N.M. Admin. Code § 13.10.12.7

Current through Register Vol. 35, No. 23, December 10, 2024

Section 13.10.12.7 - DEFINITIONS

A."CDT - 1" codes means the current dental terminology prescribed by the American dental association.

B."CPT - 4" codes means the current procedural terminology published by the American medical association.

C."HCFA" means the health care financing administration of the U.S. department of health and human services.

D."HCFA form 1450" means the health insurance claim form published by HCFA for use by institutional care practitioners, or any successor form published by HCFA to replace form 1450.

E."HCFA form 1500" means the health insurance claim form published by HCFA for use by health care practitioners, or any successor form published by HCFA to replace form 1500.

F."HCPCS" means HCFA's common procedure coding system, a coding system which describes products, supplies, procedures and health professional services and includes the American medical association's (AMA's) Physician Current Procedural Terminology, Fourth Edition (CPT-4) codes, alphanumeric codes, and related modifiers. This includes:

(1)HCPCS level 1 codes which are the AMA's CPT-4 codes and modifiers for professional services and procedures;

(2)HCPCS level 2 codes which are national alphanumeric codes and modifiers for health care products and supplies, as well as some codes for professional services not included in the AMA's CPT-4;

(3)HCPCS level 3 codes which are local alphanumeric codes and modifiers for items and services not included in HCPCS level 1 or HCPCS level 2.

G."Health care practitioner" means:

(1) an acupuncturist licensed under Chapter 61, Article 14A NMSA 1978;

(2) a chiropractor licensed under, Chapter 61, Article 4 NMSA 1978;

(3) a corporation or partnership of health care practitioners defined in this section;

(4) a dentist licensed under Chapter 61, Article 5 NMSA 1978;

(5) a nurse licensed under Chapter 61, Article 3 NMSA 1978 ;

(6) an ophthalmologist otherwise defined as a health care practitioner in this section;

(7) an optometrist licensed under Chapter 61, Article 2 NMSA 1978;

(8) a physician licensed under Chapter 61, Article 6 NMSA 1978;

(9) a podiatrist licensed under Chapter 61, Article 8 NMSA 1978;

(10) a psychologist licensed under Chapter 61, Article 9 NMSA 1978;

(11) a speech, physical, respiratory or occupational therapist licensed under Chapter 61, Articles 12, 12A, 12B, or 14B NMSA 1978;

(12) a counselor or therapist licensed under Chapter 61, Article 9A NMSA 1978;

(13) an osteopath licensed under Chapter 61, Article 10 NMSA 1978; and

(14) a home health care provider.

H."ICD - 9 - CM codes" means the disease codes in the International Classification of Diseases, Ninth Revision, clinical modifications published by the U.S. department of health and human services.

I."Institutional care practitioner" means a health facility as defined under Chapter 24, Article 1 NMSA 1978.

J."Issuer" means an insurer, fraternal benefit society, non profit health care plan, health maintenance organization, prepaid plan, third party administrator, and any other entity reimbursing the costs of health care expenses, other than a governmental agency.

K."J512 form" means the uniform dental claim form approved by the American dental association for use by dentists.

L."Medicare" means the health insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended.

M."Medical assistance or medicaid" means Title XIX of the federal Social Security Act ( 42 U.S.C. 1396, et seq.) as then constituted or later amended; and

N."Revenue codes" means the codes established for use by institutional care practitioners by the national uniform billing committee.

N.M. Admin. Code § 13.10.12.7

7/1/94, 7/1/97; Recompiled 11/30/01