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01966
Quick jump to procedure code: Printer Friendly Version
01968

01967: Anesth/analg vag delivery CPT® 01967: NEURAXIAL LABOR ANALGESIA/ANESTHESIA FOR PLANNED VAGINAL DELIVERY (THIS INCLUDES ANY REPEAT SUBARACHNOID NEEDLE PLACEMENT AND DRUG INJECTION AND/OR ANY NECESSARY REPLACEMENT OF AN EPIDURAL CATHETER DURING LABOR)

Short Description: Anesth/analg vag delivery

--

CPT copyright 2016 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

Unadjusted-National Fee Schedule Amount
ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Napa
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Yuba City
CALIFORNIA NORTH-San Francisco/Oakland/Hayward (Marin County)
CALIFORNIA NORTH-Vallejo/Fairfield
CALIFORNIA NORTH-Bakersfield
CALIFORNIA NORTH-Chico
CALIFORNIA NORTH-Fresno
CALIFORNIA NORTH-Hanford/Corcoran
CALIFORNIA NORTH-Madera
CALIFORNIA NORTH-Merced
CALIFORNIA NORTH-Modesto
CALIFORNIA NORTH-Redding
CALIFORNIA NORTH-Riverside/San Bernardino/Ontario
CALIFORNIA NORTH-Sacramento/Roseville/Arden/Arcade
CALIFORNIA NORTH-Salinas
CALIFORNIA NORTH-San Jose/Sunnyvale/Santa Clara (San Benito County)
CALIFORNIA NORTH-Santa Cruz/Watsonville
CALIFORNIA NORTH-Santa Rosa
CALIFORNIA NORTH-Stockton/Lodi
CALIFORNIA NORTH-Visalia/Porterville
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-El Centro
CALIFORNIA SOUTH-San Diego/Carlsbad
CALIFORNIA SOUTH-San Luis Obispo/Paso Robles/Arroyo Grande
CALIFORNIA SOUTH-Santa Maria/Santa Barbara
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
MAINE-Southern Maine
MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
MINNESOTA-Entire State
MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
PENNSYLVANIA-Rest of Pennsylvania
PUERTO RICO-Entire Territory
RHODE ISLAND-Entire State
SOUTH CAROLINA-Entire State
SOUTH DAKOTA-Entire State
TENNESSEE-Entire State
TEXAS-Brazoria
TEXAS-Dallas
TEXAS-Galveston
TEXAS-Houston
TEXAS-Beaumont
TEXAS-Fort Worth
TEXAS-Austin
TEXAS-Rest of Texas
UTAH-Entire State
VERMONT-Entire State
VIRGIN ISLANDS-Entire State
VIRGINIA-Entire State
WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State


2017 OPPS Status Indicator: N

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
Percentage
ICD-10 Code
Description
Related DRG(s)
53.5%
O80
Encounter for full-term uncomplicated delivery
767-768
774
775
11.3%
O76
Abnormality in fetal heart rate and rhythm complicating labor and delivery
781
782
4.2%
O62.2
Other uterine inertia
781
782
2.8%
O24.12
Pre-existing type 2 diabetes mellitus, in childbirth
767-768
774
2.8%
O75.9
Complication of labor and delivery, unspecified
781
782
1.4%
O62.0
Primary inadequate contractions
781
782
1.4%
O36.4XX0
Maternal care for intrauterine death, not applicable or unspecified
781
782
1.4%
O14.20
HELLP syndrome (HELLP), unspecified trimester
781
998
1.4%
O62.1
Secondary uterine inertia
781
782
1.4%
O42.013
Preterm premature rupture of membranes, onset of labor within 24 hours of rupture, third trimester
781
782

* Commonly Associated ICD-10 codes derived from CMS Q3 2016 Limited Data Set (LDS) claims data.
This data represents an analysis of 11,119,991 claims processed for 1,414,138 beneficiaries in the third quarter of 2016.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

01967 not found in an Local Coverage Determination (LCD) for your contractor. No other coverage policies found in database.

CCI and MUE Edits*         Hide this section.

