Medical Procedure Codes

These types of procedure codes are used to obligate and pay medical expenditures.

• CPT Codes - Current Procedural Terminology (National Codes) - Physician Services.
• HCFA Codes - Health Care Finance Administration Common Procedure Code System (National Codes) - for use by a variety of entities; i.e., dental codes have a D prefix.
• Local Codes (Kansas Codes) - Eyeglasses are one example of local codes that have a Y prefix.

The three types of procedure codes listed above may be used by different providers to identify services provided to RS. Since all providers in Kansas must use the above codes to bill an insurance company (including Medicaid), the provider will be familiar with the codes for services they provide.

In some circumstances involving physician or hospital services, the procedure code may be located in the CPT manual using the following procedures:

• In the index, alphabetically find the procedure to determine the location of the manual. (Except for the physician office visits, physician hospital visits, and physician consultations (procedure codes 99201 through 99499) in the front of the manual, all other codes are in numerical order.
• If the procedure code needed is available, enter the code number and four zeros in KMIS to determine the rate.

Procedure code modifiers: A modifier code is a two (2) digit code that identifies a specific type of service, a variation of the service identified by the base code, for example, assistant surgeon, anesthesia.

The following are HCPCS modifiers:

PA Physicians Assistant
TC Technical Component - Applies to taking of the x-ray
WC Charge for clinic room and supplies for surgery not performed in a hospital.
WG Optical Services (Optometrists and Opticians) - Purchase of eyeglasses.
WP Specified Outpatient Procedures
26 Professional Component - Such as interpretation of an x-ray y a physician.
30 Anesthesia Services (General) (See the “IND” code on KMIS for procedure points).
50 Bilateral Procedures
80 Assistant Surgery

EXAMPLE: Anesthesia Services for an Appendectomy 449503000

Base Code for Appendectomy 44950
Modifier for Anesthesia Services 3000

EXAMPLE: Professional Component of Chest X-ray Procedure 710102600

Base code for Chest X-ray 71010
Modifier for Professional Component 2600

Effective Date: May 1, 1998