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Workers' compensation -- HIPAA 835 Health care claim payment/remittance advice



5221.4033 Outpatient limitation for medical/surgical facility fee

Subp. 2b. Procedure codes subject to limitation (table continued ...)

CPT/HCPCS
procedure code
CPT/HCPCS
description
92508 Speech/hearing therapy
92511 Nasopharyngoscopy
92512 Nasal function studies
92516 Facial nerve function test
92520 Laryngeal function studies
92565 Stenger test, pure tone
92571 Filtered speech hearing test
92575 Sensorineural acuity test
92576 Synthetic sentence test
92577 Stenger test, speech
92582 Conditioning play audiometry
93721 Plethysmography tracing
93797 Cardiac rehab
93798 Cardiac rehab/monitor
95010 Sensitivity skin tests
95015 Sensitivity skin tests
95056 Photosensitivity tests
95065 Nose allergy test
95075 Ingestion challenge test
95144 Antigen therapy services
95145 Antigen therapy services
95146 Antigen therapy services
95147 Antigen therapy services
95148 Antigen therapy services
95149 Antigen therapy services
95165 Antigen therapy services
95170 Antigen therapy services
95180 Rapid desensitization
95831 Limb muscle testing, manual
95832 Hand muscle testing, manual
95833 Body muscle testing, manual
95834 Body muscle testing, manual
95851 Range of motion measurements
95852 Range of motion measurements
95857 Tensilon test
96405 Intralesional chemotherapy administration
96406 Intralesional chemotherapy administration
96445 Chemotherapy, intracavitary
96450 Chemotherapy, into central nervous system
96542 Chemotherapy injection
98940 Chiropractor manip of spine
98941 Chiropractor manip of spine
98942 Chiropractor manip of spine
98943 Chiropractor manip extra spinal
99201 Office/outpatient visit, new
99202 Office/outpatient visit, new
99203 Office/outpatient visit, new
99204 Office/outpatient visit, new
99205 Office/outpatient visit, new
99211 Office/outpatient visit, established
99212 Office/outpatient visit, established
99213 Office/outpatient visit, established
99214 Office/outpatient visit, established
99215 Office/outpatient visit, established
99241 Office consultation
99242 Office consultation
99243 Office consultation
99244 Office consultation
99245 Office consultation
99271 Confirmatory consultation
99272 Confirmatory consultation
99273 Confirmatory consultation
99274 Confirmatory consultation
99354 Prolonged service, office
99355 Prolonged service, office
M0101 Foot care hygiene
 Back to rule page  |  Page two  |  Page three  |  Page four

Statutory authority:  MS s 175.171; 176.101; 176.135; 176.1351; 176.136; 176.231; 176.83

History:  18 SR 1472; 20 SR 530; 25 SR 1142

Posted:  June 11, 2008

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