Column 1 CCI Edits for 01967
Denied Codes (1)
Effective
Modifier
Accepted (2)
0178T 64 lead ecg w/i&r
04/01/2009 Yes
0179T 64 lead ecg w/tracing
04/01/2009 Yes
0180T 64 lead ecg w/i&r only
04/01/2009 Yes
01996 Hosp manage cont drug admin
01/01/2002 Yes
0213T Njx paravert w/us cer/thor
07/01/2010 Yes
0216T Njx paravert w/us lumb/sac
07/01/2010 Yes
0228T Njx tfrml eprl w/us cer/thor
10/01/2010 Yes
0230T Njx tfrml eprl w/us lumb/sac
10/01/2010 Yes
31505 Diagnostic laryngoscopy
01/01/2002 Yes
31515 Laryngoscopy for aspiration
01/01/2002 Yes
31527 Laryngoscopy for treatment
01/01/2002 Yes
31622 Dx bronchoscope/wash
01/01/2002 Yes
31634 Bronch w/balloon occlusion
01/01/2011 Yes
31645 Bronchoscopy clear airways
01/01/2002 Yes
31647 Bronchial valve init insert
01/01/2013 Yes
36000 Place needle in vein
01/01/2002 Yes
36010 Place catheter in vein
01/01/2002 No
36011 Place catheter in vein
01/01/2002 Yes
36012 Place catheter in vein
01/01/2002 Yes
36013 Place catheter in artery
01/01/2002 Yes
36014 Place catheter in artery
01/01/2002 Yes
36015 Place catheter in artery
01/01/2002 Yes
36400 Bl draw < 3 yrs fem/jugular
01/01/2002 Yes
36405 Bl draw <3 yrs scalp vein
01/01/2002 Yes
36406 Bl draw <3 yrs other vein
01/01/2002 Yes
36410 Non-routine bl draw 3/> yrs
01/01/2002 Yes
36420 Vein access cutdown < 1 yr
01/01/2002 Yes
36425 Vein access cutdown > 1 yr
01/01/2002 Yes
36430 Blood transfusion service
01/01/2002 Yes
36440 Bl push transfuse 2 yr/<
01/01/2002 Yes
36591 Draw blood off venous device
10/01/2015 No
36592 Collect blood from picc
10/01/2015 No
36600 Withdrawal of arterial blood
01/01/2002 Yes
36640 Insertion catheter artery
01/01/2002 Yes
43752 Nasal/orogastric w/tube plmt
01/01/2004 Yes
43753 Tx gastro intub w/asp
01/01/2011 Yes
43754 Dx gastr intub w/asp spec
01/01/2011 Yes
61026 Injection into brain canal
07/01/2009 Yes
61055 Injection into brain canal
07/01/2009 Yes
62280 Treat spinal cord lesion
01/01/2002 Yes
62281 Treat spinal cord lesion
01/01/2002 Yes
62282 Treat spinal canal lesion
01/01/2002 Yes
62284 Injection for myelogram
01/01/2002 Yes
62320 Njx interlaminar crv/thrc
01/01/2017 Yes
62321 Njx interlaminar crv/thrc
01/01/2017 Yes
62322 Njx interlaminar lmbr/sac
01/01/2017 Yes
62323 Njx interlaminar lmbr/sac
01/01/2017 Yes
62324 Njx interlaminar crv/thrc
01/01/2017 Yes
62325 Njx interlaminar crv/thrc
01/01/2017 Yes
62326 Njx interlaminar lmbr/sac
01/01/2017 Yes
62327 Njx interlaminar lmbr/sac
01/01/2017 Yes
64400 N block inj trigeminal
01/01/2002 Yes
64402 N block inj facial
01/01/2002 Yes
64405 N block inj occipital
01/01/2002 Yes
64408 N block inj vagus
01/01/2002 Yes
64410 N block inj phrenic
01/01/2002 Yes
64413 N block inj cervical plexus
01/01/2002 Yes
64415 N block inj brachial plexus
01/01/2002 Yes
64416 N block cont infuse b plex
01/01/2003 Yes
64417 N block inj axillary
01/01/2002 Yes
64418 N block inj suprascapular
01/01/2002 Yes
64420 N block inj intercost sng
01/01/2002 Yes
64421 N block inj intercost mlt
01/01/2002 Yes
64425 N block inj ilio-ing/hypogi
01/01/2002 Yes
64430 N block inj pudendal
01/01/2002 Yes
64435 N block inj paracervical
01/01/2002 Yes
64445 N block inj sciatic sng
01/01/2002 Yes
64446 N blk inj sciatic cont inf
01/01/2003 Yes
64447 N block inj fem single
01/01/2003 Yes
64448 N block inj fem cont inf
01/01/2003 Yes
