docJan 8th - 2013 CPT Codes
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Jan 8th - 2013 CPT Codes
CareOregon Advantage Plus/Star AND CareOregon OHP Plus NO AUTHORIZATION REQUIRED - CPT CODE LIST Revised February 15, 2015 PLEASE NOTE: See Authorization Overview document for details regarding CareOregon's CPT code changes occur annually and occasionally through out the year. It's important that INSTRUCTIONS 1. Use this code list in conjuction with the Authorization Guidelines based on the member's 2. This list only applies when the services are performed in following settings: a) office , b) ancillary, c) ASC for ASC approved procedures, and d) facility day patient/surgery OHP MEMBERS - additional instructions: 1. For diagnostic (dx) procedures - Prioritized list does not apply 2. For treatment (tx) procedures - Prioritized list applies Procedure Code Dx or Tx Procedure 10021-10022 10060-10180 11000-11057 11100-11101 Dx Tx Tx Dx 11200-11201 11300-11313 11600-11646 11719-11765 11770-11772 11960-11976 11981-11983 12001-13160 14000-14350 15271-15276 Tx Tx Tx Tx Tx Tx Tx Tx Tx Tx 15277 15278 17000-17315 19000-19030 19100-19101 Tx Tx Tx Tx Dx 19105 19110-19120 19125-19272 19296-19298 20005-20150 20200-20251 20600-20610 20650-20696 Tx Tx Dx Tx Tx Dx Tx Tx Limitations or Special Instructions No auth applies to COA mbrs only! Excluded svc for OHP mbrs. No auth applies to COA mbrs only! Excluded svc for OHP mbrs. No auth applies to COA mbrs only! Excluded svc for OHP mbrs. Biopsy Codes CareOregon NO authorization required CPT Code List - Revised 2/15/15- Page 1 of 11 20697 20900 21116 21310-21497 21501-21550 21557-21632 21800 - 21825 22010-22015 22305-22328 23065-23066 23077-23220 23350 23500-23680 23700 23930-23931 24065-24066 24077-24155 24500-24685 25000-25040 25065-25066 25077-25107 25246 25500-25695 26010-26037 26100-26110 26600-26785 26990-26991 27040-27041 27093-27095 27193 - 27269 27275 27280-27286 27290-27295 27301-27303 27323 27370 27372 27500-27566 27570 27580 27590-27598 27600-27612 27613-27614 27615-27616 27645-27647 27648 27750-27848 27860 Tx Tx Dx Tx Tx Tx Tx Tx Tx Dx Tx Dx Tx Tx Tx Dx Tx Tx Tx Dx Tx Dx Tx Tx Dx Tx Tx Dx Dx Tx Tx Tx Tx Tx Dx Dx Tx Tx Tx Tx Tx Tx Dx Tx Tx Dx Tx Tx No auth applies to COA mbrs only! Excluded svc for OHP mbrs. Inj proc for TMJ arthrography Biopsy Codes Inj proc for shoulder arthrography Biopsy Codes Biopsy Codes Inj proc for wrist arthrography Biopsy Codes Injection procedures. Biopsy Code Inj proc for knee arthrography Biopsy Codes Inj proc for ankle arthrography CareOregon NO authorization required CPT Code List - Revised 2/15/15- Page 2 of 11 27870-27871 27880-27889 28001-28005 28400-28675 28705-28760 28800-28825 29000-29515 29700-29750 29805-29863 29870-29907 30901-30920 31231-31235 31502 31505-31510 31511-31513 31515 31520 31525-31526 31527-31531 31535-31536 31540-31541 31545-31546 31560-31561 31570-31571 31575-31576 31577-31578 31579 31615 31620 31622-31626 Tx Tx Tx Tx Tx Tx Tx Tx Dx Dx Tx Dx Tx Dx Tx Dx Dx Dx Tx Dx Tx Tx Tx Tx Dx Tx Dx Dx Tx Dx 31627 31628-31629 31630-31631 31632-31633 31634-31649 Tx Dx Tx Dx Tx 31651-31661 31717 31720-31725 31730 32550-32557 32607-32609 33202-33249 