CPT code and description
99000 – Handling and/or conveyance of specimen for transfer from the office to a laboratory -average fee amount-$0.00
99070 – Supplies and materials (except spectacles), provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided)
Handling fees, CPT codes 99000 and 99001
CPT codes 99000 and 99001 are designated as status B codes (bundled and never separately reimbursed) on the Physician Fee Schedule RBRVU file. Moda Health clinical edits will deny CPT 99000 or 99001 with explanation code WGO (Service/supply is considered incidental and no separate payment can be made. Payment is always bundled into a related service), whether 99000
or 99001 is billed with another code or as the sole service for that date. This edit is not eligible for a modifier bypass
Laboratory Handling
Laboratory handling and conveyance CPT codes 99000 and 99001 and HCPCS code H0048 are included in the overall management of a patient and are not separately reimbursed when submitted with another code, or when submitted as the only code on a claim for the same date of service.
Submitting CPT 99000 with Modifier 59
Blue Cross and Blue Shield of Texas (BCBSTX) regularly evaluates the coding practices of physicians and other providers who submit claims for services. This includes issues such as bundling and use of CPT modifiers.
BCBSTX recently studied the use of Modifier 59 (distinct procedural service) with the submission of CPT 99000 (handling and/or conveyance of specimen for transfer from the physician’s office to a laboratory).
Because CPT 99000 is purely an administrative service and not a procedure, BCBSTX considers use of Modifier 59 for this code to be inappropriate.
This inappropriate use of Modifier 59 results in an override of a claim system edit that considers CPT 99000 incidental to any other service performed on that date of service, including CPT 36415 for routine collection of venous blood, and results in overpayment. Please do not submit claims for CPT 99000 with Modifier 59.
Payment policy
10/16/06 “Specimen Handling and/or Conveyance or Implementation of Orders for Devices” to “Specimen Handling and/or Conveyance.” and clarified reimbursement policy for 99000.
Combined statements related to Therapeutic, prophylactic or diagnostic injection(Allergen Immunotherapy)and statements related Office Visit(s). Removed “Routine office visits provided in addition to preventive health office visits are considered mutually exclusive to the preventive health office visit.”
11/05/07 In the Pathologist section added code 85060 to the list of codes eligible for clinical interpretation. Changed the wording from “Pathology interpretation of all other codes in the 80002-87999 range is considered an integral service.” to “Pathology interpretation of all other codes in the 80002-87999 range is considered an integral to the laboratory test.” Changed the words “mutually exclusive” to “incidental” in the Cardiac Stress Test section. Removed code 93000 and 93040 because the incidental logic no longer applies to 99291 and 99292 in the Critical Care section. Code 93798 removed from the Electrocardiograms section. Removed code 82800, 82805, 82810, 93000, 93040 and 94640 because the incidental logic no longer applies to codes 99296, 99294, 99295, 99296 and 99298 in the Neonatal Intensive Care Services. Changed the word from “incidental” to “mutually exclusive” in the Transvaginal Ultrasound section. Removed the Maldistribution of Inspired Gas, hlamydia Testing by Direct or Amplified Probe Technique, Fluoroscopic Guidance and Voiding Pressure Studies section. Removed any deleted codes. Policy reviewed 10/26/07 by Senior Medical Director of Provider Partnerships, Medical and Reimbursement
Policy.
6/7/2011 Further defined “When a lumbar laminectomy, facetectomy or foraminotomy is performed in conjunction with a lumbar spinal fusion procedure, the lumbar laminectomy, facetectomy or foraminotomy will be considered incidental to the lumbar spinal fusion.” Notification 3/15/2011 with an Effective date of 6/19/2011. (dpe)
Policy implementation information from 3/30/2006-05/05/2008 restored. Added information regarding After Hours Care and Specimen Handling. “After Hours Care – Reimbursement is not provided for CPT codes 99050 and 99051 for a facility credentialed and contracted as an urgent care center” and “CPT codes 99000 and 99001, the handling and/or conveyance of specimen, are eligible for payment to the provider’s office when the laboratory service is not performed in the provider’s office and the independent laboratory bills BCBSNC directly for the test. The independent laboratory/reference laboratory will not be reimbursed for 99000 and 99001.” Removed the following information from Topics of Frequent Interest Related to Blue Care, Blue Choice, Blue Options, and Classic Blue Products as not longer applicable : “Visual Acuity Screening – Visual acuity screening (99173) is considered incidental to routine office visits and preventive health visits. separate reimbursement is not allowed for incidental services.” Notification given 6/7/2011 for effective date of 9/1/2011.
MATERIALS AND SUPPLIES – CPT CODE 99070
Anthem’s reimbursement for materials and supplies provided by the physician is included in the global reimbursement of the primary service being provided. Materials and supplies are not separately payable. Therefore, CPT code 99070 is not separately payable. If a provider bills with CPT code 99070 for a material or supply that is not usually part of the primary service, and CPT code 99070 is denied, the provider may call the Customer Service number listed on the member’s card or Provider Inquiry for a manual review of the claim.
Anthem’s reimbursement, if any, is reduced by any applicable deductibles, copayments and/or coinsurance as defined in the member’s contract for benefits and coverage.
99070 for Reporting Supplies, Materials, Supplements, Remedies, etc.
For HCFA1500 claims with dates of service 04/01/2015 and following, Moda Health will deny CPT code 99070 to provider write-off with an explanation code mapped to Claim
Adjustment Reason Code 189 (Not otherwise classified or “unlisted” procedure code
Page 3 of 10 (CPT/HCPCS) was billed when there is a specific procedure code for this
procedure/service.). There is always a procedure code more specific than 99070 available to be used.
Correct coding guidelines require that the most specific, comprehensive code available be selected to report services or items billed. (
Moda Health accepts HCPCS codes for processing. Therefore, 99070 is never the most specific code available to use to report a supply, drug, tray, or material provided over and above those usually included in a service rendered.
Any HCPCS Level II code in the HCPCS book is more specific than 99070. The HCPCS book also includes a wide variety of more specific unlisted codes that should be used in place of 99070 when the billing office cannot identify a listed HCPCS code to describe the supply or material being billed. The use of more specific HCPCS Level II procedure codes helps to ensure more accurate determination of benefits and processing of the claim.
It is important to note that not all HCPCS codes will be eligible for covered benefits under the member’s contract, and if covered, not all HCPCS codes will be eligible for separate reimbursement.
For reimbursement of covered medical and surgical supplies, an appropriate Level II HCPCS code must be submitted. The non-specific CPT code 99070 (supplies and materials, except spectacles, provided by the physician or other health care professional over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]) is not reimbursable in any setting
Supply Code L8680
Effective May 1, 2016 HCPCS code L8680 is no longer separately billable, with CPT code 63650, for Medicare because payment for electrode cost has been incorporated in CPT code 63650.
Time Reporting:
Time for anesthesia procedures may be reported as is customary in the local area. Anesthesia time begins when the anesthesiologist begins to prepare the patient for the induction of anesthesia in the operating room or in an equivalent area and ends when the anesthesiologist is no longer in personal attendance, that is, when the patient may be safely placed under postoperative supervision.
Physicians Services:
Physician’s services rendered in the office, home, or hospital, consultation and other medical services are listed in the “Codes” section entitled Evaluation and Management Services (99200 series). “Special Services and Reporting” (99000 series) are presented in the Medicine section.
Materials Supplied by Physician:
Supplies and materials provided by the physician (eg, sterile trays, drugs) over and above those usually included with the office visit or other services rendered may be listed separately. List drugs, tray supplies, and materials provided. Identify as 99070.
