Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.
Effective for dates of service on or after February 1, 2020, diagnostic doppler sonography benefits will change for Texas Medicaid.
Overview of Benefit Changes
Changes to this medical benefit include the following:
- Additional payable provider types for some services
- Diagnosis code updates
Additional Payable Provider Types
The technical component for procedure codes 93886, 93888, 93890, 93892, and 93893 will be added as a benefit for physician providers when provided in the office setting.
Diagnosis Code Updates
Diagnosis code limitations will change for diagnostic doppler studies. New diagnosis codes will be added and some currently payable diagnosis codes will no longer be allowed. Below is a summary of all diagnosis limitations that will be effective for dates of service on or after February 1, 2020.
Extracranial Arterial Doppler Studies
Procedure codes 93880 and 93882 will be limited to the following diagnosis codes:
Diagnosis Codes |
||||||
D446 |
D447 |
D7821 |
D7822 |
G450 |
G451 |
G452 |
G453 |
G454 |
G458 |
G459 |
G460 |
G461 |
G462 |
G463 |
G464 |
G465 |
G466 |
G467 |
G468 |
G8101 |
G8102 |
G8103 |
G8104 |
G8111 |
G8112 |
G8113 |
G8114 |
G8191 |
G8192 |
G8193 |
G8194 |
G830 |
G8311 |
G8312 |
G8313 |
G8314 |
G8321 |
G8322 |
G8323 |
G8324 |
G8331 |
G8332 |
G8333 |
G8334 |
G9751 |
G9752 |
G9761 |
G9762 |
H3401 |
H3402 |
H3403 |
H3411 |
H3412 |
H3413 |
H34211 |
H34212 |
H34213 |
H34231 |
H34232 |
H34233 |
H3582 |
H5311 |
H53121 |
H53122 |
H53123 |
H53131 |
H53132 |
H53133 |
H59311 |
H59312 |
H59313 |
H59319 |
H59321 |
H59322 |
H59323 |
H59329 |
H59331 |
H59332 |
H59333 |
H59339 |
H59341 |
H59342 |
H59343 |
H59349 |
H9541 |
H9542 |
H9551 |
H9552 |
I2510 |
I340 |
I341 |
I342 |
I350 |
I351 |
I352 |
I610 |
I611 |
I612 |
I613 |
I614 |
I615 |
I616 |
I618 |
I619 |
I6300 |
I63011 |
I63012 |
I63013 |
I6302 |
I63031 |
I63032 |
I63033 |
I6309 |
I6310 |
I63111 |
I63112 |
I63113 |
I6312 |
I63131 |
I63132 |
I63133 |
I6319 |
I6320 |
I63211 |
I63212 |
I63213 |
I63219 |
I6322 |
I63231 |
I63232 |
I63233 |
I6329 |
I63311 |
I63312 |
I63313 |
I63321 |
I63322 |
I63323 |
I63331 |
I63332 |
I63333 |
I63341 |
I63342 |
I63343 |
I6339 |
I63411 |
I63412 |
I63413 |
I63421 |
I63422 |
I63423 |
I63431 |
I63432 |
I63433 |
I63441 |
I63442 |
I63443 |
I6349 |
I63511 |
I63512 |
I63513 |
I63521 |
I63522 |
I63523 |
I63531 |
I63532 |
I63533 |
I63541 |
I63542 |
I63543 |
I6359 |
I636 |
I638 |
I6501 |
I6502 |
I6503 |
I651 |
I6521 |
I6522 |
I6523 |
I658 |
I6601 |
I6602 |
I6603 |
I6611 |
I6612 |
I6613 |
I6621 |
I6622 |
I6623 |
I663 |
I668 |
I671 |
I672 |
I676 |
I6781 |
I6782 |
I67841 |
I67848 |
