Information posted September 11, 2009
This is an update to an article posted on this website on the TMHP Code Updates – Procedure Code Review web page on May 15, 2009, titled, “Second-Quarter Procedure Code Review Updates.” Effective for dates of service on or after July 1, 2009, procedure codes 31075, 31205, and 31420 did not become payable as assistant surgery benefits, and surgery procedure code 31717 became payable. Additionally, provider type and place of surgery changes were applied to some surgery and radiology procedure codes.
Reminder: To align with Centers for Medicare & Medicaid Services (CMS) requirements
for easy access to all Texas Medicaid fees, TMHP completed the second-quarter procedure code review. Effective for dates of service on or after July 1, 2009, provider type, place of service (POS), and type-of-service (TOS) changes were applied to some procedure codes. Providers are encouraged to refer to the TMHP fee schedules available on this website to confirm coverage before submitting claims.
Effective for dates of service on or after July 1, 2009, the following changes were applied to the procedure codes indicated:
Procedure
Code Changes Applied
31075 31205 31420
Are not reimbursed as assistant surgery benefits. These procedure codes did not become payable as assistant surgery.
31717 May be reimbursed to physicians in the office, inpatient hospital, or outpatient hospital setting.
Radiology Procedures: Magnetic Resonance Imaging (MRI)
77058 Total component:
Is not reimbursed to nurse practitioners (NPs), clinical nurse specialists (CNSs), physician assistant (PAs), and radiation treatment centers in the office setting.
Is not reimbursed to radiation treatment centers and hospital-based rural health clinics (RHCs) in the outpatient hospital setting.
Is not reimbursed in the inpatient hospital or independent laboratory setting.
Professional interpretation component:
Is not reimbursed to NPs, CNSs, and PAs in the office or outpatient hospital setting.
Is not reimbursed to NPs, CNSs, PAs, and hospitals in the inpatient hospital setting.
Is not reimbursed in the independent laboratory setting.
Technical component:
Is not reimbursed to NPs, CNSs, PAs, and radiation treatment centers in the office setting.
Is not reimbursed in the home, skilled nursing facility (SNF), intermediary care facility (ICF), outpatient hospital, independent laboratory, or extended care facility (ECF) setting.
Code Changes Applied
77059 Total component:
Is not reimbursed to NPs, CNSs, PAs, radiologists, and radiation treatment centers in the office setting.
Is not reimbursed to radiation treatment centers and hospital-based RHCs in the outpatient hospital setting.
Professional interpretation component:
Is not reimbursed to NPs, CNSs, and PAs in the office or outpatient hospital setting.
Is not reimbursed to NPs, CNSs, PAs, and hospitals in the inpatient hospital setting.
Technical component:
Is not reimbursed to NPs, CNSs, PAs, and radiation treatment centers in the office setting.
Is not reimbursed in the home, SNF, ICF, outpatient hospital, independent laboratory, or ECF setting.
Radiology Procedures: Radiation Oncology
77261 Total component:
May be reimbursed to radiation treatment centers in the office setting. May be reimbursed to physicians in the inpatient or outpatient hospital setting.
77262 Total component:
May be reimbursed to radiation treatment centers in the office setting. May be reimbursed to physicians in the inpatient or outpatient hospital setting.
77263 Total component:
May be reimbursed to radiation treatment centers in the office setting. May be reimbursed to physicians in the inpatient or outpatient hospital setting.
77280 Total component:
May be reimbursed to radiation treatment centers in the office setting. May be reimbursed to physicians in the inpatient hospital setting.
May be reimbursed to physicians and hospitals in the outpatient hospital setting.
Professional interpretation component:
May be reimbursed to physicians in the office setting.
Technical component:
May be reimbursed to radiation treatment centers in the office setting. Is not reimbursed in the outpatient hospital setting.
77285 Total component:
May be reimbursed to radiation treatment centers in the office setting. May be reimbursed to physicians in the inpatient hospital setting.
May be reimbursed to physicians and hospitals in the outpatient hospital setting.
77285 Professional interpretation component:
May be reimbursed to physicians in the office setting. 77285 Technical component:
May be reimbursed to radiation treatment centers in the office setting. Is not reimbursed in the outpatient hospital setting.
