Docstoc

Non-Covered - Ohio HCAP - Ohio Hospital Care Assurance Program

Document Sample
Non-Covered - Ohio HCAP - Ohio Hospital Care Assurance Program Powered By Docstoc
					HCAP / Medicaid
Non-Covered Revenue Codes (First Three Digits) Bill Type IP OP X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X Page 1 of 5

Code 022 023 024 100 101 115 125 135 140 141 142 143 144 145 146 147 148 149 155 167 172 173 174 180 182 183 184 185 189 190 191 192 193 194 199 200 201 202 203 204 206 207 208 209 210 211 212 213 214 219 220 221 222 223 224 229 230 231 232 233 234 235 239 240 241 242 243 249 253

Category Health Insurance - PPS Health Insurance - PPS Health Insurance - PPS All inclusive rate All inclusive rate Room and Board Private (Medical or General) Room and Board semi-private 2 bed (Medical or General) Room and Board semi-private 3 and 4 bed (Medical or General) Room and Board Private Deluxe Room and Board Private Deluxe Room and Board Private Deluxe Room and Board Private Deluxe Room and Board Private Deluxe Room and Board Private Deluxe Room and Board Private Deluxe Room and Board Private Deluxe Room and Board Private Deluxe Room and Board Private Deluxe Room and Board Ward (Medical or General) Other Room and Board Nursery Nursery Nursery Leave of Absence Leave of Absence Leave of Absence Leave of Absence Leave of Absence Leave of Absence Subacute Care Subacute Care Subacute Care Subacute Care Subacute Care Subacute Care Intensive Care Intensive Care Intensive Care Intensive Care Intensive Care Intensive Care Intensive Care Intensive Care Intensive Care Coronary Care Coronary Care Coronary Care Coronary Care Coronary Care Coronary Care Special Charges Special Charges Special Charges Special Charges Special Charges Special Charges Incremental Nursing Charge Rate Incremental Nursing Charge Rate Incremental Nursing Charge Rate Incremental Nursing Charge Rate Incremental Nursing Charge Rate Incremental Nursing Charge Rate Incremental Nursing Charge Rate All Inclusive Ancillary All Inclusive Ancillary All Inclusive Ancillary All Inclusive Ancillary All Inclusive Ancillary Pharmacy

Description Skilled Nursing Facility PPS Home Health PPS Inpatient Rehabilitation Facility PPS All inclusive - Room and Board + Ancillary All inclusive - Room and Board Hospice Hospice Hospice General classification Medical/Surgical/Gyn OB Pediatric Psychiatric Hospice Detoxification Oncology Rehabilitation Other Hospice Self Care Newborn Level II Newborn Level III Newborn Level IV General classification Patient convenience Therapeutic leave ICF/MR - any reason Nursing Home (for hospitalization) Other leave or absence General Classification Subacute Care - Level I Subacute Care - Level II Subacute Care - Level III Subacute Care - Level IV Other Subacute Care General classification Surgical Medical Pediatric Psychiatric Intermediate ICU Burn Care Trauma Other Intensive Care General classification Myocardial Infarction Pulmonary Care Heart Transplant Intermediate ICU Other Coronary Care General classification Admission Charge Technical Support Charge U.R. Service Charge Late Discharge; Medically Necessary Other Special Charges General classification Nursery OB ICU CCU Hospice Other General classification Basic Comprehensive Specialty Other Inclusive Take Home Drugs

Note the "Bill Type" indicator in columns D and E. Not all Revenue Codes listed are non-allowable in all instances

HCAP / Medicaid
Non-Covered Revenue Codes (First Three Digits) Bill Type IP OP X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X Page 2 of 5

Code 256 257 273 274 277 290 291 292 293 294 299 303 362 367 374 500 509 520 521 522 523 526 529 540 541 542 543 544 545 546 547 548 549 550 551 552 559 560 561 562 569 570 571 572 579 580 581 582 583 589 590 599 600 601 602 603 604 609 624 630 631 632 633 636 640 641 642 643 644

