Beacon

Current Prepayment Medical Review Log

The table below provides you with a list of the most current prepayment reviews being conducted by the Part B Medical Review Department.  This is not an all inclusive list.

March 2017

Review Description Codes
Ambulance Service; ALS, Emergency A0427
Ambulance Service; BLS, Non-Emergency A0428
E & M Time Studies 99201-99499
Chiropractic Manipulation 3-4 regions w/modifier AT 98941
Initial Hospital Care; E&M 99223
Office Visits; Established Patient 99211-99215
Subsequent Hospital Care 99231-99233
Subsequent Nursing Facility Care 99309-99310
ESRD Service 4 visits per month 90960
Travel Allowance for specimen collection P9603-P9604
Widespread Targeted Review 99214- Office or other outpatient visit for the evaluation and management of an established patient 99214
Widespread Targeted Review 99223- Initial hospital care, per day, for the evaluation and management of a patient 99223
Widespread Prepay Probe Review Evaluation and Management 99211-99212 with Modifier 25 on the same date of service as a pulmonary diagnostic procedure 94010-94799 99211-99212
Widespread Targeted Review 22510-22515 Vertebral Augmentation Procedures (VAPs) 22510-22515
Widespread Targeted Review 99233- Subsequent hospital care, per day, for the evaluation and management of a patient 99233
Drug Screening G0477/G0478/G0479/G0480/
G0481/G0482/G0483/80171/80299/ 82492/83789/80177/82542/83992

February 2017

Review Description Codes
Ambulance Service; ALS, Emergency A0427
Ambulance Service; BLS, Non-Emergency A0428
E & M Time Studies 99201-99499
Chiropractic Manipulation 3-4 regions w/modifier AT 98941
Initial Hospital Care; E&M 99223
Office Visits; Established Patient 99211-99215
Subsequent Hospital Care 99231-99233
Subsequent Nursing Facility Care 99309-99310
ESRD Service 4 visits per month 90960
Travel Allowance for specimen collection P9603-P9604
Office or other outpatient visit for the evaluation and management of an established patient: Widespread Prepay Probe 99214
Initial Hospital Care: Widespread Prepay Probe 99223
Widespread Probe Review of Evaluation and Management 99211-99212 with Modifier 25 on the same date of service as a pulmonary diagnostic procedure 94010-94799 99211-99212
Drug Screening G0477/G0478/G0479/G0480/
G0481/G0482/G0483/80171/80299/ 82492/83789/80177/82542/83992

January 2017

Review Description Codes
Ambulance Service; ALS, Emergency A0427
Ambulance Service; BLS, Non-Emergency A0428
E & M Time Studies 99201-99499
Chiropractic Manipulation 3-4 regions w/modifier AT 98941
Initial Hospital Care; E&M 99223
Office Visits; Established Patient 99211-99215
Subsequent Hospital Care 99231-99233
Subsequent Nursing Facility Care 99309-99310
ESRD Service 4 visits per month 90960
Travel Allowance for specimen collection P9603-P9604
Office or other outpatient visit for the evaluation and management of an established patient: Widespread Prepay Probe 99214
Initial Hospital Care: Widespread Prepay Probe 99223
Widespread Probe Review of Evaluation and Management 99211-99212 with Modifier 25 on the same date of service as a pulmonary diagnostic procedure 94010-94799 99211-99212
Drug Screening G0477/G0478/G0479/G0480/
G0481/G0482/G0483/80171/80299/ 82492/83789/80177/82542/83992

December 2016

Review Description Codes
Ambulance Service; ALS, Emergency A0427
Ambulance Service; BLS, Non-Emergency A0428
E & M Time Studies 99201-99499
Chiropractic Manipulation 3-4 regions w/modifier AT 98941
Initial Hospital Care; E&M 99223
Office Visits; Established Patient 99211-99215
Subsequent Hospital Care 99231-99233
Subsequent Nursing Facility Care 99309-99310
ESRD Service 4 visits per month 90960
Travel Allowance for specimen collection P9603-P9604
Office or other outpatient visit for the evaluation and management of an established patient: Widespread Prepay Probe 99214
Initial Hospital Care: Widespread Prepay Probe 99223
Widespread Probe Review of Evaluation and Management 99211-99212 with Modifier 25 on the same date of service as a pulmonary diagnostic procedure 94010-94799 99211-99212
Drug Screening G0477/G0478/G0479/G0480/
G0481/G0482/G0483/80171/80299/ 82492/83789/80177/82542/83992

