|
Services
|
Covered CPT/HCPCS Codes
|
|
Emergency Department Visits, Levels 1-5
|
99281-99285
|
|
Initial and Subsequent Observation and Observation Discharge Day Management
|
99217-99220, 99224-99226, and 99234-99236
|
|
Initial Hospital Care and Hospital Discharge Day Management
|
99221-99223, 99238-99239
|
|
Initial Nursing Facility Visits, All Levels and Nursing facility Discharge Day Management
|
99304-99306, 99315-99316
|
|
Critical Care Services
|
99291-99292
|
|
Domiciliary, Rest Home, or Custodial Care Services
|
99327-99328, 99334-99337
|
|
Home Visits, New and Established Patient, All Levels
|
99341-99345, 99347-99350
|
|
Inpatient Neonatal and Pediatric Critical Care, Initial and Subsequent
|
99468-99473, 99475-99476
|
|
Initial and Continuing Intensive Care Services
|
99477-99478
|
|
Care Planning for Patients with Cognitive Impairment
|
99483
|
|
Psychological and Neuropsychological Testing
|
96130-96133, 96136-96139
|
|
Therapy Services, Physical and Occupational Therapy, All Levels
|
97161-97168, 97110, 97112, 97116, 97535, 97750, 97755, 97760, 97761, 92521-92524, 92507
|
|
Radiation Treatment Management Services
|
77427
|