state of maryland department of health and mental
TRANSCRIPT
State of MarylandDepartment of Health and MentalParris N. Glendening, Governor - Martin ~ Wasserman, M.D., J.D., Secretary
MARYLAND MEDICAL ASSISTANCE PROGRAMPhysicians' Transmittal No. 121
Nurse Practitioner Transmittal No. 13Clinic Transmittal No. 55
TO:
'A~"/-'- ./
August 21, 1998PhysiciansNurse PractitionersFree-Standing Clini~/l.
FROM: Martin p.Secretary
v., J.D.
NOTE: Please ensure that appropriate staff members inyour organization are informed about the contentsof this transmittal.
0: Proposed Amendment to COMAR 10.09.02 Physicians I
Services
EPPECTIVE DATE:December 29, 1997
A~:rON':
Proposed Regulations (Permanent Status)
PROGRAM CONTACT PERSON:Robert Zielaskiewicz (410) 767-];48];
COMMENT PERIOD EXPIRED: November 10, 1.997
The amendments to Regulations .01, .03, .06 and .07under COMAR 10.09.02 Physicians' Services have been approvedas proposed in the Maryland Register (24:21 Md. R. 1468 -1469) - These amendments supplement the Maryland MedicalAssistance Program Physicians' Services Provider Fee Manual,revision 1996, with the 1997 Physicians' CUrrent ProceduralTerminology, 4th Edition (CPT-4) additions and deletions andother changes to reflect current reimbursement policy;define the mental health services that the Mental HygieneAdministration will be responsible for providing to Medicaidrecipients; and require providers to comply with COMAR10.09.59 Rehabilitation Services, 10.09.70 Maryland Medicaid
(Continued on reverse)
201 West Preston Street - Baltimore, Maryland 21201TOO for Disabled - Maryland Relay Service (BOO) 735- 225B
Healthy People in Healthy Communities
-2-(
Managed Care Program: Specialty Mental Health System andCOMAR 10.21.25 Fee Schedule- Mental Health Services-Community-Based Programs and Individual Practitioners.
The adopted amendment, as it has been published in theMaryland Reqister, and Supp. No.1 are attached to thistransmittal. Please note the following:
1. Varicella (chicken pox) vaccine is covered under theVaccines for Children (VFC) progam. The .Z-codeR forvaricella vaccine administration is ZO716 (ages 1-18).
2. The preauthorization requirement for procedures92004, 92014 and 92015 has been deleted. Use these codes forroutine examinations as described in CPT. Local HCPCS W9200has also been deleted. Use CPT Evaluation and Managementcodes for exams related to specific medical problems.
3. Sterilization reversal procedures are not covered
4. Local HCPCS M9999, critical care unclassified, is nolonger used. Use CPT critical care, 9929~ - 99292, or NICUcodes, 99295-99297, as applicable.
5. Allergy immunotherapy codes 95144 - 95165 have beencorrected to reflect 1996 CPT definition revisions. Themaximum number of units {vials} for procedure 95144 is 2.For procedures 95145 - 95165 the units are the number ofdoses administered.
MPW:rz
Attaclnnents
PROPOSED ACTION ON REGULATIONS
or call Ronald Wmdaor, Dislocated Workers Unit,- . The comments must be received not
10, 1997..06
JR.of LaOOr,
ouslymust
:7 Md. R.560 - 561
Symbols
.01
.02 Definitions.A.B. Terms Defined.(1) - (6) ..
(7) - text unchanged)means the employee is at
- due to hospitaldownsizing, and m~itherm
riskclosure. lnugel;thl.:
. from the hos-or job classificationmerge1; ~nsurr.,
"t
(a)pital thatthator downsizill6;
(b)c,nsing.Commission.,that themdelicensure,
(c)Licensing.
Department
of Labor,
.038(2)laid off due to
. the «nployee
( originally
Services.
downsizing.[(6)J (8) unchanged)
.03
A.B.
sureClosure, Merger, or Deticen-
(1) Aor mergehadaJ'Health
hasof
that is planning to closeanotherof its beds delicenaed by tJ1e
Hygiene, shall provide tJ1e, and:Commission, with a listing of all
laid off due toCostwsi
videwith
. to downsizeof Labor; Ucensing,
employees who will be laid oh
(3)- m(3>m {4} (originally proposed text
Title 10
MARYLAND REGISTER, VOL 24,ISSUE 21 FRIDAY, OCTOBER 10,1817
toclO.l
of Labor. Li .
Cost ~wI chaptr,r;
'ure, merg.r;or
Subtitle 09 MEDICAL CARE PROGRAMS10.09.02 Physiclans'Services
Authority: Health-GeneralArticle, §§2-104lbl, 15-103. and 15-105.ADDOtated Code of Mazyjand
Notice of Proposed Action197-307-PJ
The Secretary of Health and Mental Hygiene proposes toamend Regulations .01, .03, .06, and .07 under COMAR10.09.02 Physicians' Services.