64449 N block inj lumbar plexus
01/01/2004 Yes
64450 N block other peripheral
01/01/2002 Yes
64461 Pvb thoracic single inj site
01/01/2016 Yes
64463 Pvb thoracic cont infusion
01/01/2016 Yes
64479 Inj foramen epidural c/t
04/01/2002 Yes
64483 Inj foramen epidural l/s
04/01/2002 Yes
64486 Tap block unil by injection
01/01/2015 Yes
64487 Tap block uni by infusion
01/01/2015 Yes
64488 Tap block bi injection
01/01/2015 Yes
64489 Tap block bi by infusion
01/01/2015 Yes
64490 Inj paravert f jnt c/t 1 lev
01/01/2010 Yes
64493 Inj paravert f jnt l/s 1 lev
01/01/2010 Yes
64505 N block spenopalatine gangl
01/01/2002 Yes
64508 N block carotid sinus s/p
01/01/2002 Yes
64510 N block stellate ganglion
01/01/2002 Yes
64517 N block inj hypogas plxs
01/01/2004 Yes
64520 N block lumbar/thoracic
01/01/2002 Yes
64530 N block inj celiac pelus
01/01/2002 Yes
64550 Apply neurostimulator
01/01/2002 Yes
64553 Implant neuroelectrodes
01/01/2002 Yes
64555 Implant neuroelectrodes
01/01/2002 Yes
64565 Implant neuroelectrodes
01/01/2002 Yes
67500 Inject/treat eye socket
01/01/2002 No
76000 Fluoroscope examination
01/01/2002 Yes
76001 Fluoroscope exam extensive
10/01/2009 Yes
76970 Ultrasound exam follow-up
01/01/2017 Yes
76998 Us guide intraop
01/01/2007 No
77002 Needle localization by xray
01/01/2010 No
90865 Narcosynthesis
01/01/2002 Yes
92511 Nasopharyngoscopy
01/01/2002 Yes
92512 Nasal function studies
01/01/2002 Yes
92516 Facial nerve function test
01/01/2002 Yes
92520 Laryngeal function studies
01/01/2002 Yes
92537 Caloric vstblr test w/rec
01/01/2016 Yes
92538 Caloric vstblr test w/rec
01/01/2016 Yes
92950 Heart/lung resuscitation cpr
01/01/2002 Yes
92953 Temporary external pacing
01/01/2002 Yes
92960 Cardioversion electric ext
01/01/2002 Yes
92961 Cardioversion electric int
01/01/2002 Yes
93000 Electrocardiogram complete
01/01/2002 Yes
93005 Electrocardiogram tracing
01/01/2002 Yes
93010 Electrocardiogram report
01/01/2002 Yes
93040 Rhythm ecg with report
01/01/2002 Yes
93041 Rhythm ecg tracing
01/01/2002 Yes
93042 Rhythm ecg report
01/01/2002 Yes
93050 Art pressure waveform analys
01/01/2016 No
93303 Echo transthoracic
01/01/2002 No
93304 Echo transthoracic
01/01/2002 No
93306 Tte w/doppler complete
01/01/2009 Yes
93307 Tte w/o doppler complete
01/01/2002 Yes
93308 Tte f-up or lmtd
01/01/2002 Yes
93312 Echo transesophageal
01/01/2002 Yes
93313 Echo transesophageal
01/01/2002 Yes
93314 Echo transesophageal
01/01/2002 Yes
93315 Echo transesophageal
07/01/2002 Yes
93316 Echo transesophageal
07/01/2002 Yes
93317 Echo transesophageal
07/01/2002 Yes
93318 Echo transesophageal intraop
07/01/2002 No
93351 Stress tte complete
01/01/2009 Yes
93355 Echo transesophageal (tee)
01/01/2015 No
93451 Right heart cath
01/01/2011 Yes
93456 R hrt coronary artery angio
01/01/2011 Yes
93457 R hrt art/grft angio
01/01/2011 Yes
93561 Cardiac output measurement
04/01/2008 No
93562 Card output measure subsq
04/01/2008 No
93701 Bioimpedance cv analysis
01/01/2002 No
93922 Upr/l xtremity art 2 levels
01/01/2002 Yes
93923 Upr/lxtr art stdy 3+ lvls
01/01/2002 Yes
93924 Lwr xtr vasc stdy bilat
01/01/2002 Yes
93925 Lower extremity study
01/01/2002 Yes
93926 Lower extremity study
01/01/2002 Yes
93930 Upper extremity study
01/01/2002 Yes
93931 Upper extremity study
01/01/2002 Yes
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
