Practice Management and Prior Authorization for Interventional Pain and Orthopedic Spine Surgery. Patients Access and Healthcare Financial Management Consulting Company | GoHealthcare Practice Solutions
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    • 2023 ORTHOPEDIC VALUE BASED CARE CONFERENCE
    • 2023 AAOS Annual Meeting of the American Academy of Orthopaedic Surgeons
    • 2023 ASIPP 25th Annual Meeting of the American Society of Interventional Pain Management
    • 2023 Becker's 20th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference
    • 2023 FSIPP Annual Conference by FSIPP FSPMR Florida Society Of Interventional Pain Physicians
    • 2023 New York and New Jersey Pain Medicine Symposium
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ICd-10 Coding Guideline effective october 1, 2021

10/7/2021

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Welcome your ICD-10 Coding Guidelines Effective October 1, 2021 (Download the PDF file)
diagnosis_icd-10_coding_guidelines_effective_october_1_2021.pdf
File Size: 639 kb
File Type: pdf
Download File

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Billing and coding drug testing

3/12/2020

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Pain Management Practice Offices - Billing and Coding for Drug Testing Payers' Policy, Documentation and Utilization Guidelines are all here!
DISCLAIMER: Below are payers' guidelines and policy that we have been using  primarily for compliance, medical necessity and utilization guidelines. These policy serves as our guide in all that we do in revenue cycle management, patients access and prior authorization process and we are sharing this to our provider, group and facility clients. All these payer guidelines and the contents on this page are from its own sources and public web portals domain. It is always your responsibility to contact your local carriers, commercial payers, claims adjusters and case managers should you have any questions and any concerns regarding medical necessity policy and determination including utilization and medical/surgical frequency guideline. Reimbursement and clinical guideline questions should always be given to your payers and obtain information/answers from your insurance payers.
Local Coverage Determination, Medical Policy and Guideline
​Read the Coverage Guidance:
  • Coverage Indications
  • Limitations
  • Diagnosis Cross over based on Medical Necessity

Medicare Part B California

Billing and Coding Controlled Substance Monitoring and Drugs of Abuse Testing (L36668) California

Medicare Part B Florida

Medicare Part B Hawaii

Billing and Coding Controlled Substance Monitoring and Drugs of Abuse Testing (L36668) Hawaii

Medicare Part B Indiana

​Billing and Coding Drug Testing LCD L34645 Local Coverage Determination  Indiana

Medicare Part B Iowa

Billing and Coding Drug Testing LCD L34645 Local Coverage Determination  Iowa

Medicare Part B Kansas

Billing and Coding Drug Testing LCD L34645 Local Coverage Determination  Kansas

​Medicare Part B Michigan

Billing and Coding Drug Testing LCD L34645 Local Coverage Determination  Michigan

​Medicare Part B Missouri

Billing and Coding Drug Testing LCD L34645 Local Coverage Determination  Missouri

Medicare Part B New Jersey

Medicare Part B New York

​Medicare Part B Nebraska

Billing and Coding Drug Testing LCD L34645 Local Coverage Determination Nebraska

Medicare Part B Nevada

Billing and Coding Controlled Substance Monitoring and Drugs of Abuse Testing (L36668) Nevada

Medicare Part B North Carolina

​​

Medicare Part B South Carolina

Medicare Part B Washington State

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Medical policy and guidelines

3/11/2020

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DISCLAIMER: Below are payers' guidelines and policy that we have been using  primarily for compliance, medical necessity and utilization guidelines. These policy serves as our guide in all that we do in revenue cycle management, patients access and prior authorization process and we are sharing this to our provider, group and facility clients. All these payer guidelines and the contents on this page are from its own sources and public web portals domain. It is always your responsibility to contact your local carriers, commercial payers, claims adjusters and case managers should you have any questions and any concerns regarding medical necessity policy and determination including utilization and medical/surgical frequency guideline. Reimbursement and clinical guideline questions should always be given to your payers and obtain information/answers from your insurance payers.
PAYERS LIST IS IN ANY ORDER

