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December 2016 Texas Medicaid Provider Procedures Manual

Radiology and Laboratory Services Handbook : 2 Independent Laboratory : 2.2 Services, Benefits, Limitations, and Prior Authorization : 2.2.15 Urinalysis and Chemistry

2.2.15
The following urinalysis and chemistry procedure codes may be reimbursed by Texas Medicaid for once per day:
 
Texas Medicaid limits reimbursement for the procedure codes listed in the table above to one per day without a modifier and one per day with a modifier when billed by the same provider.
Procedure code 84583 will deny if billed on the same day by the same provider as procedure codes 81000, 81005, or 81020.
Procedure codes 82013, 82105, 82106, 82677, 83080, 84163, and 84704 are limited to one per 210 days when billed by any provider.
Procedure code 83698 is limited to the following diagnosis codes:
 
Procedure code 83698 is limited to two per rolling year when billed by any provider. Claims submitted for procedure code 83698 that are in excess of two per year may be considered on appeal with documentation of any of the following:
Procedure codes 82757, 84066, 84152, and 84154 are limited to male clients.
Procedure codes 82120, 84135, and 84138 are limited to female clients.
The following procedure codes are restricted to females who are 10 through 55 years of age:
 
Refer to:
Subsection 9.2.26.8, “Helicobacter Pylori (H. pylori)” in the Medical and Nursing Specialists Physicians and Physician Assistants Handbook (Vol. 2, Provider Handbooks) for information about limitations on procedure codes 83009, 83013, and 83014.

Texas Medicaid & Healthcare Partnership
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