Section 20-2-I - GUIDELINESA.Unlisted Services or Procedures . When reporting a service or procedure that is not listed in this fee schedule, use the appropriate unlisted procedure code. The bill must be accompanied by a Special Report as described below. If a HCPCS or CPT code has been established subsequent to the release of this fee schedule, include the code(s) with the Special Report.B.Multiple Procedures . When multiple procedures are performed on the same date or at the same session, it is appropriate to designate them by separate entries.C.Separate Procedures . Separate procedures are commonly carried out as an integral component of another procedure. They should not be billed in conjunction with the related procedure. These procedures may be billed when performed independently by adding modifier 59 to the specific "separate procedure" code.D.By Report (BR) . "BR" in the Amount column indicates services that are too new, unusual, or variable in the the nature of their performance to permit the assignment of a definable fee. Such services should be substantiated by documentation submitted with the bill. Sufficient information should be included to permit proper identification and a sound evaluation.E.Special Report . Any test/service that is not provided routinely should be reported with the appropriate code designating the service and the billing for that test/service should include a description of the procedure, the process used, and a full report of the findings. Special reports to justify the necessity of a service do not warrant a separate fee.F.Materials Supplied by Physician . Supplies and materials usually included in an office visit are included in the reimbursement for the office visit. Other unusual supplies and materials should be identified with CPT code 99070 or a specific HCPCS code. Reimbursement shall be limited to the lesser of the billed amount, the Fee Schedule MAR or the usual and customary rate for items not listed in this Fee Schedule.G.Audiological Function Tests . The audiometric tests (92551-92597) require the use of calibrated electronic equipment, recording of results and a report with interpretation. Hearing tests (such as whispered voice, tuning fork) that are otorhinolaryngologic Evaluation and Management services are not reported separately.. All services include testing of both ears. Use modifier 52 if a test is applied to one ear instead of two ears.H.Psychological Services 1. Payment for a psychiatric diagnostic interview/evaluation includes history and mental status determination, development of a treatment plan when necessary and the preparation of a written report that must be submitted with the required billing form. Use of an E/M code with a diagnostic interview/evaluation is not appropriate.2. Psychotherapy codes are used regardless of place of service. The CPT code most closely matching the length of the session must be billed.3. Use of an E/M code with a psychotherapy code should follow the guidelines from CPT and American Psychiatric Association recommendatations.4. A service level adjustment factor is used to determine payment for psychotherapy when a provider other than a psychiatrist provides the service. In those instances, the reimbursement amount for the CPT code is paid at eighty-five percent (85%) of the maximum reimbursement allowance. This applies to psychologists, social workers, counselors and other non-physician providers.I.Electromyography (EMG) and Nerve Conduction Studies (NCS). Payment for EMG services includes the initial set of electrodes and all supplies necessary to perform the service. The physician may be paid for a consultation or new patient visit in addition to the EMG performed on the same day, with supporting documentation required as outlined in the Evaluation and Management section. When an EMG is performed on the same day as a follow up visit, payment may be made for the EMG only unless documentation supports the need for a medical service in addition to the EMG. 1. Only a licensed allopathic or osteopathic physician certified in Neurology/Physical Medicine and Rehabilitation (PMR)/Electrodiagnostic medicine is entitled to reimbursement for performing an electromyogram (EMG) and/or a nerve conduction study (NCS).2. Reimbursement for automated nerve conduction studiesis not allowed under this Fee Schedule.3. Referral for an electromyogram and/or a nerve conduction study shall be at the discretion and direction of the physician in charge of care, and neither the payer nor the payer's agent may unilaterally or arbitrarily redirect the patient to another provider for these tests. The payer or the payer's agent may, however, discuss with the physician in charge of care, appropriate providers for the conduct of these tests in an effort to reach an agreement with the physician in charge as to who will conduct an electromyogram and/or nerve conduction study in any given case.J.Manipulative Services. Chiropractic and Osteopathic manipulative services, which are medicine services, are addressed in the Therapeutic Services section.