New Jersey Administrative Code, Subchapter 9, Section 10:54-9.10 - Descriptions and Qualifiers for Level II and Level III Procedure Codes (except for Pathology/Laboratory) | New Jersey Administrative Code

(a) Introduction:

1. The following is a list of procedure codes with the "modifier L" in the IND column on the list of HCPCS Procedure Codes representing procedure codes specifically used by New Jersey Medicaid and not included in the CPT-4.

(b) Mental Health services:

H5025	Psychotherapy Group (Maximum 8 persons per group: 90 minutes,
per person, per session)
W9106	Crisis Intervention--An emergency procedure provided in a
nursing home by a psychiatric physician to a resident of that
home to meet the immediate need of the resident in psychiatric
crisis and the need of the facility. Request for this service
shall be initiated by the attending physician, or by the nursing
service director, supervisor or designee. Procedure includes
written evaluation, drug prescription, conference with staff and
recommendation of treatment plan. Use of procedure is limited to
once in six months.

(c) Maternity Care:

W9050	Attendance during and pediatric care to newborns at-risk vaginal
deliveries.
QUALIFIER: Attendance by a physicians other than the
physicians(s) rendering maternity care. Medically necessity for
required attendance must be fully documented on the hospital
record as well as a brief explanation written in ITEM 24 on the
1500 N.J. claim form. (Example: Fetal distress). If difficulties
occur so that criteria of prolonged services (HCPCS 99150) or
critical care (99160) can be met, the HCPCS 99150 or 99160 can
be substituted in lieu of W9050. Payment may be in addition to
eligible payment for normal newborn care through HCPCS 99431 or
Hospital Inpatient (99221, 99222, 99223, 99231, 99232, 99233) or
Critical Care (99291 or 99292) codes, as applicable.
W9055	Attendance during and pediatric care to newborns at-risk
caesarean section deliveries.
QUALIFIER: Attendance by a physicians other than the
physician(s) rendering maternity care. Medically necessity for
required attendance must be fully documented on the hospital
record as well as a brief explanation written in ITEM 24 on the
1500 N.J. claim form. (Example: Fetal distress). If difficulties
occur so that criteria of prolonged services (HCPCS 99150) or
critical care (99160) can be met, then HCPCS 99150 or 99160 can
be substituted in lieu of W9050. Payment may be in addition to
eligible payment for normal newborn care through HCPCS 99431 or
Hospital Inpatient (99221, 99222, 99223, 99231, 99232, 99233) or
Critical Care (99291 or 99292) codes, as applicable.

W9855 WM	Initial Antepartum visit. (Separate procedure)
W9855
W9856 WM	Subsequent Antepartum visit. (Separate procedure).
W9856	Indicate the specific dates of service on the HCFA 1500
claim form in Item 24

(d) Intrauterine devices:

W0001 WF	Supplying and inserting the intrauterine device "Paragard"
by a physician including the post insertion visit.
W0001 WM WF	Supplying and inserting the intrauterine device "Paragard"
by a certified nurse-midwife including the post-insertion
visit.
W0002 WF	Supplying and inserting the intrauterine device
"Progestasert" by a physician including the post-insertion
visit.
W0002 WM WF	Supplying and inserting the intrauterine device
"Progestasert" by a certified nurse-midwife including the
post-insertion visit.
W0004 WF	Removal of an IUD by a physician followed at the same
visit by the insertion of the intrauterine device
"Paragard" by a physician including the post-insertion
visit.
W0004 WM WF	Removal of an IUD by a certified nurse-midwife (CNM)
followed at the same visit by the insertion of the
intrauterine device "Paragard" by a CNM including the
post-insertion visit.
W0008 WF	Removal of an IUD by a physician followed at the same
visit by the insertion of the intrauterine device
"Progestasert" by a physician including the post-insertion
visit.
W0008 WM WF	Removal of an IUD by a certified nurse-midwife (CNM)
followed at the same visit by the insertion of the
intrauterine device "Progestasert" by a CNM including the
post-insertion visit.