I6789 |
I680 |
I69031 |
I69032 |
I69033 |
I69034 |
I69041 |
I69042 |
I69043 |
I69044 |
I69051 |
I69052 |
I69053 |
I69054 |
I69131 |
I69132 |
I69133 |
I69134 |
I69141 |
I69142 |
I69143 |
I69144 |
I69151 |
I69152 |
I69153 |
I69154 |
I69231 |
I69232 |
I69233 |
I69234 |
I69241 |
I69242 |
I69243 |
I69244 |
I69251 |
I69252 |
I69253 |
I69254 |
I69331 |
I69332 |
I69333 |
I69334 |
I69341 |
I69342 |
I69343 |
I69344 |
I69351 |
I69352 |
I69353 |
I69354 |
I69831 |
I69832 |
I69833 |
I69834 |
I69841 |
I69842 |
I69843 |
I69844 |
I69851 |
I69852 |
I69853 |
I69854 |
I69931 |
I69932 |
I69933 |
I69934 |
I69941 |
I69942 |
I69943 |
I69944 |
I69951 |
I69952 |
I69953 |
I69954 |
I720 |
I749 |
I76 |
I771 |
I772 |
I773 |
I776 |
I7771 |
I7789 |
I97610 |
I97611 |
I97618 |
I97620 |
I97621 |
I97630 |
I97631 |
I97638 |
J95830 |
J95831 |
J95860 |
J95861 |
K9161 |
K91840 |
K91841 |
K91870 |
K91871 |
L7621 |
L7622 |
L7631 |
L7632 |
M96830 |
M96831 |
M96840 |
M96841 |
N99820 |
N99821 |
N99840 |
N99841 |
R0989 |
R221 |
R260 |
R261 |
R295 |
R29810 |
R4701 |
R4702 |
R471 |
R4781 |
R4789 |
R55 |
S15011A |
S15011D |
S15011S |
S15012A |
S15012D |
S15012S |
S15021A |
S15021D |
S15021S |
S15022A |
S15022D |
S15022S |
S15091A |
S15091D |
S15091S |
S15092A |
S15092D |
S15092S |
S15111A |
S15111D |
S15111S |
S15112A |
S15112D |
S15112S |
S15121A |
S15121D |
S15121S |
S15122A |
S15122D |
S15122S |
S15191A |
S15191D |
S15191S |
S15192A |
S15192D |
S15192S |
S25111A |
S25111D |
S25111S |
S25112A |
S25112D |
S25112S |
S25121A |
S25121D |
S25121S |
S25122A |
S25122D |
S25122S |
S25191A |
S25191D |
S25191S |
S25192A |
S25192D |
S25192S |
T82817A |
T82817D |
T82817S |
T82818A |
T82818D |
T82818S |
T82827A |
T82827D |
T82827S |
T82828A |
T82828D |
T82828S |
T82837A |
T82837D |
T82837S |
T82838A |
T82838D |
T82838S |
T82847A |
T82847D |
T82847S |
T82848A |
T82848D |
T82848S |
T82857A |
T82857D |
T82857S |
T82858A |
T82858D |
T82858S |
T82867A |
T82867D |
T82867S |
T82868A |
T82868D |
T82868S |
T8381XA |
T8381XD |
T8381XS |
T8382XA |
T8382XD |
T8382XS |
T8383XA |
T8383XD |
T8383XS |
T8384XA |
T8384XD |
T8384XS |
T8385XA |
T8385XD |
T8385XS |
T8386XA |
T8386XD |
T8386XS |
T85818A |
T85818D |
T85818S |
T85828A |
T85828D |
T85828S |
T85838A |
T85838D |
T85838S |
T85848A |
T85848D |
T85848S |
T85858A |
T85858D |
T85858S |
T85868A |
T85868D |
T85868S |
T85898A |
T85898D |
T85898S |
Z09 |
Z98890 |
The following diagnosis codes may be used as indicated below:
- Use diagnosis code R0989 to report carotid bruit.
- Use diagnosis code R221 to report pulsatile neck mass.
- Use diagnosis code R55 when symptomatology indicates a strong clinical suspicion of vertebrobasilar insufficiency.