77290 Total component:
May be reimbursed to radiation treatment centers in the office setting. May be reimbursed to physicians in the inpatient hospital setting.
May be reimbursed to physicians and hospitals in the outpatient hospital setting.
77290 Professional interpretation component:
May be reimbursed to physicians in the office setting. 77290 Technical component:
May be reimbursed to radiation treatment centers in the office setting. Is not reimbursed in the outpatient hospital setting.
77295 Total component:
May be reimbursed to radiation treatment centers in the office setting. May be reimbursed to physicians in the inpatient hospital setting.
May be reimbursed to physicians and hospitals in the outpatient hospital setting.
77295 Professional interpretation component:
May be reimbursed to physicians in the office setting. 77295 Technical component:
May be reimbursed to radiation treatment centers in the office setting. Is not reimbursed in the outpatient hospital setting.
77299 Total component:
May be reimbursed to radiation treatment centers in the office setting. May be reimbursed to physicians in the inpatient hospital setting.
May be reimbursed to physicians and hospitals in the outpatient hospital setting.
77299 Professional interpretation component:
May be reimbursed to physicians in the office setting. 77299 Technical component:
May be reimbursed to radiation treatment centers in the office setting. Is not reimbursed in the outpatient hospital setting.
77300 Total component:
May be reimbursed to radiation treatment centers in the office setting. Is not reimbursed to radiation treatment centers, hospitals, and
radiological and physiological laboratories in the inpatient hospital setting. Is not reimbursed to radiation treatment centers and radiological and physiological laboratories in the outpatient hospital setting.
77300 Professional interpretation component:
May be reimbursed to physicians in the office setting. 77300 Technical component:
May be reimbursed to radiation treatment centers in the office setting. Is not reimbursed in the outpatient hospital setting.
77301 Total component:
Is not reimbursed to hospitals and hospital-based RHCs in the office setting.
May be reimbursed to physicians in the inpatient hospital setting.
Is not reimbursed to radiation treatment centers in the outpatient hospital setting.
77301 Technical component:
May be reimbursed to radiation treatment centers in the office setting. Is not reimbursed in the outpatient hospital setting.
Code Changes Applied
77305 Total component:
May be reimbursed to radiation treatment centers in the office setting. Is not reimbursed to radiation treatment centers, hospitals, and
radiological and physiological laboratories in the inpatient hospital setting. Is not reimbursed to radiation treatment centers and radiological and physiological laboratories in the outpatient hospital setting.
77305 Professional interpretation component:
May be reimbursed to physicians in the office setting. 77305 Technical component:
May be reimbursed to radiation treatment centers in the office setting. Is not reimbursed in the outpatient hospital setting.
77310 Total component:
May be reimbursed to radiation treatment centers in the office setting. Is not reimbursed radiation treatment centers, hospitals, and radiological and physiological laboratories in the inpatient hospital setting.
Is not reimbursed radiation treatment centers and radiological and physiological laboratories in the outpatient hospital setting.
77310 Professional interpretation component:
May be reimbursed to physicians in the office setting. 77310 Technical component:
May be reimbursed to radiation treatment centers in the office setting. Is not reimbursed in the outpatient hospital setting.
77315 Total component:
May be reimbursed to radiation treatment centers in the office setting. Is not reimbursed to radiation treatment centers, hospitals, and
radiological and physiological laboratories in the inpatient hospital setting. Is not reimbursed to radiation treatment centers and radiological and physiological laboratories in the outpatient hospital setting.
77315 Professional interpretation component:
May be reimbursed to physicians in the office setting. 77315 Technical component:
May be reimbursed to radiation treatment centers in the office setting. Is not reimbursed in the outpatient hospital setting.
77326 Total component:
May be reimbursed to radiation treatment centers in the office setting. Is not reimbursed to radiation treatment centers, hospitals, and
radiological and physiological laboratories in the inpatient hospital setting. Is not reimbursed to radiation treatment centers and radiological and physiological laboratories in the outpatient hospital setting.
77326 Professional interpretation component:
May be reimbursed to physicians in the office setting. 77326 Technical component:
May be reimbursed to radiation treatment centers in the office setting. Is not reimbursed in the outpatient hospital setting.
