PCP Billable List and Specialist Billing Revision
First Priority Health has revised the Billable Services and the Drugs and Biologicals listings, effective August 1, 2005. Revisions include: some reimbursement fees and the addition of the following codes.
Procedure Code / Description / Reimbursement90715 / Boostrix, tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine, absorbed / $41.25
Procedure Code / Description / Office Reimbursement / Facility Reimbursement
11310 / Shaving of epidermal or dermal lesion (.5 cm or less) / $74.50 / $44.33
11311 / Shaving of epidermal or
dermal lesion (.6 cm to
1.0 cm) / $92.75 / $64.50
12002 / Simple repair of
superfi cial wounds (2.6
cm to 7.5 cm) / $161.48 / $117.95
20600 / Arthrocentesis small joint / $73.87 / $43.57
20605 / Arthrocentesis
intermediate joint / $80.27 / $52.33
20610 / Arthrocentesis major joint / $101.00 / $52.33
92552 / Pure tone audiometry / - / $18.15
The following codes have been removed:
ProcedureCode / Code Termination
Date / Procedure Code / Code Termination
Date
90709 / 12/31/02 / J1561 / 12/31/02
94665 / 12/31/02 / J1739 / 3/31/02
J0340 / 3/31/02 / J1741 / 3/31/02
J0695 / 3/31/02 / J1820 / 12/31/02
J1050 / 12/31/02 / J2000 / 12/31/03
J1095 / 12/31/02
PCPs and Specialists please note: On the Drugs and Biologicals listing, the following codes listed below will be removed effective August 1, 2005, because they are part of a member’s First Priority Health pharmacy benefit and not part of a member’s First Priority Health medical benefit. Therefore, if any type of medical provider submits these codes under the medical benefit, they will deny as not being covered under the member’s medical benefit.
J0725 J7194 J7616 J9214 J9218
J1650 J7611 J8499 J9515
J3030 J7613 J9213 J9516
A complete PCP Billing Listing is available on BCNEPA’s Provider Center by clicking on the Provider Relations Building icon. This site is accessible via NaviNet or BCNEPA Secure Access. (policy update 0707003)