Bulletin: 05-204 - January 2006 Non-Outpatient Prospective Payment System Outpatient Code Editor (Non-OPPS OCE) Specifications Version 21.1

This bulletin should be shared with all health care practitioners and managerial members of the provider/supplier staff. Additional copies may be downloaded from our website at www.highmarkmedicareservices.com

Coming in 2006! Beginning January 1, 2006, Medicare prescription drug coverage will be available to people with Medicare. Health care professionals can find information about this new coverage at www.cms.hhs.gov/medlearn/drugcoverage.asp, on the CMS website.

Announcing the new CMS web page dedicated to providing all the latest NPI news for Fee-For-Service (FFS) Medicare providers! Visit http://www.cms.hhs.gov/NationalProvIdentStand/ on the web! While this page is dedicated to the Medicare FFS community, it contains helpful information and links that may benefit all health care providers.

Reminder--Health care providers are required by law to apply for a National Provider Identifier (NPI). To apply online, visit: https://nppes.cms.hhs.gov

The Non-OPPS OCE has been updated with new additions, changes, and deletions to Healthcare Common Procedure Coding System/Current Procedural Terminology, Fourth Edition (HCPCS/CPT-4) codes. This OCE is used to process bills from hospitals not paid under OPPS.

Policy

The following are changes made to version 21.0 of the Non-OPPS OCE with various effective dates:

The new HCPCS/CPT codes as listed in Appendix A have been added to the list of valid codes in the Non-OPPS OCE.
The HCPCS/CPT codes as listed in Appendix B have been deleted from the Non-OPPS OCE.
The HCPCS/CPT codes as listed in Appendix C have been added to the list of Non-Reportable procedures in the Non-OPPS OCE.
The following codes have been added to the Procedures for Females Only List, effective 1/1/06:

Code	Description
01965	Anesth, inc/missed ab proc
01966	Anesth, induced ab procedure
57295	Change vaginal graft
58110	Bx done w/colposcopy add-on

The following code has been added to the Procedures for Males Only list, effective 1/1/06:

Code	Description
0137T	Prostate saturation sampling

The following code has been removed from the Non-Covered List (NCL), effective 8/1/00 or when the code was placed on the NCL, if more recent:

Code	Description
A0888	Non-covered ambulance mileage

The following codes have been removed from the Non-Reportable List, effective 1/1/06:

Code	Description
L3000	Ft insert ucb Berkeley shell
L3001	Foot insert remov molded spe
L3002	Foot insert plastazote or eq
L3003	Foot insert silicone gel eac
L3031	Foot lamin/prepreg composite
L3040	Ft arch suprt premold longit
L3050	Foot arch supp premold metat
L3060	Foot arch supp longitud/meta
L3070	Arch suprt att to sho longit
L3080	Arch supp att to shoe metata
L3090	Arch supp att to shoe long/m
L3100	Hallus-valgus nght dynamic s
L3140	Abduction rotation bar shoe
L3150	Abduct rotation bar w/o shoe
L3160	Shoe styled positioning dev
L3170	Foot plastic heel stabilizer
L3201	Oxford w supinat/pronat inf
L3202	Oxford w/ supinat/pronator c
L3203	Oxford w/ supinator/pronator
L3204	Hightop w/supp/pronator inf
L3206	Hightop w/supp/pronator chi
L3207	Hightop w/supp/pronator jun
L3208	Surgical boot each infant
L3209	Surgical boot each child
L3211	Surgical boot each junior
L3212	Benesch boot pair infant
L3213	Benesch boot pair child
L3214	Benesch boot pair junior
L3215	Orthopedic ftwear ladies oxf
L3216	Orthoped ladies shoes dpth i
L3217	Ladies shoes hightop depth i
L3219	Orthopedic mens shoes oxford
L3221	Orthopedic mens shoes dpth i
L3222	Mens shoes hightop depth inl
L3230	Custom shoes depth inlay
L3250	Custom mold shoe remov prost
L3251	Shoe molded to pt silicone s
L3252	Shoe molded plastazote cust
L3253	Shoe molded plastazote cust
L3254	Orth foot non-stndard size/w
L3255	Orth foot non-standard size/
L3257	Orth foot add charge split s
L3265	Plastazote sandal each
L3300	Sho lift taper to metatarsal
L3310	Shoe lift elev heel/sole neo
L3320	Shoe lift elev heel/sole cor
L3330	Lifts elevation metal Extens
L3332	Shoe lifts tapered to one-ha
L3334	Shoe lifts elevation heel /i
L3340	Shoe wedge sach
L3350	Shoe heel wedge
L3360	Shoe sole wedge outside sole
L3370	Shoe sole wedge between sole
L3380	Shoe clubfoot wedge
L3390	Shoe outflare wedge
L3400	Shoe metatarsal bar wedge ro
L3410	Shoe metatarsal bar between
L3420	Full sole/heel wedge btween
L3430	Sho heel count plast reinfor
L3440	Heel leather reinforced
L3450	Shoe heel sach cushion type
L3455	Shoe heel new leather standa
L3460	Shoe heel new rubber standar
L3465	Shoe heel Thomas with wedge
L3470	Shoe heel thomas extend to b
L3480	Shoe heel pad & depress for
L3485	Shoe heel pad removable for
L3500	Ortho shoe add leather insol
L3510	Orthopedic shoe add rub insl
L3520	O shoe add felt w leath insl
L3530	Ortho shoe add half sole
L3540	Ortho shoe add full sole
L3550	O shoe add standard toe tap
L3560	O shoe add horseshoe toe tap
L3570	O shoe add instep extension
L3580	O shoe add instep velcro clo
L3590	O shoe convert to sof counte
L3595	Ortho shoe add march bar
L3600	Trans shoe calip plate exist
L3610	Trans shoe caliper plate new
L3620	Trans shoe solid stirrup exi
L3630	Trans shoe solid stirrup new
L3640	Shoe dennis browne splint bo
L3649	Orthopedic shoe modifica NOS

If you have any questions regarding this bulletin, please contact the appropriate Customer Contact Center at:

Maryland Providers: 1-866-488-0545
Pennsylvania Providers: 1-800-560-6170

Attachments

[Appendix A] [Appendix B] [Appendix C]

Medicare Part A
(* = off-site link)

Search Part A

Electronic Mailing Lists

Background:

Assistance:

Medicare Part A(* = off-site link)

Search Part A

Electronic Mailing Lists

Background:

Assistance:

Medicare Part A
(* = off-site link)