93970 Extremity study
01/01/2002 Yes
93971 Extremity study
01/01/2002 Yes
93975 Vascular study
01/01/2002 Yes
93976 Vascular study
01/01/2002 Yes
93978 Vascular study
01/01/2002 Yes
93979 Vascular study
01/01/2002 Yes
93980 Penile vascular study
01/01/2002 Yes
93981 Penile vascular study
01/01/2002 Yes
94002 Vent mgmt inpat init day
01/01/2007 Yes
94004 Vent mgmt nf per day
01/01/2007 Yes
94200 Lung function test (mbc/mvv)
01/01/2002 Yes
94250 Expired gas collection
01/01/2002 No
94640 Airway inhalation treatment
01/01/2002 Yes
94644 Cbt 1st hour
04/01/2008 Yes
94660 Pos airway pressure cpap
01/01/2002 Yes
94662 Neg press ventilation cnp
01/01/2002 Yes
94680 Exhaled air analysis o2
01/01/2002 Yes
94681 Exhaled air analysis o2/co2
01/01/2002 Yes
94690 Exhaled air analysis
01/01/2002 Yes
94760 Measure blood oxygen level
01/01/2002 No
94761 Measure blood oxygen level
01/01/2002 No
94762 Measure blood oxygen level
01/01/2002 Yes
94770 Exhaled carbon dioxide test
01/01/2002 Yes
95812 Eeg 41-60 minutes
01/01/2003 No
95813 Eeg over 1 hour
01/01/2003 No
95816 Eeg awake and drowsy
01/01/2003 No
95819 Eeg awake and asleep
01/01/2003 No
95822 Eeg coma or sleep only
01/01/2003 No
95829 Surgery electrocorticogram
01/01/2003 No
95955 Eeg during surgery
01/01/2002 No
95956 Eeg monitor technol attended
04/01/2002 No
95957 Eeg digital analysis
04/01/2002 No
96360 Hydration iv infusion init
01/01/2009 No
96365 Ther/proph/diag iv inf init
01/01/2009 No
96372 Ther/proph/diag inj sc/im
01/01/2009 No
96373 Ther/proph/diag inj ia
01/01/2009 No
96374 Ther/proph/diag inj iv push
01/01/2009 No
96375 Tx/pro/dx inj new drug addon
01/01/2009 No
96376 Tx/pro/dx inj same drug adon
07/01/2009 No
96377 Applicaton on-body injector
01/01/2017 No
99151 Mod sed same phys/qhp <5 yrs
01/01/2017 No
99152 Mod sed same phys/qhp 5/>yrs
01/01/2017 No
99153 Mod sed same phys/qhp ea
01/01/2017 No
99155 Mod sed oth phys/qhp <5 yrs
01/01/2017 No
99156 Mod sed oth phys/qhp 5/>yrs
01/01/2017 No
99157 Mod sed other phys/qhp ea
01/01/2017 No
99201 Office/outpatient visit new
01/01/2002 No
99202 Office/outpatient visit new
01/01/2002 No
99203 Office/outpatient visit new
01/01/2002 No
99204 Office/outpatient visit new
01/01/2002 No
99205 Office/outpatient visit new
01/01/2002 No
99211 Office/outpatient visit est
01/01/2002 No
99212 Office/outpatient visit est
01/01/2002 No
99213 Office/outpatient visit est
01/01/2002 No
99214 Office/outpatient visit est
01/01/2002 No
99215 Office/outpatient visit est
01/01/2002 No
99217 Observation care discharge
01/01/2002 No
99218 Initial observation care
01/01/2002 No
99219 Initial observation care
01/01/2002 No
99220 Initial observation care
01/01/2002 No
99221 Initial hospital care
01/01/2002 No
99222 Initial hospital care
01/01/2002 No
99223 Initial hospital care
01/01/2002 No
99224 Subsequent observation care
01/01/2011 No
99225 Subsequent observation care
01/01/2011 No
99226 Subsequent observation care
01/01/2011 No
99231 Subsequent hospital care
01/01/2002 No
99232 Subsequent hospital care
01/01/2002 No
99233 Subsequent hospital care
01/01/2002 No
99234 Observ/hosp same date
07/01/2009 No
99235 Observ/hosp same date
07/01/2009 No
99236 Observ/hosp same date
07/01/2009 No
99238 Hospital discharge day
01/01/2002 No
99239 Hospital discharge day
07/01/2009 No
99281 Emergency dept visit
