Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid www.mass.gov/masshealth MassHealth Transmittal Letter FPA-46 June 2012 TO: Family Planning Agencies Participating in MassHealth FROM: Julian J. Harris, M.D., Medicaid Director RE: Family Planning Manual (New Modifiers for Provider Preventable Conditions That Are National Coverage Determinations) This letter transmits updates to Subchapter 6 of the Family Planning Manual to add modifiers for Provider Preventable Conditions (PPCs) that are National Coverage Determinations. For more information about PPCs and related billing instructions, see Transmittal Letter ALL-195. These updates are effective for dates of service on or after July 1, 2012. MassHealth Website This transmittal letter and attached pages are available on the MassHealth website at www.mass.gov/masshealth. Questions If you have any questions about the information in this transmittal letter, please contact MassHealth Customer Service at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974. NEW MATERIAL (The pages listed here contain new or revised language.) Family Planning Manual Pages vi, 6-13, and 6-14 OBSOLETE MATERIAL (The pages listed here are no longer in effect.) Family Planning Manual Pages vi, 6-13, and 6-14 — transmitted by Transmittal Letter FPA-45 Commonwealth of Massachusetts MassHealth Provider Manual Series: Family Planning Agency Manual Subchapter Number and Title: Table of Contents Page: vi Transmittal Letter: FPA-46 Date: 07/01/12 6. Service Codes and Descriptions Definitions - 6-1 Service Codes and Descriptions: Visits - 6-1 Service Codes and Descriptions: Contraceptive Supplies and Drugs - 6-3 Service Codes and Descriptions: Medical and Surgery Procedures - 6-4 Service Codes and Descriptions: Laboratory Services - 6-5 Modifiers for Provider Preventable Conditions That Are National Coverage Determinations - 6-14 Appendix A. Directory - A-1 Appendix B. Enrollment Centers - B-1 Appendix C. Third-Party-Liability Codes - C-1 Appendix U. DPH-Designated Serious Reportable Events That Are Not Provider Preventable Conditions - U-1 Appendix V. MassHealth Billing Instructions for Provider Preventable Conditions - V-1 Appendix W. EPSDT Services: Medical and Dental Protocols and Periodicity Schedules - W-1 Appendix X. Family Assistance Copayments and Deductibles - X-1 Appendix Y. EVS Codes/Messages - Y-1 Appendix Z. EPSDT/PPHSD Screening Services Codes - Z-1 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: 07/01/12 605 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 8815: 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 BethesdaSystem); 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: 07/01/12 605 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.