Consistent with CMS Change Request 10901 and due to system changes, the order of the Coding Section has been revised and new sections for CPT/HCPCS Modifiers and Other Coding Information have been added. A56673 - Billing and Coding: Outpatient Observation Bed/Room Services. Before sharing sensitive information, make sure you're on a federal government site. In her current position, Debbie monitors, interprets and communicates current and upcoming regulatory and compliance issues as they relate to specific entities concerning Medicare and other payers. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. xref This article is being revised in order to adhere to CMS requirements per Chapter 13, Section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles. This email will be sent from you to the AMA CPT coding guidelines CMS NCCI Manual (edits and policies) CMS Medicare Claims Processing Manual, Chapter 4 - Part B Hospital, 290.2.2 for Observation Services ConnectiCare covers observation services that extend beyond 48 hours when Medicare coverage criteria are met. Observation services are commonly ordered for patients who present to the emergency department and who then require a significant period of treatment or monitoring in order to make a decision concerning their admission or discharge. The documentation should clearly state the method of assessment during observation and, if necessary, treatment in order to determine if the patient should be admitted or may be safely discharged. preparation of this material, or the analysis of information provided in the material. A Draft article will eventually be replaced by a Billing and Coding article once the Proposed LCD is released to a final LCD. xb```b``c`a`` @Q_2 EEVI4b_.3c. NOTE: All in-article links open in a new tab. Billing and Coding Guidelines . Hospitals should not report as observation care, services that are part of another Part B service, such as postoperative monitoring during a standard recovery period (e.g., 4-6 hours), which should be billed as recovery room services." that a physician may bill only for an initial hospital or observation care service if the physician sees a patient in the ED and decides to either place the patient in observation status or admit the patient as a . You, your employees and agents are authorized to use CPT only as agreed upon with the AMA internally within your organization within the United States for the sole use by yourself, employees and agents. Federal government websites often end in .gov or .mil. will not infringe on privately owned rights. endstream endobj 1593 0 obj <. 0000009274 00000 n 0000004966 00000 n This could be before, at the time of, or after the time of the discharge order. <<1A370848C2D34F4EA28E1EEFD9179200>]>> For the following CPT code, the long description was changed. If the order was written at 2 p.m. on Monday, the hospital would begin the observation hours at that time. See the Inpatient Hospital Services module for exceptions to this rule. Absence of a Bill Type does not guarantee that the According to the Medicare Claims Processing Manual, Chapter 4, Section 290.2.2, observation services should not be billed: For services that are part of another Part B service, such as postoperative monitoring during a standard recovery period (e.g., 4-6 hours); For routine preparation services furnished prior to diagnostic testing and recovery . The Medicare Benefit Policy Manual includes a complete list of the payable 'Part B Only' services. CMS FAQ: Patient has outpatient surgery at 3:00 pm and needs to stay overnight. required field. As used herein, "you" and "your" refer to you and any organization on behalf of which you are acting. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. The American Hospital Association ("the AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. MAC Medical Review Activity for the month included: This material was compiled to share information. R2. In most instances Revenue Codes are purely advisory. Missouri Per State Regulations, effective 7/1/2020, observation is covered from 24 up to 72 hours only when administering and monitoring Zulresso (HCPCs code C9055). Outpatient observation services are not to be used for the convenience of the hospital, its physicians, patients, or patient's families, or while awaiting placement to another health care facility.Outpatient observation services must be patient specific and not part of the facilities standard operating procedure or protocol for a given diagnosis or service. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. Examples of such services include, but are not limited to, diagnostic x-ray tests, diagnostic laboratory tests, surgical dressings and splints, prosthetic devices, and certain other services." an effective method to share Articles that Medicare contractors develop. 05101, 05201, 05301, 05401, 05102, 05202, 05302, 05402, 52280 . This revision is due to the Annual CPT/HCPCS Code Update. LCD - Outpatient Observation Bed/Room Services (L34552). The references listed below are provided for guidance.In addition to the references below, please visit the Evaluation & Management (E/M) Center of the Novitas Solutions website to find more information about physician services billing. Reproduced with permission. and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only Since there was not a lot of MAC Medical Review activity this month, lets look beyond the MAC reviews to a finding reported in the OIG compliance review of Northwestern Memorial Hospital released in March 2015. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). Consistent with CMS guidelines, an Observation Care CPT code (99218-99220) should be reported for a patient admitted to Observation Care for less than 8 hours on the same calendar date. In most cases, the decision to discharge a patient from observation care or admit to inpatient status can usually be made in less than 24 hours but no more than 48 hours. 