Category Pharmacy Pharmacy Medical/Surgical Supplies and Devices Medical/Surgical Supplies and Devices Medical/Surgical Supplies and Devices Durable Medical Equipment (Other than Rental) Durable Medical Equipment (Other than Rental) Durable Medical Equipment (Other than Rental) Durable Medical Equipment (Other than Rental) Durable Medical Equipment (Other than Rental) Durable Medical Equipment (Other than Rental) Laboratory Operating Room Services Operating Room Services Anesthesia Outpatient Services Outpatient Services Free Standing Clinic Free Standing Clinic Free Standing Clinic Free Standing Clinic Free Standing Clinic Free Standing Clinic Ambulance Ambulance Ambulance Ambulance Ambulance Ambulance Ambulance Ambulance Ambulance Ambulance Skilled Nursing Skilled Nursing Skilled Nursing Skilled Nursing Medical Social Services Medical Social Services Medical Social Services Medical Social Services Home Health Aide Home Health Aide Home Health Aide Home Health Aide Other Visits (Home Health) Other Visits (Home Health) Other Visits (Home Health) Other Visits (Home Health) Other Visits (Home Health) Units of Service (Home Health) Units of Service (Home Health) Oxygen (Home Health) Oxygen (Home Health) Oxygen (Home Health) Oxygen (Home Health) Oxygen (Home Health) Oxygen (Home Health) Medical/Surgical Supplies and Devices Drugs Requiring Identification Drugs Requiring Identification Drugs Requiring Identification Drugs Requiring Identification Drugs Requiring Identification Home IV Therapy Services (Home IV Therapy Only) Home IV Therapy Services (Home IV Therapy Only) Home IV Therapy Services (Home IV Therapy Only) Home IV Therapy Services (Home IV Therapy Only) Home IV Therapy Services (Home IV Therapy Only)

Description Experimental Drugs Non-Prescription Drugs Take Home Supplies Prosthetic / Orthotic Devices Oxygen/Take Home General classification Rental Purchase of new DME Purchase of used DME Supplies/Drugs for DME Effectiveness (HHA only) Other Equipment Renal Patient (Home) Organ Transplant Other Kidney Transplant Acupuncture General classification Other Outpatient Services General classification Rural Health - Clinic Rural Health - Home Family Practice Urgent Care Clinic Other Free Standing Clinic General classification Supplies Medical Transport Heart Mobile Oxygen Air Ambulance Neonatal Ambulance Service Pharmacy Telephone EKG Other Ambulance General classification Visit Charge Hourly Charge Other Skilled Nursing General classification Visit Charge Hourly Charge Other Medical Social Services General classification Visit Charge Hourly Charge Other Home Health Aide General classification Visit Charge Hourly Charge Assessment Other Home Health Visits General classification Other Home Health Units of Service General classification Oxygen - Stationary/Equip/Supply or Contents Oxygen - Stationary/Equip/Supply Under 1 LPM Oxygen - Stationary/Equip/Supply Over 4 LPM Oxygen - Portable Add-on Other Oxygen FDA Investigational Devices General classification Single Source Drug Multiple Source Drug Restrictive Prescription Drugs Requiring Detailed Coding General classification Nonroutine Nursing, Central Line IV Site Care, Peripheral Line IV Start/Change, Peripheral Line Nonroutine Nursing, Peripheral Line

Note the "Bill Type" indicator in columns D and E. Not all Revenue Codes listed are non-allowable in all instances

HCAP / Medicaid
Non-Covered Revenue Codes (First Three Digits) Bill Type IP OP X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X Page 3 of 5

Code 645 646 647 648 649 650 651 652 655 656 657 658 659 660 661 662 663 669 670 671 672 679 681 682 683 684 689 780 789 800 801 802 803 804 809 810 811 812 813 814 819 820 821 822 823 824 825 829 830 831 832 833 834 835 839 840 841 842 843 844 845 849 850 851 852 853 854 855 859

