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The following chart is periodically revised. Refer to Appendix 3 of this handbook for applicable type of service (TOS) codes and descriptions.
|
Current Procedural Terminology (CPT) Procedure Codes |
||
|
Service |
Code(s) |
Type of Service |
|
Insertion, implantable contraceptive capsules |
11975 |
2 |
|
Removal, implantable contraceptive capsules |
11976 |
2 |
|
Removal with reinsertion, implantable contraceptive capsules |
11977 |
2 |
|
Intrauterine Device — Female Genital System |
58300-58301 |
2 |
|
Maternity Care and Delivery |
59025, 59300, 59400-59430, 59610-59614, W6000-W6001 |
9 |
|
59400-59410, 59514, |
8 |
|
|
Diagnostic Ultrasound |
76816 |
4 |
|
76819 |
4, Q, U |
|
|
Urinalysis |
81001-81003 |
5 |
|
Chemistry |
82565, 82950, 84132, 84295, 84450, 84520, 84550, 84703 |
5 |
|
Hematology and Coagulation |
85018, 85025, 85027 |
5 |
|
Immunology |
86592, 86703, 86762 |
5 |
|
Unlisted Immunology Procedure |
86849 (Newborn screening card) |
5 |
|
Transfusion Medicine |
86850, 86900 |
5 |
|
Microbiology |
87070, 87081, 87210, 87340, 87491, 87880 |
5 |
|
Cytopathology |
88164 |
5 |
|
Immune Globulins |
90384 |
1 |
|
Therapeutic or Diagnostic Infusions |
90780-90781 |
1 |
|
Therapeutic, Prophylactic or Diagnostic Injections |
90782 |
9 |
|
Special Services, Procedures and Reports |
99000-99001 |
9 |
|
99070 |
1 |
|
|
Evaluation and Management |
99201-99215 |
9 |
|
Prolonged Services* |
99354*-99355* |
9 |
|
Newborn Care |
99432 |
9 |
|
99436 |
1 |
|
|
99440 |
9 |
|
|
Unlisted Evaluation and Management Service |
99499 |
9 |
|
Preventive Medicine |
99381, 99391 |
9 |
|
Injection, ampicillin sodium/sulbactam sodium, per 1.5 gram |
J0295 |
1 |
Injection, medroxyprogesterone acetate for contraceptive use, 150 mg |
J1055 |
9 |
Injection, methylergonovine maleate, [Methergine Maleate], up to 0.2 mg |
J2210 |
1 |
Injection, oxytetracycline HCl, up to 50 mg |
J2460 |
1 |
Injection, RHo(D) immune globulin, human, [Rhogam], one dose package |
J2790 |
1 |
Injection, phytonadione (vitamin K), per 1 mg |
J3430 |
1 |
Intrauterine copper contraceptive |
J7300 |
1 |
Levonorgestrel-releasing intrauterine contraceptive system, 52 mg |
J7302 |
1 |
*This procedure code must be submitted on a HCFA 1500 claim form with documentation attached to the claim showing medical necessity. This code should be billed by a certified nurse midwife (CNM) only in place of service "4" (home) when the CNM attends the labor of a patient and subsequently admits the patient to the hospital for the birth.
Wisconsin Medicaid
Nurse Midwife Services Handbook
PHC 1411, September 2003