November 2016

Review Description Codes
Ambulance Service; ALS, Emergency A0427
Ambulance Service; BLS, Non-Emergency A0428
E & M Time Studies 99201-99499
Chiropractic Manipulation 3-4 regions w/modifier AT 98941
Initial Hospital Care; E&M 99223
Office Visits; Established Patient 99211-99215
Subsequent Hospital Care 99231-99233
Subsequent Nursing Facility Care 99309-99310
ESRD Service 4 visits per month 90960
Travel Allowance for specimen collection P9603-P9604
Office or other outpatient visit for the evaluation and management of an established patient: Widespread Prepay Probe 99214
Initial Hospital Care: Widespread Prepay Probe 99223
Widespread Probe Review of Evaluation and Management 99211-99212 with Modifier 25 on the same date of service as a pulmonary diagnostic procedure 94010-94799 99211-99212
Drug Screening G0477/G0478/G0479/G0480/
G0481/G0482/G0483/80171/80299/ 82492/83789/80177/82542/83992

 

October 2016

Review Description Codes
Ambulance Service; ALS, Emergency A0427
Ambulance Service; BLS, Non-Emergency A0428
E & M Time Studies 99201-99499
Chiropractic Manipulation 3-4 regions w/modifier AT 98941
Initial Hospital Care; E&M 99223
Office Visits; Established Patient 99211-99215
Subsequent Hospital Care 99231-99233
Subsequent Nursing Facility Care 99309-99310
ESRD Service 4 visits per month 90960
Travel Allowance for specimen collection P9603-P9604
Office or other outpatient visit for the evaluation and management of an established patient: Widespread Prepay Probe 99214
Initial Hospital Care: Widespread Prepay Probe 99223
Widespread Probe Review of Evaluation and Management 99211-99212 with Modifier 25 on the same date of service as a pulmonary diagnostic procedure 94010-94799 99211-99212
Drug Screening G0477/G0478/G0479/G0480/
G0481/G0482/G0483/80171/80299/ 82492/83789/80177/82542/83992

 

September 2016

Review Description Codes
Ambulance Service; ALS, Emergency A0427
Ambulance Service; BLS, Non-Emergency A0428
E & M Time Studies 99201-99499
Chiropractic Manipulation 3-4 regions w/modifier AT 98941
Initial Hospital Care; E&M 99223
Office Visits; Established Patient 99211-99215
Subsequent Hospital Care 99231-99233
Subsequent Nursing Facility Care 99309-99310
ESRD Service 4 visits per month 90960
Travel Allowance for specimen collection P9603-P9604
Office or other outpatient visit for the evaluation and management of an established patient: Widespread Prepay Probe 99214
VAPS- Percutaneous Vertebroplasty and Augmentation: Widespread Prepay Probe 22510-22515
Subsequent Hospital Care: Widespread Prepay Probe 99233
Initial Hospital Care: Widespread Prepay Probe 99223
Widespread Probe Review of Evaluation and Management 99211-99212 with Modifier 25 on the same date of service as a pulmonary diagnostic procedure 94010-94799 99211-99212
Drug Screening G0477/G0478/G0479/G0480/
G0481/G0482/G0483/80171/80299/ 82492/83789/80177/82542/83992

 

August 2016

Review Description Codes
Ambulance Service; ALS, Emergency A0427
Ambulance Service; BLS, Non-Emergency A0428
E & M Time Studies 99201-99499
Emergency Department Visit; E & M 99285
Initial Hospital Care; E&M 99223
Office Visits; Established Patient 99211-99215
Subsequent Hospital Care 99231-99233
Subsequent Nursing Facility Care 99309-99310
Ultrasound Guidance for Needle Placement 76942
Self-Administered Injections- Phentolamine Mesylate J2760
Home Visit, established patient 99348
Utilization of Modifier 24 with Ophthalmology E & M Codes 99201-99215 & 92002-92014
Office or other outpatient visit for the evaluation and management of an established patient: Widespread Prepay Probe 99214
VAPS- Percutaneous Vertebroplasty and Augmentation: Widespread Prepay Probe 22510-22515
Subsequent Hospital Care: Widespread Prepay Probe 99233
Initial Hospital Care: Widespread Prepay Probe 99223
Widespread Probe Review of Evaluation and Management 99211-99212 with Modifier 25 on the same date of service as a pulmonary diagnostic procedure 94010-94799 99211-99212
Chiropractic Manipulation 3-4 regions w/modifier AT 98941

