Highmark Medical Policy Bulletin |
Section: | Visits |
Number: | V-31 |
Topic: | Medical Visits and Associated Services |
Effective Date: | August 18, 2003 |
Issued Date: | November 1, 2003 |
Date Last Reviewed: |
Indications and Limitations of Coverage
The services on the Text Attachment are considered an integral part of a doctor’s medical care. If any of the services on the Text Attachment are reported on the same day as medical care, and the charges are itemized, combine the charges and pay only the medical care. Payment for the medical care performed on the same date of service includes the allowance for these procedures. A participating, preferred, or network provider cannot bill the member separately for hypnosis in this case. If any of the services on the Text Attachment are reported independently, process it for payment under the appropriate code. Modifier 25 may be reported with medical care to identify it as a significant, separately identifiable service from the integral service. When the 25 modifier is reported, the patient’s records must clearly document that separately identifiable medical care has been rendered. |
15852 | 17250 | 20500 | 20690 | 21100 | 29130 |
29131 | 29200 | 29220 | 29240 | 29260 | 29280 |
29520 | 29530 | 29540 | 29550 | 29580 | 29590 |
31502 | 31505 | 32005 | 35400 | 36000 | 36410 |
43752 | 46600 | 50688 | 54235 | 54450 | 57150 |
57160 | 58350 | 65430 | 69210 | 87168 | 87169 |
91060 | 91123 | 92100 | 92260 | 92504 | 92511 |
94760 | 94761 | 95831 | 95832 | 95833 | 95834 |
95851 | 95852 | 95875 | 96902 | 99050 | 99052 |
99054 | 99056 | 99070 | 99172 | 99173 | 99354 |
99355 | 99356 | 99357 | 99358 | 99359 | 99374 |
99375 | 99377 | 99378 | 99379 | 99380 | G0179 |
G0180 | G0181 | G0182 | G0268 | G0272 | S0395 |
S0820 | S9092 | S9441 | S9474 |
Traditional (UCR/Fee Schedule) Guidelines
Code 92260 may be paid in addition to medical care reported on the same day. |
Comprehensive / Wraparound / PPO / Major Medical Guidelines
Managed Care (HMO/POS) Guidelines
[Version 009 of V-31] |
[Version 008 of V-31] |
[Version 007 of V-31] |
[Version 006 of V-31] |
[Version 005 of V-31] |
[Version 004 of V-31] |
[Version 003 of V-31] |
[Version 002 of V-31] |
[Version 001 of V-31] |
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