Dec 10, 2016 | Medical billing basics
HYSTERECTOMY Federal regulations governing payment of a hysterectomy under Medicaid (Title XIX) prohibit payment for a hysterectomy under the following circumstances: • If the hysterectomy is performed solely for the purpose of terminating reproductive capability OR •...
Dec 9, 2016 | Medical billing basics
Procedure codes and Description• 43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) b brushing or washing, when performed (separate procedure) $670.47• 43236; with directed submucosal injection(s) any substance...
Dec 9, 2016 | Medical billing basics
Modifier 33: Preventive service; when the primary purpose of the service is the delivery of an evidence based service in accordance with a US Preventive Services Task Force A or B rating in effect and other preventive services identified in preventive services...
Dec 9, 2016 | Medical billing basics
49585 Repair umbilical hernia, age 5 years or older; reducible Hospital Outpatient Department APC 5341 APC Description Peritoneal and Abdominal Procedures (CPT codes: 49491, 49492, 49495, 49496, 49500, 49501, 49505, 49507, 49520, 49521, 49525, 49540, 49550, 49553,...
Dec 9, 2016 | Medical billing basics
Repair initial incisional or ventral hernia; reducible 49560 Incarcerated or strangulated 49561 Implantation of mesh or other prosthesis for open incisional or ventral hernia repair, or closure of debridement (use with 11004–11006, 49560–49566) +49568 Question:...
Dec 7, 2016 | Medical billing basics
Procedure Code and Description procedure code 30802 – Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg. electrocautery, radiofrequency ablation, or tissue volume reduction), intramural (ie. submucosal)...
Dec 5, 2016 | Medical billing basics
Induced Abortion Medicaid payment for induced abortion is restricted to those that meet the following criteria: • A physician has found, and so certifies in his/her own handwriting, that on the basis of his/her professional judgment, the life of the pregnant woman...
Nov 29, 2016 | Medical billing basics
A. Any entity which provides and/or bills members and/or BCBSKS for health care services which advertises or represents itself to the general public as being owned, controlled, managed, affiliated with, or operated by a contracting provider must also be contracting...
Nov 22, 2016 | Medical billing basics
A. The conditions of these policies and procedures and the contracting provider agreement apply to all benefit programs, indemnity and to self-insured plans administered by BCBSKS or its subsidiaries, including those with deductibles, coinsurance and shared payments....
Nov 19, 2016 | Medical billing basics
A. All non-physicians, who are defined as eligible providers under the member’s BCBSKS contract and who are providing services as defined in their Kansas licensure or certification, shall bill their charges to BCBSKS under their own National Provider Identifier (NPI)...