(e) Pulmonary function tests:

W9450	Combined pulmonary function testing (for basic evaluation of
pulmonary physiology includes complete spirometry and any 6 or
more pulmonary function studies

(f) Hepatitis B Vaccine Immunization:

1. Coverage is available for post exposure prophylaxis and for vaccination of individuals in selected high risk groups, regardless of age, in accordance with the criteria defined by the CDC. In all such cases, the need for this vaccination must be fully documented in the recipient's medical record. In order to facilitate reimbursement for Hepatitis B immunoprophylaxis for high risk individuals, manufacturer, age, and dose specific procedure codes have been developed for use by physicians and independent clinics providing this service.

2. EXCEPTION: The New Jersey Medicaid program will reimburse for the universal vaccination of infants born on and after January 1, 1992, whose immunization was delayed beyond the newborn period because this policy was not yet in effect. However, the immunization schedule must be completed before the infant's second birthday.

W9096	Hepatitis B immunoprophylaxis with Recombivax HB,
0.25 ml dose. This code applies only to newborns of HBsAg
negative mothers.
W9096 22	Hepatitis B immunoprophylaxis with Recombivax HB,
0.5 ml dose. This code applies only to newborns of HBsAg
positive mothers.
W9097	Hepatitis B immunoprophylaxis with Recombivax HB,
0.25 ml dose. This code applies only to high risk recipients
under 11 years of age (exclusive of newborns).
W9098	Hepatitis B immunoprophylaxis with Recombivax HB,
0.5 ml dose. This code applies only to high risk recipients
11-19 years of age.
W9099	Hepatitis B immunoprophylaxis with Recombivax HB,
1.0 ml dose. This code applies only to high risk recipients
over 19 years of age.
W9333	Hepatitis B immunoprophylaxis with Engerix-B,
0.5 ml dose. This code applies only when immunizing
newborns.
W9334	Hepatitis B immunoprophylaxis with Engerix-B,
0.5 ml dose. This code applies only to high risk recipients
under 11 years of age (exclusive of newborns).
W9335	Hepatitis B immunoprophylaxis with Engerix-B,
1.0 ml dose. This code applies only to high risk recipients
over 11 years of age.

(g) Certified Nurse Midwife code for Home Delivery:

Z0250 WM	Home Delivery Pack
QUALIFIER: All drugs and supplies, etc. necessary for the
delivery in this setting.

(h) Speech-language pathology:

Z0300	Speech/Language Pathology--Initial Visit Screening Examination
QUALIFIER: Screening examination only, per individual, per
provider.
NOTE: It is the intent of the program to reimburse for either a
screening examination or a comprehensive speech/ evaluation
rendered to the patient, not both. If, as a result of the
screening examination, it is felt that a comprehensive
examination is necessary, it should be completed at that time or
at the earliest mutual convenience of the patient and the
provider. The screening examination, in this instance becomes an
integral part of the comprehensive speech/language evaluation
and the claim submitted to the Program shall be for a
comprehensive evaluation. If, however, the documentation reveals
that the screening examination did not support the need for a
comprehensive evaluation, the code that must be billed is Z0300
Speech/Language Pathology--Initial Visit Screening Examination.
Z0310	Initial Comprehensive Speech/Language Pathology Evaluation by a
Certified Speech/Language Pathologist.
QUALIFIER: This procedure code is used to bill for assessment
and diagnosis(es) a problem, or problems, in any of the
following areas: language competence and performance,
phonological development or articulation skills, and/or physical
integrity and performance of the speech mechanism including the
respiratory, phonatory and articulation systems. Such evaluation
requires 3 hours on the average. Discussion and consultation
with the patient and/or family regarding findings and a written
report are considered an integral part of the evaluation.
NOTE: It is the intent of the program to reimburse for either a
screening examination or a comprehensive speech/ evaluation
rendered to the patient, not both. If, as a result of the
screening examination, it is felt that a comprehensive
examination is necessary, it should be completed at that time or
at the earliest mutual convenience of the patient and the
provider. The screening examination, in this instance, becomes
an integral part of the comprehensive evaluation and the claim
submitted to the Program shall be for a comprehensive
speech/language evaluation. If, however, the documentation
reveals that the screening examination did not support the need
for a comprehensive evaluation, the code that must be billed is
Z0300 Speech/Language Pathology--Initial Visit Screening
Examination.