77327 Total component:
May be reimbursed to radiation treatment centers in the office setting. Is not reimbursed to radiation treatment centers, hospitals, and
77327 Professional interpretation component:
May be reimbursed to physicians in the office setting. 77327 Technical component:
May be reimbursed to radiation treatment centers in the office setting. Is not reimbursed in the outpatient hospital setting.
77328 Total component:
May be reimbursed to radiation treatment centers in the office setting. Is not reimbursed to radiation treatment centers, hospitals, and
radiological and physiological laboratories in the inpatient hospital setting. Is not reimbursed to radiation treatment centers and radiological and physiological laboratories in the outpatient hospital setting.
77328 Professional interpretation component:
May be reimbursed to physicians in the office setting. 77328 Technical component:
May be reimbursed to radiation treatment centers in the office setting. Is not reimbursed in the outpatient hospital setting.
77332 Total component:
May be reimbursed to radiation treatment centers in the office setting. Is not reimbursed to radiation treatment centers, hospitals, and
radiological and physiological laboratories in the inpatient hospital setting. Is not reimbursed to radiation treatment centers and radiological and physiological laboratories in the outpatient hospital setting.
77332 Professional interpretation component:
May be reimbursed to physicians in the office setting. 77332 Technical component:
May be reimbursed to radiation treatment centers in the office setting. Is not reimbursed in the outpatient hospital setting.
77333 Total component:
May be reimbursed to radiation treatment centers in the office setting. Is not reimbursed to radiation treatment centers, hospitals, radiological and physiological laboratories in the inpatient hospital setting.
Is not reimbursed to radiation treatment centers and radiological and physiological laboratories in the outpatient hospital setting.
77333 Professional interpretation component:
May be reimbursed to physicians in the office setting. 77333 Technical component:
May be reimbursed to radiation treatment centers in the office setting. Is not reimbursed in the outpatient hospital setting.
77334 Total component:
May be reimbursed to radiation treatment centers in the office setting. Is not reimbursed to radiation treatment centers, hospitals, radiological and physiological laboratories in the inpatient hospital setting.
Is not reimbursed to radiation treatment centers and radiological and physiological laboratories in the outpatient hospital setting.
77334 Professional interpretation component:
May be reimbursed to physicians in the office setting. 77334 Technical component:
May be reimbursed to radiation treatment centers in the office setting. Is not reimbursed in the outpatient hospital setting.
Code Changes Applied
77373 Total component:
Is not reimbursed to hospital-based RHCs in the office setting. Is not reimbursed in the inpatient hospital setting.
Is not reimbursed to physicians, radiation treatment centers, freestanding RHCs, and hospital-based RHCs in the outpatient hospital setting. 77399 Total component:
May be reimbursed to radiation treatment centers in the office setting. Is not reimbursed in the inpatient hospital setting.
Is not reimbursed to physicians, radiation treatment centers, and radiological and physiological laboratories in the outpatient hospital setting.
Surgery Procedures: Digestive
42145 Is not reimbursed in the office setting.
Is not reimbursed to NPs, CNSs, PAs, and nurse midwives (CNMs) in the inpatient hospital or outpatient hospital setting.
May be reimbursed to dentistry group in the inpatient hospital or outpatient hospital setting.
42205 Is not reimbursed in the office setting.
Is not reimbursed to NPs, CNSs, PAs, and CNMs in the inpatient hospital or outpatient hospital setting.
42665 Is not reimbursed to NPs, CNSs, PAs, and CNMs in the office, inpatient hospital, or outpatient hospital setting.
42960 Is not reimbursed to NPs, CNSs, PAs, and CNMs in the inpatient hospital or outpatient hospital setting.
47630 Is not reimbursed in the office setting.
Is not reimbursed to NPs, CNSs, PAs, and CNMs in the inpatient hospital or outpatient hospital setting.
49080 Is not reimbursed to NPs, CNSs, PAs, and CNMs in the office, inpatient hospital, or outpatient hospital setting.
49081 Is not reimbursed to NPs, CNSs, PAs, and CNMs in the office, inpatient hospital, or outpatient hospital setting.
49420 Is not reimbursed to NPs, CNSs, PAs, and CNMs in the office, inpatient hospital, or outpatient hospital setting.
49421 Is not reimbursed to NPs, CNSs, PAs, and CNMs in the inpatient hospital or outpatient hospital setting.
