CodeMap® 




2017 ICD-10 Diagnosis Code Set Loaded     


10/1/2016 NCD Edits Loaded     


2016 October OPPS Fee Schedule Updated     


2016-C 7/1/2016 DME/PEN Fee Schedules Updated     


2016 October ASC Fee Schedule Updated     


Q4 2016 ASP Drug Pricing Updated     


Q4 2016 CCI Edits Loaded     


Q4 2016 MUE Edits Loaded     


LCD Database Current Through 11/28/2016     

1901 North Roselle Road
Suite 640
Schaumburg, IL 60195
847-381-5465 Phone
847-381-4606 Fax
customerservice@codemap.com
      


User Information

Create New Account

Lost Password

Username:
Password:


Quick Links

Laboratory Fee Schedule

2017
2016

Physician Fee Schedule

2017
2016

OPPS Fee Schedule

2017-FR
2016

ASC Fee Schedule

2016
2015

APC Codes

2016
2015

ASP Drug Pricing Files





99078
Quick jump to procedure code: Printer Friendly Version
99082

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 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
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


2016 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.
PercentageICD-9ICD-10 Conversions
4.3% V68.9    Encounter for unspecified administrative purpose Z02.9   Encounter for administrative examinations, unspecified
3.8% V68.89    Encounter for other specified administrative purpose Z02.89   Encounter for other administrative examinations
2.9% V70.0    Routine general medical examination at a health care facility Z00.00   Encounter for general adult medical examination without abnormal findings
2.5% V70.3    Other medical examination for administrative purposes Z02.89   Encounter for other administrative examinations
2.2% 729.1    Myalgia and myositis, unspecified M60.9   Myositis, unspecified
OR:
M79.1   Myalgia
OR:
M79.7   Fibromyalgia
2.0% 250.00    Diabetes mellitus without complication, type II or unspecified type, not stated as uncontrolled E11.9   Type 2 diabetes mellitus without complications
2.0% 724.2    Lumbago M54.5   Low back pain
1.8% 401.9    Unspecified hypertension I10   Essential (primary) hypertension
1.8% 780.79    Other malaise and fatigue G93.3   Postviral fatigue syndrome
OR:
R53.1   Weakness
OR:
R53.81   Other malaise
OR:
R53.83   Other fatigue
1.6% 724.4    Thoracic or lumbosacral neuritis or radiculitis, unspecified M54.14   Radiculopathy, thoracic region
OR:
M54.15   Radiculopathy, thoracolumbar region
OR:
M54.16   Radiculopathy, lumbar region
OR:
M54.17   Radiculopathy, lumbosacral region

* 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.

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.

CCI Edits for 99080
Denied Codes (1)
Effective
Modifier
Accepted (2)
0405T Ovrsght xtrcorp liv asst pat
01/01/2016 No
36591 Draw blood off venous device
10/01/2015 No
36592 Collect blood from picc
10/01/2015 No
99455 Work related disability exam
07/01/2016 Yes
99456 Disability examination
07/01/2016 Yes
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
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
99495 Trans care mgmt 14 day disch
01/01/2013 No
99496 Trans care mgmt 7 day disch
01/01/2013 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.


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 2015: 52,668
Total Services Denied 2015: 52,667 (100.0%)
National Charges Submitted 2015: $ 305,691.00
National Charges Allowed 2015: $ 0.00
National Average (No Modifier) Fee Submitted 2015: $ 5.54
National Average (No Modifier) Fee Allowed 2015: $ 0.00
National Average (QW) Fee Submitted 2015: $ 0.00
National Average (QW) Fee Allowed 2015: $ 0.00


Top 5 Performing Specialties 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Family practice 18,111 34.4% $ 6.80 18,111 100.0%
Internal medicine 10,342 19.6% $ 3.86 10,342 100.0%
General surgery 10,070 19.1% $ 0.19 10,070 100.0%
Nurse practitioner 3,314 6.3% $ 9.87 3,314 100.0%
Physician assistant
(eff 5/92)
1,953 3.7% $ 2.73 1,953 100.0%

Top 5 Places of Service 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 32,521 61.7% $ 6.53 32,521 100.0%
Inpatient hospital 7,250 13.8% $ 2.05 7,250 100.0%
Outpatient hospital 2,785 5.3% $ 2.72 2,785 100.0%
Home 2,441 4.6% $ 0.88 2,441 100.0%
Skilled nursing facility 2,393 4.5% $ 4.48 2,393 100.0%

Top 5 Modifiers Submitted 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 52,362 99.4% $ 5.54 52,362 100.0%
25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Day of a Procedure 57 0.1% $ 97.42 57 100.0%
GY 57 0.1% $ 48.91 57 100.0%
GA - Advanced Beneficiary Notice (ABN) on File 43 0.1% $ 65.00 43 100.0%
GW 36 0.1% $ 2.36 36 100.0%

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.
12/07/2016 12:16:20 54.167.149.128

CodeMap¨ is a Registered Trademark of Wheaton Partners, LLC.