CodeMap® Report 99080
CodeMap® 




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     


2018-A October APC Fee Schedule Updated     


October 2017 ASP Drug Pricing Updated     


Q1 2018 CCI Edits Loaded     


Q1 2018 MUE Edits Loaded     


LCD Database Current Through 12/11/2017     

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2017

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99078
Quick jump to procedure code: Printer Friendly Version
99082

99080: SPECIAL REPORTS OR FORMS

CPT® 99080: Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form


Short Description: SPECIAL REPORTS OR FORMS

--

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: B

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)
4.0%
I10
Essential (primary) hypertension
304-305
2.1%
E78.5
Hyperlipidemia, unspecified
642
1.9%
K21.9
Gastro-esophageal reflux disease without esophagitis
391-392
1.9%
I25.10
Atherosclerotic heart disease of native coronary artery without angina pectoris
302-303
1.9%
E11.9
Type 2 diabetes mellitus without complications
008
010
637-639
1.9%
E78.2
Mixed hyperlipidemia
642
1.7%
E03.9
Hypothyroidism, unspecified
643-645
1.6%
E55.9
Vitamin D deficiency, unspecified
640-641
1.5%
I48.91
Unspecified atrial fibrillation
308-310
793
1.3%
J44.9
Chronic obstructive pulmonary disease, unspecified
190-192

* 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.

99080 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 99080
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
(1) These codes will be denied when submitted for payment on the same date of service as 99080.

(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 99080
Denied Codes (1)
Effective
Modifier
Accepted (2)
0405T OVRSGHT XTRCORP LIV ASST PAT
01/01/2016 No
99455 WORK RELATED DISABILITY EXAM
07/01/2016 Yes
99456 DISABILITY EXAMINATION
07/01/2016 Yes
99484 CARE MGMT SVC BHVL HLTH COND
01/01/2018 No
99487 CMPLX CHRON CARE W/O PT VSIT
01/01/2013 No
99489 CMPLX CHRON CARE ADDL 30 MIN
01/01/2013 No
99490 CHRON CARE MGMT SRVC 20 MIN
01/01/2015 No
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
99492 1ST PSYC COLLAB CARE MGMT
01/01/2018 No
99493 SBSQ PSYC COLLAB CARE MGMT
01/01/2018 No
99494 1ST/SBSQ PSYC COLLAB CARE
01/01/2018 No
99495 TRANS CARE MGMT 14 DAY DISCH
01/01/2013 No
99496 TRANS CARE MGMT 7 DAY DISCH
01/01/2013 No
G0506 Comp asses care plan ccm svc
07/01/2017 No
(1) These codes will be denied when submitted for payment on the same date of service as 99080.

(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.


2018 Medically Unlikely Edits for 99080


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 0 1 Not Listed
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical Not Listed
Rationale: CMS Policy Code Descriptor / CPT Instruction 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 99080*         Hide this section.



Annual Procedures - Tests Performed / Denied


Total National Services (all modifiers) Submitted 2016: 138,251
Total Services Denied 2016: 138,251 (100.0%)
National Charges Submitted 2016: $ 503,752.39
National Charges Allowed 2016: $ 0.00
National Average (No Modifier) Fee Submitted 2016: $ 3.41
National Average (No Modifier) Fee Allowed 2016: $ 0.00
National Average (QW) Fee Submitted 2016: $ 0.01
National Average (QW) Fee Allowed 2016: $ 0.00


Top 5 Performing Specialties 2016 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Internal medicine 59,516 43.0% $ 1.19 59,516 100.0%
Family practice 40,243 29.1% $ 2.90 40,243 100.0%
Nurse practitioner 9,607 6.9% $ 3.17 9,607 100.0%
Physician assistant
(eff 5/92)
4,660 3.4% $ 3.60 4,660 100.0%
Cardiology 4,261 3.1% $ 2.37 4,261 100.0%

Top 5 Places of Service 2016 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 104,750 75.8% $ 3.62 104,750 100.0%
Inpatient hospital 19,210 13.9% $ 2.12 19,210 100.0%
Skilled nursing facility 7,361 5.3% $ 4.91 7,361 100.0%
Nursing facility 1,993 1.4% $ 9.43 1,993 100.0%

Top 5 Modifiers Submitted 2016 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 135,880 98.3% $ 3.41 135,880 100.0%
59 - Distinct Procedural Service 934 0.7% $ 6.17 934 100.0%
76 - Repeat Procedure by Same Physician 263 0.2% $ 0.12 263 100.0%
GY 240 0.2% $ 36.27 240 100.0%
AQ 190 0.1% $ 3.33 190 100.0%

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.

No part of this web page or data displayed may be redistibuted or used without the express written consent of Wheaton Partners, LLC.
12/15/2017 02:16:41 54.90.207.75

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