(i) PreAdmission Screening and Annual Resident Review (PASARR)

There are two sets of HCPCS procedure codes used for PreAdmission Screening (PAS) of PASARR Level II Screening as follows:

1. The reimbursement for both HCPCS procedure codes 90801 and W9847 with a Medicaid maximum fee allowance of $ 100.00 is used by a psychiatrist and can be used in any setting for hospital or community.

i. Psychiatric diagnostic interview examination including history, mental status, or disposition (may include communication with family or other sources, ordering and medical interpretation of laboratory or other medical diagnostic studies. In certain circumstances other informants will be seen in lieu of the patient)

NOTE: The HCPCS codes 99313, W9849, 99333 and W9848 cannot

bill along with consultation codes when rendered by the same

physicians. The provider must use HCPCS codes 90801 and W9847.

QUALIFIER: This procedure is used for Medicare/Medicaid

applicants who require an initial PASARR Level II Screen

PreAdmission Screening (PAS of PASARR) and are being examined

by a psychiatrist to determine the need for specialized

services for mental illness, prior to admission into a nursing

facility (NF), as required by Federal law.

It must be performed only by a Board Certified or Board

Eligible Psychiatrist who must personally examine the patient.

For hospital patients, the examining psychiatrist must attach

a completed Division of Mental Health and Hospitals

Psychiatric Evaluation form (DMH&H-1989) to the patient's

clinical chart. The hospital Discharge Planning or Social

Services unit will be responsible for the submission of the

Psychiatric Evaluation form to the Division of Mental Health

and Hospitals, CN-727, Trenton, New Jersey 08625-0727,

Attention: PASARR Coordinator.

For community patients, the examining psychiatrist will be

responsible for obtaining the Division of Mental Health and

Hospitals Psychiatric Evaluation form (DMH&H-1989) from the

Medicaid District Office and submitting the completed form to

the Division of Mental Health & Hospitals, CN-727, Trenton,

New Jersey 08625-0727, Attention: PASARR Coordinator.

NOTE: The evaluation form must be mailed no later than 48

hours following the consultation to prevent undue delay in

patient placement.

2. The reimbursement for both HCPCS procedure codes 99333 and W9848 with a Medicaid maximum fee allowance of $ 44.00 is used by an attending physician (non-psychiatrist) when a psychiatrist is not readily or immediately available in a community setting.

i. Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least two of these three components:

(1) A detailed interval history;

(2) A detailed examination;

(3) Medical decision making of high complexity.

QUALIFIER: This procedure is used for Medicare/Medicaid

persons residing in the community (currently at home or

boarding home) who are applicants to Medicare/Medicaid nursing

facilities and are being examined by an attending physician to

determine the need for specialized services for mental illness.

If this examination reveals the need for a more specialized

examination, a psychiatric consultation may be requested by

the attending physician. Existing consultation codes for

limited consultation and for comprehensive consultation may be

used for this purpose by the consulting psychiatrist as

appropriate.

If the individual has a diagnosis of Alzheimer's disease or

related dementias, as described in the 1987 edition of the

Diagnostic and Statistical Manual of Mental Disorders,

documentation must be provided to the admitting Medicaid

certified nursing facility, for the individual's clinical

record, on the history, physical examination, and diagnostic

workup, to support the diagnosis. (A new examination does not

have to be completed.)

The examining attending physician will be responsible for

obtaining the Division of Mental Health and Hospitals

Psychiatric Evaluation form (DMH&H-1989) from the Medicaid

District Office and submitting the completed form to the

Division of Mental Health and Hospitals, CN-727, Trenton, New

Jersey 08625-0727, Attention: PASARR Coordinator.

NOTE: The evaluation form must be mailed no later than 48

hours following the consultation to prevent undue delay in

patient placement.