Category Home IV Therapy Services (Home IV Therapy Only) Home IV Therapy Services (Home IV Therapy Only) Home IV Therapy Services (Home IV Therapy Only) Home IV Therapy Services (Home IV Therapy Only) Home IV Therapy Services (Home IV Therapy Only) Hospice Services Hospice Services Hospice Services Hospice Services Hospice Services Hospice Services Hospice Services Hospice Services Respite Care (Home Health Agency Only) Respite Care (Home Health Agency Only) Respite Care (Home Health Agency Only) Respite Care (Home Health Agency Only) Respite Care (Home Health Agency Only) Outpatient Special Residence Charge Outpatient Special Residence Charge Outpatient Special Residence Charge Outpatient Special Residence Charge Trauma Response (Charge for Trauma Team Activation) Trauma Response (Charge for Trauma Team Activation) Trauma Response (Charge for Trauma Team Activation) Trauma Response (Charge for Trauma Team Activation) Trauma Response (Charge for Trauma Team Activation) Telemedicine Telemedicine Inpatient Renal Dialysis Inpatient Renal Dialysis Inpatient Renal Dialysis Inpatient Renal Dialysis Inpatient Renal Dialysis Inpatient Renal Dialysis Organ Acquisition Organ Acquisition Organ Acquisition Organ Acquisition Organ Acquisition Organ Acquisition Hemodialysis Outpatient or Home Hemodialysis Outpatient or Home Hemodialysis Outpatient or Home Hemodialysis Outpatient or Home Hemodialysis Outpatient or Home Hemodialysis Outpatient or Home Hemodialysis Outpatient or Home Peritoneal Dialysis Outpatient or Home Peritoneal Dialysis Outpatient or Home Peritoneal Dialysis Outpatient or Home Peritoneal Dialysis Outpatient or Home Peritoneal Dialysis Outpatient or Home Peritoneal Dialysis Outpatient or Home Peritoneal Dialysis Outpatient or Home Continuous Ambulatory Peritoneal Dialysis (CAPD) Outpatient or Home Continuous Ambulatory Peritoneal Dialysis (CAPD) Outpatient or Home Continuous Ambulatory Peritoneal Dialysis (CAPD) Outpatient or Home Continuous Ambulatory Peritoneal Dialysis (CAPD) Outpatient or Home Continuous Ambulatory Peritoneal Dialysis (CAPD) Outpatient or Home Continuous Ambulatory Peritoneal Dialysis (CAPD) Outpatient or Home Continuous Ambulatory Peritoneal Dialysis (CAPD) Outpatient or Home Continuous Cycling Peritoneal Dialysis (CCPD) Outpatient or Home Continuous Cycling Peritoneal Dialysis (CCPD) Outpatient or Home Continuous Cycling Peritoneal Dialysis (CCPD) Outpatient or Home Continuous Cycling Peritoneal Dialysis (CCPD) Outpatient or Home Continuous Cycling Peritoneal Dialysis (CCPD) Outpatient or Home Continuous Cycling Peritoneal Dialysis (CCPD) Outpatient or Home Continuous Cycling Peritoneal Dialysis (CCPD) Outpatient or Home

Description Training Patient/Caregiver Central Line Training , Disabled Patient, Central Line Training, Patient/Caregiver, Peripheral Line Training, Disabled Patient, Peripheral Line Other IV Therapy Services General classification Routine Home Care Continuous Home Care Inpatient Respite Care General Inpatient Care (non-respite) Physician Services Room & Board - Nursing Facility Other Hospice General classification Hourly Charge/Skilled Nursing Hourly Charge/Home Health Aid/Homemaker Daily Respite Charge Other Respite Charge General classification Hospital Based Contracted Other Special Residence Charge Level I Level II Level III Level IV Other Trauma Response General classification Other Telemedicine General classification Inpatient Hemodialysis Inpatient Peritoneal Inpatient CAPD Inpatient CCPD Other Inpatient Dialysis General classification Living Donor Cadaver Donor Unknown Donor Unsuccessful Organ Search Donor Bank Charges Other Donor General classification Hemodialysis-Composite or Other Rate Home Supplies Home Equipment Maintenance / 100% Support Services Other Outpatient Hemodialysis General classification Peritoneal-Composite or Other Rate Home Supplies Home Equipment Maintenance / 100% Support Services Other Outpatient General classification CAPD-Composite or Other Rate Home Supplies Home Equipment Maintenance / 100% Support Services Other Outpatient-CAPD General classification CCPD-Composite or Other Rate Home Supplies Home Equipment Maintenance / 100% Support Services Other Outpatient-CCPD

Note the "Bill Type" indicator in columns D and E. Not all Revenue Codes listed are non-allowable in all instances

