state of maryland department of health and mental

State of MarylandDepartment of Health and MentalParris N. Glendening, Governor - Martin ~ Wasserman, M.D., J.D., Secretary

MARYLAND MEDICAL ASSISTANCE PROGRAMPhysicians' Transmittal No. 121

Nurse Practitioner Transmittal No. 13Clinic Transmittal No. 55

TO:

'A~"/-'- ./

August 21, 1998PhysiciansNurse PractitionersFree-Standing Clini~/l.

FROM: Martin p.Secretary

v., J.D.

NOTE: Please ensure that appropriate staff members inyour organization are informed about the contentsof this transmittal.

0: Proposed Amendment to COMAR 10.09.02 Physicians I

Services

EPPECTIVE DATE:December 29, 1997

A~:rON':

Proposed Regulations (Permanent Status)

PROGRAM CONTACT PERSON:Robert Zielaskiewicz (410) 767-];48];

COMMENT PERIOD EXPIRED: November 10, 1.997

The amendments to Regulations .01, .03, .06 and .07under COMAR 10.09.02 Physicians' Services have been approvedas proposed in the Maryland Register (24:21 Md. R. 1468 -1469) - These amendments supplement the Maryland MedicalAssistance Program Physicians' Services Provider Fee Manual,revision 1996, with the 1997 Physicians' CUrrent ProceduralTerminology, 4th Edition (CPT-4) additions and deletions andother changes to reflect current reimbursement policy;define the mental health services that the Mental HygieneAdministration will be responsible for providing to Medicaidrecipients; and require providers to comply with COMAR10.09.59 Rehabilitation Services, 10.09.70 Maryland Medicaid

(Continued on reverse)

201 West Preston Street - Baltimore, Maryland 21201TOO for Disabled - Maryland Relay Service (BOO) 735- 225B

Healthy People in Healthy Communities

-2-(

Managed Care Program: Specialty Mental Health System andCOMAR 10.21.25 Fee Schedule- Mental Health Services-Community-Based Programs and Individual Practitioners.

The adopted amendment, as it has been published in theMaryland Reqister, and Supp. No.1 are attached to thistransmittal. Please note the following:

1. Varicella (chicken pox) vaccine is covered under theVaccines for Children (VFC) progam. The .Z-codeR forvaricella vaccine administration is ZO716 (ages 1-18).

2. The preauthorization requirement for procedures92004, 92014 and 92015 has been deleted. Use these codes forroutine examinations as described in CPT. Local HCPCS W9200has also been deleted. Use CPT Evaluation and Managementcodes for exams related to specific medical problems.

3. Sterilization reversal procedures are not covered

4. Local HCPCS M9999, critical care unclassified, is nolonger used. Use CPT critical care, 9929~ - 99292, or NICUcodes, 99295-99297, as applicable.

5. Allergy immunotherapy codes 95144 - 95165 have beencorrected to reflect 1996 CPT definition revisions. Themaximum number of units {vials} for procedure 95144 is 2.For procedures 95145 - 95165 the units are the number ofdoses administered.

MPW:rz

Attaclnnents

PROPOSED ACTION ON REGULATIONS

or call Ronald Wmdaor, Dislocated Workers Unit,- . The comments must be received not

10, 1997..06

JR.of LaOOr,

ouslymust

:7 Md. R.560 - 561

Symbols

.01

.02 Definitions.A.B. Terms Defined.(1) - (6) ..

(7) - text unchanged)means the employee is at

- due to hospitaldownsizing, and m~itherm

riskclosure. lnugel;thl.:

. from the hos-or job classificationmerge1; ~nsurr.,

"t

(a)pital thatthator downsizill6;

(b)c,nsing.Commission.,that themdelicensure,

(c)Licensing.

Department

of Labor,

.038(2)laid off due to

. the «nployee

( originally

Services.

downsizing.[(6)J (8) unchanged)

.03

A.B.

sureClosure, Merger, or Deticen-

(1) Aor mergehadaJ'Health

hasof

that is planning to closeanotherof its beds delicenaed by tJ1e

Hygiene, shall provide tJ1e, and:Commission, with a listing of all

laid off due toCostwsi

videwith

. to downsizeof Labor; Ucensing,

employees who will be laid oh

(3)- m(3>m {4} (originally proposed text

Title 10

MARYLAND REGISTER, VOL 24,ISSUE 21 FRIDAY, OCTOBER 10,1817

toclO.l

of Labor. Li .

Cost ~wI chaptr,r;

'ure, merg.r;or

Subtitle 09 MEDICAL CARE PROGRAMS10.09.02 Physiclans'Services

Authority: Health-GeneralArticle, §§2-104lbl, 15-103. and 15-105.ADDOtated Code of Mazyjand

Notice of Proposed Action197-307-PJ

The Secretary of Health and Mental Hygiene proposes toamend Regulations .01, .03, .06, and .07 under COMAR10.09.02 Physicians' Services.

