Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid 600 Washington Street Boston, MA 02111 www.mass.gov/masshealth MASSHEALTH TRANSMITTAL LETTER FPA -36 May 2004 TO: Family Planning Agencies Participating in MassHealth FROM: Beth Waldman, Medicaid Director RE: Family Planning Agency Manual (Revisions to Service Codes and Descriptions) This letter transmits revisions to the Family Planning Agency Manual service codes and descriptions. The revisions are effective for dates of service on or after April 30, 2004. Please Note: Providers may use either the new or obsolete service codes for dates of service from May 1, 2004, through June 30, 2004. Providers must use the new service codes for dates of service on or after July 1, 2004. How to Obtain a Fee Schedule with the New Service Codes If you wish to obtain a fee schedule, you may purchase Division of Health Care Finance and Policy regulations from either the Massachusetts State Bookstore or from the Division of Health Care Finance and Policy (see addresses and telephone numbers below). Providers must contact them first to find out the price of the publication. The Division of Health Care Finance and Policy also has the regulations available on disk. The regulation title is 114.3 CMR 16.00: Surgery and Related Anesthesia Care and 114.3 CMR 20.00: Laboratory. Massachusetts State Bookstore Division of Health Care Finance and Policy State House, Room 116 Two Boylston Street Boston, MA 02133 Boston, MA 02116 Telephone: 617-727-2834 Telephone: 617-988-3100 www.mass.gov/sec/spr www.mass.gov/dhcfp MASSHEALTH TRANSMITTAL LETTER FPA-36 May 2004 Page 2 Providers with questions about the information in this transmittal letter may contact MassHealth Provider Services at 617-628-4141 or 1-800-325-5231. NEW MATERIAL (The pages listed here contain new or revised language.) Family Planning Agency Manual Pages 6-1 through 6-12 OBSOLETE MATERIAL (The pages listed here are no longer in effect.) Family Planning Agency Manual Pages 6-1 through 6-12—transmitted by Transmittal Letter FPA-35 Commonwealth of Massachusetts Division of Medical Assistance Provider Manual Series SUBCHAPTER NUMBER AND TITLE 6 SERVICE CODES AND DESCRIPTIONS PAGE 6-1 FAMILY PLANNING AGENCY MANUAL TRANSMITTAL LETTER FPA-36 DATE 04/30/04 (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. 602 Service Codes and Descriptions: Visits Service Code Service Description 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 (brief service) 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 (comprehensive service) 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) Commonwealth of Massachusetts Division of Medical Assistance Provider Manual Series SUBCHAPTER NUMBER AND TITLE 6 SERVICE CODES AND DESCRIPTIONS PAGE 6-2 FAMILY PLANNING AGENCY MANUAL TRANSMITTAL LETTER FPA-36 DATE 04/30/04 Service Code Service Description 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.) S4989 Contraceptive intrauterine device (e.g., Progestacert IUD), including implants and supplies (I.C.) S4993 Contraceptive pills for birth control 604 Service Codes and Descriptions: Medical and Surgery Procedures Service Code Service Description 11975 Insertion, implantable contraceptive capsules (global rate for Norplant System of Contraception, includes counseling prior to insertion, the price of the Norplant device, the insertion procedure, and one follow-up visit) 11976 Removal, implantable contraceptive capsules (S.P.) 11977 Removal with reinsertion, implantable contraceptive capsules (global rate for Norplant System of Contraception, includes the price of the Norplant device, removal of an old device, insertion of a new device, and one follow-up visit) 19100 Biopsy of breast; percutaneous, needle core, not using imaging guidance (separate procedure) 49080 Peritoneocentesis, abdominal paracentesis, or peritoneal lavage (diagnostic or therapeutic); initial 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 56606 each separate additional lesion (List separately in addition to code for primary procedure.) Commonwealth of Massachusetts Division of Medical Assistance Provider Manual Series SUBCHAPTER NUMBER AND TITLE 6 SERVICE CODES AND DESCRIPTIONS PAGE 6-3 FAMILY PLANNING AGENCY MANUAL TRANSMITTAL LETTER FPA-36 DATE 04/30/04 Service Code Service Description 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) 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. Service Code Service Description 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, qualitative (e.g., VDRL, RPR, ART) (86592), antibody screen, RBC, each serum technique (86850); blood typing, ABO (86900); and blood typing, Rh (D) (86901).) Commonwealth of Massachusetts Division of Medical Assistance Provider Manual Series SUBCHAPTER NUMBER AND TITLE 6 SERVICE CODES AND DESCRIPTIONS PAGE 6-4 FAMILY PLANNING AGENCY MANUAL TRANSMITTAL LETTER FPA-36 DATE 04/30/04 Code Service Description 80061 80074 80076 Lipid panel (This panel must include the following: cholesterol, serum, total (82465); lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718); and triglycerides (84478).) 