Code
|
Description
|
BCBSND MUE Value
|
Effective Date
|
90832
|
Psychotherapy, 30 minutes with patient
|
1
|
8/1/2020
|
90834
|
Psychotherapy, 45 minutes with patient
|
1
|
8/1/2020
|
90837
|
Psychotherapy, 60 minutes with patient
|
1
|
8/1/2020
|
95165
|
Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy, single or multiple antigens
|
None
|
4/1/2019
|
96137
|
Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; each additional 30 minutes
|
17
|
1/1/2019
|
96139
|
Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; each additional 30 minutes
|
17
|
1/1/2019
|
96171
|
Health behavior intervention, family (without the patient present), face-to-face; each additional 15 minutes (List separately in addition to code for primary service)
|
None
|
10/1/2020
|
99201
|
Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making.
|
2
|
8/1/2020
|
99202
|
Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter.
|
2
|
8/1/2020
|
99203
|
Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 30-44 minutes of total time is spent on the date of the encounter.
|
2
|
8/1/2020
|
99204
|
Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 45-59 minutes of total time is spent on the date of the encounter.
|
2
|
8/1/2020
|
99205
|
Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 60-74 minutes of total time is spent on the date of the encounter.
|
2
|
8/1/2020
|
99211
|
Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal.
|
2
|
8/1/2020
|
99212
|
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 10-19 minutes of total time is spent on the date of the encounter.
|
2
|
8/1/2020
|
99213
|
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter.
|
2
|
8/1/2020
|
99214
|
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter.
|
2
|
8/1/2020
|
99215
|
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.
|
2
|
8/1/2020
|
A0425
|
Ground Mileage, per statute mile
|
None
|
7/1/2018
|
A0435
|
Fixed wing air mileage, per statute mile
|
None
|
7/1/2018
|
A0436
|
Rotary wing air mileage, per statute mile
|
None
|
7/1/2018
|
J0202
|
Injection, Alemtuzumab, 1 mg
|
41
|
7/1/2018
|
J0295
|
Injection, Ampicillin Sodium/Sulbactam Sodium, per 1.5 gm
|
18
|
7/1/2018
|
J0461
|
Injection, Atropine Sulfate, 0.01 mg
|
100,000
|
7/1/2018
|
J0690
|
Injection, Cefazolin Sodium, 500 mg
|
24
|
7/1/2018
|
J0696
|
Injection, Ceftriaxone Sodium, per 250 mg
|
42
|
7/1/2018
|
J0743
|
Injection, Cilastatin sodium, Imipenem, per 250 mg
|
54
|
7/1/2018
|
J0744
|
Injection, Ciprofloxacin for intravenous infusion, 200 mg
|
20
|
7/1/2018
|
J0878
|
Injection, Daptomycin, 1 mg
|
2,000
|
7/1/2018
|
J1000
|
Injection, Dep-estradiol Cypionate, up to 5 mg
|
5
|
7/1/2018
|
J1040
|
Injection, Methylprednisolone Acetate, 80 mg
|
51
|
7/1/2018
|
J1559
|
Injection, Immune Globulin (Hizentra), 100 mg
|
536
|
7/1/2018
|
J1580
|
Injection, Garamycin, Gentamicin up to 80 mg
|
17
|
7/1/2018
|
J1726
|
Injection, Hydroxyprogesterone Caproate, (Makena), 10 mg
|
100
|
7/1/2018
|
J2426
|
Injection, paliperidone palmitate extended release, 1 mg
|
234
