Monday, July 26, 2010

Billing CPT 95810,95808,95807 WITH covered diagnosis

Medicare is establishing the following coverage for CPT/HCPCs 95807, 95808, 95810:

Covered for ICD-9-CM indications:

278.01 MORBID OBESITY
307.41 - 307.48 TRANSIENT DISORDER OF INITIATING OR MAINTAINING SLEEP - REPETITIVE INTRUSIONS OF SLEEP
327.10 - 327.15 ORGANIC HYPERSOMNIA, UNSPECIFIED - HYPERSOMNIA DUE TO MENTAL DISORDER
327.19 OTHER ORGANIC HYPERSOMNIA
327.20 - 327.27 ORGANIC SLEEP APNEA, UNSPECIFIED - CENTRAL SLEEP APNEA IN CONDITIONS CLASSIFIED ELSEWHERE
327.29 OTHER ORGANIC SLEEP APNEA
327.30 - 327.37 CIRCADIAN RHYTHM SLEEP DISORDER, UNSPECIFIED - CIRCADIAN RHYTHM SLEEP DISORDER IN CONDITIONS CLASSIFIED ELSEWHERE
327.40 - 327.42 ORGANIC PARASOMNIA, UNSPECIFIED - REM SLEEP BEHAVIOR DISORDER
327.44 PARASOMNIA IN CONDITIONS CLASSIFIED ELSEWHERE
327.51 - 327.53 PERIODIC LIMB MOVEMENT DISORDER - SLEEP RELATED BRUXISM
333.2 MYOCLONUS
347.00 - 347.01 NARCOLEPSY, WITHOUT CATAPLEXY - NARCOLEPSY, WITH CATAPLEXY
347.10 - 347.11 NARCOLEPSY IN CONDITIONS CLASSIFIED ELSEWHERE, WITHOUT CATAPLEXY - NARCOLEPSY IN CONDITIONS CLASSIFIED ELSEWHERE, WITH CATAPLEXY
518.83 CHRONIC RESPIRATORY FAILURE
780.50 - 780.51 UNSPECIFIED SLEEP DISTURBANCE - INSOMNIA WITH SLEEP APNEA, UNSPECIFIED
780.53 - 780.58 HYPERSOMNIA WITH SLEEP APNEA, UNSPECIFIED - SLEEP RELATED MOVEMENT DISORDER, UNSPECIFIED
786.04 CHEYNE-STOKES RESPIRATION

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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download