Commonwealth of Massachusetts MassHealth Provider Manual Series: Family Planning Agency Manual Subchapter Number and Title: 6. Service Codes and Descriptions Page: 6-1 Transmittal Letter: FPA-45 Date: 01/01/12 601: Definitions and Early Periodic Screening, Diagnosis and Treatment (EPSDT) Services (A) New Patient: a patient who has not received any professional services from the provider within the past three years. (B) Established Patient: a patient who has received professional services from the provider within the past three years. (C) Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services: MassHealth pays for the services represented by the codes listed in Subchapter 6 in effect at the time of service, subject to all conditions and limitations in MassHealth regulations at 130 CMR 421.000 and 450.000. A family planning agency provider may request prior authorization for any medically necessary service reimbursable under the federal Medicaid Act in accordance with 130 CMR 450.144, 42 U.S.C. 1396d(a), and 42 U.S.C. 1396d(r)(5) for a MassHealth Standard or CommonHealth member younger than 21 years of age, even if it is not designated as covered or payable in Subchapter 6 of the Family Planning Agency Manual. 602: Service Codes and Descriptions: Visits New Patient 99201: Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a problem-focused history; a problem-focused examination; and straightforward medical decision making 99202: Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: an expanded problem focused history; an expanded problem focused examination; straightforward medical decision making 99203: Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a detailed history; a detailed examination; and medical decision making of low complexity 99205: Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of high complexity Commonwealth of Massachusetts MassHealth Provider Manual Series: Family Planning Agency Manual Subchapter Number and Title: 6. Service Codes and Descriptions Page: 6-2 Transmittal Letter: FPA-45 Date: 01/01/12 602 Service Codes and Descriptions: Visits (cont.) Established Patient 99211: Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician (minimal service) 99213: Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: an expanded problem-focused history; an expanded problem-focused examination; medical decision making of low complexity (limited service) 99215: Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity (comprehensive service) Preventive Medicine, New Patient 99384: Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization(s), laboratory/diagnostic procedures, new patient; adolescent (age 12 through 17 years) 99385: Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization(s), laboratory/diagnostic procedures, new patient; 18-39 years 99386: Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization(s), laboratory/diagnostic procedures, new patient; 40-64 years Preventive Medicine, Established Patient 99394: Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization(s), laboratory/diagnostic procedures, established patient; adolescent (age 12 through 17 years) 99395: Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization(s), laboratory/diagnostic procedures, established patient; 18-39 years Commonwealth of Massachusetts MassHealth Provider Manual Series Subchapter Number and Title 6. Service Codes and Descriptions Page 6-3 Family Planning Agency Manual Transmittal Letter FPA-47 Date 07/01/12 603 Service Codes and Descriptions: Contraceptive Supplies and Drugs Service Code Service Description 99396 Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization(s), laboratory/diagnostic procedures, established patient; 40-64 years Preventive Medicine, Individual Counseling 99402 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes (HIV pre- and post-test counseling only; two visits per day; maximum eight visits per year) A4261 Cervical cap for contraceptive use (I.C.) A4266 Diaphragm for contraceptive use (includes applicator and cream or jelly) A4267 Contraceptive supply, condom, male, each A4268 Contraceptive supply, condom, female, each A4269 Contraceptive supply, spermicide (e.g., foam, gel), each (per package/tube) J1055 Injection, medroxyprogesterone acetate for contraceptive use, 150 mg (Use for Depo-Provera.) (I.C.) J1056 Injection, medroxyprogesterone acetate/estradiol cypionate, 5 mg/25 mg (Use for Lunelle monthly contraceptive.) (I.C.) J3490-FP Unclassified drugs (Use for medications and injectibles related to family planning services, with the exception of (a) Rho(D) human immune globulin; and (b) contraceptive injectables such as Depo-Provera, items for which MassHealth will pay