3. There is one set of HCPCS procedure codes used for Annual Resident Review (ARR) of PASARR as follows:

The reimbursement for both HCPCS procedure codes 99313 and W9849 with a Medicaid maximum fee allowance of $ 44.00 are used for Medicare/Medicaid nursing facility patients who are being evaluated by an attending physician for the purposes of an annual resident review to determine the need for specialized services for mental illness.

i. Subsequent nursing facility care, per day, for the evaluation and management of a new or established patient, which requires at least two of these three components:

(1) A detailed interval history;

(2) A detailed examination;

(3) Medical decision making of moderate to high complexity.

QUALIFIER: If this examination reveals the need for a more

specialized examination, a psychiatric consultation may be

requested by the attending physician. Existing consultation

codes for limited consultation and for comprehensive

consultation may be used for this purpose by the consulting

psychiatrist as appropriate.

If the individual has a diagnosis of Alzheimer's disease or

related dementias, as described in the 1987 edition of the

Diagnostic and Statistical Manual of Mental Disorders,

documentation must be provided to the admitting Medicaid

certified nursing facility, for the individual's clinical

record, on the history, physical examination, and diagnostic

workup, to support the diagnosis. (A new examination does not

have to be completed.)

These codes can only be utilized on an annual basis by the

same physician on the same patient.

The examining attending physician must attach a completed

Division of Mental Health and Hospitals Psychiatric Evaluation

form (DMH&H-1989) to the patient's clinical chart. The Nursing

Facility administrator will be responsible for providing these

forms to the attending physician as well as submitting the

completed form to the Division of Mental Health and Hospitals,

CN-727, Trenton, New Jersey 08625-0727, Attention: PASARR

Coordinator.

NOTE:	The evaluation form must be mailed no later than 48
hours following the consultation.

(j) HealthStart Maternity Medical Care Services and Health Support Services for Physicians

1. Separate reimbursement shall be available for Maternity Medical Care Services and Maternity Health Support Services.

2. Maternity Medical Care Services shall be billed as a total obstetrical package when feasible, but may also be billed as separate services.

3. The enhanced reimbursement (i.e. HealthStart procedure codes) for delivery and postpartum care shall be claimed only for a patient who received at least one antepartum HealthStart maternity medical and Health Support Service.

4. Laboratory, other diagnostic procedures, and all necessary medical consultations are eligible for separate reimbursement.

i. Laboratory procedures performed by an outside laboratory shall be reimbursed to the laboratory.

5. HealthStart Maternity Medical Care Services codes are as follows:

W9025	HealthStart INITIAL ANTEPARTUM MATERNITY	72.00	69.00
MEDICAL CARE VISIT, includes:
W9025 WM	67.00

1. History, including system review;

2. Complete physical examination;

3. Risk assessment;

4. Initial plan of care;

5. Patient counseling and treatment;

6. Routine and special laboratory services on site or by referral, as appropriate;

7. Referrals for other medical consultations, as appropriate (including dental); and

8. Coordination with the HealthStart Health Support Services provider, as applicable.

W9026	HealthStart SUBSEQUENT	22.00	21.00
ANTEPARTUM MATERNITY MEDICAL CARE VISIT,
includes:
W9026 WM	19.00

1. Interim history;

2. Physical examination;

3. Risk assessment;

4. Review of plan of care;

5. Patient counseling and treatment;

6. Laboratory services on site or by referral, as appropriate;

7. Referrals for other medical consultations, as appropriate (including dental);

8. Coordination with HealthStart case coordinator.

NOTE:	This code may be billed only for the 2nd through
antepartum visit.
NOTE:	If medical necessity dictates, corroborated by the
record, additional visits above the fifteenth visit
may be reimbursed under procedure code, i.e. 99211,
99212, 99213, 99214, and 99215. The date and place of
service shall be included on each claim detail line on
the 1500 N.J. claim form. The claim form should
clearly indicate the reason for the medical necessity
and date for each additional visit.
W9027	HealthStart REGULAR DELIVERY, includes: 465.00 418.00
W9027 WM	371.00

1. Admission history;

2. Complete physical examination;

3. Vaginal delivery with or without episiotomy and/or forceps;

4. Inpatient postpartum care;

5. Referral to postpartum follow-up care provider including:

(a) Mother's hospital discharge summary; and the

(b) Infant's discharge summary, as appropriate.

