CodeMap® Report 21089
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2018 ICD-10 Diagnosis Code Set Loaded     


10/01/2017 NCD Edits Loaded     


2017-D October DME Fee Schedule     


2017-A PEN Fee Schedule-no changes for rest of 2017     


2017-D October ASC Fee Schedule Updated     


2017-D October APC Fee Schedule Updated     


October 2017 ASP Drug Pricing Updated     


Q4 2017 CCI Edits Loaded     


Q4 2017 MUE Edits Loaded     


LCD Database Current Through 10/16/2017     

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21088
Quick jump to procedure code: Printer Friendly Version
21100

21089: Prepare face/oral prosthesis

CPT® 21089: UNLISTED MAXILLOFACIAL PROSTHETIC PROCEDURE


Short Description: Prepare face/oral prosthesis

--

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 Wage Index Adjustment for Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payments
Zip Code:
2017 October Unadjusted OPPS Payment $177.09
2017 APC Code: 5161
Level 1 ENT Procedures

2017 OPPS Status Indicator: T

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.
Limited claims data available for this procedure.
Percentage
ICD-10 Code
Description
Related DRG(s)
18.2%
C41.9
Malignant neoplasm of bone and articular cartilage, unspecified
542-544
18.2%
C01
Malignant neoplasm of base of tongue
011-013
146-148
18.2%
C07
Malignant neoplasm of parotid gland
011-013
146-148
18.2%
C32.0
Malignant neoplasm of glottis
011-013
146-148
9.1%
C90.00
Multiple myeloma not having achieved remission
820-822
823-825
840-842
9.1%
M2660
This diagnosis code is no longer active.
9.1%
Z85.89
Personal history of malignant neoplasm of other organs and systems
826-830
843-845

* 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.

21089 not found in an Local Coverage Determination (LCD) for your contractor. Other contractors covering 21089

CCI and MUE Edits*         Hide this section.


Medically Unlikely Edits for 21089

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.


   21089 Top 5 Ordering Providers National*
RICHARD CARDOSO -HOUSTON,TX 83
BETSY DAVIS -CHARLESTON,SC 73
RUTH APONTE-WESSON -HOUSTON,TX 48
MARK CHAMBERS -HOUSTON,TX 38
THERESA HOFSTEDE -HOUSTON,TX 29

*Based on 2015 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 21089*         Hide this section.



Annual Procedures - Tests Performed / Denied


Total National Services (all modifiers) Submitted 2016: 909
Total Services Denied 2016: 479 (52.7%)
National Charges Submitted 2016: $ 1,454,401.78
National Charges Allowed 2016: $ 212,240.13
National Average (No Modifier) Fee Submitted 2016: $1597.04
National Average (No Modifier) Fee Allowed 2016: $527.51


Top 5 Performing Specialties 2016 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Oral surgery
(dentists only)
669 73.6% $1606.57 374 55.9%
Maxillofacial surgery
(eff 5/92)
143 15.7% $2022.80 49 34.3%
Unknown physician specialty 37 4.1% $1586.50 36 97.3%
Critical care
(intensivists)
(eff 5/92)
28 3.1% $155.00 0 0.0%
Family practice 9 1.0% $565.49 9 100.0%

Top 5 Places of Service 2016 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Outpatient hospital 540 59.4% $2066.45 250 46.3%
Office 326 35.9% $990.76 222 68.1%
Inpatient hospital 38 4.2% $368.92 2 5.3%
Home 4 0.4% $191.35 4 100.0%
Other unlisted facility 1 0.1% $750.00 1 100.0%

Top 5 Modifiers Submitted 2016 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 709 78.0% $1597.04 358 50.5%
59 - Distinct Procedural Service 47 5.2% $659.98 45 95.7%
GY 38 4.2% $2957.50 38 100.0%
58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period 32 3.5% $2247.09 9 28.1%
GC 32 3.5% $404.56 1 3.1%

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.



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10/21/2017 08:00:54 54.80.148.252

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