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Provider Manual

Coding Quick Reference

Last Updated on October 29, 2018
Security Health Plan Group and Direct Pay Coding
Multiple surgery First paid at 100%; subsequent at 50%
E & M new patient Follow CMS guidelines
Bilaterals 1 code, with 50 modifier paid at 150% of Security Health Plan fee schedule
Unusual service 22 modifier - notes required
Prolonged services Manual review - physician notes required
Physician assistant Bill under PA's number
Physical Therapy  Commercial Products Note: Times based CPT codes such as physical therapy follow Medicare guidelines. 
Surgical assist

M.D. - 20% - 80 modifier
P.A. - 16% - AS modifier
N.P. - 16% - AS modifier

E & M on the same day as a procedure by the same provider Deny E & M unless a 25 modifier, then service is reviewed for payment - notes will be requested by claim reviewer if needed
Anesthesia/Moderate Sedation Use appropriate modifiers with anesthesia codes. Commercial Products Note: Time based CPT codes follow Medicare guidelines.
DME rental/purchase
Note: Providers must use Security Health Plan affiliated DME vendors
DME rented by the month or day
Modifier - RR (rental)
Modifier - NU (new/purchased)
Global x-ray/lab
Professional component
Technical component
No modifier
Modifier 26 as allowed by CCI
Modifier TC as allowed by CCI
Pre- and post-operative CMS guidelines
Incidental surgery procedure Bundled/unbundled edits according to CCI guidelines
Norplant Separate codes for insertion and supply