|
4/1/2022
|
J2543
|
Injection, Piperacillin Sodium/Tazobactam Sodium, 1 gram/0.125 grams (1.125 grams)
|
24
|
7/1/2018
|
J2675
|
Injection, Progesterone, per 50 mg
|
10
|
7/1/2018
|
J2790
|
Injection, RHO (D) Immune Globulin, Human, Full Dose, 300 mg
|
5
|
7/1/2018
|
J3370
|
Injection, Vancomycin HCL, 500 mg
|
25
|
7/1/2018
|
J3475
|
Injection, Magnesium Sulfate, per 500 mg
|
200
|
7/1/2018
|
J3590
|
Injection, Unclassified biologics
|
None
|
7/1/2018
|
J7178
|
Injection, Human Fibrinogen Concentrate, not otherwise specified, 1 mg
|
9,900
|
7/1/2018
|
J7179
|
Injection, Von Willebrand Factor (Recombinant), (Vonvendi), 1 IU VWF:RCO
|
27,300
|
7/1/2018
|
J7180
|
Injection, Factor XIII (Antihemophilic Factor, Human), per 1 IU
|
7,000
|
7/1/2018
|
J7181
|
Injection, Factor XIII A-subunit, (Recombinant), per 1 IU
|
5,000
|
7/1/2018
|
J7183
|
Injection, Von Willebrand Factor Complex (Human), Wilate, 1 IU VWF:RCO
|
16,500
|
7/1/2018
|
J7186
|
Injection, Antihemophilic Factor VIII/Von Willebrand Factor Complex (Human), per factor VIII IU
|
50,000
|
7/1/2018
|
J7187
|
Injection, Von Willebrand Factor Complex (Humate-P), per IU VWF:RCO
|
36,000
|
7/1/2018
|
J7188
|
Injection, Factor VIII (Antihemophilic Factor, Recombinant), (Obizur), per IU
|
161,000
|
7/1/2018
|
J7189
|
Injection, Factor VIIA (Antihemophilic Factor, Recombinant), per 1 microgram
|
145,000
|
7/1/2018
|
J7190
|
Injection, Factor VIII (Antihemophilic Factor, Human) per IU
|
33,500
|
7/1/2018
|
J7192
|
Injection, Factor VIII (Antihemophilic Factor, Recombinant) per IU, noc
|
31,000
|
7/1/2018
|
J7193
|
Injection, Factor IX (Antihemophilic Factor, Purified, non-recombinant), per IU
|
27,000
|
7/1/2018
|
J7194
|
Injection, Factor IX, Complex, per IU
|
20,500
|
7/1/2018
|
J7195
|
Injection, Factor IX (Antihemophilic Factor, Recombinant) per IU, nos
|
35,000
|
7/1/2018
|
J7198
|
Injection, Anti-inhibitor, per IU
|
27,000
|
7/1/2018
|
J7200
|
Injection, Factor IX (Antihemophilic Factor, Recombinant), Rixubis, per IU
|
40,250
|
7/1/2018
|
J7201
|
Injection, Factor IX, FC Fusion Protein (Recombinant), per IU
|
27,000
|
7/1/2018
|
J7202
|
Injection, Factor IX, Albumin Fusion Protein, (Recombinant), Idelvion, 1 IU
|
13,500
|
7/1/2018
|
J7205
|
Injection, Factor III FC Fusion (Recombinant), per IU
|
28,250
|
7/1/2018
|
J7207
|
Injection, Factor VIII (Antihemophilic Factor, Recombinant) Pegylated, 1 IU
|
24,250
|
7/1/2018
|
J7209
|
Injection, Factor VIII, (Antihemophilic Factor, Recombinant), (NUWIQ), 1 IU
|
26,500
|
7/1/2018
|
J9060
|
Injection, Cisplatin, powder or solution, 10 mg
|
54
|
7/1/2018
|
J9260
|
Injection, Methotrexate sodium, 50 mg
|
798
|
7/1/2018
|
Q9966
|
Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml
|
350
|
7/1/2018
|
V2520
|
Contact Lens Hydrophilic, Spherical, per lens
|
None
|
7/1/2018
|
V2521
|
Contact Lens Hydrophilic, Toric, or Prism Ballast, per lens
|
None
|
7/1/2018
|
V2522
|
Contact Lens Hydrophilic, Bifocal, per lens
|
None
|
7/1/2018
|
V2523
|
Contact Lens Hydrophilic, Extended wear, per lens
|
None
|
7/1/2018
|