humanitarian Device Exemption (HDE) Process

Infusion Therapy Services as Performed by Home Infusion Providers

Inpatient Hospital Readmission

Intravenous (IV) Administration of Fluids as a Treatment of a Medical Condition or for the Preparation of Pharmaceuticals, Biologics, and other Substances

Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products

Marijuana for Medical Use

Modifier 62: Two Surgeons

Modifier 66: Surgical Team

Modifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS

Never Events and Preventable Adverse Events

Obsolete or Unreliable Diagnostic Tests and Medical Services

Online Evaluation and Management Service

Outpatient Short-Term Rehabilitation Services Included in Capitation

Photography Used for Documentation/Record-Keeping Purposes

Physical Medicine and Rehabilitation Services Eligible for Reimbursement Above Capitation to Physical and Occupational Therapy (PT/OT) Providers for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products

Physician Standby Services

Podiatry Services Included in Capitation for Pennsylvania Based Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products

PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services

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Attachment D

Preventive Care Services

Prolonged Face-to-Face Physician Services

Radiologic Guidance of a Procedure

Reimbursement for Associated Services Performed in Conjunction with Dental Services

Reporting and Documentation Requirements for Anesthesia Services

Reporting of Healthcare Common Procedure Coding System (HCPCS) C Series Codes

Reporting Requirements for Drugs and Biologicals

Services Paid Above Capitation for Health Maintenance Organization (HMO) Primary Care Physicians

STAT Laboratory Tests Performed in the Outpatient Hospital Setting for Health Maintenance Organization (HMO) and Point of Service (POS) Products

Team Conferences

X-rays Associated with Fractures in the Office Setting