Section 8: Medicine
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- Nerve conduction studies: CPT Codes 95900, 95903, 95904, and 95937 require the number of nerves in the time field. These should be listed on Form 25M or the Form 1500. There is a technical and professional component for each of these codes in the new Medical Fee Schedule and modifiers are required.
- Special Services CPT codes will require modifiers. Please reference the Master File to see which codes require 26 and 27.
Technical (taking) “27” or “TC”
Professional (reading) “26”
- The North Carolina Industrial Commission has reviewed processing procedures of diagnostic testing when physicians perform both the technical and professional components at a hospital facility. In accordance with the North Carolina State Health Plan, whom by law the Industrial Commission is to emulate, the North Carolina Industrial Commission is issuing the following rules to apply in cases when the physician or radiologist performs the interpretation (professional) and the diagnostic services (technical) within the hospital facility.
- Hospital may charge for use of equipment.
- No allowance for hospital visit, unless medically necessary for physician to treat patient.
- The Industrial Commission asked Medicode to research CPT Codes
90700-90799. Because of the
variance of cost for the different injections, the providers are not
receiving reimbursement to cover their cost.
We are implementing a policy to allow flexibility in payment when the
injection materials have a significant cost over and above the value of the
procedure. The invoice may be attached to the bill to verify the cost.
If invoice is not submitted, the Carrier has the right to request a
copy if they feel it necessary. We allow a 20 percent (20%) markup above the
When an injection is given during an office visit service provided by a physician, the cost of providing the injection is included in the payment for the office visit. The cost of the injectable medication may be billed using CPT code 99070 or the CPT code(s) assigned in the North Carolina workers’ Compensation Fee Schedule, which is for materials. When the injection is provided without services by the physician, you may use CPT code 99211 and charge for the medication using code 99070 or CPT codes assigned in the Fee Schedule which is for the materials.
- These codes range from 90801 through 90899. None of these codes require time with the exception of 90830. For this code please enter a (1) for 0 to 60 minutes and a (2) for two hours et cetera.
- There are no codes assigned in the CPT book. The Industrial Commission has its own codes:
|Code||Procedure Description||Time Required||Allowance|
|PSY01||Consultation||No time required||$119.00|
|PSY02||Return visit||Time required||$75.00 per hour|
|PSY03||Testing||Time required||$75.00 per hour|
|PSY04||Group||Time required||$20.00 per hour|
- Hypnotherapy—Psychologists are authorized to use CPT Code 90880—the Commission will allow this code for the amount listed in the N.C. Medical Fee Schedule.
- Psychologists may utilize the CPT codes for biofeedback procedures.
- The North Carolina Industrial Commission wishes to address changes in fees for two CPT Codes. Based on recommendation from the North Carolina Industrial Commission Medical Advisory Committee and a decision from the North Carolina Industrial Commission, the reimbursement rates for biofeedback will be changed.
|CPT Code 90901||$78.00||($22.00)|
|CPT Code 90911||$124.00||($176.11)|