01/01/2002 No
99282 Emergency dept visit
01/01/2002 No
99283 Emergency dept visit
01/01/2002 No
99284 Emergency dept visit
01/01/2002 No
99285 Emergency dept visit
01/01/2002 No
99304 Nursing facility care init
01/01/2006 No
99305 Nursing facility care init
01/01/2006 No
99306 Nursing facility care init
01/01/2006 No
99307 Nursing fac care subseq
01/01/2006 No
99308 Nursing fac care subseq
01/01/2006 No
99309 Nursing fac care subseq
01/01/2006 No
99310 Nursing fac care subseq
01/01/2006 No
99315 Nursing fac discharge day
07/01/2009 No
99318 Annual nursing fac assessmnt
01/01/2006 No
99324 Domicil/r-home visit new pat
01/01/2006 No
99325 Domicil/r-home visit new pat
01/01/2006 No
99326 Domicil/r-home visit new pat
01/01/2006 No
99327 Domicil/r-home visit new pat
01/01/2006 No
99328 Domicil/r-home visit new pat
01/01/2006 No
99334 Domicil/r-home visit est pat
01/01/2006 No
99335 Domicil/r-home visit est pat
01/01/2006 No
99336 Domicil/r-home visit est pat
01/01/2006 No
99337 Domicil/r-home visit est pat
01/01/2006 No
99341 Home visit new patient
01/01/2002 No
99342 Home visit new patient
01/01/2002 No
99343 Home visit new patient
01/01/2002 No
99347 Home visit est patient
01/01/2002 No
99348 Home visit est patient
01/01/2002 No
99349 Home visit est patient
01/01/2002 No
99354 Prolong e&m/psyctx serv o/p
01/01/2002 No
99355 Prolong e&m/psyctx serv o/p
01/01/2002 No
99356 Prolonged service inpatient
01/01/2002 No
99357 Prolonged service inpatient
01/01/2002 No
99415 Prolong clincl staff svc
01/01/2016 No
99416 Prolong clincl staff svc add
01/01/2016 No
99466 Ped crit care transport
01/01/2009 No
99468 Neonate crit care initial
01/01/2009 No
99469 Neonate crit care subsq
01/01/2009 No
99471 Ped critical care initial
01/01/2009 No
99472 Ped critical care subsq
01/01/2009 No
99475 Ped crit care age 2-5 init
01/01/2009 No
99476 Ped crit care age 2-5 subsq
01/01/2009 No
99477 Init day hosp neonate care
01/01/2008 No
99478 Ic lbw inf < 1500 gm subsq
01/01/2009 No
99479 Ic lbw inf 1500-2500 g subsq
01/01/2009 No
99480 Ic inf pbw 2501-5000 g subsq
01/01/2009 No
99485 Suprv interfacilty transport
01/01/2013 No
99497 Advncd care plan 30 min
01/01/2016 No
C8921 Tte w or w/o fol w/cont, com
07/01/2008 Yes
C8922 Tte w or w/o fol w/cont, f/u
07/01/2008 Yes
C8923 2d tte w or w/o fol w/con,co
07/01/2008 Yes
C8924 2d tte w or w/o fol w/con,fu
07/01/2008 Yes
C8925 2d tee w or w/o fol w/con,in
07/01/2008 Yes
C8926 Tee w or w/o fol w/cont,cong
07/01/2008 Yes
C8927 Tee w or w/o fol w/cont, mon
07/01/2008 No
C8929 Tte w or wo fol wcon,doppler
01/01/2010 Yes
C8930 Tte w or w/o contr, cont ecg
01/01/2010 Yes
G0380 Lev 1 hosp type b ed visit
10/01/2008 Yes
G0381 Lev 2 hosp type b ed visit
10/01/2008 Yes
G0382 Lev 3 hosp type b ed visit
10/01/2008 Yes
G0383 Lev 4 hosp type b ed visit
10/01/2008 Yes
G0384 Lev 5 hosp type b ed visit
10/01/2008 Yes
G0406 Inpt/tele follow up 15
07/01/2010 No
G0407 Inpt/tele follow up 25
07/01/2010 No
G0408 Inpt/tele follow up 35
07/01/2010 No
G0425 Inpt/ed teleconsult30
07/01/2010 No
G0426 Inpt/ed teleconsult50
07/01/2010 No
G0427 Inpt/ed teleconsult70
07/01/2010 No
G0463 Hospital outpt clinic visit
07/01/2014 No
(1) These codes will be denied when submitted for payment on the same date of service as 01967.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.



