Appendix 1

Wisconsin Medicaid-Allowable Procedure Codes for Certified Nurse Midwives

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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,
59610-59614

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.

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Wisconsin Medicaid
Nurse Midwife Services Handbook
PHC 1411, September 2003