35471-35476 36000 36002 36005 36010-36015 Tx Dx Dx Tx Tx Dx Tx Tx Tx Tx Dx Tx Arthroscopy Arthroscopy Diagnostic endoscopy No auth applies to COA mbrs only! Excluded svc for OHP mbrs. No auth applies to COA mbrs only! Excluded svc for OHP mbrs. CareOregon NO authorization required CPT Code List - Revised 2/15/15- Page 3 of 11 36100-36218 36221-36228 36245-36248 36251-36254 36260-36262 36400-36460 36555-36598 36600-36620 36625-36660 36800-36870 37184-37200 37211- 37217 Tx Dx Tx Dx 37250-37251 38220-38221 38300 38500-38530 40490 Dx Dx Tx Dx Dx 40800 40808-40816 40830-40831 41019 41100-41108 41250-41252 41800-41806 41820-41850 42100 42180-42182 42300-42320 42700 43200 43201 43202 43204-43206 43211 43212-43229 43231-43232 43233 43235 43236 43237-43239 43240-43241 43242 43243-43251 Tx Dx Tx Tx Dx Tx Tx Tx Dx Tx Tx Tx Dx Tx Dx Tx Dx Tx Dx Tx Dx Tx Dx Tx Dx Tx 43252 43253-43254 43255 Tx Dx Tx Tx Tx Dx Tx Tx Tx Tx Biopsy Codes Biopsy Code No auth applies to COA mbrs only! Excluded svc for OHP mbrs. Biopsy Codes Biopsy Codes Biopsy Code No auth applies to COA mbrs only! Excluded svc for OHP mbrs. CareOregon NO authorization required CPT Code List - Revised 2/15/15- Page 4 of 11 43257 43259 43260-43270 43752-43761 44388-44397 44970 45300-45387 Tx Dx Tx Tx Dx Tx Dx 45391-45392 46600-46615 46900-46924 47000-47001 47100 48400 49082-49084 49180 49400 49402-49436 49440-49465 50200 50551-50580 50590 50684-50690 50951-50980 51020-51597 51600-51610 51700-51720 51725-51798 52000-52010 52204-52318 52320-52346 52351 52352-52356 52400 Dx Dx Tx Dx Dx Dx Dx Dx Dx Tx Tx Dx Dx Tx Dx Dx Tx Dx Tx Dx Dx Dx Tx Dx Tx Dx 52402 52450-52640 52647-52648 52649 53600-53601 53620-53661 54050-54055 54065 54100 54500-54505 54512-54535 54640-54650 54670 Dx Tx Tx Tx Tx Tx Tx Tx Dx Dx Tx Tx Tx No auth applies to COA mbrs only! Excluded svc for OHP mbrs. Colonoscopy through stoma Endoscopy procedures including colonscopy No auth applies to COA mbrs only! Excluded svc for OHP mbrs. Endoscopy procedures Biopsy Codes Biopsy Code Inj proc for pancreatography Biopsy Code Biopsy Code Endoscopy procedures Inj proc for ureterography/ureterophyelography Endoscopy procedures No auth applies to COA mbrs only! Excluded svc for OHP mbrs. Biopsy Code Biopsy Codes CareOregon NO authorization required CPT Code List - Revised 2/15/15- Page 5 of 11 55250 Tx 55300-55400 55700-55706 55875-55876 56405-56440 56501-56515 56605-56606 56820-56821 57022-57023 57061-57065 57100-57105 57150-57180 57420-57421 57423-57452 57454-57460 57461 57500 57505-57522 57530-57531 57800 58100-58110 58120 Tx Dx Tx Tx Tx Dx Dx Tx Tx Dx Tx Dx Tx Dx Tx Dx Tx Tx Tx Dx Tx 58300 58301 Tx Tx 58340 Dx 58565 Tx 58600-58615 Tx 58670-58671 58673 59000-59070 59100-59160 59412 59812-59830 59840-59866 Tx Tx Tx Tx Tx Tx Tx 59870 60000 60100 60200-60281 60500-60650 Tx Tx Dx Tx Tx Vasectomy - No auth applies to OHP mbrs only! No auth applies to COA mbrs only! Excluded svc for OHP mbrs. Biopsy Codes Biopsy Codes Endoscopy procedures Biopsy Codes Biopsy Codes No auth applies to OHP mbrs only. Excluded svc for COA mbrs. No auth applies to OHP mbrs only Cath/intro of saline/contrast for sonohysterography or hysterosalpingography Sterilization