 

 

July 2016

Review Description Codes
Ambulance Service; ALS, Emergency A0427
Ambulance Service; BLS, Non-Emergency A0428
E & M Time Studies 99201-99499
Emergency Department Visit; E & M 99285
Initial Hospital Care; E&M 99223
Office Visits; Established Patient 99211-99215
Subsequent Hospital Care 99231-99233
Subsequent Nursing Facility Care 99309-99310
Ultrasound Guidance for Needle Placement 76942
Self-Administered Injections- Phentolamine Mesylate J2760
Home Visit, established patient 99348
Utilization of Modifier 24 with Ophthalmology E & M Codes 99201-99215 & 92002-92014
Office or other outpatient visit for the evaluation and management of an established patient: Widespread Prepay Probe 99214
VAPS- Percutaneous Vertebroplasty and Augmentation: Widespread Prepay Probe 22510-22515
Subsequent Hospital Care: Widespread Prepay Probe 99233
Initial Hospital Care: Widespread Prepay Probe 99223
Widespread Probe Review of Evaluation and Management 99211-99212 with Modifier 25 on the same date of service as a pulmonary diagnostic procedure 94010-94799 99211-99212

 

June 2016

Review Description Codes
Ambulance Service; ALS, Emergency A0427
Ambulance Service; BLS, Non-Emergency A0428
E & M Time Studies 99201-99499
Emergency Department Visit; E & M 99285
Initial Hospital Care; E&M 99223
Office Visits; Established Patient 99211-99215
Subsequent Hospital Care 99231-99233
Subsequent Nursing Facility Care 99309-99310
Ultrasound Guidance for Needle Placement 76942
Self-Administered Injections- Phentolamine Mesylate J2760
Home Visit, established patient 99348
Utilization of Modifier 24 with Ophthalmology E & M Codes 99201-99215 & 92002-92014
Office or other outpatient visit for the evaluation and management of an established patient: Widespread Prepay Probe 99214
VAPS- Percutaneous Vertebroplasty and Augmentation: Widespread Prepay Probe 22510-22515
Subsequent Hospital Care: Widespread Prepay Probe 99233
Initial Hospital Care: Widespread Prepay Probe 99223
Widespread Probe Review of Evaluation and Management 99211-99212 with Modifier 25 on the same date of service as a pulmonary diagnostic procedure 94010-94799 99211-99212

May 2016

Review Description Codes
Ambulance Service; ALS, Emergency A0427
Ambulance Service; BLS, Non-Emergency A0428
E & M Time Studies 99201-99499
Emergency Department Visit; E & M 99285
Initial Hospital Care; E&M 99223
Office Visits; Established Patient 99211-99215
Subsequent Hospital Care 99231-99233
Subsequent Nursing Facility Care 99309-99310
Ultrasound Guidance for Needle Placement 76942
Self-Administered Injections- Phentolamine Mesylate J2760
Home Visit, established patient 99348
Utilization of Modifier 24 with Ophthalmology E & M Codes 99201-99215 & 92002-92014
Office or other outpatient visit for the evaluation and management of an established patient: Widespread Prepay Probe 99214
VAPS- Percutaneous Vertebroplasty and Augmentation: Widespread Prepay Probe 22510-22515
Subsequent Hospital Care: Widespread Prepay Probe 99233
Initial Hospital Care: Widespread Prepay Probe 99223
Widespread Probe Review of Evaluation and Management 99211-99212 with Modifier 25 on the same date of service as a pulmonary diagnostic procedure 94010-94799 99211-99212

 

April 2016

Review Description Codes
Ambulance Service; ALS, Emergency A0427
Ambulance Service; BLS, Non-Emergency A0428
E & M Time Studies 99201-99499
Emergency Department Visit; E & M 99285
Initial Hospital Care; E&M 99223
Office Visits; Established Patient 99211-99215
Subsequent Hospital Care 99231-99233
Subsequent Nursing Facility Care 99309-99310
Ultrasound Guidance for Needle Placement 76942
Self-Administered Injections- Phentolamine Mesylate J2760
Home Visit, established patient 99348
Utilization of Modifier 24 with Ophthalmology E & M Codes 99201-99215 & 92002-92014
Office or other outpatient visit for the evaluation and management of an established patient: Widespread Prepay Probe 99214
VAPS- Percutaneous Vertebroplasty and Augmentation: Widespread Prepay Probe 22510-22515
Subsequent Hospital Care: Widespread Prepay Probe 99233
Initial Hospital Care: Widespread Prepay Probe 99223
Widespread Probe Review of Evaluation and Management 99211-99212 with Modifier 25 on the same date of service as a pulmonary diagnostic procedure 94010-94799 99211-99212