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).) 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 81001 81002 81003 81005 81007 81025 81099 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 automated, with microscopy nonautomated, without microscopy automated, without microscopy Urinalysis; qualitative or semiquantitative, except immunoassays bacteriuria screen, except by culture or dipstick Urine pregnancy test, by visual color comparison methods Unlisted urinalysis procedure 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 82247 82248 Albumin; serum Bilirubin; total direct 82270 Blood, occult; by peroxidase activity (e.g., guaiac), qualitative; feces, 1-3 simultaneous determinations 82273 other sources 82310 Calcium; total Commonwealth of Massachusetts Division of Medical Assistance Provider Manual Series SUBCHAPTER NUMBER AND TITLE 6 SERVICE CODES AND DESCRIPTIONS PAGE 6-5 FAMILY PLANNING AGENCY MANUAL TRANSMITTAL LETTER FPA-36 DATE 04/30/04 Code Service Description 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 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 (HDL cholesterol) 84060 Phosphatase, acid; total 84066 prostatic 84075 Phosphatase, alkaline 84078 heat stable (total not included) 84080 isoenzymes Commonwealth of Massachusetts Division of Medical Assistance Provider Manual Series SUBCHAPTER NUMBER AND TITLE 6 SERVICE CODES AND DESCRIPTIONS PAGE 6-6 FAMILY PLANNING AGENCY MANUAL TRANSMITTAL LETTER FPA-36 DATE 04/30/04 Code Service Description 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 84165 Protein, electrophoretic fractionation and quantitation 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 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) Commonwealth of Massachusetts Division of Medical Assistance Provider Manual Series SUBCHAPTER NUMBER AND TITLE 6 SERVICE CODES AND DESCRIPTIONS PAGE 6-7 FAMILY PLANNING AGENCY MANUAL TRANSMITTAL LETTER FPA-36 DATE 04/30/04 Service Code Service Description 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 85660 automated 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; qualitative (e.g., VDRL, RPR, ART) 86593 quantitative 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. Commonwealth of Massachusetts Division of Medical Assistance Provider Manual Series SUBCHAPTER NUMBER AND TITLE 6 SERVICE CODES AND DESCRIPTIONS PAGE 6-8 FAMILY PLANNING AGENCY MANUAL TRANSMITTAL LETTER FPA-36 DATE 04/30/04 Code Service Description 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) 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 Commonwealth of Massachusetts Division of Medical Assistance Provider Manual Series SUBCHAPTER NUMBER AND TITLE 6 SERVICE CODES AND DESCRIPTIONS PAGE 6-9 FAMILY PLANNING AGENCY MANUAL TRANSMITTAL LETTER FPA-36 DATE 04/30/04 Service Code Service Description 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 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 pallidum Service Code Service Description Commonwealth of Massachusetts Division of Medical Assistance Provider Manual Series SUBCHAPTER NUMBER AND TITLE 6 SERVICE CODES AND DESCRIPTIONS PAGE 6-10 FAMILY PLANNING AGENCY MANUAL TRANSMITTAL LETTER FPA-36 DATE 04/30/04 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 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 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 Service Code Service Description Commonwealth of Massachusetts Division of Medical Assistance Provider Manual Series SUBCHAPTER NUMBER AND TITLE 6 SERVICE CODES AND DESCRIPTIONS PAGE 6-11 FAMILY PLANNING AGENCY MANUAL TRANSMITTAL LETTER FPA-36 DATE 04/30/04 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 88107 smears and filter preparation 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 8814288143 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 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.) Commonwealth of Massachusetts Division of Medical Assistance Provider Manual Series SUBCHAPTER NUMBER AND TITLE 6 SERVICE CODES AND DESCRIPTIONS PAGE 6-12 FAMILY PLANNING AGENCY MANUAL TRANSMITTAL LETTER FPA-36 DATE 04/30/04 Code Service Description 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 OTHER PROCEDURES 89050 Cell count, miscellaneous body fluids (e.g., cerebrospinal fluid, joint fluid), except blood This publication contains codes that are copyrighted by the American Medical Association. Certain terms used in the service descriptions for HCPCS codes are defined in the Current Procedural Terminology (CPT) code book.