proc- No auth applies to #1) OHP mbrs only AND #2) when done in an office setting! Auth required if done in ASC or hospital setting! Sterilization consent is required. Sterilization proc- No auth applies to OHP mbrs only! Sterilization consent is required. Auth required for COA mbrs. No auth applies to OHP mbrs only! Auth required for COA mbrs. Abortions Biopsy Code CareOregon NO authorization required CPT Code List - Revised 2/15/15- Page 6 of 11 61070 61796-61800 62267 62270 62272-62273 62284 62290-62291 62365 62367-62370 63620-63621 63661-63664 Tx Tx Dx Dx Tx Dx Dx Tx Tx Tx Tx Inj procedure for myelography Inj procedure for discography 64718-64721 Tx 65270-65286 Tx 66761-66762 Tx 66820-66825 Tx 66830-66986 Tx 67005-67040 Tx 67220-67229 Tx 67311-67340 Tx 67810 Dx Biopsy Code 69000-69020 Tx 69100-69105 Dx Biopsy Codes 69990 Dx Radiology including Nuclear Medicine and Diagnostic Ultrasound CPT Codes 70010-70553 Dx Diagnostic radiology No auth applies to COA mbrs only! Excluded svc for OHP 70554-70555 Dx mbrs. 70557-72158 Dx Diagnostic radiology. No auth applies to OHP mbrs only! Excluded svc for COA 72159 Dx mbrs. 72170-73223 Dx Diagnostic radiology No auth applies to OHP mbrs only! Excluded svc for COA 73225 Dx mbrs. 73500- 74260 Dx Diagnostic radiology/ultrasound/mammography/bone 74270-74740 Dx studies. No auth applies to COA mbrs only! Excluded svc for OHP 74742 Dx mbrs. 74775-76376 Dx No auth applies to COA mbrs only! Excluded svc for OHP 76377 Dx mbrs. 76380-77082 Dx No auth applies to COA mbrs only! Excluded svc for OHP 77084 Dx mbrs. 77261-77372 Tx Radiation oncology procedures No auth applies to COA mbrs only! Excluded svc for OHP 77373 Tx mbrs. 77399-77432 Tx Radiation oncology procedures CareOregon NO authorization required CPT Code List - Revised 2/15/15- Page 7 of 11 77435 77469-77799 78012-78350 Tx Tx Dx 78351 78414-78458 78466-78483 78494-78607 78610-78808 78999 79005-79999 Dx Dx Dx Dx Dx Dx Tx 80047-80102 80150-80412 Dx Dx 80414, 80415 80416-81099 81206-81208 81210 81220-81224 81240-81251 81255-81257 81261-81264 81267-81275 81292-81342 81370-82106 Dx Dx Dx Dx Dx Dx Dx Dx Dx Dx Dx 82107 82108-82608 Dx DX 82610 82615-82747 Dx Dx 82757 82759-83690 Dx Dx 83695-83704 83718-83887 83915-83986 83992-84022 Dx Dx Dx Dx 84030 84035-84144 Dx Dx 84145 84146-84430 Dx Dx 84431 Dx No auth applies to COA mbrs only! Excluded svc for OHP mbrs. Radiation oncology procedures Nuclear medicine No auth applies to COA mbrs only! Excluded svc for OHP mbrs. Nuclear medicine Nuclear medicine Nuclear medicine Nuclear medicine Nuclear medicine Radiopharmaceutical therapy Pathology and Laboratory CPT Codes No auth applies to COA mbrs only! Excluded svc for OHP mbrs. Genetic Testing for Cystic Fibrosis No auth applies to COA mbrs only! Excluded svc for OHP mbrs. No auth applies to COA mbrs only! Excluded svc for OHP mbrs. No auth applies to COA mbrs only! Excluded svc for OHP mbrs. No auth applies to COA mbrs only! Excluded svc for OHP mbrs. No auth applies to COA mbrs only! Excluded svc for OHP mbrs. No auth applies to COA mbrs only! Excluded svc for OHP mbrs. No auth applies to COA mbrs only! Excluded svc for OHP mbrs. CareOregon NO authorization required