Transcranial Arterial Doppler Studies
Procedure codes 93886, 93888, 93890, 93892, and 93893 will be limited to the following diagnosis codes:
Diagnosis Codes |
||||||
D7821 |
D7822 |
G450 |
G452 |
G453 |
G454 |
G458 |
G459 |
G460 |
G461 |
G462 |
G9382 |
G9389 |
G9731 |
G9732 |
G9748 |
G9749 |
G9751 |
G9752 |
G9761 |
G9762 |
H59311 |
H59312 |
H59313 |
H59319 |
H59321 |
H59322 |
H59323 |
H59329 |
H59331 |
H59332 |
H59333 |
H59339 |
H59341 |
H59342 |
H59343 |
H59349 |
H9541 |
H9542 |
H9551 |
H9552 |
I6011 |
I6012 |
I602 |
I6031 |
I6032 |
I604 |
I6051 |
I6052 |
I606 |
I608 |
I610 |
I611 |
I613 |
I614 |
I615 |
I616 |
I618 |
I63011 |
I63012 |
I63013 |
I6302 |
I63031 |
I63032 |
I63033 |
I6309 |
I63111 |
I63112 |
I63113 |
I6312 |
I63131 |
I63132 |
I63133 |
I6319 |
I63211 |
I63212 |
I63213 |
I6322 |
I63231 |
I63232 |
I63233 |
I6329 |
I63311 |
I63312 |
I63313 |
I63321 |
I63322 |
I63323 |
I63331 |
I63332 |
I63333 |
I63341 |
I63342 |
I63343 |
I6339 |
I63411 |
I63412 |
I63413 |
I63421 |
I63422 |
I63423 |
I63431 |
I63432 |
I63433 |
I63441 |
I63442 |
I63443 |
I6349 |
I63511 |
I63512 |
I63513 |
I63521 |
I63522 |
I63523 |
I63531 |
I63532 |
I63533 |
I63541 |
I63542 |
I63543 |
I6359 |
I636 |
I638 |
I639 |
I6501 |
I6502 |
I6503 |
I651 |
I6521 |
I6522 |
I6523 |
I658 |
I6601 |
I6602 |
I6603 |
I6611 |
I6612 |
I6613 |
I6621 |
I6622 |
I6623 |
I663 |
I668 |
I671 |
I672 |
I677 |
I6781 |
I6782 |
I67841 |
I67848 |
I6789 |
I679 |
I726 |
I749 |
I76 |
I97610 |
I97611 |
I97618 |
I97620 |
I97621 |
I97630 |
I97631 |
I97638 |
J95830 |
J95831 |
J95860 |
J95861 |
K9161 |
K91840 |
K91841 |
K91870 |
K91871 |
L7621 |
L7622 |
L7631 |
L7632 |
M96830 |
M96831 |
M96840 |
M96841 |
N99820 |
N99821 |
N99840 |
N99841 |
Q282 |
Q283 |
R260 |
R261 |
R2681 |
R2689 |
R295 |
R29810 |
R4701 |
R4702 |
R471 |
R4781 |
R4789 |
R55 |
S090XXA |
S090XXD |
S090XXS |
S15111A |
S15111D |
S15111S |
S15112A |
S15112D |
S15112S |
S15121A |
S15121D |
S15121S |
S15122A |
S15122D |
S15122S |
S15191A |
S15191D |
S15191S |
S15192A |
S15192D |
S15192S |
T82818A |
T82818D |
T82818S |
T82828A |
T82828D |
T82828S |
T82838A |
T82838D |
T82838S |
T82848A |
T82848D |
T82848S |
T82858A |
T82858D |
T82858S |
T82868A |
T82868D |
T82868S |
Z09 |
The following diagnosis codes may be used as indicated below:
- Use diagnosis code G9389 to identify assessment of suspected brain death.
- Use diagnosis code I749 to report paradoxical cerebral embolism.
- Use diagnosis code R55 when symptomatology indicates a strong clinical suspicion of vertebrobasilar insufficiency.
In addition to the diagnosis codes listed in the table above, procedure codes 93886 and 93888 are benefits for clients who are 2 through 16 years of age when submitted with the following diagnosis codes:
Diagnosis Codes |
||||||
D5700 |
D5702 |
D571 |
D5720 |
D57212 |
D57219 |
D5780 |
D57812 |
D57819 |
Peripheral Arterial Doppler Studies
Procedure codes 93922, 93923, 93924, 93925, 93926, 93930, and 93931 will be limited to the following diagnosis codes:
Diagnosis Codes |
||||||
E0851 |