HCAP / Medicaid
Non-Covered Revenue Codes (First Three Digits) Bill Type IP OP X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X Page 4 of 5

Code 882 901 902 903 904 905 906 907 911 912 913 917 931 932 941 944 945 946 947 951 960 961 962 963 964 969 971 972 973 974 975 976 977 978 979 981 982 983 984 985 986 987 988 989 990 991 992 993 994 995 996 997 998 999 1000 1001 1002 1003 1004 1005 2100 2101 2102 2103 2104 2105 2106 2109 3101

Category Miscellaneous Dialysis Psychiatric/Psychological Treatments Psychiatric/Psychological Treatments Psychiatric/Psychological Treatments Psychiatric/Psychological Treatments Psychiatric/Psychological Treatments Psychiatric/Psychological Treatments Psychiatric/Psychological Treatments Psychiatric/Psychological Services Psychiatric/Psychological Services Psychiatric/Psychological Services Psychiatric/Psychological Services Medical Rehabilitation Day Program Medical Rehabilitation Day Program Other Therapeutic Services Other Therapeutic Services Other Therapeutic Services Other Therapeutic Services Other Therapeutic Services Other Therapeutic Services Professional Fees Professional Fees Professional Fees Professional Fees Professional Fees Professional Fees Professional Fees Professional Fees Professional Fees Professional Fees Professional Fees Professional Fees Professional Fees Professional Fees Professional Fees Professional Fees Professional Fees Professional Fees Professional Fees Professional Fees Professional Fees Professional Fees Professional Fees Professional Fees Patient Convenience Items Patient Convenience Items Patient Convenience Items Patient Convenience Items Patient Convenience Items Patient Convenience Items Patient Convenience Items Patient Convenience Items Patient Convenience Items Patient Convenience Items Behavioral Health Accomodations Behavioral Health Accomodations Behavioral Health Accomodations Behavioral Health Accomodations Behavioral Health Accomodations Behavioral Health Accomodations Alternative Therapy Services Alternative Therapy Services Alternative Therapy Services Alternative Therapy Services Alternative Therapy Services Alternative Therapy Services Alternative Therapy Services Alternative Therapy Services Adult Care

Description Home Dialysis Aide Visit Electroshock Treatment Milieu Therapy Play Therapy Activity Therapy IOP - Psychiatric IOP - Chemical Dependency Day Treatment Rehabilitation Partial Hospitalization - Less Intensive Partial Hospitalization - Intensive Bio Feedback Half Day Full Day Recreational Therapy Drug Rehabilitation Alcohol Rehabilitation Complex Medical Equipment (Routine) Complex Medical Equipment (Ancillary) Athletic Training General classification Psychiatric Ophthalmology Anesthesiologist (MD) Anesthetist (CRNA) Other Professional Fees Laboratory Radiology - Diagnostic Radiology - Therapeutic Radiology - Nuclear Medicine Operating Room Respiratory Therapy Physical Therapy Occupational Therapy Speech Pathology Emergency Room Outpatient Services Clinic Medical Social Services EKG EEG Hospital Visit Consultation Private Duty Nurse General classification Cafeteria/Guest Tray Private Linen Service Telephone/Telegraph TV/Radio Nonpatient Room Rentals Late Discharge Charge Admission Kits Beauty Shop/Barber Other Patient Convenience Items General classification Res.-Psychiatric Res. Treatment - Chem. Dep. Supervised Living Halfway House Group Home General classification Acupuncture Acupressure Massage Reflexology Biofeedback Hypnosis Other Alternative Therapy Medical & Social - Hourly

Note the "Bill Type" indicator in columns D and E. Not all Revenue Codes listed are non-allowable in all instances

HCAP / Medicaid
Non-Covered Revenue Codes (First Three Digits)

Code 3102 3103 3104 3105 3109

Category Adult Care Adult Care Adult Care Adult Care Adult Care

Description Social - Hourly Medical & Social - Daily Social - Daily Adult Foster Care - Daily Other Adult Care

Bill Type IP OP X X X X X X X X X X

Note the "Bill Type" indicator in columns D and E. Not all Revenue Codes listed are non-allowable in all instances

Page 5 of 5


				
DOCUMENT INFO