Medicare Part B New Jersey

Medicare Part B California

Medicare Part B Connecticut

​Medicare Part B Billing and Coding BOTOX Botulinum Toxins-Connecticut-A52848

Medicare Part B Hawaii

Medicare Part B New York

Medicare Part B Billing and Coding BOTOX Botulinum Toxins-New York-A52848

Medicare Part B Illinois

Medicare Part B Billing and Coding BOTOX Botulinum Toxins-Illinois-A52848

Medicare Part B Indiana

Medicare Part B Kansas

Medicare Part B Maine

Medicare Part B Missouri

Medicare Part B Billing and Coding BOTOX Botulinum Toxins-Massachusettes-A52848

Medicare Part B Nevada

Medicare Part B North Carolina

Medicare Part B Rhode Island

Medicare Part B Billing and Coding BOTOX Botulinum Toxins-Rhode Island-A52848

Medicare Part B South Carolina

Kyphoplasty Medicare South Carolina SC Local Coverage Determination for Vertebroplasty_Kyphoplasty (L33473)
Trigger Points Medicare South Carolina SC Local Coverage Determination for Trigger Point Injections (L37635)
Trial Stimulator South Carolina Medicare Local Coverage Determination for Spinal Cord Stimulators for Chronic Pain (L37632)
NCS EMG South Carolina SC Medicare Local Coverage Determination for Nerve Conduction Studies and Electromyography (L35048)
local_coverage_determination_for_facet_joint_injections_medial_branch_blocks_and_facet_joint_radiofrequency_neurotomy__l35996__mcr_mo.pdfFacet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy (L36471)

Medicare Part B Wisconsin

Medicare Part B Billing and Coding BOTOX Botulinum Toxins-Wisconsin-A52848​ 
For what you don't know may hurt you... always look for answers and always do the right thing.

Aetna Healthcare

Anthem Blue Cross Blue Shield of California 

Anthem Blue Cross Cryoneurolysis for Treatment of Peripheral Nerve Pain-SURG.00155
​Anthem Blue Cross Implanted Devices for Spinal Stenosis-DME.00025

Anthem Blue Cross Blue Shield of Colorado

​Anthem Blue Cross Blue Shield of Georgia

​Anthem Blue Cross Blue Shield of Indiana

​Anthem Blue Cross Blue Shield of Kentucky

Anthem Blue Cross Blue Shield of Maine

​Anthem Blue Cross Blue Shield of Missouri

Anthem Blue Cross Blue Shield of Nevada

​Anthem Blue Cross Blue Shield of New York

Anthem Blue Cross Blue Shield of Wisconsin

​Blue Cross Blue Shield of Kansas

Blue Cross Blue Shield of New Jersey

​Billing and Coding Temporomandibular Joint Disorder - Read Medical Policy of Horizon BCBSNJ
Billing and Coding Electromyography and Nerve Conduction Studies - Read Medical Policy of Horizon BCBSNJ
​Billing and Coding Ablation of Peripheral Nerves to Treat Pain - Read Medical Policy of Horizon BCBSNJ

​Blue Cross Blue Shield of Missouri

Blue Cross Blue Shield of North Carolina

Blue Cross Blue Shield of South Carolina

Centene Policy

Centene Policy - CP.MP.170. Nerve Blocks for Pain Management - Utilized by Home State Health and Ambetter

Cigna Healthcare

2020 Cigna Medical Policy for Facet Joint Injections and Medial Branch Blocks

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precertification authorization forms

3/11/2020

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DISCLAIMER: Below are payers' pre-certification and prior authorization forms that are made available for the Providers. Our company is using most of these forms. Our company process thousands of cases for pain management and spinal orthopedic surgeries. All these forms are from its payers public web portals domain. It is always your responsibility to contact your local carriers, commercial payers, claims adjusters and case managers should you have any questions and any concerns regarding precertification and or prior authorization process.

Aetna Healthcare Prior Authorization Forms

Aetna Healthcare Dorsal Column Stimulator Precertification Request Form​
Aetna Healthcare Spinal Surgery Precertification Form
A​etna Healthcare Hip Surgery Impingement Syndrome Precertification Form
Aetna Healthcare Shoulder Arthroplasty Precertification Form

​

Blue Cross Blue Shield NJ

Blue Cross Blue Shield Kansas

Blue Cross Blue Shield North Carolina

Blue Cross Blue Shield Knee Orthosis Prior Authorization Form 
BlueCross BlueShield Lumbar Sacral Orthosis/Thoracic Lumbar Sacral Orthosis Prior Authorization  Form 

Blue Cross Blue Shield South Carolina

Blue cross Blue Shield Missouri

Cigna Healthcare

Cigna HealthCare West Virginia Prior Authorization-Form
Cigna HealthCare Texas Standard Prior Authorization Request Form
​Cigna HealthCare New Mexico Prior Authorization Form

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  • About
  • Let's Meet in Person
    • 2023 ORTHOPEDIC VALUE BASED CARE CONFERENCE
    • 2023 AAOS Annual Meeting of the American Academy of Orthopaedic Surgeons
    • 2023 ASIPP 25th Annual Meeting of the American Society of Interventional Pain Management
    • 2023 Becker's 20th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference
    • 2023 FSIPP Annual Conference by FSIPP FSPMR Florida Society Of Interventional Pain Physicians
    • 2023 New York and New Jersey Pain Medicine Symposium
  • BLOG
  • Testimonials
  • FREE ASSESSMENT
  • Readers Questions
  • Resources
  • Medical Scribes | GoHealthcare Practice Solutions
  • Non-clickable Page