E0852 |
E0859 |
E0951 |
E0952 |
E0959 |
E1051 |
E1052 |
E1059 |
E1151 |
E1152 |
E1159 |
E1351 |
E1352 |
E1359 |
G9751 |
G9752 |
I2583 |
I670 |
I700 |
I70218 |
I70228 |
I7025 |
I70268 |
I70298 |
I70418 |
I70428 |
I7045 |
I70468 |
I70498 |
I70518 |
I70528 |
I7055 |
I70568 |
I70598 |
I70618 |
I70628 |
I7065 |
I70668 |
I70698 |
I70718 |
I70728 |
I7075 |
I70768 |
I70798 |
I7092 |
I7101 |
I7102 |
I7103 |
I711 |
I712 |
I713 |
I714 |
I715 |
I716 |
I723 |
I728 |
I7300 |
I7301 |
I731 |
I7389 |
I739 |
I7401 |
I7409 |
I7411 |
I7419 |
I745 |
I748 |
I770 |
I771 |
I772 |
I773 |
I775 |
I7771 |
I7772 |
I7773 |
I7774 |
I7779 |
I77810 |
I77811 |
I77812 |
I7789 |
I790 |
I791 |
I798 |
I96 |
I97410 |
I97411 |
I97418 |
I9742 |
I9751 |
I9752 |
I97610 |
I97611 |
I97618 |
J9561 |
J9562 |
J9571 |
J9572 |
J95830 |
J95831 |
K9161 |
K9162 |
K9171 |
K9172 |
K91840 |
K91841 |
L7601 |
L7602 |
L7611 |
L7612 |
L7621 |
L7622 |
L89112 |
L89113 |
L89114 |
L89122 |
L89123 |
L89124 |
L89132 |
L89133 |
L89134 |
L89142 |
L89143 |
L89144 |
L89152 |
L89153 |
L89154 |
L89812 |
L89813 |
L89814 |
L89892 |
L89893 |
L89894 |
L98421 |
L98422 |
L98423 |
L98424 |
L98425 |
L98426 |
L98428 |
L98429 |
M314 |
M315 |
M316 |
M318 |
M79609 |
M96810 |
M96811 |
M96820 |
M96821 |
M96830 |
M96831 |
N183 |
N184 |
N185 |
N186 |
N9961 |
N9962 |
N9971 |
N9972 |
N99820 |
N99821 |
R0989 |
R1901 |
R1902 |
R1903 |
R1904 |
R1905 |
R1906 |
R1907 |
R1909 |
R200 |
R201 |
R202 |
R203 |
T801XXA |
T801XXD |
T801XXS |
T8131XA |
T8131XD |
T8131XS |
T8132XA |
T8132XD |
T8132XS |
T81718A |
T81718D |
T81718S |
T8172XA |
T8172XD |
T8172XS |
T8189XA |
T8189XD |
T8189XS |
T82310A |
T82310D |
T82310S |
T82311A |
T82311D |
T82311S |
T82312A |
T82312D |
T82312S |
T82318A |
T82318D |
T82318S |
T82320A |
T82320D |
T82320S |
T82321A |
T82321D |
T82321S |
T82322A |
T82322D |
T82322S |
T82328A |
T82328D |
T82328S |
T82330A |
T82330D |
T82330S |
T82331A |
T82331D |
T82331S |
T82332A |
T82332D |
T82332S |
T82338A |
T82338D |
T82338S |
T82390A |
T82390D |
T82390S |
T82391A |
T82391D |
T82391S |
T82392A |
T82392D |
T82392S |
T82398A |
T82398D |
T82398S |
T8241XA |
T8241XD |
T8241XS |
T8242XA |
T8242XD |
T8242XS |
T8243XA |
T8243XD |
T8243XS |
T8249XA |
T8249XD |
T8249XS |
T82510A |
T82510D |
T82510S |
T82511A |
T82511D |
T82511S |
T82513A |
T82513D |
T82513S |
T82514A |
T82514D |
T82514S |
T82515A |
T82515D |
T82515S |
T82518A |
T82518D |
T82518S |
T82520A |
T82520D |
T82520S |
T82521A |
T82521D |
T82521S |
T82523A |
T82523D |
T82523S |
T82524A |
T82524D |
T82524S |
T82525A |
T82525D |
T82525S |
T82528A |
T82528D |
T82528S |
T82530A |
T82530D |
T82530S |
T82531A |
T82531D |
T82531S |
T82533A |
T82533D |
T82533S |
T82534A |
T82534D |
T82534S |
T82535A |
T82535D |
T82535S |
T82538A |
T82538D |
T82538S |
T82590A |
T82590D |
T82590S |
T82591A |
T82591D |
T82591S |
T82593A |
T82593D |
T82593S |
T82594A |
T82594D |
T82594S |
T82595A |
T82595D |
T82595S |
T82598A |
T82598D |
T82598S |
T827XXA |
T827XXD |
T827XXS |
T82817A |
T82817D |
T82817S |
T82818A |
