Wiki Substance Residential RTC CA BLUE SHIELD

Create Wiki
R

Rapidrev

Guest
Messages
15
Best answers
0
I verified that Magellan who auth. lower level of care for CA Blue Shield (RTC, PHP, IOP) There standard auth. codes for RTC is 99223, and subsequent 99233. My question is what rev code should be used for RTC. I have been using Rev code 1002, but wanted to know if anyone has billed these codes out with different REV code and if any denials ?

Thanks,
 
the CPT codes 99223 and 99233 are inpatient e/m codes that are meant for the individual physician encounters while the patient is at an inpatient facility. You would have to refer to the 1995 or 1997 e/m guidelines for proper use of those codes as those codes require greater care and documentation. I would also point out that codes 99221, 99222 and 99223 can only be used when the patient is seen by the admitting physician or hospitalist.

As for Rev coding. 1002 is used for RTC. Some insurances require all sub-acute inpatient treatment to be billed under that rev code, some insurances will pay either 1002 or 0128. Again consult your provider manual and provider contract (if applicable)
 
I have never heard of Magellan authorizing those codes.
What we use is listed below. Hope it helps.

RTC, Rev code 0101 H0018 tob 862
PHP, Rev code 0900 S0201 TOB 892
IOP, Rev code 0900 H0015 TOB 862

The 99223 is billed for the admission H&P for us.
 
You must log in or register to reply here.
Top