Benefits Meanings
What is a set dollar fee for a covered service?
Copay
What's the category folder for cpt code 30400 ?
Cosmetic Surgery
Doses applied for Chicken pox?
1 Dose
it alters the meaning or function and goes (before/after) the code
Prefix & Suffix
Is the amount that the mbr has to reach before IBX begins paying it share of claims:
Deductible
What does this cpt code 90716 represents?
Varicella (chickenpox) vaccine
Age of Autism Screening
18-24M
Define Diagnosis Codes
National standardized code developed by the National Diagnosis Coding System, based on the international classification of diseases (ICD-10)
The process used when an individual is covered by more than one health insurance plan to determine the order in which the plans share payment responsibility
Coordination of benefits (COB).
Who has to perform precertification for procedure under cpt code 27331?
Carelon
Age of Dose 4 for Pneumonia?
12-15M
These are added to procedure codes to provide additional information about how a service was performed
MODIFIERS
This term describes a government-imposed requirement that obligates regulated entities to include or cover certain healthcare services. Which is:
Where this cpt code 80220 has to be performed?
Service office, independent lab and outpatient hospital.
Doses applied for Hepatitis A
2 dose series
In which situations we use Modifiers?
• A service or procedure has both a professional and technical component.
• A service or procedure was performed by more than one physician and/or in more than one location.
• The service or procedure has been increased or reduced.
• Only part of the service was performed.
• A bilateral procedure was performed.
• Multiple procedures or services were performed.
• Unusual events that occur during a procedure or service.
What determines whether a routine service becomes a diagnostic service?
CPT & diagnostic
Which of the following cpt codes is considered medically necessary: 81209 or 84443 ?
Anxiety Screening Ages
Once a year from 12 -21 years
what is the meaning of these modifiers:
01; NU & WS
01: General Medical Care
NU: New Equipment
WS: rental-DME