T82818D |
T82818S |
T82827A |
T82827D |
T82827S |
T82828A |
T82828D |
T82828S |
T82837A |
T82837D |
T82837S |
T82838A |
T82838D |
T82838S |
T82847A |
T82847D |
T82847S |
T82848A |
T82848D |
T82848S |
T82856A |
T82856D |
T82856S |
T82857A |
T82857D |
T82857S |
T82858A |
T82858D |
T82858S |
T82867A |
T82867D |
T82867S |
T82868A |
T82868D |
T82868S |
T82897A |
T82897D |
T82897S |
T82898A |
T82898D |
T82898S |
T8381XA |
T8381XD |
T8381XS |
T8382XA |
T8382XD |
T8382XS |
T8383XA |
T8383XD |
T8383XS |
T8384XA |
T8384XD |
T8384XS |
T8385XA |
T8385XD |
T8385XS |
T8386XA |
T8386XD |
T8386XS |
T8389XA |
T8389XD |
T8389XS |
T8481XA |
T8481XD |
T8481XS |
T8482XA |
T8482XD |
T8482XS |
T8483XA |
T8483XD |
T8483XS |
T8484XA |
T8484XD |
T8484XS |
T8485XA |
T8485XD |
T8485XS |
T8486XA |
T8486XD |
T8486XS |
T8489XA |
T8489XD |
T8489XS |
T85810A |
T85810D |
T85810S |
T85818A |
T85818D |
T85818S |
T85860A |
T85860D |
T85860S |
T85868A |
T85868D |
T85868S |
T8601 |
T8602 |
T8603 |
T8609 |
T8611 |
T8612 |
T8613 |
T8619 |
T8621 |
T8622 |
T8623 |
T86290 |
T86298 |
T8631 |
T8632 |
T8633 |
T8639 |
T8641 |
T8642 |
T8643 |
T8649 |
T86810 |
T86811 |
T86812 |
T86818 |
T86830 |
T86831 |
T86832 |
T86838 |
T86848 |
T86850 |
T86851 |
T86852 |
T86858 |
T86890 |
T86891 |
T86892 |
T86898 |
T872 |
T888XXA |
Z09 |
Z4803 |
Z48812 |
Z4889 |
Z951 |
Z955 |
Z95820 |
Z95828 |
Z9861 |
Procedure codes 93922, 93923, 93930, and 93931 will also be a benefit when submitted with the following diagnosis codes for upper extremity conditions:
Diagnosis Codes |
||||||
I721 |
I742 |
I75011 |
I75012 |
I75013 |
I7776 |
L89012 |
L89013 |
L89014 |
L89022 |
L89023 |
L89024 |
M79A11 |
M79A12 |
Q2731 |
S45011A |
S45011D |
S45011S |
S45012A |
S45012D |
S45012S |
S45091A |
S45091D |
S45091S |
S45092A |
S45092D |
S45092S |
S45111A |
S45111D |
S45111S |
S45112A |
S45112D |
S45112S |
S45191A |
S45191D |
S45191S |
S45192A |
S45192D |
S45192S |
S45211A |
S45211D |
S45211S |
S45212A |
S45212D |
S45212S |
S45219A |
S45219D |
S45219S |
S45291A |
S45291D |
S45291S |
S45292A |
S45292D |
S45292S |
S45311A |
S45311D |
S45311S |
S45312A |
S45312D |
S45312S |
S45391A |
S45391D |
S45391S |
S45392A |
S45392D |
S45392S |
S45811A |
S45811D |
S45811S |
S45812A |
S45812D |
S45812S |
S45891A |
S45891D |
S45891S |
S45892A |
S45892D |
S45892S |
S55011A |
S55011D |
S55011S |
S55012A |
S55012D |
S55012S |
S55091A |
S55091D |
S55091S |
S55092A |
S55092D |
S55092S |
S55111A |
S55111D |
S55111S |
S55112A |
S55112D |
S55112S |
S55191A |
S55191D |
S55191S |
S55192A |
S55192D |
S55192S |
S55211A |
S55211D |
S55211S |
S55212A |
S55212D |
S55212S |
S55291A |
S55291D |
S55291S |
S55292A |
S55292D |
S55292S |
S55811A |
S55811D |
S55811S |
S55812A |
S55812D |
S55812S |
S55891A |
S55891D |
S55891S |
S55892A |
S55892D |
S55892S |
S65011A |
S65011D |
S65011S |
S65012A |
S65012D |
S65012S |
S65091A |
S65091D |
S65091S |
S65092A |
S65092D |
S65092S |
S65111A |
S65111D |
S65111S |
S65112A |
S65112D |
S65112S |
S65191A |
S65191D |
S65191S |
S65192A |
S65192D |
S65192S |
