KY Mediciaid Physician Fee Schedule 2021

1 KY Mediciaid Physician Fee Schedule 2021 Note:2021 Codes in Red; Refer to CPT book for descriptionsR" in PA column indicates Prior Auth is requiredCodes listed as '$ " pay 45% of billed amount not to exceed provider s usual and customary charge for the serviceThe anesthesia Base Rate is $ Each 15 minute increment=1 time use lab fee Schedule for covered codes not listed below in the 80000-89249 listed on the lab fee Schedule that begin with a P or Q are currently non-covered for physicians* See Billing Instruction manual for rate informationProc CodeProcedure DescriptionPA IndInpat Rate FacilityOutpat Rate NonFacilitTech.

2 Unit ValueNotes00100 ANES FOR PROCEDURES ON SALIVARY GLANDS, INCLUDING BIOPSY ** FOR PROCEDURES INVOLVING PLASTIC REPAIR OF CLEFT LIP ** FOR RECONSTRUCTIVE PROCED OF EYELID ** FOR ELECTROCONVULSIVE THERAPY ** FOR PROC ON EXTERNAL, MIDDLE, AND INNER EAR ,INC BIOPSY ** FOR PROC ON EXTERNAL, MIDDLE, AND INNER EAR,OTOSCOPY ** FOR PROC ON EXTERNAL, MIDDLE, AND INNER EAR, TYMPANOTOMY ** FOR PROC ON EYE; NOT OTHERWISE SPECIFIED ** FOR PROCEDURES ON EYE; LENS SURGERY ** FOR PROCEDURES ON EYE; CORNEAL TRANSPLANT ** FOR PROCEDURES ON EYE; VITREORETINAL SURGERY ** FOR PROCEDURES ON EYE; IRIDECTOMY ** FOR PROCEDURES ON EYE; OPHTHALMOSCOPY ** FOR PROC ON NOSE AND ACCESS SINUSES; NOT OTHERISE SPEC.

3 ** FOR PROC ON NOSE AND ACCESS SINUSES; RADICAL SURGERY ** Medicaid Physician Fee Schedule 2021* See Billing Instruction manual for rate informationProc CodeProcedure DescriptionPA IndInpat Rate FacilityOutpat Rate NonFacilitTech. Unit ValueNotes00164 ANES FOR PROC ON NOSE AND ACCESS SINUSES; BIOPSY SOFT TISSUE ** FOR INTRAORAL PROC, INCLUDING BIOPSY; NOT OTHERWISE SPEC ** FOR INTRAORAL PROC, INCLUDING BIOPSY; REPAIR OF CLEFT ** FOR INTRAORAL PROC, INCLUDING BIOPSY; EXCISION OF TUMOR ** FOR INTRAORAL PROC, INCLUDING BIOPSY; RADICAL SURGERY ** FOR PROC ON FACIAL BONES OR SKULL; NOT OTHERWISE SPEC ** FOR PROC ON FACIAL BONES OR SKULL; RADICAL SURGERY ** FOR INTRACRANIAL PROCEDURES; NOT OTHERWISE SPECIFIED ** , CRAN SURG, HEMOTOMA** FOR INTRACRANIAL PROCEDURES.

4 SUBDURAL TAPS ** FOR INTRACRANIAL PROCEDURES; BURR HOLES ** FOR INTRACRANIAL PROCEDURES; CRANIOPLASTY ** FOR INTRACRANIAL PROCEDURES; VASCULAR PROCEDURES ** FOR INTRACRANIAL PROCEDURES; PROC IN SITTING POSITION ** FOR INTRACRANIAL PROC; CEREBROSPINAL FLUID SHUNTING ** FOR INTRACRANIAL PROC; ELECTROCOAGULATION OF I C NERVE ** FOR ALL PROC ON THE INTEGUMENTARY SYSTEM, ** FOR ALL PROC ON ESOPHAGUS, THYROID, LARYNX, ETC ** FOR ALL PROC ON ESOPHAGUS, THYROID, AND NEEDLE BIOPSY ** FOR ALL PROC ON THE LARYNX , TRACHEA, LESS THAN 1 YR AGE ** FOR PROC ON MAJOR VESSELS OF NECK; NOT SPEC ** FOR PROC ON MAJOR VESSELS OF NECK; SIMPLE LIGATION ** of 369KY Medicaid Physician Fee Schedule 2021* See Billing Instruction manual for rate informationProc CodeProcedure DescriptionPA IndInpat Rate FacilityOutpat Rate NonFacilitTech.

