Microsoft word - 11-01-06 master w-add & ogc changes _cms-1321-fc_.doc
CMS-1321-FC ADDENDUM J: List Of CPT1/HCPCS Codes Used To Describe Certain Designated Health Service Categories2 Under Section 1877 of the Social Security Act EFFECTIVE DATE January 1, 2007 CLINICAL LABORATORY SERVICES
INCLUDE CPT codes for all clinical laboratory services in the 80000 series, except EXCLUDE CPT codes for the following blood component
INCLUDE the following CPT and HCPCS level 2 codes for other clinical laboratory services: 0026T
CMS-1321-FC CMS-1321-FC PHYSICAL THERAPY, OCCUPATIONAL THERAPY, AND SPEECH-LANGUAGE PATHOLOGY
INCLUDE the following CPT and HCPCS codes for physical therapy/occupational therapy/speech-
CMS-1321-FC CMS-1321-FC RADIOLOGY AND CERTAIN OTHER IMAGING SERVICES
INCLUDE the following CPT and HCPCS codes: 0028T
CMS-1321-FC CMS-1321-FC CMS-1321-FC CMS-1321-FC CMS-1321-FC CMS-1321-FC CMS-1321-FC CMS-1321-FC CMS-1321-FC CMS-1321-FC CMS-1321-FC
Doppler echo exam, heart [if used in conjunction with 93303-93308]
CMS-1321-FC CMS-1321-FC
A9542 In111 ibritumomab, dx A9544 I131 tositumomab, dx A9546 CO57/58 A9547 In111 oxyquinoline A9548 In111 pentetate A9550 Tc99m gluceptate A9551 Tc99m
G0202 Screeningmammographydigital G0204 Diagnosticmammographydigital G0206 Diagnosticmammographydigital G0288
CMS-1321-FC RADIATION THERAPY SERVICES AND SUPPLIES
INCLUDE the following CPT and HCPCS codes: 0073T
CMS-1321-FC CMS-1321-FC CMS-1321-FC EPO AND OTHER DIALYSIS-RELATED DRUGS
The physician self-referral prohibition does not apply to the following codes for EPO and
other dialysis-related drugs furnished in or by an ESRD facility if the conditions in §411.355(g) are satisfied: J0630
PREVENTIVE SCREENING TESTS, IMMUNIZATIONS AND VACCINES CMS-1321-FC
The physician self-referral prohibition does not apply to the following tests if they are
performed for screening purposes and satisfy the conditions in §411.355(h): 77052
Occult blood, feces Assay, bld/serum cholesterol [only
ICD-9-CM codes: V81.0, V81.1, or V.81.2]
Glucose test [only when billed with ICD-9-CM code V77.1]
Glucose tolerance test (GTT) [only when billed with ICD-9-CM code V77.1] Assay of lipoprotein [only when
billed with one of the following ICD-9-CM codes: V81.0, V81.1, or V.81.2]
CMS-1321-FC
The physician self-referral prohibition does not apply to the following immunization and
vaccine codes if they satisfy the conditions in §411.355(h): 90655
1 CPT codes and descriptions only are copyright 2006 American Medical
Association. All rights are reserved and applicable FARS/DFARS clauses
2 This list does not include codes for the following designated health
service (DHS) categories: durable medical equipment and supplies;
parenteral and enteral nutrients, equipment and supplies; prosthetics,
orthotics, and prosthetic devices and supplies; home health services;
outpatient prescription drugs; and inpatient and outpatient hospital
services. For the definitions of these DHS categories, refer to
§411.351. For more information, refer to
http://cms.hhs.gov/medlearn/refphys.asp.
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