Click here to view table.

1. Outpatient postpartum care by the 60th day after the vaginal or caesarean section delivery includes:

(a) Review of prenatal, labor and delivery course;

(b) Interim history, including information on feeding and care of the newborn;

(c) Physical examination;

(d) Referral for laboratory services, as appropriate;

(e) Referral for ongoing medical care, when appropriate; and

(f) Patient counseling and treatment.

NOTE:	The postpartum visit shall be made by the 60th
postpartum day. Include the delivery date on the
1500 N.J. claim form in Item 24A.
W9029	HealthStart REGULAR DELIVERY AND POSTPARTUM 487.00 439.00
includes:
W9029 WM	390.00

1. Admission history;

2. Complete physical examination;

3. Vaginal delivery with or without episiotomy and/or forceps;

4. Inpatient postpartum care;

5. Referral to postpartum follow-up care provider including:

(a) Mother's hospital discharge summary; and

(b) Infant's discharge summary, as appropriate.

6. Outpatient postpartum care by the 60th day after the delivery;

(a) Review of prenatal, labor and delivery course;

(b) Interim history, including information on feeding and care of the newborn;

(c) Physical examination;

(d) Referral for laboratory services, as appropriate;

(e) Referral for ongoing medical care, when appropriate; and

(f) Patient counseling and treatment.

NOTE:	This code applies to a full term or premature
vaginal delivery and includes care in the home,
birthing center or in the hospital (inpatient
setting.) Include delivery date on the 1500 N.J. claim
form in Item 24A.
W9030	HealthStart TOTAL OBSTETRICAL CARE 867.00 802.00
W9030 WM	723.00

Total obstetrical care consists of:

1. INITIAL ANTEPARTUM VISIT AND FOURTEEN SUBSEQUENT ANTEPARTUM VISITS. Specific dates are to be listed on the claim form.

NOTE:	Reimbursement will be denied if the services
delivered do not meet the criteria for the visits.
The elements of the visits shall include the
following:

a. History (initial or review), including system review;

b. Complete physical examination;

c. Risk assessment;

d. Initial and ongoing care plan;

e. Patient counseling and treatment;

f. Routine and special laboratory tests on site, or by referral, as appropriate;

g. Referral for other medical consultations, as appropriate (including dental); and

h. Coordination with the HealthStart Health Support Services provider, as applicable.

W9031	HealthStart CAESAREAN SECTION DELIVERY,	595.00	531.00
includes:

1. Admission history;

2. Complete physical examination;

3. Caesarean section delivery;

4. Inpatient postpartum care;

5. Referral to postpartum follow-up care provider, including:

a. Mother's hospital discharge summary;

b. Infant's discharge summary, as appropriate;

NOTE: Include the delivery date on the claim
form.
W9040	HealthStart enrollment process	30.00

1. Assistance with the presumptive eligibility determination for Maternity Care recipients, when and if applicable;

2. Patient registration and scheduling of the initial appointments;

3. Counseling and referral for WIC, food stamps, and other community-based services;

4. Assignment of HealthStart case coordinator; and

5. Outreach and follow-up on missed appointments.

NOTE: This code may be billed only once during
pregnancy by the same provider.
W9041	HealthStart Development of Maternity Plan of	120.00
Care, includes:

1. Case coordination services;

2. Initial assessments:

a. Nutrition;

b. Health education; and

c. Social/psychological.