5 Unit ValueNotes00400 ANES FOR PROC ON THE INTEGUMENTARY SYSTEM ** FOR PROC ON THE INTEGUMENTARY SYSTEM, RECONSTRUCTIVE ** FOR PROC ON THE INTEGUMENTARY SYSTEM, RADICAL BREAST ** FOR PROC ON THE INTEGUMENTARY SYSTEM , AND NODE DIS. ** FOR PROC ON THE INTEGUMENTARY SYSTEM, WITH CONV. ** FOR PROC ON CLAVICLE AND SCAPULA; NOT OTHERWISE SPEC ** FOR PROC ON CLAVICLE AND SCAPULA; BIOPSY OF CLAVICLE ** FOR PARTIAL RIB RESECTION; NOT OTHERWISE SPECIFIED ** FOR PARTIAL RIB RESECTION; THORACOPLASTY (ANY TYPE) ** FOR PARTIAL RIB RESECTION; RADICAL PROCEDURES ** FOR ALL PROCEDURES ON ESOPHAGUS ** FOR CLOSED CHEST PROC; (INCLUDING BRONCHOSCOPY) ** FOR CLOSED CHEST PROC; NEEDLE BIOPSY OF PLEURA ** FOR CLOSED CHEST PROCEDURES; PNEUMOCENTESIS ** FOR CLOSED CHEST PROC.

6 MEDIASTINOSCOPY AND DIAG ** FOR CLOSED CHEST PROC; MEDIAS AND DIAG, LUNG VENT ** FOR PERMANENT TRANSVENOUS PACEMAKER INSERTION ** ACCESS TO CENTRAL VENOUS CIRCULATION ** FOR TRANSVENOUS INSERTION OR REPLACEMENT OF PACING ** FOR CARDIAC ELECTROPHYSIOLOGIC PROCEDURES ** FOR TRACHEOBRONCHIAL RECONSTRUCTION ** FOR THORACOTOMY PROC INV LUNGS, PLEURA, ETC ** of 369KY Medicaid Physician Fee Schedule 2021* See Billing Instruction manual for rate informationProc CodeProcedure DescriptionPA IndInpat Rate FacilityOutpat Rate NonFacilitTech.

7 Unit ValueNotes00541 ANES FOR THORACOTOMY PROC INV LUNGS, ETC WITH VENT ** FOR THORACOTOMY PROC, DECORTICATION ** FOR THORACOTOMY PROC, THORACOPLASTY ** FOR THORACOTOMY PROC, INTRA-THORACIC ** FOR STERNAL DEBRIDEMENT ** FOR PROC ON HEART, GREAT VESSELS; W/O OXYGENATOR ** FOR PROC ON HEART, GREAT VESSELS; WITH OXYG, under AGE 1 ** FOR PROC ON HEART, GREAT VESSELS; WITH OXYG, OVER AGE 1 ** FOR PROC HEART, GREAT VESSELS;WITH HCA ** FOR DIRECT COR ARTERY BYPASS GRAFTING WITHOUT PUMP ** , CABG W/PUMP** FOR HEART TRANSPLANT OR HEART/LUNG TRANSPLANT ** FOR PROC ON CERVICAL SPINE AND CORD; NOT O/W SPEC ** FOR PROC ON CERVICAL SPINE AND CORD;SIT POSITION ** FOR PROC ON THORACIC SPINE AND CORD; NOT OTHERWISE ** FOR PROC ON THORACIC SPINE AND CORD; NOT USING ONE LUNG VENTILATION** FOR PROC ON THORACIC SPINE AND CORD; USING ONE LUNG VENTILATION** FOR PROC IN LUMBAR REGION; NOT OTHERWISE SPECIFIED ** FOR PROC IN LUMBAR REGION.