March 2016

Review Description Codes
Ambulance Service; ALS, Emergency A0427
Ambulance Service; BLS, Non-Emergency A0428
E & M Time Studies 99201-99499
Emergency Department Visit; E & M 99285
Initial Hospital Care; E&M 99223
Office Visits; Established Patient 99211-99215
Subsequent Hospital Care 99231-99233
Subsequent Nursing Facility Care 99309-99310
Ultrasound Guidance for Needle Placement 76942
Self-Administered Injections- Phentolamine Mesylate J2760
Home Visit, established patient 99348
Utilization of Modifier 24 with Ophthalmology E & M Codes 99201-99215 & 92002-92014
Office or other outpatient visit for the evaluation and management of an established patient: Widespread Prepay Probe 99214
VAPS- Percutaneous Vertebroplasty and Augmentation: Widespread Prepay Probe 22510-22515
Subsequent Hospital Care: Widespread Prepay Probe 99233
Initial Hospital Care: Widespread Prepay Probe 99223
Widespread Probe Review of Evaluation and Management 99211-99212 with Modifier 25 on the same date of service as a pulmonary diagnostic procedure 94010-94799 99211-99212

February 2016

Review Description Codes
Ambulance Service; ALS, Emergency A0427
Ambulance Service; BLS, Non-Emergency A0428
Assay of Opiates 83925
Quantitative Drug Testing & Assays 82542
E & M Time Studies 99201-99499
Emergency Department Visit; E & M 99285
Initial Hospital Care; E&M 99223
Office Visits; Established Patient 99211-99215
Physical Medicine and Rehabilitation Services All Codes
Subsequent Hospital Care 99231-99233
Subsequent Nursing Facility Care 99309-99310
Ultrasound Guidance for Needle Placement 76942
Self-Administered Injections- Phentolamine Mesylate J2760
Home Visit, established patient 99348
Utilization of Modifier 24 with Ophthalmology E & M Codes 99201-99215 & 92002-92014
Office or other outpatient visit for the evaluation and management of an established patient: Widespread Prepay Probe 99214
VAPS- Percutaneous Vertebroplasty and Augmentation: Widespread Prepay Probe 22510-22515
Subsequent Hospital Care: Widespread Prepay Probe 99233
Initial Hospital Care: Widespread Prepay Probe 99223
Widespread Probe Review of Evaluation and Management 99211-99212 with Modifier 25 on the same date of service as a pulmonary diagnostic procedure 94010-94799 99211-99212

January 2016

Review Description Codes
Ambulance Service; ALS, Emergency A0427
Ambulance Service; BLS, Non-Emergency A0428
Assay of Opiates 83925
Quantitative Drug Testing & Assays 82542
E & M Time Studies 99201-99499
Emergency Department Visit; E & M 99285
Initial Hospital Care; E&M 99223
Office Visits; Established Patient 99211-99215
Physical Medicine and Rehabilitation Services All Codes
Subsequent Hospital Care 99231-99233
Subsequent Nursing Facility Care 99309-99310
Ultrasound Guidance for Needle Placement 76942
Self-Administered Injections- Phentolamine Mesylate J2760
Home Visit, established patient 99348
Utilization of Modifier 24 with Ophthalmology E & M Codes 99201-99215 & 92002-92014
Office or other outpatient visit for the evaluation and management of an established patient: Widespread Prepay Probe 99214
VAPS- Percutaneous Vertebroplasty and Augmentation: Widespread Prepay Probe 22510-22515
Subsequent Hospital Care: Widespread Prepay Probe 99233
Initial Hospital Care: Widespread Prepay Probe 99223
Widespread Probe Review of Evaluation and Management 99211-99212 with Modifier 25 on the same date of service as a pulmonary diagnostic procedure 94010-94799 99211-99212

Archive

Prepayment Medical Review Logs are archived for the following years:

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