the provider's cost.) (I.C.) J7303 Contraceptive supply, hormone-containing vaginal ring, each J7304 Contraceptive supply, hormone-containing patch, each J7307 Etonogestrel (contraceptive) implant system, including implants and supplies (must be billed with either 11975 or 11977) S4989 Contraceptive intrauterine device (e.g., Progestacert IUD), including implants and supplies (I.C.) S4993 Contraceptive pills for birth control 90649 Human Papilloma virus (HPV) vaccine, types 6, 11, 16, 18 (quadrivalent), three-dose schedule, for intramuscular use (I.C.) 90650 Human Papilloma virus (HPV) vaccine, types 16, 18, bivalent, three-dose schedule, for intramuscular use Commonwealth of Massachusetts MassHealth Provider Manual Series Subchapter Number and Title 6. Service Codes and Descriptions Page 6-4 Family Planning Agency Manual Transmittal Letter FPA-47 Date 07/01/12 604 Service Codes and Descriptions: Medical and Surgery Procedures Service Code Service Description 11976 Removal, implantable contraceptive capsules (S.P.) 11981 Insertion, non-biodegradable drug delivery implant 11983 Removal with reinsertion, nonbiodegradable drug delivery implant 19100 Biopsy of breast; percutaneous, needle core, not using imaging guidance (separate procedure) 49082 Adominal paracentesis (diagnostic or therapeutic); without imaging guidance 49083 with imaging guidance 49084 Peritoneal lavage, including imaging guidance, when performed 55250 Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s) (Consent for Sterilization form CS-18 or CS-21 required) 55450 Ligation (percutaneous) of vas deferens, unilateral or bilateral (separate procedure) (Consent for Sterilization form CS-18 or CS-21 required) 56420 Incision and drainage of Bartholin’s gland abscess 56501 Destruction of lesion(s), vulva; simple (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery) 56605 Biopsy of vulva or perineum (separate procedure); one lesion 57061 Destruction of vaginal lesion(s); simple (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery) 57100 Biopsy of vaginal mucosa; simple (separate procedure) 57420 Colposcopy of the entire vagina, with cervix if present 57421 with biopsy(ies) 57425 Laparoscopy, surgical, colpopexy (suspension of vaginal apex) 57452 Colposcopy of the cervix including upper/adjacent vagina 57454 with biopsy(ies) of the cervix and endocervical curettage 57455 with biopsy(ies) of the cervix 57456 with endocervical curettage 57460 with loop electrode biopsy(ies) of the cervix 57461 with loop electrode conization of the cervix 57500 Biopsy, single or multiple, or local excision of lesion, with or without fulguration (separate procedure) 57505 Endocervical curettage (not done as part of a dilation and curettage) 57510 Cautery of cervix; electro or thermal 57511 cryocautery, initial or repeat 57513 laser ablation 57520 Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; cold knife or laser 57522 loop electrode excision 58100 Endometrial sampling (biopsy) with or without endocervical sampling (biopsy), without cervical dilation, any method (separate procedure) 58340 Catherization and introduction of saline or contrast material for saline infusion sonohysterography (SIS) or hysterosalpingography 58565 Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants Commonwealth of Massachusetts MassHealth Provider Manual Series: Family Planning Agency Manual Subchapter Number and Title: 6. Service Codes and Descriptions Page: 6-5 Transmittal Letter: FPA-45 Date: 01/01/12 605: Service Codes and Descriptions: Laboratory Services ORGAN OR DISEASE-ORIENTED PANELS These panels were developed for coding purposes only and should not be interpreted as clinical parameters. The tests listed with each panel identify the defined components of that panel. These panel components are not intended to limit the performance of other tests. If one performs tests in addition to those specifically indicated for a particular panel, those tests should be reported separately in addition to the panel code. 80055: Obstetric panel (This panel must include the following: blood count, complete (CBC), automated, and automated differential WBC count (85025 or 85027 and 85004) or blood count, complete (CBC), automated (85027), and appropriate manual differential WBC count (85007 or 85009); hepatitis B surface antigen (HBsAg) (87340); antibody, rubella (86762); syphilis test, non-treponemal antibody, qualitative (e.g., VDRL, RPR, ART) (86592), antibody screen, RBC, each serum technique (86850); blood typing, ABO (86900); and blood typing, Rh (D) (86901).) 80061: Lipid panel (This panel must include the following: cholesterol, serum, total (82465); lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718); and triglycerides (84478).) 