Statement of PurposeThe purpose of this amendment is to supplement the

Maryland Medical Assistance Provider Fee Manual, datedOctober, 1987, Physicians' Services fee schedule, by updat-ing the 4th Edition (CPr-4) code additions and deletions; re-Oecting current reimbursement policy, to define the mentalhealth services that the Mental Hygiene Administrationwill be responsible for providing to Medicaid recipients; andto require providers to comply with COMAR 10.09.59 Reha-bilitation Services, COMAR 10.09.70 Maryland ManagedCare Program: Specialty Mental Health System, and CO-MAR 10.21.25 Fee Schedule - Mental Health Services-Community-Based Programs and Individual Practitioners.These fee changes will be incorporated by reference in Supp.No.1 of the Physicians' Services Provider Fee M~ual-

Comparison to Federal StandardsThere is 00 corresponding federal standard to this pro-

posed regulation.

Estimate of Economic ImpactThe proposed action has no economic impact.

Economic Impact on Small Bu8iDes8e8The proposed action has minimal or no ecooomic impact

on small businesses.

Opportunity for Public CommentComments may be sent to Michele Phinney, Regulations

Coordinator, O'Cooor Building, Room 521, 201 W. PrestonStreet, Baltimore, Maryland 21201, or fax (410) 333-7687 orcall (410) 767-6499, These comments must be received notlater than November 10, 1997..01 Definitions.

A. (text unchanged)B. Terms Defined.

(1)-(15) (ten unchanged)

PROPOSED ACTION ON REGULATIONS 1469

r~ Ad-health

ex-, of

.17 under COMAR10.09.34 Hospital Services, ;

Statement of Purpose1 action transfers to the Mental

. C . for the provision of :--

Medicaid recipients. Thesemental health services are theHygiene Administration.- implement a

ruing time frame.the end of"

in the Pro-, will now

10f3gram'shave 5months

~e Pro~'s, requirements for

programs.brain

limitationAlso,coverage

tocedeI' standard to this pro-There is no I

posed regulation.

The proposed

EconomicThe proposed

on small businesses.

Impactn#omic impact. 0 mall Businesses

, al or no economic impact

. Phinney, Regulations, Room 521,201 W. Preston

21201, or fax (410) 333-7687,must be received

Comments may beCoordinator, O'ConorStreet, Baltimore, }or call (410) 767-6499.not later t&'1an ~ -

10.09.06 I.01 Definitions.

A.B. ~

w~.It

program ..of a licensed specialwith primary diag-injury resulting in

who need services de-" on home and

in productive activi-

for

(1)-(3) I'

(3.1) "Brain

1neaPl$ a programhospital that .~--

nosesfunctionalsignedcommunityties.

(23) (text '-

health services'10.09.70.1OC

, services de-

to treat the diag-(23-1)

scribed innoses set "

(24) - (text unchanged).03

A.B.

asa

(15-1) "Mental health seroices" means those serviceS de-scribed in COMAR 10.09.70.1OC rendered to treat an indi-vidual for a diagnosis set forth in COMAR 10.09.70.1OA, (16) - (29) (text unchanged)

.03 Conditions for ParticipatJon.A (text unchanged)B. SpeclrlC requirements for participation in the Prograttl

as a physicians' services provider require that the provider:(1) - (6) (text unchanged)(7) Shall agree to identify by the individual physician

practitioner's identification number each physician assis-tant or nurse practitioner who is authorized by the physi-cian to request laboratory services; [and]

(8) Shall, if participating as a surgeon, obtain a secondsurgical opinion from another physician before the perfor-mance of certain elective surgical procedures which requirehospitalization, as identified under Regulation .05H of thischapter(.); and

(9) Shall comply with the requirements for the deliveryof mental health services in accordance with COMAR10.09.59 and 10.09.70.,06 Preauthorization Requirements.

A The following procedures or services require preautho-rization:

(1) - (2) (text unchanged)[(3) Sterilization reversal procedures;][(4)] (3) - [(10)] (9) (text unchanged)

B. - E. (text unchanged)R Physicians rendering mental health services shall com-

ply with the preauthorization requirements of COMAR10.09.70.07..07 Payment Procedures.

A-C. (text unchanged)D. The Maryland Medical Assistance Program Physi-

cians' Services Provider Fee Manual, Revision 1996, is con-tained in the Medical Assistance Provider Fee Manual,dated October I, 1986, which is used in conjunction with"Physician's Current Procedural Terminology", Fourth Edi-tion, [1996] 1997 (CPT-4), published by the American Medi-cal Association. All the provisions of these documents, un-less specifically excepted, are incorporated by referencewith the following amendments: Physicians' Services Pro-vider Fee Manual Supp. No. I.