8 LUMBAR SYMPATHECTOMY ** FOR PROC IN LUMBAR REGION; DIAGNOSTIC OR THERAPEUTIC ** FOR manipulation OF THE SPINE OR FOR CLOSED PROCEDURES ** FOR EXTENSIVE SPINE AND SPINAL CORD PROCEDURES ** of 369KY Medicaid Physician Fee Schedule 2021* See Billing Instruction manual for rate informationProc CodeProcedure DescriptionPA IndInpat Rate FacilityOutpat Rate NonFacilitTech. Unit ValueNotes00700 ANES FOR PROC UPPER ANTERIOR ABDOMINAL WALL ** FOR PROC ON UPPER ANTERIOR ABD WALL; PERC LIVER BIOPSY ** FOR PROC ON UPPER POSTERIOR ABDOMINAL WALL ** UPR GI NDSC PX NOS** Effective 1/1/201800732 ANES UPR GI NDSC PX ERCP** Effective 1/1/201800750 ANES FOR HERNIA REPAIRS IN UPPER ABDOMEN; NOS ** FOR HERNIA REPAIRS IN UPPER ABD; LUMBAR AND VENTRAL ** FOR HERNIA REPAIRS IN UPPER ABDOMEN; OMPHALOCELE ** FOR HERNIA REPAIRS IN UPPER ABDOMEN.

9 TRANSABD REPAIR ** FOR ALL PROC ON MAJOR ABD BLOOD VESSELS ** FOR INTRAPERITONEAL PROC IN UPPER ABD INC LAP ** FOR INTRAPERITONEAL PROC ; HEPATECTOMY ** FOR INTRAPERITONEAL PROC IN UPPER ABD INC WHIPPLE ** FOR INTRAPERITONEAL PROC IN UP ABD INC LIVER TRANS ** FOR INTRAPERITONEAL PROC IN UP ABD INC GASTRIC BYPASS ** FOR PROC ON LOW ANTE ABD WALL; NOS ** FOR PROC ON LOW ANTE ABD WALL; PANNICULECTOMY ** LWR INTST NDSC NOS** Effective 1/1/201800812 ANES LWR INTST SCR COLSC** Effective 1/1/201800813 ANES UPR LWR GI NDSC PX** Effective 1/1/201800820 ANES FOR PROC ON LOWER POSTERIOR ABDOMINAL WALL ** FOR HERNIA REPAIRS IN LOWER ABD; NOS ** FOR HERNIA REPAIRS IN LOWER ABD; VENTRAL AND INCISIONAL ** FOR HERNIA REPAIRS IN THE LOWER ABD;NOS ** FOR HERNIA REPAIRS IN THE LOWER ABD.

10 NOS ** of 369KY Medicaid Physician Fee Schedule 2021* See Billing Instruction manual for rate informationProc CodeProcedure DescriptionPA IndInpat Rate FacilityOutpat Rate NonFacilitTech. Unit ValueNotes00840 ANES FOR INTRAPERITONEAL PROC IN LOWER ABD INC LAP ** FOR AMINOCENTESIS ** FOR ABDOMINOPERINEAL RESECTION ** FOR RADICAL HYSTERECTOMY ** FOR PELVIC EXENTERATION ** FOR TUBAL LIGATION/TRANSECTION ** FOR EXTRAPERITONEAL PROCEDURES LOWER ABD ** FOR RENAL PROCEDURES ** FOR TOTAL CYSTECTOMY ** FOR RADICAL PROSTATECTOMY ** FOR ADRENALECTOMY ** FOR RENAL TRANSPLANT ** FOR CYSTOLITHOTOMY ** FOR LITHOTRIPSY, EXTRACORPOREAL SHOCK WAVE ** FOR LITHOTRIPSY, EXTRACORPOREAL SHOCK WAVE; W/O WATER ** FOR PROC MAJOR LOWER ABD VESSELS.