80074: Acute hepatitis panel (This panel must include the following: hepatitis A antibody (HAAb); IgM antibody (86709); hepatitis B core antibody (HbcAb), IgM antibody (86705); hepatitis B surface antigen (HbsAg) (87340); and hepatitis C antibody (86803).) 80076: Hepatic function panel (This panel must include the following: albumin (82040); bilirubin, total (82247); bilirubin, direct (82248); phosphatase, alkaline (84075); protein, total (84155); transferase, alanine amino (ALT) (SGPT) (84460); and transferase, aspartate amino (AST) (SGOT) (84450).) URINALYSIS 81000: Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; nonautomated, with microscopy 81001: automated, with microscopy 81002: nonautomated, without microscopy 81003: automated, without microscopy 81005: Urinalysis; qualitative or semiquantitative, except immunoassays 81007: bacteriuria screen, except by culture or dipstick 81025: Urine pregnancy test, by visual color comparison methods 81099: Unlisted urinalysis procedure Commonwealth of Massachusetts MassHealth Provider Manual Series: Family Planning Agency Manual Subchapter Number and Title: 6. Service Codes and Descriptions Page: 6-6 Transmittal Letter: FPA-45 Date: 01/01/12 605: Service Codes and Descriptions: Laboratory Services (cont.) CHEMISTRY The material for examination may be from any source unless otherwise specified in the code description. The examination is quantitative unless specified. Clinical information derived from the results of laboratory data that is mathematically calculated (e.g., free thyroxine index (T7)) is considered part of the test procedure and therefore is not a separately reportable service. 82040: Albumin; serum 82247: Bilirubin; total 82248: direct 82270: Blood, occult; by peroxidase activity (e.g., guaiac), qualitative; feces, 1-3 simultaneous determinations 82273: other sources 82310: Calcium; total 82465: Cholesterol, serum or whole blood, total 82540: Creatine 82550: Creatine kinase (CK), (CPK); total 82565: Creatinine; blood 82570: other source 82607: Cyanocobalamin (vitamin B-12) 82627: Dehydroepiandrosterone-sulfate (DHEA-S) 82670: Estradiol 82671: Estrogens; fractionated 82672: total 82677: Estriol 82679: Estrone 82746: Folic acid; serum 82947: Glucose; quantitative, blood (except reagent strip) 82950: post-glucose dose (includes glucose) 82951: tolerance test (GTT), three specimens (includes glucose) 82955: Glucose 6 phosphate dehydrogenase (G6PD); quantitative 82960: screen 83001: Gonadotropin; follicle-stimulating hormone (FSH) 83002: luteinizing hormone (LH) 83003: Growth hormone, human (HGH) (somatotropin) 83036: Hemoglobin; glycated 83491: Hydroxycorticosteroids, 17 (17 OHCS) 83540: Iron 83550: Iron-binding capacity Commonwealth of Massachusetts MassHealth Provider Manual Series: Family Planning Agency Manual Subchapter Number and Title: 6. Service Codes and Descriptions Page: 6-7 Transmittal Letter: FPA-45 Date: 01/01/12 605: Service Codes and Descriptions: Laboratory Services (cont.) 83586: Ketosteroids, 17 (17 KS); total 83593: fractionation 83615: Lactate dehydrogenase (LD), (LDH) 83625: isoenzymes, separation and quantitation 83718: Lipoprotein, direct measurement; high density cholesterol (HDLcholesterol) 84060: Phosphatase, acid; total 84066: prostatic 84075: Phosphatase, alkaline 84078: heat stable (total not included) 84080: isoenzymes 84132: Potassium; serum 84144: Progesterone 84146: Prolactin 84155: Protein, total, except by refractometry; serum 84156: urine 84157: other source (e.g., synovial fluid, cerebrospinal fluid) 84160: Protein, total, by refractometry, any source 84163: Pregnancy-associated plasma Protein-A (PAPP-A) 84165: Protein; electrophoretic fractionation andquantitation, serum 84166: electrophoretic fractionation and quantitation, other fluids with concentration (e.g., urine, CSF) 84295: Sodium; serum 84300: urine 84402: Testosterone; free 84403: total 84436: Thyroxine; total 84437: requiring elution (e.g., neonatal) 84439: free 84443: Thyroid stimulating hormone (TSH) 84450: Transferase; aspartate amino (AST) (SGOT) 84460: alanine amino (ALT) (SGPT) 84478: Triglycerides 84479: Thyroid hormone (T3 or T4) uptake or thyroid hormone binding ratio (THBR) 84480: Triiodothyronine T3; total (TT-3) 84520: Urea nitrogen; quantitative 84550: Uric acid; blood 84590: Vitamin A 84702: Gonadotropin, chorionic (hCG); quantitative 84703: qualitative Commonwealth of Massachusetts MassHealth Provider Manual Series: Family Planning Agency Manual Subchapter Number and Title: 6. Service Codes and Descriptions Page: 6-8 Transmittal Letter: FPA-45 Date: 01/01/12 605: Service Codes and Descriptions: Laboratory Services (cont.) HEMATOLOGY