Accountable Health Care IPA
Memorandum
**VERY IMPORTANT**PLEASE READ**
Date:March 01, 2012
To: Providers
From:Quality Management Department
RE:Anthem Blue Cross Proprietary Codes
Child Health and Disability Prevention Program
National Standard Codes Replacing
Anthem Blue Cross Proprietary Codes
IPA Bulletin
This bulletin is an update about information in Anthem Blue Cross’ State Sponsored Business Provider Operations Manual (Manual). For access to the latest Manual, go online to .
Effective March 1, 2012 Anthem Blue Cross will require providers and Independent Practice Associations (IPAs) to use the national standard CPT-4/HCPCS codes. We will also require that the Medi-Cal local modifier SL (applicable with Vaccines for Children [VFC] vaccine codes) be used for all Child Health and Disability Prevention (CHDP) program services.
If your contract mandates that you pay CHDP services, please update your systems with the following code changes in a timely manner so that your providers can properly submit claims under the new coding guidelines as of March 1, 2012. All claims submitted with this date of service and thereafter must utilize the new codes. Additionally, the PM-160 “Information Only” forms are to be mailed as previously required, and please ensure that these forms are legible.
Any additional questions and more details of the exact code cross walking can be obtained from your local Community Resource Coordinator (CRC). Telephone contact information is listed at the end of this bulletin. Please ensure that your IT and claims departments receive this information.
Guidelines for accepting CHDP Claims
When accepting claims data for CHDP services, please use the following guidelines to process your encounters:
- For Primary Diagnosis, please use diagnosis code V20.2 or V70.0
- Primary Care Physicians: well visit services with range 99800-99808 will be replaced with standard CPT-4 range 99381 – 99385 for new patients and 99391-99395 for established patients.
- Health Assessment Providers (School Based Clinics and Local Health Departments) well visit services with range 99810 – 99818 will be replaced with standard CPT-4 ranges
99381 – 99385 for new patients and 99391-99395 for established patients.
Health Screening Procedures with range 99820-99825 will be replaced with the following CPT-4 standard codes:
CPT-4 Codes / DescriptionS0612 / Pelvic Exam-19 years up to 22 years of age
99173 / Snellen Eye Test or Equivalent Visual Acuity Test age 3 yrs through 18 years of age
92552 / Bi-Aural Hearing Tests-Audiometric: Pure Tone Audiometry
86580 / PPD Screening-TB: Mantoux Test
For CHDP only, please continue to use HCPCS code D1203 for topical application of fluoride on children younger than 6 years of age and up to three times in a 12- month period. (This is a medical benefit and not dental.)
Clinical Laboratory Test services with range 99830-99840 will be replaced with standard CPT-4 codes. All clinical labs must be CHDP-certified and have an active Clinical Laboratory Improvement Amendments (CLIA) certification. There are limited lab tests that can be drawn and analyzed in the provider’s office and providers are required to have a CLIA Waiver certification to render these services. Additionally, there are limited lab tests by providers that are drawn in the office and sent to the lab to receive a reimbursement.
Please use the following CPT-4 standard codes appropriately when processing provider claims for the correct services rendered.
Clinical Laboratories: collection and analysis- Place of Service 81 (process as global except when modifier is noted)
CPT-4 Codes / Description82947 / Blood glucose assay
84030 / Phenylketonuria (PKU) blood test- (under 1 month of age)
81002 or 81003 / Urine “Dipstick”
81007 / Urinalysis, routine, complete
85660 / Sickle Cell Status (Hemoglobin Electrophoresis)
82465 / Total Cholesterol
83655 (26/TC) / Lead Blood Level
86592 / VDRL, RPR, or ART
87590 / Gonorrhea (GC) test
88150 / Pap Smear
87110 / Chlamydia Test
87177 / Ova and/or Parasites
Primary Care and Health Assessment Providers: specimen collected and analyzed in office requires CLIA Waiver (process as global except when modifier is noted)
CPT-4 Codes / Description82947 / Blood glucose assay
83026 or 85018 / Hemoglobin or Hemotocrit
84030 / Phenylketonuria (PKU) blood test- (under 1 month of age)
81002 or 81003 / Urine “Dipstick”
81007 / Urinalysis, routine, complete
82465 / Total Cholesterol
83655 (26/TC)* / Lead Blood Level
*When certified to perform Lead Blood Level (83655) test in the office, bill code without modifiers when performing both professional and technical components. For providers without certification, use modifier 26 when performing the professional component only.
Primary Care and Health Assessment Providers: collection and handling of specimen sent to lab for analysis (process as global except when modifier is noted)
CPT-4 Codes / Description82947 / Blood glucose assay
83026 or 85018 / Hemoglobin or Hemotocrit
85660 / Sickle Cell Status (Hemoglobin Electrophoresis)
82465 / Total Cholesterol
83655.26 / Lead Blood Level
86592 / VDRL, RPR, or ART
87590 / Gonorrhea (GC) test
87110 / Chlamydia Test
Immunizations and vaccines with range 99845-99868 will be replaced with standard CPT-4 codes. When processing claims for immunizations obtained from the VFC Program, the Medi-Cal local modifier SL is required with the appropriate CPT-4 code on each line. When the immunization is not covered by VFC, do not use the SL modifier.
When processing claims with CHDP vaccines, whether VFC-related or not, please remember to process claims lines with the standard administration fee CPT-4 codes 90460-90461 or 90471-90474 appropriately.
For More Information
You can find related information on our website; go to Select Other Anthem Websites: Providers on the bottom right, and under the heading Learn More, click State Sponsored Plans. Under Forms and Tools, select the link for CHDP Proprietary Codes Cross Walked to National Standard Codes.
In the future, you’ll be able to find additional related information in our Provider Operations Manual; go to Select Other Anthem Websites: Providers on the bottom right, and under the heading Learn More, click State Sponsored Plans. Under Provider Communications, click Provider Operations Manuals and Important Updates, and then select the link for the provider operations manual for Medi-Cal.
If you have specific questions or concerns, please contact your local CRC:
Fresno/Madera / 1-559-488-1380Los Angeles / 1-818-655-1255
Sacramento/Bay Area / 1-916-325-4200
Stanislaus/San Joaquin / 1-209-558-2762
Tulare/Kings / 1-559-733-6578
References:
Anthem BlueCross State Sponsored Business Provider Bulletin