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70240
Quick jump to procedure code: Printer Friendly Version
7025F

CPT® 70250: RADIOLOGIC EXAMINATION, SKULL; LESS THAN 4 VIEWS

Short Description: X-ray exam of skull

--

CPT copyright 2015 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Marin/Napa/Solano
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Rest of North California
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-Rest of South California
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
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FLORIDA-Miami
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2016 Physician
Fee Schedule:

Global Fee $ 36.19
26 Modifier $ 12.90
TC Modifier $ 23.29

2016 Wage Index Adjustment for Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payments
Zip Code:
2016 Unadjusted OPPS Payment $100.69


*Based on National 2013 Medicare Part B submitted claims.
Revenue Code(s):
320-Radiology diagnostic-general classification


2016 APC Code: 5522
Level 2 X-Ray and Related Services

2016 OPPS Status Indicator: Q1

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.
PercentageICD-9ICD-10 Conversions
19.7% 784.0    Headache G44.1   Vascular headache, not elsewhere classified
OR:
R51   Headache
6.0% V45.2    Presence of cerebrospinal fluid drainage device Z98.2   Presence of cerebrospinal fluid drainage device
5.5% 959.01    Head injury, unspecified S09.8XXA   Other specified injuries of head, initial encounter
OR:
S09.90XA   Unspecified injury of head, initial encounter
4.6% V53.01    Fitting and adjustment of cerebral ventricular shunt Z45.41   Encounter for adjustment and management of cerebrospinal fluid drainage device
2.5% V82.89    Special screening for other specified conditions Z13.89   Encounter for screening for other disorder
2.5% 784.2    Swelling, mass, or lump in head and neck R22.0   Localized swelling, mass and lump, head
OR:
R22.1   Localized swelling, mass and lump, neck
2.4% V71.89    Observation for other specified suspected conditions Z03.6   Encounter for observation for suspected toxic effect from ingested substance ruled out
OR:
Z03.89   Encounter for observation for other suspected diseases and conditions ruled out
2.2% 920    Contusion of face, scalp, and neck except eye(s) S00.93XA   Contusion of unspecified part of head, initial encounter
OR:
S10.93XA   Contusion of unspecified part of neck, initial encounter
1.9% 331.4    Obstructive hydrocephalus G91.1   Obstructive hydrocephalus
1.5% 719.45    Pain in joint, pelvic region and thigh M25.559   Pain in unspecified hip

* Commonly Associated ICD-10 codes derived from 2010 Physician Supplier Part B Medicare claims data and 2015 CMS General Equivalency Mapping Codes (GEM).
This data represents an analysis of 43 million claims processed for 1.7 million beneficiaries in 2010.

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

70250 not found in an Local Coverage Determination (LCD) for your contractor. Other contractors covering 70250

CCI and MUE Edits*         Hide this section.

CCI Edits for 70250
Denied Codes (1) Effective Modifier
Accepted (2)
36591 Draw blood off venous device 10/01/2015 No
36592 Collect blood from picc 10/01/2015 No
70260 X-ray exam of skull 01/01/1996 No
(1) These codes will be denied when submitted for payment on the same date of service as 70250.

(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 70250

Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 2 2 Not Listed
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical Not Listed
Rationale: Clinical: Data Clinical: Data 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.


   70250 Top 5 Ordering Providers National*
YING ZHAO -ATHENS,TX 502
EUGENE AGNONE -ROSEVILLE,MI 447
NAIYER IMAM -ROANOKE,VA 404
EARL TYLER -GREENVILLE,TX 286
DAVID KARASICK -PHILADELPHIA,PA 262

   70250 Top 5 Ordering Organizations National*
SYMPHONY DIAGNOSTIC SERVICES NO 1 LLC-MD 3,170
KAN-DI-KI, LLC-CA 1,733
CORRIDOR MEDICAL SERVICES INC-TX 1,035
COMMUNITY PORTABLE XRAY-TX 937
METROSTAT DIAGNOSTIC SERVICES INC-TX 702

*Based on 2014 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 70250*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2014: 60,874
Total Services Denied 2014: 6,409 (10.5%)
National Charges Submitted 2014: $ 3,904,893.00
National Charges Allowed 2014: $ 1,057,804.00
National Average (No Modifier) Fee Submitted 2014: $112.78
National Average (No Modifier) Fee Allowed 2014: $ 38.14
National Average (26) Fee Submitted 2014: $ 48.27
National Average (26) Fee Allowed 2014: $ 12.90
National Average (TC) Fee Submitted 2014: $ 72.25
National Average (TC) Fee Allowed 2014: $ 25.54


Top 5 Performing Specialties 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Diagnostic radiology 36,226 59.5% $ 55.66 3,765 10.4%
Portable X-ray supplier 17,144 28.2% $ 62.87 1,613 9.4%
Family practice 1,455 2.4% $ 76.36 129 8.9%
Neurosurgery 768 1.3% $ 98.08 112 14.6%
Internal medicine 686 1.1% $ 73.75 67 9.8%

Top 5 Places of Service 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Outpatient hospital 13,390 22.0% $ 47.40 1,309 9.8%
Nursing facility 11,293 18.6% $ 76.58 1,173 10.4%
Inpatient hospital 11,273 18.5% $ 48.63 1,191 10.6%
Office 10,937 18.0% $105.74 1,491 13.6%
Emergency room - hospital 6,668 11.0% $ 46.32 478 7.2%

Top 5 Modifiers Submitted 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
26 - Professional Component 40,959 67.3% $ 48.28 3,930 9.6%
No Modifier 11,472 18.8% $112.79 1,371 12.0%
TC - Technical Component 7,619 12.5% $ 72.27 907 11.9%
GW 349 0.6% $ 90.34 27 7.7%
59 - Distinct Procedural Service 131 0.2% $102.16 13 9.9%

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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06/30/2016 07:43:09 54.158.238.70

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