AND COAGULATION 85007: Blood count; blood smear, microscopic examination with manual differential WBC count 85008: blood smear, microscopic examination without manual differential WBC count 85009: manual differential WBC count, buffy coat 85013: spun microhematocrit 85014: hematocrit (Hct) 85018: hemoglobin (Hgb) 85025: complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count 85027: complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) 85041: red blood cell (RBC), automated 85610: Prothrombin time 85651: Sedimentation rate, erythrocyte; nonautomated 85652: automated 85660: Sickling of RBC, reduction IMMUNOLOGY 86038: Antinuclear antibodies (ANA) 86171: Complement fixation tests, each antigen 86235: Extractable nuclear antigen, antibody to, any method (e.g., nRNP, SS-A, SS-B, Sm, RNP, Sc170, J01), each antibody 86280: Hemagglutination inhibition test (HAI) 86308: Heterophile antibodies; screening 86309: titer 86310: titers after absorption with beef cells and guinea pig kidney 86317: Immunoassay for infectious agent antibody, quantitative, not otherwise specified 86318: Immunoassay for infectious agent antibody, qualitative or semiquantitative, single step method (e.g., reagent strip) 86592: Syphilis test, non-treponemal antibody; qualitative (e.g., VDRL, RPR, ART) 86593: quantitative Commonwealth of Massachusetts MassHealth Provider Manual Series: Family Planning Agency Manual Subchapter Number and Title: 6. Service Codes and Descriptions Page: 6-9 Transmittal Letter: FPA-45 Date: 01/01/12 605 Service Codes and Descriptions: Laboratory Services (cont.) The following codes (86628-86804) are qualitative or semiquantitative immunoassays performed by multiple step methods for the detection of antibodies to infectious agents. For immunoassays by single step method (e.g., reagent strips), use code 86318. Procedures for the identification of antibodies should be coded as precisely as possible. For example, an antibody to a virus could be coded with increasing specificity for virus, family, genus, species, or type. In some cases, further precision may be added to codes by specifying the class of immunoglobulin being detected. When multiple tests are done to detect antibodies to organisms classified more precisely than the specificity allowed by available codes, it is appropriate to code each as a separate service. For example, a test for antibody to an enterovirus is coded as 86658. Coxsackieviruses are enteroviruses, but there are no codes for the individual species of enterovirus. If assays are performed for antibodies to coxsackie A and B species, each assay should be separately coded. Similarly, if multiple assays are performed for antibodies of different immunoglobulin classes, each assay should be coded separately. When a coding option exists for reporting IgM specific antibodies (e.g., 86632) the corresponding ono-specific code (e.g., 86631) may be reported for performance of either an antibody analysis not specific for a particular immunoglobulin class or an IgG analysis. 86628: Antibody; Candida 86631: Chlamydia 86632: Chlamydia, IgM 86687: HTLV-I 86688: HTLV-II 86689: HTLV or HIV antibody, confirmatory test (e.g., Western Blot) 86692: hepatitis, delta agent 86694: herpes simplex, non-specific type test 86695: herpes simplex, type 1 86696: herpes simplex, type 2 86701: HIV-1 86702: HIV-2 86703: HIV-1 and HIV-2, single assay 86704: Hepatitis B core antibody (HBcAb); total 86705: IgM antibody 86706: Hepatitis B surface antibody (HBsAb) 86707: Hepatitis Be antibody (HBeAb) 86708: Hepatitis A antibody (HAAb); total 86709: IgM antibody 86762: Antibody; rubella 86781: Treponema pallidum, confirmatory test (e.g., FTA-abs) 86803: Hepatitis C antibody 86804: confirmatory test (e.g., immunoblot) Commonwealth of Massachusetts MassHealth Provider Manual Series: Family Planning Agency Manual Subchapter Number and Title: 6. Service Codes and Descriptions Page: 6-10 Transmittal Letter: FPA-45 Date: 01/01/12 605: Service Codes and Descriptions: Laboratory Services (cont.) TRANSFUSION MEDICINE 86850: Antibody screen, RBC, each serum technique 86900: Blood typing; ABO 86901: Rh (D) (I.C.) 86906: Rh phenotyping, complete MICROBIOLOGY 87070: Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates 87075: any source; except blood, anaerobic with isolation and presumptive identification of isolates 87081: Culture, presumptive, pathogenic organisms, screening only 87086: Culture, bacterial; quantitative colony count, urine 87088: with isolation and presumptive identification of isolates, urine 87101: Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; skin, hair, or nail 87102: other source (except blood) 87103: blood 87110: Culture, Chlamydia, any