0000001333 00000 n Some articles contain a large number of codes. CMS 1599 F. Fed Reg Vol 78. CPT codes, descriptions and other data only are copyright 2022 American Medical Association. Title XVIII of the Social Security Act, 1862(a)(1)(A) allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.Title XVIII of the Social Security Act, 1862 (a)(7) excludes routine physical examinations.eCFR Title 42 Chapter IV Subchapter BPart 419CMS Internet-Only Manual, Pub 100-02, Medicare Benefit Policy Manual, Chapter 6, 20.6. The attending physician's order including clock time for the observation service or clock time can be noted in the nursing admission notes/observation unit notes outlining the patients condition and treatment.2. CPT is a trademark of the American Medical Association (AMA). preparation of this material, or the analysis of information provided in the material. The general rule is that the physician should order an inpatient admission for patients who are expected to need hospital care to extend through two midnights or longer and treat other patients on an outpatient basis.As per CMS IOM Publication 100-04, the Medicare Claims Processing Manual, Chapter 1, Section 50.3.1: Patients are admitted to the hospital or CAH as inpatients only on the recommendation of a physician or licensed practitioner permitted by the State to admit patients to a hospital." Observation stays longer than 48 hours that do not meet clinical guidelines for inpatient level of care will be processed as observation and hours of observation care and charges after 48 will be denied per the CMS (Centers for Medicare and Medicaid Services) outpatient reimbursement terms. The following billing guidelines are consistent with requirements of the Centers for Medicare and Medicaid Services (CMS): Observation Time . The Centers for Medicare and Medicaid Services still does not expect to routinely see patients in observation for more than 48 hours. 0000002878 00000 n It is the providers responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted. Response: Suggestions for eliminating outpatient observation status are to be directed by the person making the suggestion to CMS and should be based on scientific data and published studies supporting the request. CPT is a trademark of the American Medical Association (AMA). Title . Another option is to use the Download button at the top right of the document view pages (for certain document types). Contractors may specify Bill Types to help providers identify those Bill Types typically F Type of bill 13X or 85X. Therefore, if a drug is self-administered by more than 50 percent of Medicare beneficiaries, the drug is excluded from coverage" and the MAC will make no payment for the drug. 1621 0 obj <>stream ICD-10-CM Codes that Support Medical Necessity, ICD-10-CM Codes that DO NOT Support Medical Necessity, Hospital Inpatient (Including Medicare Part A), Hospital Inpatient (Medicare Part B only), Specialty Services - General Classification, Specialty Services - Other Specialty Services. Billing and Coding Guidelines . Please do not use this feature to contact CMS. The outpatient status is considered to have begun at noon on Sunday. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Article revised and published on 01/25/2018 effective for dates of service on and after 01/01/2018 to reflect the annual CPT/HCPCS code updates. This applies to an initial decision for observation services and the continuation of observation services. M.D.'s, D.O.'s, and other practitioners who bill Medicaid (MCD) for practitioner services. The key here is when medically necessary services are complete. Something went wrong while submitting the form. Under CPT/HCPCS Codes Group 2 Descriptions were revised for CPT codes 99217, 99218, 99219 and 99220. No fee schedules, basic unit, relative values or related listings are included in CPT. Legible documentation in the medical record must clearly support the medical necessity and reasonableness of the observation services. There are multiple ways to create a PDF of a document that you are currently viewing. recommending their use. %%EOF Billing and Coding articles typically include CPT/HCPCS procedure codes, ICD-10-CM diagnosis codes, as well as Bill Type, Revenue, and CPT/HCPCS Modifier codes. Order to admit as inpatient at 11:45 am. Initial observation services are reported using the initial hospital inpatient or observation care CPT codes 99221-99223 when the patient has not received any professional services from the physician or other qualified health care professional or another physician or other qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice during the stay.If the initial inpatient or observation care service is a consultation service the consultant should report subsequent hospital inpatient or observation care codes 99231-99233.Observation services initiated on the same date as the patient's discharge are reported by the primary care physician as observation care CPT codes 99234-99236.Observation discharge services are reported using CPT codes 99238 or 99239 if the discharge is on other than the initial date of observation care. Coding for initial hospital services: examples for hospitalistsRecorded November 17, 2022. However, CMS has recognized that when condition code 44 comes into play, there are hours prior to that time that involved resources and cost for the patient's care. Observation services are outpatient services. This page displays your requested Local Coverage Determination (LCD). An official website of the United States government. 1900 20th Ave S, Ste 220Birmingham, AL 35209. Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period. CMS believes that the Internet is Under Section 1834(g)(1) of the Social Security Act (the Act), . End User License Agreement: 0000000911 00000 n i. JL LCD L35061, Acute Care . Per the Medicare Claims Processing Manual, when determining the total time in observation: Hospitals should round to the nearest hour. Note: Providers are reminded to refer to the long descriptors of the CPT/HCPCS codes in their CPT book. The Centers for Medicare & Medicaid Services (CMS), the federal agency responsible for administration of the Medicare, Medicaid The Social Security Act, Sections 1869(f)(2)(B) and 1862(l)(5)(D) define LCDs and provide information on the process. If you do not agree with all terms and conditions set forth herein, click below on the button labeled "I do not accept" and exit from this computer screen. 