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Claims Processing

last modified 06/12/2014 - 11:39 AM

Find fee schedules and other information for claims processing.

  

Fee Schedules:    CPT Codes; Durable Medical Equipment (DME); HCPCS; Lab; Radiology; Ladies First; PAC 8 & 9; Vision

  Please note that the tabs for the 2014 Fee Schedule have been modified.  Please read the Index page for more info.

  2014 Fee Schedules

  2013 Fee Schedules

  2012 Fee Schedules

 

OPPS Fee Schedules:    For Outpatient services billed on a UB-04 claim 

  2014 OPPS Fee Schedules

  2013 OPPS Fee Schedules

  2012 OPPS Fee Schedules

 

High Tech Radiology:    Requires a MedSolutions Prior Authorization

  2013 - 2014 Radiology is included in the CPT Fee Schedule (top of this page)

  2012 Radiology

 

ICD-9 Surgical Procedure Codes Requiring Prior Authorization

  Code List   (12/31/2013)

  Code List   (07/03/2013)

 

Dental Procedures Fee Schedule 

  January 1, 2014        (For services beginning 1/1/14; Revised/Posted 3/26/14)

  November 1, 2013    (For services beginning 11/1/13; Revised/Posted 11/20/13)

  January 1, 2013        (For services beginning 01/01/13; Posted 4/5/13)

  January 1, 2011        (For services beginning 01/01/11; Posted 05/23/11)

 

Non-Emergency Medical Transportation (NEMT) Fee Schedule

  Per Member Per Month    (Valid for dates of service on/after 7/1/2012)

  2011 Fee Schedule          (Valid for dates of service through 6/30/2012)

 

Hub & Spoke Health Home Rates  (Posted 2/6/14)

Children's Personal Care Services (Posted 6/12/14)

 

Note: CPT and CDT codes, descriptions and other data only are copyright 2012 American Medical Association (AMA) and American Dental Association (ADA), respectively. All rights reserved. CPT is a registered trademark of the AMA. CDT is a registered trademark of the ADA. Applicable FARS and DFARS Restrictions apply to government use. The AMA and ADA assume no liability for data contained or not contained herein.

 

 

NOTE: Effective for dates of service:  July 1, 2009 to October 31, 2013

Medicaid rates paid to some providers will be reduced by 2%. The reduction will be captured in the last step of claims processing and is not reflected in the rates posted here. The remittance advice (RA) will state that the payment is a reduced amount of 2% from the posted DVHA fee schedules.