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99192
Quick jump to procedure code: Printer Friendly Version
99199

99195: Phlebotomy CPT® 99195: PHLEBOTOMY, THERAPEUTIC (SEPARATE PROCEDURE)

Short Description: Phlebotomy

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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-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
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CALIFORNIA SOUTH-Santa Maria/Santa Barbara
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WASHINGTON-Seattle (King County)
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WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State

2017 Physician
Fee Schedule:

Global Fee $101.57

2017 Wage Index Adjustment for Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payments
Zip Code:
2017 October Unadjusted OPPS Payment $ 54.55


*Based on National 2013 Medicare Part B submitted claims.
2017 APC Code: 5733
Level 3 Minor Procedures

2017 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
28.0% 238.4    Polycythemia vera D45   Polycythemia vera
18.0% 275.0    No longer a valid ICD-9 code. Click here to search for current ICD-9 code.

No related ICD-10 codes.
8.6% 289.0    Polycythemia, secondary D75.1   Secondary polycythemia
2.6% 289.6    Familial polycythemia D75.0   Familial erythrocytosis
2.6% 275.03    Other hemochromatosis E83.118   Other hemochromatosis
OR:
E83.119   Hemochromatosis, unspecified
2.6% 276.51    Dehydration E86.0   Dehydration
1.7% 275.01    Hereditary hemochromatosis E83.110   Hereditary hemochromatosis
1.4% 272.0    Pure hypercholesterolemia

No related ICD-10 codes.
1.3% 401.9    Unspecified hypertension I10   Essential (primary) hypertension
1.0% 285.9    Anemia, unspecified D64.9   Anemia, unspecified

* 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.

99195 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 99195
Denied Codes (1)
Effective
Modifier
Accepted (2)
36000 Place needle in vein
01/01/1996 Yes
36405 Bl draw <3 yrs scalp vein
01/01/1996 Yes
36420 Vein access cutdown < 1 yr
01/01/1996 Yes
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
36425 Vein access cutdown > 1 yr
01/01/1996 Yes
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 99195.

(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 99195
Denied Codes (1) Effective Modifier
Accepted (2)
36400 Bl draw < 3 yrs fem/jugular 01/01/1996 Yes
36406 Bl draw <3 yrs other vein 01/01/1996 Yes
36410 Non-routine bl draw 3/> yrs 01/01/1996 Yes
86890 Autologous blood process 01/01/1996 Yes
86891 Autologous blood op salvage 01/01/1996 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 36400.

(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 99195


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.


   99195 Top 5 Ordering Providers National*
STEPHEN HENRY -PASADENA,CA 1,089
ABRAHAM ISHAAYA -LOS ANGELES,CA 647
NANI KANEN -BURLINGAME,CA 603
ISAAC LEVY -PEMBROKE PINES,FL 576
REDDY ALLAM -MONTCLAIR,NJ 547

   99195 Top 5 Ordering Organizations National*
SOUTH BEND MEDICAL FOUNDATION, INC-IN 190
INLAND NORTHWEST BLOOD CENTER-WA 83
NORTHERN CALIFORNIA COMMUNITY BLOOD BANK-CA 82
INTERPATH LABORATORY, INC.-OR 77
BLOODSOURCE, INC.-CA 44

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



   Medicare Part B Utilization Data for 99195*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2015: 79,106
Total Services Denied 2015: 3,255 (4.1%)
National Charges Submitted 2015: $ 14,632,296.15
National Charges Allowed 2015: $ 7,507,592.92
National Average (No Modifier) Fee Submitted 2015: $184.24
National Average (No Modifier) Fee Allowed 2015: $ 98.42


Top 5 Performing Specialties 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Hematology/oncology
(eff 5/92)
48,571 61.4% $192.70 1,440 3.0%
Medical oncology
(eff 5/92)
12,742 16.1% $197.46 290 2.3%
Internal medicine 6,191 7.8% $136.23 329 5.3%
Family practice 2,694 3.4% $133.21 210 7.8%
Hematology
(eff 5/92)
2,228 2.8% $221.85 90 4.0%

Top 5 Places of Service 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 77,597 98.1% $185.55 2,457 3.2%
Independent laboratory 597 0.8% $128.45 86 14.4%
Outpatient hospital 594 0.8% $201.86 594 100.0%
Home 153 0.2% $104.75 21 13.7%
Other unlisted facility 74 0.1% $ 63.47 12 16.2%

Top 5 Modifiers Submitted 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 70,457 89.1% $184.24 2,819 4.0%
59 - Distinct Procedural Service 7,730 9.8% $191.05 371 4.8%
XE 337 0.4% $219.82 9 2.7%
Q6 - Physician Services 204 0.3% $215.98 6 2.9%
XU 168 0.2% $128.35 20 11.9%

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.

No part of this web page or data displayed may be redistibuted or used without the express written consent of Wheaton Partners, LLC.
05/22/2017 12:37:10 54.146.5.196

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