Current through Register Vol. 24-18, September 15, 2024
(1) The medicaid agency requires an
outpatient hospital provider to report the appropriate current procedural
terminology (CPT) or health care common procedure coding system (HCPCS) codes
in addition to the required revenue codes on an outpatient claim line when
using any of the following revenue code categories and subcategories:
(a) "IV therapy," only subcategories "general
classification" and "infusion pump";
(b) "Medical/surgical supplies and devices,"
only subcategory "other supplies/devices";
(c) "Oncology";
(d) "Laboratory";
(e) "Laboratory pathological";
(f) "Radiology - Diagnostic";
(g) "Radiology - Therapeutic and/or
chemotherapy administration";
(h)
"Nuclear medicine";
(i) "CT
scan";
(j) "Operating room
services," only subcategories "general classification" and "minor
surgery";
(k) "Blood and blood
components";
(l) "Administration,
processing, and storage for blood components";
(m) "Other imaging services";
(n) "Respiratory services";
(o) "Physical therapy";
(p) "Occupational therapy";
(q) "Speech therapy - Language
pathology";
(r) "Emergency room,"
only subcategories "general classification" and "urgent care";
(s) "Pulmonary function";
(t) "Audiology";
(u) "Cardiology";
(v) "Ambulatory surgical care";
(w) "Clinic," only subcategories "general
classification" and "other clinic";
(x) "Magnetic resonance technology
(MRT)";
(y) "Medical/surgical
supplies - Extension," only subcategory "surgical dressings";
(z) "Pharmacy - Extension" subcategories
"Erythropoietin (EPO) less than ten thousand units," "Erythropoietin (EPO) ten
thousand or more units," "drugs requiring detailed coding," and
"self-administrable drugs";
(aa)
"Labor room/delivery," only subcategories "general classification," "labor,"
"delivery," and "birthing center";
(bb) "EKG/ECG (electrocardiogram)";
(cc) "EEG (electroencephalogram)";
(dd) "Gastro-intestinal services";
(ee) "Specialty room - Treatment/observation
room," subcategory "treatment room and observation room";
(ff) "Telemedicine," only subcategory "other
telemedicine";
(gg)
"Extra-corporeal shock wave therapy (formerly lithotripsy)";
(hh) "Acquisition of body components," only
subcategories "general classification" and "cadaver donor";
(ii) "Hemodialysis - Outpatient or home,"
only subcategory "general classification";
(jj) "Peritoneal dialysis - Outpatient or
home," only subcategory "general classification";
(kk) "Continuous ambulatory peritoneal
dialysis (CAPD) - Outpatient or home," only subcategory "general
classification";
(ll) "Continuous
cycling peritoneal dialysis (CCPD) -Outpatient or home," only subcategory
"general classification";
(mm)
"Miscellaneous dialysis," only subcategories "general classification" and
"ultrafiltration";
(nn) "Behavioral
health treatments/services," only sub-category "electroshock therapy";
(oo) "Other diagnostic
services";
(pp) "Other therapeutic
services," only subcategories "general classification," "cardiac
rehabilitation," and "other therapeutic service"; and
(qq) Other revenue code categories and
subcategories identified and published by the agency.
(2) For an outpatient claim line requiring a
CPT or HCPCS code, the agency denies payment if the required code is not
reported on the line.
11-14-075, recodified as §182-550-1350, filed 6/30/11,
effective 7/1/11. Statutory Authority:
RCW
74.08.090,
74.09.500. 07-14-018, §
388-550-1350, filed 6/22/07, effective 8/1/07. Statutory Authority:
RCW
74.04.050,
74.04.057,
74.08.090, and
Public Law
104-191. 03-19-044, § 388-550-1350, filed
9/10/03, effective 10/11/03.