source 87140: Culture, typing; immunofluorescent method, each antiserum 87164: Dark field examination, any source (e.g., penile, vaginal, oral, skin); includes specimen collection 87177: Ova and parasites, direct smears, concentration and identification 87181: Susceptibility studies, antimicrobial agent; agar dilution method, per agent (e.g., antibiotic gradient strip) 87184: disk method, per plate (12 or fewer agents) 87186: microdilution or agar dilution (minimum inhibitory concentration (MIC) or breakpoint), each multiantimicrobial, per plate 87188: macrobroth dilution method, each agent 87205: Smear, primary source; with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types 87206: fluorescent and/or acid fast stain for bacteria, fungi, parasites, viruses, or cell types 87207: special stain for inclusion bodies or parasites (e.g., malaria, coccidia, microsporidia, trypanosomes, herpes viruses) 87210: wet mount for infectious agents (e.g., saline, India ink, KOH preps) 87220: Tissue examination by KOH slide of samples from skin, hair, or nails for fungi or ectoparasite ova or mites (e.g., scabies) 87252: Virus isolation; tissue culture inoculation, observation, and presumptive identification by cytopathic effect 87253: tissue culture, additional studies or definitive identification (e.g., hemabsorption, neutralization, immunofluoresence stain), each isolate Commonwealth of Massachusetts MassHealth Provider Manual Series: Family Planning Agency Manual Subchapter Number and Title: 6. Service Codes and Descriptions Page: 6-11 Transmittal Letter: FPA-45 Date: 01/01/12 605: Service Codes and Descriptions: Laboratory Services (cont.) Infectious agents by antigen detection, immunofluorescence microscopy, or nucleic acid probe techniques should be reported as precisely as possible. The most specific code possible should be reported. For identification of antibodies to many of the listed infectious agents, see 86602-86804. 87270: Infectious agent antigen detection by immunofluorescent technique; chlamydia trachomatis 87273: herpes simplex virus type 2 87274: herpes simplex virus type 1 87285: Treponema pallidum605 87320: Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple step method; Chlamydia trachomatis 87340: hepatitis B surface antigen (HBsAg) 87350: hepatitis Be antigen (HBeAg) 87380: hepatitis, delta agent 87389: HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result 87390: HIV-1 87391: HIV-2 87480: Infectious agent detection by nucleic acid (DNA or RNA); Candida species, direct probe technique 87481: Candida species, amplified probe technique 87482: Candida species, quantification 87490: Chlamydia trachomatis, direct probe technique 87491: Chlamydia trachomatis, amplified probe technique 87492: Chlamydia trachomatis, quantification 87510: Gardnerella vaginalis, direct probe technique 87511: Gardnerella vaginalis, amplified probe technique 87512: Gardnerella vaginalis, quantification 87515: hepatitis B virus, direct probe technique 87516: hepatitis B virus, amplified probe technique 87517: hepatitis B virus, quantification 87520: hepatitis C, direct probe technique 87521: hepatitis C, amplified probe technique 87522: hepatitis C, quantification 87528: herpes simplex virus, direct probe technique 87529: herpes simplex virus, amplified probe technique 87530: herpes simplex virus, quantification 87534: HIV-1, direct probe technique 87535: HIV-1, amplified probe technique 87536: HIV-1, quantification 87537: HIV-2, direct probe technique Commonwealth of Massachusetts MassHealth Provider Manual Series: Family Planning Agency Manual Subchapter Number and Title: 6. Service Codes and Descriptions Page: 6-12 Transmittal Letter: FPA-45 Date: 01/01/12 605: Service Codes and Descriptions: Laboratory Services (cont.) 87538: HIV-2, amplified probe technique 87539: HIV-2, quantification 87590: Neisseria gonorrhoeae, direct probe technique 87591: Neisseria gonorrhoeae, amplified probe technique 87592: Neisseria gonorrhoeae, quantification 87620: papillomavirus, human, direct probe technique 87621: papillomavirus, human, amplified probe technique 87622: papillomavirus, human, quantification 87810: Infectious agent detection by immunoassay with direct optical observation; Chlamydia trachomatis 87850: Neisseria gonorrhoeae ANATOMIC PATHOLOGY CYTOPATHOLOGY 88104: Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation 88106: filter method only with interpretation 88108: Cytopathology, concentration technique, smears and interpretation (e.g., Saccomanno technique) 88112: Cytopathology, selective cellular enhancement technique with interpretation (e.g., liquid based slide preparation method), except cervical or vaginal 88130: Sex