3. Case conference with Maternity Medical Care provider;

4. Initial plan of care developed by the HealthStart case coordinator;

5. Basic guidance and health education services;

6. Referral for other services including follow-up with County Boards of Social Services; and

7. Outreach, referral and follow-up activities including phone calls and letters.

NOTE: This code may be billed only once during
the pregnancy by the same provider.
W9042	HealthStart Subsequent Maternity Health Support	50.00
Services Visit, includes:

1. Case coordination;

2. Review and update of care plan;

3. Coordination with maternity medical care provider;

4. Health education instruction;

5. Social/psychological guidance;

6. Nutrition guidance;

7. Home visit for high risk clients; and

8. Outreach, referral and follow-up activities including phone calls and letters.

NOTE: This code may be billed only once per
trimester and not more than twice per
pregnancy.
W9043	HealthStart Postpartum Maternity Health Support	100.00
Services, includes:

1. Case coordination services;

2. Review of the plan of care;

3. Review of the summary of hospital stay records and current medical status;

4. Nutrition assessment and counseling;

5. Social/psychological assessment and counseling;

6. Health education assessment and instruction;

7. Home visit(s) as applicable;

8. Referral, outreach and follow-up services;

9. Referral for pediatric preventive care and follow-up;

10. Transfer of pertinent information to pediatric, future family planning and medical care providers; and

11. Completion of the plan of care.

(k) HealthStart Pediatric Preventive Care code requirements are as follows:

1. HealthStart Pediatric Care Guidelines provide for up to nine preventive child health visits for a child under two years of age.

i. All preventive child health visits shall be billed using the HealthStart Preventive Child Health Visit codes appropriate to the child's age at the time of visit. Each preventive child health visit HCPCS procedure code may be claimed only once per child.

ii. Claims shall be submitted using Form MC-19, EPSDT/HealthStart Screening and Related Procedures.

2. Laboratory, other diagnostic procedures, and all necessary medical consultations shall be eligible for separate reimbursement.

i. Laboratory procedures performed by an outside laboratory shall be reimbursed to the laboratory.

3. HealthStart Pediatric Preventive Care codes represent visits based on an infant's age according to the following schedule:

W9060	Under 6 weeks	31.00	26.00
W9061	Between 6 weeks and 3 months	31.00	26.00
W9062	Between 3 months and 5 months	31.00	26.00
W9063	Between 5 months and 8 months	31.00	26.00
W9064	Between 8 months and 11 months	31.00	26.00
W9065	Between 11 months and 14 months	31.00	26.00
W9066	Between 14 months and 17 months	31.00	26.00
W9067	Between 17 months and 20 months	31.00	26.00
W9068	Between 20 months and 24 months	31.00	26.00

4. Early and Periodic, Screening, Diagnosis and Testing (EPSDT)

W9060 WT	Under 6 weeks	23.00	18.00
W9061 WT	Between 6 weeks and 3 months	23.00	18.00
W9062 WT	Between 3 months and 5 months	23.00	18.00
W9063 WT	Between 5 months and 9 months	23.00	18.00
W9064 WT	Between 9 months and 11 months	23.00	18.00
W9065 WT	Between 11 months and 14 months	23.00	18.00
W9066 WT	Between 14 months and 17 months	23.00	18.00
W9067 WT	Between 17 months and 20 months	23.00	18.00
W9068 WT	Between 20 months and 24 months	23.00	18.00
W9820	Every 12 months thereafter	23.00	18.00
NOTE:See N.J.A.C. 10:54-5.5 for more information about
EPSDT.

5. HealthStart Pediatric Preventive Care Visit includes the following elements:

i. History including behavior and environmental factors;

ii. Developmental assessment; and

iii. Complete, unclothed physical examination by a physician or a nurse practitioner under the personal supervision of a physician, to include:

(1) measurements: height, weight and head circumference;

(2) vision and hearing screening; and

(3) nutritional assessment.

iv. Assessment and administration of immunizations (see appropriate HCPCS procedure codes for reimbursement amounts);

v. Anticipatory guidance;

vi. Arrangement for diagnosis and treatment of medical problems uncovered during the visit. This includes self-referrals and/or referrals to other providers as medically indicated;

vii. Appropriate laboratory procedures performed, or referred, in accordance with HealthStart Pediatric Care Guidelines.