Statement of PurposeThe purpose of this amendment is to supplement the
Maryland Medical Assistance Provider Fee Manual, datedOctober, 1987, Physicians' Services fee schedule, by updat-ing the 4th Edition (CPr-4) code additions and deletions; re-Oecting current reimbursement policy, to define the mentalhealth services that the Mental Hygiene Administrationwill be responsible for providing to Medicaid recipients; andto require providers to comply with COMAR 10.09.59 Reha-bilitation Services, COMAR 10.09.70 Maryland ManagedCare Program: Specialty Mental Health System, and CO-MAR 10.21.25 Fee Schedule - Mental Health Services-Community-Based Programs and Individual Practitioners.These fee changes will be incorporated by reference in Supp.No.1 of the Physicians' Services Provider Fee M~ual-
Comparison to Federal StandardsThere is 00 corresponding federal standard to this pro-
posed regulation.
Estimate of Economic ImpactThe proposed action has no economic impact.
Economic Impact on Small Bu8iDes8e8The proposed action has minimal or no ecooomic impact
on small businesses.
Opportunity for Public CommentComments may be sent to Michele Phinney, Regulations
Coordinator, O'Cooor Building, Room 521, 201 W. PrestonStreet, Baltimore, Maryland 21201, or fax (410) 333-7687 orcall (410) 767-6499, These comments must be received notlater than November 10, 1997..01 Definitions.
A. (text unchanged)B. Terms Defined.
(1)-(15) (ten unchanged)
PROPOSED ACTION ON REGULATIONS 1469
r~ Ad-health
ex-, of
.17 under COMAR10.09.34 Hospital Services, ;
Statement of Purpose1 action transfers to the Mental
. C . for the provision of :--
Medicaid recipients. Thesemental health services are theHygiene Administration.- implement a
ruing time frame.the end of"
in the Pro-, will now
10f3gram'shave 5months
~e Pro~'s, requirements for
programs.brain
limitationAlso,coverage
tocedeI' standard to this pro-There is no I
posed regulation.
The proposed
EconomicThe proposed
on small businesses.
Impactn#omic impact. 0 mall Businesses
, al or no economic impact
. Phinney, Regulations, Room 521,201 W. Preston
21201, or fax (410) 333-7687,must be received
Comments may beCoordinator, O'ConorStreet, Baltimore, }or call (410) 767-6499.not later t&'1an ~ -
10.09.06 I.01 Definitions.
A.B. ~
w~.It
program ..of a licensed specialwith primary diag-injury resulting in
who need services de-" on home and
in productive activi-
for
(1)-(3) I'
(3.1) "Brain
1neaPl$ a programhospital that .~--
nosesfunctionalsignedcommunityties.
(23) (text '-
health services'10.09.70.1OC
, services de-
to treat the diag-(23-1)
scribed innoses set "
(24) - (text unchanged).03
A.B.
asa
(15-1) "Mental health seroices" means those serviceS de-scribed in COMAR 10.09.70.1OC rendered to treat an indi-vidual for a diagnosis set forth in COMAR 10.09.70.1OA, (16) - (29) (text unchanged)
.03 Conditions for ParticipatJon.A (text unchanged)B. SpeclrlC requirements for participation in the Prograttl
as a physicians' services provider require that the provider:(1) - (6) (text unchanged)(7) Shall agree to identify by the individual physician
practitioner's identification number each physician assis-tant or nurse practitioner who is authorized by the physi-cian to request laboratory services; [and]
(8) Shall, if participating as a surgeon, obtain a secondsurgical opinion from another physician before the perfor-mance of certain elective surgical procedures which requirehospitalization, as identified under Regulation .05H of thischapter(.); and
(9) Shall comply with the requirements for the deliveryof mental health services in accordance with COMAR10.09.59 and 10.09.70.,06 Preauthorization Requirements.
A The following procedures or services require preautho-rization:
(1) - (2) (text unchanged)[(3) Sterilization reversal procedures;][(4)] (3) - [(10)] (9) (text unchanged)
B. - E. (text unchanged)R Physicians rendering mental health services shall com-
ply with the preauthorization requirements of COMAR10.09.70.07..07 Payment Procedures.
A-C. (text unchanged)D. The Maryland Medical Assistance Program Physi-
cians' Services Provider Fee Manual, Revision 1996, is con-tained in the Medical Assistance Provider Fee Manual,dated October I, 1986, which is used in conjunction with"Physician's Current Procedural Terminology", Fourth Edi-tion, [1996] 1997 (CPT-4), published by the American Medi-cal Association. All the provisions of these documents, un-less specifically excepted, are incorporated by referencewith the following amendments: Physicians' Services Pro-vider Fee Manual Supp. No. I.