S65211A |
S65211D |
S65211S |
S65212A |
S65212D |
S65212S |
S65291A |
S65291D |
S65291S |
S65292A |
S65292D |
S65292S |
S65311A |
S65311D |
S65311S |
S65312A |
S65312D |
S65312S |
S65391A |
S65391D |
S65391S |
S65392A |
S65392D |
S65392S |
S65411A |
S65411D |
S65411S |
S65412A |
S65412D |
S65412S |
S65491A |
S65491D |
S65491S |
S65492A |
S65492D |
S65492S |
S65510A |
S65510D |
S65510S |
S65511A |
S65511D |
S65511S |
S65512A |
S65512D |
S65512S |
S65513A |
S65513D |
S65513S |
S65514A |
S65514D |
S65514S |
S65515A |
S65515D |
S65515S |
S65516A |
S65516D |
S65516S |
S65517A |
S65517D |
S65517S |
S65518A |
S65518D |
S65518S |
S65590A |
S65590D |
S65590S |
S65591A |
S65591D |
S65591S |
S65592A |
S65592D |
S65592S |
S65593A |
S65593D |
S65593S |
S65594A |
S65594D |
S65594S |
S65595A |
S65595D |
S65595S |
S65596A |
S65596D |
S65596S |
S65597A |
S65597D |
S65597S |
S65598A |
S65598D |
S65598S |
S65811A |
S65811D |
S65811S |
S65812A |
S65812D |
S65812S |
S65891A |
S65891D |
S65891S |
S65892A |
S65892D |
S65892S |
T870X1 |
T870X2 |
Procedure codes 93922, 93923, 93924, 93925, and 93926 will also be a benefit when submitted with the following diagnosis codes for lower extremity conditions:
Diagnosis Codes |
||||||
I70211 |
I70212 |
I70213 |
I70221 |
I70222 |
I70223 |
I70231 |
I70232 |
I70233 |
I70234 |
I70235 |
I70238 |
I70241 |
I70242 |
I70243 |
I70244 |
I70245 |
I70248 |
I70261 |
I70262 |
I70263 |
I70291 |
I70292 |
I70293 |
I70411 |
I70412 |
I70413 |
I70421 |
I70422 |
I70423 |
I70431 |
I70432 |
I70433 |
I70434 |
I70435 |
I70438 |
I70441 |
I70442 |
I70443 |
I70444 |
I70445 |
I70448 |
I70461 |
I70462 |
I70463 |
I70491 |
I70492 |
I70493 |
I70511 |
I70512 |
I70513 |
I70521 |
I70522 |
I70523 |
I70531 |
I70532 |
I70533 |
I70534 |
I70535 |
I70538 |
I70541 |
I70542 |
I70543 |
I70544 |
I70545 |
I70548 |
I70561 |
I70562 |
I70563 |
I70591 |
I70592 |
I70593 |
I70611 |
I70612 |
I70613 |
I70621 |
I70622 |
I70623 |
I70631 |
I70632 |
I70633 |
I70634 |
I70635 |
I70638 |
I70641 |
I70642 |
I70643 |
I70644 |
I70645 |
I70648 |
I70661 |
I70662 |
I70663 |
I70691 |
I70692 |
I70693 |
I70711 |
I70712 |
I70713 |
I70721 |
I70722 |
I70723 |
I70731 |
I70732 |
I70733 |
I70734 |
I70735 |
I70738 |
I70741 |
I70742 |
I70743 |
I70744 |
I70745 |
I70748 |
I70761 |
I70762 |
I70763 |
I70791 |
I70792 |
I70793 |
I724 |
I743 |
I75021 |
I75022 |
I75023 |
I7777 |
I83011 |
I83012 |
I83013 |
I83014 |
I83015 |
I83018 |
I83021 |
I83022 |
I83023 |
I83024 |
I83025 |
I83028 |
L89212 |
L89213 |
L89214 |
L89222 |
L89223 |
L89224 |
L89312 |
L89313 |
L89314 |
L89322 |
L89323 |
L89324 |
L8942 |
L8943 |
L8944 |
L89512 |
L89513 |
L89514 |
L89522 |
L89523 |
L89524 |
L89612 |
L89613 |
L89614 |
L89622 |
L89623 |
L89624 |
L97111 |
L97112 |
L97113 |
L97114 |
L97115 |
L97116 |
L97118 |
L97119 |
L97121 |
L97122 |
L97123 |
L97124 |
L97125 |
L97126 |
L97128 |
L97129 |
L97205 |
L97206 |
L97208 |
L97209 |
L97211 |
L97212 |
L97213 |
L97214 |
L97215 |
L97216 |
L97218 |
L97219 |
L97221 |
L97222 |
L97223 |
L97224 |
L97305 |
L97306 |