chromatin identification; Barr bodies Codes 88141-88155, 88164-88167 are used to report cervical or vaginal screening by various methods and to report physician interpretation services. Use codes 88150-88154 to report Pap smears that are examined using non-Bethesda reporting. Use codes 88164-88167 to report Pap smears that are examined using the Bethesda System of reporting. Use codes 88142-88143 to report specimens collected in fluid medium with automated thin layer preparation that are examined using any system of reporting (Bethesda or non-Bethesda). Within each of these three code families choose the one code that describes the screening method(s) used. Codes 88141 and 88155 should be reported in addition to the screening code chosen when the additional services are provided. 88141: Cytopathology, cervical or vaginal (any reporting system); requiring interpretation by physician (List separately in addition to code for technical service.) 88142: Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision 88143: with manual screening and rescreening under physician supervision Commonwealth of Massachusetts MassHealth Provider Manual Series: Family Planning Agency Manual Subchapter Number and Title: 6. Service Codes and Descriptions Page: 6-13 Transmittal Letter: FPA-46 Date: 01/01/12 605: Service Codes and Descriptions: Laboratory Services (cont.) 88147: Cytopathology smears, cervical or vaginal; screening by automated system under physician supervision 88148: screening by automated system with manual rescreening under physician supervision 88150: Cytopathology, slides, cervical or vaginal; manual screening under physician supervision 88152: with manual screening and computer-assisted rescreening under physician supervision 88153: with manual screening and rescreening under physician supervision 88154: with manual screening and computer-assisted rescreening using cell selection and review under physician supervision 88155: Cytopathology, slides, cervical or vaginal, definitive hormonal evaluation (e.g., maturation index, karyopyknotic index, estrogenic index) (List separately in addition to code(s) for other technical and interpretation services.) 88160: Cytopathology, smears, any other source; screening and interpretation 88161: preparation, screening, and interpretation 88162: extended study involving over 5 slides and/or multiple stains (I.C.) 88164: Cytopathology, slides, cervical or vaginal (the Bethesda System); manual screening under physician supervision 88165: with manual screening and rescreening under physician supervision 88166: with manual screening and computer-assisted rescreening under physician supervision 86167: with manual screening and computer-assisted rescreening using cell selection and review under physician supervision 88199: Unlisted cytopathology procedure (I.C.) CYTOGENETIC STUDIES 88261: Chromosome analysis; count five cells, one karyotype, with banding 88262: count 15 to 20 cells, two karyotypes, with banding 88267: Chromosome analysis, amniotic fluid or chorionic villus, count 15 cells, one karyotype, with banding 88280: Chromosome analysis; additional karyotypes, each study 88285: additional cells counted, each study SURGICAL PATHOLOGY Codes 88300 through 88309 are further clarified in the Current Procedural Terminology (CPT) code book. 88300: Level I - surgical pathology, gross examination only 88302: Level II - surgical pathology, gross and microscopic examination 88304: Level III - surgical pathology, gross and microscopic examination 88305: Level IV - surgical pathology, gross and microscopic examination 88307: Level V - surgical pathology, gross and microscopic examination 88309: Level VI - surgical pathology, gross and microscopic examination Commonwealth of Massachusetts MassHealth Provider Manual Series: Family Planning Agency Manual Subchapter Number and Title: 6. Service Codes and Descriptions Page: 6-14 Transmittal Letter: FPA-46 Date: 01/01/12 605: Service Codes and Descriptions: Laboratory Services (cont.) OTHER PROCEDURES 89050: Cell count, miscellaneous body fluids (e.g., cerebrospinal fluid, joint fluid), except blood 606: Modifiers for Provider Preventable Conditions That Are National Coverage Determinations PA: Surgical or other invasive procedure on wrong body part PB: Surgical or other invasive procedure on wrong patient PC: Wrong surgery or other invasive procedure on patient For more information on the use of these modifiers, see Appendix V of your provider manual. This publication contains codes that are copyrighted by the American Medical Association. Certain terms used in the s for HCPCS codes are defined in the Physician’s Current Procedural Terminology (CPT) code book. Document ends.