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99195
Quick jump to procedure code: Printer Friendly Version
99201

CPT® 99199: UNLISTED SPECIAL SERVICE, PROCEDURE OR REPORT

Short Description: Special service/proc/report

--

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
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RHODE ISLAND-Entire State
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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
17.0% XX0.00    No longer a valid ICD-9 code. Click here to search for current ICD-9 code.

No related ICD-10 codes.
6.5% 730.26    Unspecified osteomyelitis, lower leg M86.9   Osteomyelitis, unspecified
3.1% 999.9    Other and unspecified complications of medical care, not otherwise classified T88.8XXA   Other specified complications of surgical and medical care, not elsewhere classified, initial encounter
OR:
T88.9XXA   Complication of surgical and medical care, unspecified, initial encounter
3.0% 707.15    Ulcer of other aprt of foot L97.509   Non-pressure chronic ulcer of other part of unspecified foot with unspecified severity
2.5% 729.5    Pain in limb M79.609   Pain in unspecified limb
1.9% 730.07    Acute osteomyelitis, ankle and foot M86.179   Other acute osteomyelitis, unspecified ankle and foot
OR:
M86.279   Subacute osteomyelitis, unspecified ankle and foot
1.7% 427.31    Atrial fibrillation I48.91   Unspecified atrial fibrillation
1.6% 723.1    Cervicalgia M54.2   Cervicalgia
1.5% 088.81    Lyme disease A69.20   Lyme disease, unspecified
1.4% 728.87    Muscle weakness (generalized) M62.81   Muscle weakness (generalized)

* 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.

99199 not found in an Local Coverage Determination (LCD) for your contractor. Other contractors covering 99199

CCI and MUE Edits*         Hide this section.


Medically Unlikely Edits for 99199

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.


   99199 Top 5 Ordering Providers National*
MOHINDER CHAWDHRY -BATTLE CREEK,MI 237
ANTHONY CRIBELLI -CAMBRIDGE,NE 228
JASON LIEBLER -MARLETTE,MI 161
KRISTY PENICK -BATTLE CREEK,MI 148
KRISTA SCOTT -TRAVERSE CITY,MI 142

   99199 Top 5 Ordering Organizations National*
PACIFIC DIAGNOSTIC LABORATORIES-CA 26

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



   Medicare Part B Utilization Data for 99199*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2015: 137,640
Total Services Denied 2015: 132,878 (96.5%)
National Charges Submitted 2015: $ 19,678,676.00
National Charges Allowed 2015: $ 162,450.00
National Average (No Modifier) Fee Submitted 2015: $142.71
National Average (No Modifier) Fee Allowed 2015: $ 50.72
National Average (26) Fee Submitted 2015: $219.24
National Average (26) Fee Allowed 2015: $ 0.00
National Average (QW) Fee Submitted 2015: $ 31.50
National Average (QW) Fee Allowed 2015: $ 0.00


Top 5 Performing Specialties 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
General practice 77,222 56.1% $163.19 76,358 98.9%
Family practice 16,301 11.8% $ 72.84 16,292 99.9%
Unknown physician specialty 9,830 7.1% $ 72.89 9,822 99.9%
Clinical laboratory
(billing independently)
6,694 4.9% $ 37.74 6,688 99.9%
Infectious disease 4,076 3.0% $275.76 4,076 100.0%

Top 5 Places of Service 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 68,591 49.8% $ 88.43 64,823 94.5%
Home 17,555 12.8% $156.88 17,444 99.4%
Other unlisted facility 8,327 6.0% $317.44 8,018 96.3%
Independent laboratory 8,283 6.0% $ 38.85 8,273 99.9%
Outpatient hospital 2,141 1.6% $305.74 2,130 99.5%

Top 5 Modifiers Submitted 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 111,619 81.1% $142.71 110,528 99.0%
CC 11,926 8.7% $ 42.88 8,795 73.7%
GY 7,309 5.3% $367.41 7,309 100.0%
76 - Repeat Procedure by Same Physician 4,624 3.4% $ 74.72 4,245 91.8%
59 - Distinct Procedural Service 1,351 1.0% $ 76.33 1,330 98.4%

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 12:17:35 54.167.149.128

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