L97308 |
L97309 |
L97311 |
L97312 |
L97313 |
L97314 |
L97315 |
L97316 |
L97318 |
L97319 |
L97321 |
L97322 |
L97323 |
L97324 |
L97325 |
L97326 |
L97328 |
L97329 |
L97411 |
L97412 |
L97413 |
L97414 |
L97416 |
L97418 |
L97419 |
L97421 |
L97422 |
L97423 |
L97424 |
L97425 |
L97426 |
L97428 |
L97429 |
L97511 |
L97512 |
L97513 |
L97514 |
L97521 |
L97522 |
L97523 |
L97524 |
L97811 |
L97812 |
L97813 |
L97814 |
L97816 |
L97818 |
L97819 |
L97821 |
L97822 |
L97823 |
L97824 |
L98411 |
L98412 |
L98413 |
L98414 |
L98415 |
L98416 |
L98418 |
L98419 |
M79A21 |
M79A22 |
Q2732 |
S75011A |
S75011D |
S75011S |
S75012A |
S75012D |
S75012S |
S75021A |
S75021D |
S75021S |
S75022A |
S75022D |
S75022S |
S75091A |
S75091D |
S75091S |
S75092A |
S75092D |
S75092S |
S75111A |
S75111D |
S75111S |
S75112A |
S75112D |
S75112S |
S75121A |
S75121D |
S75121S |
S75122A |
S75122D |
S75122S |
S75191A |
S75191D |
S75191S |
S75192A |
S75192D |
S75192S |
S75211A |
S75211D |
S75211S |
S75212A |
S75212D |
S75212S |
S75221A |
S75221D |
S75221S |
S75222A |
S75222D |
S75222S |
S75291A |
S75291D |
S75291S |
S75292A |
S75292D |
S75292S |
S75811A |
S75811D |
S75811S |
S75812A |
S75812D |
S75812S |
S75891A |
S75891D |
S75891S |
S75892A |
S75892D |
S75892S |
S85011A |
S85011D |
S85011S |
S85012A |
S85012D |
S85012S |
S85091A |
S85091D |
S85091S |
S85092A |
S85092D |
S85092S |
S85141A |
S85141D |
S85141S |
S85142A |
S85142D |
S85142S |
S85151A |
S85151D |
S85151S |
S85152A |
S85152D |
S85152S |
S85171A |
S85171D |
S85171S |
S85172A |
S85172D |
S85172S |
S85181A |
S85181D |
S85181S |
S85182A |
S85182D |
S85182S |
S85211A |
S85211D |
S85211S |
S85212A |
S85212D |
S85212S |
S85291A |
S85291D |
S85291S |
S85292A |
S85292D |
S85292S |
S85311A |
S85311D |
S85311S |
S85312A |
S85312D |
S85312S |
S85391A |
S85391D |
S85391S |
S85392A |
S85392D |
S85392S |
S85411A |
S85411D |
S85411S |
S85412A |
S85412D |
S85412S |
S85491A |
S85491D |
S85491S |
S85492A |
S85492D |
S85492S |
S85511A |
S85511D |
S85511S |
S85512A |
S85512D |
S85512S |
S85591A |
S85591D |
S85591S |
S85592A |
S85592D |
S85592S |
S85811A |
S85811D |
S85811S |
S85812A |
S85812D |
S85812S |
S85891A |
S85891D |
S85891S |
S85892A |
S85892D |
S85892S |
S95011A |
S95011D |
S95011S |
S95012A |
S95012D |
S95012S |
S95091A |
S95091D |
S95091S |
S95092A |
S95092D |
S95092S |
S95111A |
S95111D |
S95111S |
S95112A |
S95112D |
S95112S |
S95191A |
S95191D |
S95191S |
S95192A |
S95192D |
S95192S |
S95211A |
S95211D |
S95211S |
S95212A |
S95212D |
S95212S |
S95291A |
S95291D |
S95291S |
S95292A |
S95292D |
S95292S |
S95811A |
S95811D |
S95811S |
S95812A |
S95812D |
S95812S |
S95891A |
S95891D |
S95891S |
S95892A |
S95892D |
S95892S |
T871X1 |
T871X2 |
Peripheral Venous Doppler Studies
Procedure codes 93970 and 93971 will be limited to the following diagnosis codes:
Diagnosis Codes |
||||||
I2601 |
I2602 |
I2609 |
I2690 |
I2692 |
I2699 |
I749 |
I8001 |
I8002 |
I8003 |
I8011 |
I8012 |
I8013 |
I80211 |
I80212 |
I80213 |
I80221 |
I80222 |
I80223 |
I80231 |
I80232 |
I80233 |