(1) Sickle cell, PKU screening, as appropriate;

(2) Hemoglobin or hematocrit twice, at 6-9 months and 20-24 months of age;

(3) Urinalysis, twice: at 6-9 months and 20-24 months of age;

(4) Tuberculin test, annually; and

(5) Lead screening using blood lead level determinations between 6 and 12 months, at 2 years of age, and annually up to 6 years of age. At all other visits, screening shall consist of verbal assessment and blood lead level testing, as indicated.

viii. Case coordination: referral for nutritional, psychological, social and other community services, as appropriate; provision or arrangement for 24-hour telephone physician access and sick care; and outreach and follow-up activities in accordance with the HealthStart Pediatric Care Guidelines.

(l) Diagnostic Radiology Services:

R0070	Transportation of portable x-ray equipment and personnel to
home or nursing home, per trip to facility or location, one
patient seen

(m) Rehabilitative Services:

(n) Level III descriptions:

W1000	Renal transplantation, implantation of graft, with
immunosuppressant therapy, with recipient splenectomy and
recipient nephrectomy, unilateral and bilateral
W1001	Resuturing of dislocated intraocular lens, requiring an incision
W1002	Myringotomy with insertion of collar button, unilateral
W1003	Myringotomy with insertion of collar button, bilateral
W1008	Discission of lens capsule; incisional technique (needling of
lens), initial
W1009	Discission of lens capsule; incisional technique (needling of
lens), subsequent
W2000	Dislocation, lumbar, simple, closed reduction with anesthesia
W3600	Injection procedure for intraosseous venography
W3650	Insertion of port-a-cath into subclavian for chemotherapy
W4850	Insertion of tenckhoff catheter with concurrent omentectomy,
panniculectomy, lysis of adhesions, or other related surgical
procedure. (See code 49420 and 49421 for insertion without
omentectomy, panniculectomy, etc.)
W5650	Removal of a foreign body from the vagina of a child
W5750	VABRA aspiration biopsy
W5760	Insertion of fletcher applicator for cesium implant, initial
W5760 76	Insertion of fletcher applicator for cesium implant, subsequent
W5920	Caudal anesthesia (epidural block) limited to obstetrical cases
only eligible for reimbursement only when given by other than
the delivery physician
W5930	Manual removal of placenta by other than the physician
effecting delivery
W6499 AA	Anesthesia for ECT, cat scan or MRI
W9170	Peritoneal dialysis, 3rd to 14th day
W9200	Subnormal vision exam, a continuation eye exam with limited
additional test to determine if subnormal visit on devices
would benefit problems not normalized
W9205	Subnormal vision work-up with written report, prior
authorization required this is a battery of extensive tests and
independent procedures to determine
W9215	Screening examination
W9220	Split lamp examination
W9310	Patient activated ECG recorders office, or nursing home, with
or without transtelephonic transmissions of the recording
W9378	Transtelephonic cardiac pacemaker monitoring with EKG once per
week limitation
W9382	Transtelephonic pacemaker monitoring, lithium battery (single
chamber) 37th month & beyond, allowed once per 4 weeks & if
more frequent then only by documented medical necessity
W9384	Transtelephonic pacemaker monitoring, lithium battery (dual
chamber) 2nd to 6th month & 37th month & beyond allowed once
per 4 weeks & if more frequent only by documented medical
necessity
W9385	Transtelephonic pacemaker monitoring, lithium battery (single
chamber) 1st month after implant allowed once per 2 weeks & if
more frequent than only by documented medical necessity
W9386	Transtelephonic pacemaker monitoring, lithium battery (single
chamber) 2nd month to 36th month allowed once per 8 weeks & if
more frequent than only by documented medical necessity
W9387	Transtelephonic pacemaker monitoring, lithium battery (dual
chamber) 1st month after implant allowed once per 2 weeks & if
more frequent than only by documented medical necessity
W9388	Transtelephonic pacemaker monitoring, lithium battery (dual
chamber) 7th to 36th month allowed once per 8 weeks & if more
frequent than only by documented medical necessity