CPT Code List - Revised 2/15/15- Page 8 of 11 84432-84704 Dx 84830 84999-86304 86308-86355 Dx Dx Dx 86356 86357-86384 Dx Dx 86386 86403-86431 86485-86890 Dx Dx Dx 86891 86900-86906 86920-86950 Dx Dx Dx 86960 86965-87149 87150 87152 87153 87158-87807 87808 87809-87999 88104-88121 Dx Dx Dx Dx Dx Dx Dx Dx Dx 88125 88130-88241 88280-88381 88387-88720 89049-89230 Dx Dx Dx Dx Dx No auth applies to COA mbrs only! Excluded svc for OHP mbrs. No auth applies to COA mbrs only! Excluded svc for OHP mbrs. No auth applies to COA mbrs only! Excluded svc for OHP mbrs. No auth applies to COA mbrs only! Excluded svc for OHP mbrs. No auth applies to COA mbrs only! Excluded svc for OHP mbrs. No auth applies to COA mbrs only! Excluded svc for OHP mbrs. 89240 Dx No auth applies to COA mbrs only! Excluded svc for OHP mbrs. Medicine CPT Codes 91000-91299 90935-90997 90999 Dx Tx Tx Dialysis/End Stage Renal Disease Services 91111, 91117 91120-91122 92002-92014 Dx Dx Tx 92015 92018-92020 92025 92060 Dx Tx Dx Dx No auth applies to COA mbrs only! Excluded svc for OHP mbrs. Refractive exam - No auth applies to CareOregon Advantage members, OHP Plus children (<21) and OHP Plus adults who are pregnant or have a diagnosis of aphakia or keratonconus. CareOregon NO authorization required CPT Code List - Revised 2/15/15- Page 9 of 11 92065 92081-92287 92502-92504 92511-92524 92531-92534 92540-92558 92560-92588 92590-92591 Tx Dx Dx Dx Dx Dx Dx Dx 92592-92593 92594-92595 92610-92617 92960-92961 92973-92998 93000-93229 93260-93261 93268-93278 93279-93284 93285 93286-93290 93291 93292-39296 93297-93352 93355 93451-93568 93571-93657 93660 93662-93668 Dx Dx Dx Tx Tx Dx Tx Dx Tx Dx Tx Dx Tx Dx Tx Dx Tx Dx Tx 93701 93724-93790 93880-93888 Dx Dx Dx 93890-93893 93922-93998 94010-94450 Dx Dx Dx 94452-94453 94620-94621 94640-94668 94680-94799 95250-95830 95831-95852 95857-95927 Dx Dx Tx Dx Dx Dx Dx 95928-95929 95939-95975 95978-95979 Dx Dx Dx Vestibular function tests Audiologic function tests Audiologic function tests No auth applies to COA mbrs only! Excluded svc for OHP mbrs. Cardioversion No auth applies to COA mbrs only! Excluded svc for OHP mbrs. No auth applies to COA mbrs only! Excluded svc for OHP mbrs. Pulmonary studies No auth applies to COA mbrs only! Excluded svc for OHP mbrs. Pulmonary studies Pulmonary tx procedures Pulmonary studies Diagnostic tests No auth applies to COA mbrs only! Excluded svc for OHP mbrs. CareOregon NO authorization required CPT Code List - Revised 2/15/15- Page 10 of 11 95980-95982 95990-96004 96360-96549 96365-96379 96401-96425 96440-96549 97597-97602 Dx Dx Tx Tx Tx Tx Tx 97760-97761 Tx 97810-97811, 97813-97814 98925-98929 99143-99150 99170-99173 99175 Tx Tx Tx Dx Dx No auth applies to COA mbrs only! Excluded svc for OHP mbrs. Injections and infusions Chemotherapy for FDA approved agent only! Other injection & infusion services Orthotic management & prosthetic training by orthopedic surgeon only! All other providers, authorization is required! When performed in a PCP office; chemical dependency treatment; OHP members receiving Hospice care; or a diagnosis of HIV CareOregon NO authorization required CPT Code List - Revised 2/15/15- Page 11 of 11
