Section 20-2-II - GuidelinesA.Transportation Services Including Ambulance (A0021 - A0999)1. Transportation service codes include ground and air ambulance, non-emergency transportation (taxi, bus, automobile, wheelchair van), and ancillary transportation-related fees.2. No exemption for air ambulance according to the Airline Deregulation Act (ADA) is allowed based on the rules and regulations of the current 2016 MWCC Fee Schedule.3. Modifiers are required when reporting transportation services. Modifiers are single digits used to identify origin and destination. The first modifier identifies the transport place of origin and the second modifier the destination. Origin and destination modifiers are as follows: D Diagnostic or therapeutic site other than "P" or "H" when these are used as origin codes
E Residential, domiciliary, custodial facility (other than 1819 facility)
G Hospital-based ESRD facility
H Hospital
I Site of transfer (e.g., airport or helicopter pad) between modes of ambulance transport
J Free-standing ESRD facility
N Skilled nursing facility (SNF)
P Physician's office
R Residence
S Scene of accident or acute event
X Intermediate stop at physician's office on way to hospital (includes HMO non-hospital facility, clinic, etc. destination code only).
Note: Modifier X can only be used as a destination code in the second position of a modifier.
4. Transportation codes can also be found in the S codes. See S0207, S0208, S0209, and S0215.B.Medical and Surgical Supplies (A4206 - A8004)1. These A codes include a wide variety of medical, surgical, and some DME related supplies and services.2. For rules related to DME supplies, accessories, maintenance, and repair, see F. Durable Medical Equipment below.C.Administrative, Miscellaneous, and Investigational (A9150 - A9999)1. These A codes include non-prescription drugs, exercise equipment, radiopharmaceutical diagnostic imaging agents, as well as other miscellaneous supplies.D.Enteral and Parenteral Therapy (B4000 - B9999)1. B codes include supplies, formulae, nutrition solutions and infusion pumps.E.Outpatient PPS (C1300 - C9899)1. C codes include drugs, biologicals, and devices used by hospitals. Non-OPPS hospitals, Critical Access Hospitals (CAHs), Indian Health Services Hospitals (IHS), hospitals located in American Samoa, Guam, Saipan, or the Virgin Islands, and Maryland waiver hospitals may report these codes at their discretion.
2. These codes are only used for facility (technical) services.F.Durable Medical Equipment (DME) (E0100 - E8002)1. E codes include durable medical equipment such as canes, crutches, walkers, commodes, decubitus care, bath and toilet aids, hospital beds, oxygen and related respiratory equipment, monitoring equipment, pacemakers, patient lifts, safety equipment, restraints, traction equipment, fracture frames, wheelchairs, and artificial kidney machines.2. All durable medical equipment shall have prior authorization from the payer before obtaining the equipment. The payer has the choice of vendor for purchase or rental of DME.3. If an injured/ill employee is receiving DME items for both compensable and non-compensable medical conditions, only those items that apply to the work related injury should be listed on claims and invoices submitted to the employer.4. If the rental price for DME exceeds or equals the total purchase price, the employer shall purchase instead of renting equipment. The vendor shall make the payer aware of the price options.5. When rental payments total the purchase price, the equipment is considered purchased and no additional reimbursement is made. 6. The return of rented equipment is the dual responsibility of the injured worker and the DME supplier. The employer is not responsible for additional rental periods solely due to delay in equipment return.7. For codes E0676, E0935, and E0936 the Amount listed is per day.G.Procedures/Professional Services (Temporary) (G0008 - G9186)1. G codes identify professional health care procedures and services that would otherwise be reported using CPT codes.2. Procedures and professional services identified by G codes may have a corresponding CPT code. When both a G code and CPT code describe the same procedure, the CPT code is required for reporting purposes.3. G codes also include procedures and professional services that do not currently have a valid CPT code. In such cases, the applicable G code should be used for reporting purposes.H.Drugs and Biologicals (J0120 - J9999)1. J codes include drugs that ordinarily cannot be self-administered, chemotherapy drugs, immunosuppressive drugs, inhalation solutions, and other miscellaneous drugs and solutions.2. These codes report only the costs associated with provision of the drug. Administration including injection, infusion, or inhalation is reported separately using the applicable CPT code(s).3. Additional codes for drugs and biologicals may be found in the Q codes and S codes.I.Temporary Codes (K0001 - K9999)1. K codes are temporary codes used to report durable medical equipment that do not yet have a permanent national code.2. For rules related to DME supplies, accessories, maintenance, and repair, see F. Durable Medical Equipment above.J.Orthotic Procedures and Devices (L0000 - L4999) and Prosthetic Procedures (L5000 - L9900)1. L codes include orthotic and prosthetic procedures and devices as well as scoliosis equipment, orthopedic shoes, and prosthetic implants.2. The payer shall only pay for orthotics and prosthetics prescribed by the treating physician for a compensable injury/illness. Prior authorization must be obtained from the payer.K.Medical Services (M0000 - M0301)1. M codes include office services, cellular therapy, prolotherapy, intragastric hypothermia, IV chelation therapy, and fabric wrapping of an abdominal aneurysm.2. These codes are rarely reported and may not be reimbursed as they represent services for which the therapeutic efficacy has not been established, the procedure is considered experimental, or the procedure has been replaced with a more effective treatment modality.L.Pathology and Laboratory Services (P0000 - P9999)1. P codes include chemistry, toxicology, and microbiology tests, screening Papanicolaou procedures, and various blood products.2. Blood and blood product codes report the supply of the blood or blood product only.3. The administration of blood or blood product is reported separately.4. Code 36430 for transfusion of blood or blood components is reported only once per encounter regardless of the number of units provided. M.Temporary Codes (Q0035 - Q9980)1. Q codes include temporary codes developed for reporting services and supplies that do not have a permanent national HCPCS code or CPT code. Included in this section are codes for:a. Oral anti-emetic drugsf. Other supplies/services 2. Cast supplies and splints should be reported with the appropriate code from Q4001 - Q4051. These codes report the cost of the supply only.3. Cast supplies and splints are reported in addition to the CPT code for fracture management.4. Cast supplies and splints are reported in addition to CPT codes for application of the cast or splint.5. Refer to the CPT guidelines for rules related to reporting fracture management and cast application. N.Diagnostic Radiology Services (R0000 - R5999)1. R codes are used for the transportation of portable x-ray and/or EKG equipment.2. Only a single reasonable transportation charge is allowed for each trip to a single location.3. When more than one patient receives x-ray or EKG services at the same location, the allowable transport charge is divided among all patients.O.Temporary National Codes (Non-Medicare) (S0000 - S9999)1. The S codes are used by the private sector to report drugs, services, and supplies for which there are no national codes, but for which codes are needed by the private sector to implement policies, program, or claims processing. Mississippi uses S codes with modified descriptions to report home health services.2. See J codes for reporting rules related to drugs and biologicals.P.Vision Services (V0000 - V2999)1. These V codes include vision-related supplies, including spectacles, lenses, contact lenses, prostheses, intraocular lenses, and miscellaneous lenses.Q.Hearing Services (V5000 - V5999)1. These V codes include hearing tests and related supplies and equipment, speech-language pathology screenings, and repair of augmentative communicative systems.R. The Facility Fee for outpatient services is the APC Amount.