TMPPM 2008 > Texas Medicaid Services > Dental > Billing TMHP

    
 

19.23.2 Claim Form Completion

All claims, including those from the anesthesiologist and the hospital, ASC, or HASC, must include the appropriate national procedure code(s).

Provider
Diagnosis Code
CPT Code

HASC

52100, 5220

F-41899 with modifier EP

ASC

52100, 5220

F-41899 with modifier EP

ANES

52100, 5220

7-00170 with modifier EP

CRNA

52100, 5220

7-00170 with modifier EP

Use CMS-1500 or UB-04 CMS-1450

Texas Medicaid & Healthcare Partnership
CPT only copyright 2007 American Medical Association. All rights reserved.
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