E. - P. (text unchanged)Q. Reimbursement.

(1) - (3) (text unchanged)(4) The Program shall reimburse providers for mental

health services performed by a physician according to thefees established under COMAR 10.21.25 and the require-ments of this chaptel:

R. - S. (text '~DchAnged)MARTIN P. WASSERMAN, M.D.

Secretary of Health and Mental Hygiene,Program

the provider:se~ces provider require(text unchanged)inform the Managed Care

of ~e !?ePar.tment's :

(1)(8) Assur-

Finance

stay for adischarge from a hospital :"" . [and]

. with the provider i~:::- ,10.09.35,10.09.43, orwho presents for services is

care programs[.1" and

-when aone of~

-1- COMAR 10.09.02Physicians' Services

CPT-4 1997 Additions

AFTERCAREDAYS

MAXIMUMPAYMENT

CPT-4CODE DEFINITION*

010000000000000090090090090090090090090090090090090090090090090000000090090090030000090010010010010000000000000000000000000000000000000

110101101111012117201172115756157571575820150209562095724149243412618526546265512655326554265562730632491372503725143496490214990652301598666158668801688106881168815759457594690875908769090192240925489297892979933039330493315

R

R

R

A

Debride skin, fx 114.00Debride skin/muscle, fx 136.00Debride skin, muscle, bone, fx 189.00Debride nail, 1-5 9.00Debride nail, 6 or more 8.00Free muscle flap, microvasc 892.00Free skin flap, microvasc 892.00Free facial flap, microvasc 892.00Excise epiphyseal bar 357.00Iliac bone graft, microvasc 899.00Metatarsal bone graft, microva 931.00Radical rection of elbow 363.00Repair tendon/muscle, arm 238.00Remove finger bone 89.00Repair non-union, hand 180.00Great toe-hand transfer 1215.00Single toe-hand transfer 1207.00Double toe-hand transfer 1440.00Toe joint transfer 1227.00Excision of hip joint/muscle 350.00Lung volume reduction B.R.Intravascular ultrasound 36.00Intravascular ultrasound 28.00Free jejunum flap, microvasc B.R.Drain abdominal abscess 240.00Free omental flap, microvasc B.R.Cystoscopy and treatment 123.00Multifetal Abortion 131.00Resect nasopharynx, skull 615.00Dilate tear duct opening 12.00Probe nasolacrimal duct 14.00Probe nasolacrimal duct 60.00Probe nasolacrimal duct 50.00Intravascular ultrasound 67.00Intravascular ultrasound 37.00Psychophysiological therapy 21.00Psychophysiological therapy 42.00Biofeedback training, any metho 10.00ICG Angiography 44.00posturoqraphy 33.00Intravascular ultrasound, heart 98.00Intravascular ultrasound, heart 61.00Echo transthoracic 38.00Echo transthoracic 30.00Echo trans esophageal 56.00

Supp. 1


CPT-4 1997 Additions(Continued)

CPT-4CODE

MAXIMUMPAYMENT

AFTERCAREDAYS* DEFINITION

9999999999

000000000000000000000000000000

Echo transesophageal 17.00Echo transesophageal 39.00Autonomic nervous function test 15.00Autonomic nervous function test 16.00Autonomic nervous function test 15.00Orthotic training 8.00Chiropractic manipulation 10.00Chiropractic manipulation 12.00Chiropractic manipulation 15.00Chiropractic manipulation 9.00

Supp. 1

3355578888

3399959999

1122204444

6712340123


CPT-4 1997 Deletions

117001170111710117111575520960209712533025331265522655726558265594288053640563605636168800688206882568830909009090290904909069690890910909159320193202932049320593208932099321093220932219322294160975009750197521

Supp. 1


1997 Policy Changes

MAXIMUMPAYMENT

AFTERCAREDAYS

CPT-4CODE DEFINITION

287.00B.R.

169.000.000.000.00B.R-

-

000060000000000000000

-

0085721256364815540058750587526456592004920149201596110951459514695147951489514995165992959929699297W9200Z0716Z0744Z0745

R

R

-000000000000000000000000000000

000000000

12.504.004.004.004.004.003.00

210.62104.52

52.21

Contin anesth labor, c-sec.Reconstruct eye socketsPercutaneous vein catheter.Vasovasostomy,vasovasorrhaphyTubal reanastomosisTubouterine implantationImplant neurostimulator elect.No preauthorization requiredNo preauthorization requiredNo preauthorization requiredDevelopmental test, limitedProvision of antigens, dosesTwo single stinging insectThree single stinging insectFour single stinging insectFive single stinging insectprovision of antigens, dosesNICU initialNICU subsequentNICU subsequentDeletedVaricella vaccine admin.Hepatitis B vacc. admin.Hepatitis B vacc. admin.

10.0010.0010.00

Supp. 1

-5- COMAR 10.09.02Pathology & Laboratory

CPT-4 1997 Additions

CPT-4CODE

MAXIMUMPAYMENT

AFTERCAREDAYS* DEFINITION

Assay for tacrolimusCollagen crosslinksMolecular diagnosticsTroponin

80197825238390284484

RRRR

B.R.B.R.B.R.B.R.

NANANANA

Supp. 1

state of maryland department of health and mental

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