Column 2 CCI Edits for 01967

Denied Codes (1)
Effective
Modifier
Accepted (2)
59400 Obstetrical care
04/01/2002 No
59409 Obstetrical care
04/01/2002 No
59410 Obstetrical care
04/01/2002 No
59412 Antepartum manipulation
04/01/2002 No
59414 Deliver placenta
04/01/2002 No
59610 Vbac delivery
04/01/2002 No
59612 Vbac delivery only
04/01/2002 No
59614 Vbac care after delivery
04/01/2002 No
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
97597 Rmvl devital tis 20 cm/<
01/01/2005 No
97598 Rmvl devital tis addl 20cm/<
01/01/2005 No
97602 Wound(s) care non-selective
04/01/2006 No
97605 Neg press wound tx
04/01/2006 No
97606 Neg press wound tx >50 cm
04/01/2006 No
97607 Neg press wnd tx
01/01/2015 No
97608 Neg press wound tx >50 cm
01/01/2015 No
(1) These codes will be denied when submitted for payment on the same date of service as 01967.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.


Medically Unlikely Edits for 01967


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: Not Listed Not Listed Not Listed
Adjudication Indicator: Not Listed Not Listed Not Listed
Rationale: Not Listed Not Listed Not Listed

* The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.



   Medicare Part B Utilization Data for 01967*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2015: 7,426
Total Services Denied 2015: 900 (12.1%)
National Charges Submitted 2015: $ 17,342,403.01
National Charges Allowed 2015: $ 3,380,593.61
National Average (No Modifier) Fee Submitted 2015: $690.00
National Average (No Modifier) Fee Allowed 2015: $131.58


Top 5 Performing Specialties 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Anesthesiology 5,203 70.1% $2385.44 592 11.4%
CRNA
(eff. 1/87)
(Anesthesiologist Assistants were removed from this specialty 4/1/03)
2,157 29.0% $2226.42 293 13.6%
Anesthesiologist Assistants
(eff. 4/1/03--previously grouped with Certified Registered Nurse Anesthetists
(CRNA))
17 0.2% $2115.97 0 0.0%
Pain Management
(eff. 1/1/02)
13 0.2% $2090.74 5 38.5%
Interventional Pain Management
(IPM)
(eff. 4/1/03)
11 0.1% $1349.45 1 9.1%

Top 5 Places of Service 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Inpatient hospital 7,330 98.7% $2340.11 880 12.0%
Outpatient hospital 86 1.2% $1996.46 19 22.1%
Office 3 0.0% $770.00 0 0.0%
Emergency room - hospital 3 0.0% $3135.33 0 0.0%
Ambulatory surgical center 2 0.0% $1414.50 0 0.0%

Top 5 Modifiers Submitted 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
AA - Anesthesia services personally furnished by an anesthesiologist. 4,527 61.0% $2422.52 532 11.8%
QZ 1,599 21.5% $2443.76 218 13.6%
QX 585 7.9% $1654.83 86 14.7%
QK - Medical direction of two, three, or four concurrent anesthesia procedures involving 432 5.8% $2262.71 45 10.4%
QY 252 3.4% $1741.02 13 5.2%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.

All information on this web site is compiled directly from information obtained from the Center for Medicare and Medicaid Services (CMS) and from its Contractors.

CodeMap® has made every reasonable effort to ensure the accuracy of the information contained on this web site. However, the ultimate responsibility for correct coding and claims submission lies with the provider of services. CodeMap® makes no representation, warranty, or guarantee that this compilation of Medicare information is error-free or that the use of this information will result in Medicare coverage and subsequent payment of claims. Final coverage and payment of claims are subject to many factors exclusively controlled by CMS and its contractors.

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06/24/2017 02:09:54 54.159.66.70

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