I80291 |
I80292 |
I80293 |
I808 |
I821 |
I82220 |
I82411 |
I82412 |
I82413 |
I82421 |
I82422 |
I82423 |
I82431 |
I82432 |
I82433 |
I82441 |
I82442 |
I82443 |
I82491 |
I82492 |
I82493 |
I82511 |
I82512 |
I82513 |
I82521 |
I82522 |
I82523 |
I82531 |
I82532 |
I82533 |
I82541 |
I82542 |
I82543 |
I82591 |
I82592 |
I82593 |
I82611 |
I82612 |
I82613 |
I82621 |
I82622 |
I82623 |
I82711 |
I82712 |
I82713 |
I82721 |
I82722 |
I82723 |
I82811 |
I82812 |
I82813 |
I82890 |
I82891 |
I82A11 |
I82A12 |
I82A13 |
I82A21 |
I82A22 |
I82A23 |
I82C11 |
I82C12 |
I82C13 |
I82C21 |
I82C22 |
I82C23 |
I83011 |
I83012 |
I83013 |
I83014 |
I83015 |
I83018 |
I83021 |
I83022 |
I83023 |
I83024 |
I83025 |
I83028 |
I8311 |
I8312 |
I83211 |
I83212 |
I83213 |
I83214 |
I83215 |
I83218 |
I83221 |
I83222 |
I83223 |
I83224 |
I83225 |
I83228 |
I83811 |
I83812 |
I83813 |
I83891 |
I83892 |
I83893 |
I87001 |
I87002 |
I87003 |
I87011 |
I87012 |
I87013 |
I87021 |
I87022 |
I87023 |
I87031 |
I87032 |
I87033 |
I87091 |
I87092 |
I87093 |
I871 |
I872 |
I87311 |
I87312 |
I87313 |
I87321 |
I87322 |
I87323 |
I87331 |
I87332 |
I87333 |
I87391 |
I87392 |
I87393 |
I96 |
J80 |
J9600 |
J9601 |
J9602 |
J9690 |
L97111 |
L97112 |
L97113 |
L97114 |
L97115 |
L97116 |
L97118 |
L97119 |
L97121 |
L97122 |
L97123 |
L97124 |
L97125 |
L97126 |
L97128 |
L97129 |
L97211 |
L97212 |
L97213 |
L97214 |
L97215 |
L97216 |
L97218 |
L97219 |
L97221 |
L97222 |
L97223 |
L97224 |
L97225 |
L97226 |
L97228 |
L97229 |
L97311 |
L97312 |
L97313 |
L97314 |
L97315 |
L97316 |
L97318 |
L97319 |
L97321 |
L97322 |
L97323 |
L97324 |
L97325 |
L97326 |
L97328 |
L97329 |
L97411 |
L97412 |
L97413 |
L97414 |
L97415 |
L97416 |
L97418 |
L97419 |
L97421 |
L97422 |
L97423 |
L97424 |
L97425 |
L97426 |
L97428 |
L97429 |
L97511 |
L97512 |
L97513 |
L97514 |
L97515 |
L97516 |
L97518 |
L97519 |
L97521 |
L97522 |
L97523 |
L97524 |
L97525 |
L97526 |
L97528 |
L97529 |
L97811 |
L97812 |
L97813 |
L97814 |
L97815 |
L97816 |
L97818 |
L97819 |
L97821 |
L97822 |
L97823 |
L97824 |
L97825 |
L97826 |
L97828 |
L97829 |
M7121 |
M7122 |
M79601 |
M79602 |
M79604 |
M79605 |
M79621 |
M79622 |
M79631 |
M79632 |
M79641 |
M79642 |
M79644 |
M79645 |
M79651 |
M79652 |
M79661 |
M79662 |
M79671 |
M79672 |
M79674 |
M79675 |
O2221 |
O2222 |
O2223 |
O2231 |
O2232 |
O2233 |
O870 |
O871 |
O88211 |
O88212 |
O88213 |
O8822 |
O8823 |
Q2731 |
Q2732 |
Q278 |
R042 |
R0600 |
R0602 |
R0609 |
R0682 |
R071 |
R0781 |
R0782 |
R0789 |
R079 |
R2231 |
R2232 |
R2233 |
R2241 |
R2242 |
R2243 |
R600 |
R601 |
R609 |
T800XXA |
T801XXA |
T8172XA |
T82817A |
T82818A |
T82827A |
T82828A |
T82837A |
T82838A |
T82847A |
T82848A |
T82857A |
T82858A |
T82867A |
T82868A |
T8381XA |
T8382XA |
T8383XA |
T8384XA |
T8385XA |
T83868A |
T85818A |
T85828A |
T85838A |
T85848A |
T85858A |
T85868A |
T85898A |
In addition to the diagnosis codes listed in the table above, procedure code 93971 will also be a benefit when submitted with diagnosis code Z01810, Z01818, or Z09.
For more information, call the TMHP Contact Center at 800-925-9126.