E. - P. (text unchanged)Q. Reimbursement.
(1) - (3) (text unchanged)(4) The Program shall reimburse providers for mental
health services performed by a physician according to thefees established under COMAR 10.21.25 and the require-ments of this chaptel:
R. - S. (text '~DchAnged)MARTIN P. WASSERMAN, M.D.
Secretary of Health and Mental Hygiene,Program
the provider:se~ces provider require(text unchanged)inform the Managed Care
of ~e !?ePar.tment's :
(1)(8) Assur-
Finance
stay for adischarge from a hospital :"" . [and]
. with the provider i~:::- ,10.09.35,10.09.43, orwho presents for services is
care programs[.1" and
-when aone of~
-1- COMAR 10.09.02Physicians' Services
CPT-4 1997 Additions
AFTERCAREDAYS
MAXIMUMPAYMENT
CPT-4CODE DEFINITION*
010000000000000090090090090090090090090090090090090090090090090000000090090090030000090010010010010000000000000000000000000000000000000
110101101111012117201172115756157571575820150209562095724149243412618526546265512655326554265562730632491372503725143496490214990652301598666158668801688106881168815759457594690875908769090192240925489297892979933039330493315
R
R
R
A
Debride skin, fx 114.00Debride skin/muscle, fx 136.00Debride skin, muscle, bone, fx 189.00Debride nail, 1-5 9.00Debride nail, 6 or more 8.00Free muscle flap, microvasc 892.00Free skin flap, microvasc 892.00Free facial flap, microvasc 892.00Excise epiphyseal bar 357.00Iliac bone graft, microvasc 899.00Metatarsal bone graft, microva 931.00Radical rection of elbow 363.00Repair tendon/muscle, arm 238.00Remove finger bone 89.00Repair non-union, hand 180.00Great toe-hand transfer 1215.00Single toe-hand transfer 1207.00Double toe-hand transfer 1440.00Toe joint transfer 1227.00Excision of hip joint/muscle 350.00Lung volume reduction B.R.Intravascular ultrasound 36.00Intravascular ultrasound 28.00Free jejunum flap, microvasc B.R.Drain abdominal abscess 240.00Free omental flap, microvasc B.R.Cystoscopy and treatment 123.00Multifetal Abortion 131.00Resect nasopharynx, skull 615.00Dilate tear duct opening 12.00Probe nasolacrimal duct 14.00Probe nasolacrimal duct 60.00Probe nasolacrimal duct 50.00Intravascular ultrasound 67.00Intravascular ultrasound 37.00Psychophysiological therapy 21.00Psychophysiological therapy 42.00Biofeedback training, any metho 10.00ICG Angiography 44.00posturoqraphy 33.00Intravascular ultrasound, heart 98.00Intravascular ultrasound, heart 61.00Echo transthoracic 38.00Echo transthoracic 30.00Echo trans esophageal 56.00
Supp. 1
-2- COMAR 10.09.02Physicians' Services
CPT-4 1997 Additions(Continued)
CPT-4CODE
MAXIMUMPAYMENT
AFTERCAREDAYS* DEFINITION
9999999999
000000000000000000000000000000
Echo transesophageal 17.00Echo transesophageal 39.00Autonomic nervous function test 15.00Autonomic nervous function test 16.00Autonomic nervous function test 15.00Orthotic training 8.00Chiropractic manipulation 10.00Chiropractic manipulation 12.00Chiropractic manipulation 15.00Chiropractic manipulation 9.00
Supp. 1
3355578888
3399959999
1122204444
6712340123
-3- COMAR 10.09.02Physicians' Services
CPT-4 1997 Deletions
117001170111710117111575520960209712533025331265522655726558265594288053640563605636168800688206882568830909009090290904909069690890910909159320193202932049320593208932099321093220932219322294160975009750197521
Supp. 1
-4- COMAR 10.09.02Physicians' Services
1997 Policy Changes
MAXIMUMPAYMENT
AFTERCAREDAYS
CPT-4CODE DEFINITION
287.00B.R.
169.000.000.000.00B.R-
-
000060000000000000000
-
0085721256364815540058750587526456592004920149201596110951459514695147951489514995165992959929699297W9200Z0716Z0744Z0745
R
R
-000000000000000000000000000000
000000000
12.504.004.004.004.004.003.00
210.62104.52
52.21
Contin anesth labor, c-sec.Reconstruct eye socketsPercutaneous vein catheter.Vasovasostomy,vasovasorrhaphyTubal reanastomosisTubouterine implantationImplant neurostimulator elect.No preauthorization requiredNo preauthorization requiredNo preauthorization requiredDevelopmental test, limitedProvision of antigens, dosesTwo single stinging insectThree single stinging insectFour single stinging insectFive single stinging insectprovision of antigens, dosesNICU initialNICU subsequentNICU subsequentDeletedVaricella vaccine admin.Hepatitis B vacc. admin.Hepatitis B vacc. admin.
10.0010.0010.00
Supp. 1
-5- COMAR 10.09.02Pathology & Laboratory
CPT-4 1997 Additions
CPT-4CODE
MAXIMUMPAYMENT
AFTERCAREDAYS* DEFINITION
Assay for tacrolimusCollagen crosslinksMolecular diagnosticsTroponin
80197825238390284484
RRRR
B.R.B.R.B.R.B.R.
NANANANA
Supp. 1