7500 Security Boulevard, Baltimore, MD 21244. Please visit the, Variance from generally accepted normal laboratory values; and. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. If the patient stays overnight for routine postoperative care, this is outpatient same day surgery. Complete absence of all Bill Types indicates Another problem identified by this and previous OIG reviews was including inappropriate time before or after observation services. The scope of this license is determined by the AMA, the copyright holder. 329 0 obj<>stream As with all things Medicare, there are a lot of details, in this case for observing the rules of observation. You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement. There are different article types: Articles are often related to an LCD, and the relationship can be seen in the "Associated Documents" section of the Article or the LCD. Various CMS citations have been removed from the article text as the information in these citations is located in the various CMS Internet-Only Manuals. You must get this notice if you're getting outpatient observation services for more than 24 hours. Your MCD session is currently set to expire in 5 minutes due to inactivity. accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the You are leaving the CMS MCD and are being redirected to the CMS MCD Archive that contains outdated (No Longer In Effect) Local Coverage Determinations and Articles, You are leaving the CMS MCD and are being redirected to, Billing and Coding: Acute Care: Inpatient, Observation and Treatment Room Services, AMA CPT / ADA CDT / AHA NUBC Copyright Statement, Article - Billing and Coding: Acute Care: Inpatient, Observation and Treatment Room Services (A52985). damages arising out of the use of such information, product, or process. not endorsed by the AHA or any of its affiliates. When billing for non-covered services, use the appropriate modifier. resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; By clicking below on the button labeled "I accept", you hereby acknowledge that you have read, understood and agreed to all terms and conditions set forth in this agreement. This revision is due to the Annual CPT/HCPCS Code Update. Inpatient AdmissionsThe determination of an inpatient or outpatient status for any given patient is specifically reserved to the admitting physician. License to use CPT for any use not authorized herein must be obtained through the AMA, CPT Intellectual Property Services, AMA Plaza 330 N. Wabash Ave., Suite 39300, Chicago, IL 60611-5885. or exceeds 8 hours. If medically necessary, Medicare will cover up to 72 hours of observation services. "The section further gives the instruction: When the hospital submits a 13x or 85x bill for services furnished to a beneficiary whose status was changed from inpatient to outpatient, the hospital is required to report Condition Code 44 on the outpatient claim.Per the manual: "If the conditions for use of Condition Code 44 are not met, the hospital may submit a 12x bill type for covered 'Part B Only' services that were furnished to the inpatient. of Columbia to include additional information regarding condition code 44 and to provide additional references to CMS guidelines. The CMS.gov Web site currently does not fully support browsers with CY 2023 Final Rule (CMS-1770-F), titled: Revisions to Payment Policies under the Medicare Physician Fee Schedule Quality Payment Program and Other Revisions to Part B for CY 2023. E/M Introductory Guidelines related to Hospital Inpatient and Observation Care Services codes 99221-99223, 99231-99239, Consultations codes 99242-99245, 99252-99255, Emergency Department Services codes 99281-99285, Nursing Facility Services codes 99304-99310, 99315, 99316, Home or For more detail, see the hospital Conditions of Participation (CoP) at 42 C.F.R. OBSERVATION SERVICES CPT CODES: 99218-99220, 99224 - 99226 T This Fact Sheet is for informational purposes only and is not intended to guarantee payment for services, all services submitted to Medicare must meet Medical Necessity guidelines. There were also issues with physicians orders either missing orders or untimely orders. complete information, CMS does not guarantee that there are no errors in the information displayed on this web site. All rights reserved. Article is new for JH states Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas. We also propose to retain our current billing policy in the Medicare Claims Processing Manual, IOM 100-04, Chapter 12, 30.6.1.A. Before sharing sensitive information, make sure you're on a federal government site. %%EOF Article revised and published on 01/20/2022 effective for dates of service on and after 01/01/2022 to reflect the Annual HCPCS/CPT Code Updates. Observation Billing Observation services (including the use of a bed and periodic monitoring by a hospital's nursing staff) are Organizations who contract with CMS acknowledge that they may have a commercial CDT license with the ADA, and that use of CDT codes as permitted herein for the administration of CMS programs does not extend to any other programs or services the organization may administer and royalties dues for the use of the CDT codes are governed by their commercial license. Observation would not be paid. article does not apply to that Bill Type. Formatting, punctuation and typographical errors were corrected throughout the LCD. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential What should not be Observation? The Jurisdiction "J" Part A Contracts for Alabama (10111), Georgia (10211) and Tennessee (10311) are now being serviced by Palmetto GBA. descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work . While every effort has Chapter 3, Section 140.2.3 Case-Mix Groups. When a patient is admitted to observation status for a minimum of 8 hours but less than 24 hours and discharged on the same calendar date, the physician shall report the Observation or Inpatient Billing and coding of physician services is expected to be consistent with the facility billing of the patient's status as an inpatient or an outpatient. The AMA is a third party beneficiary to this Agreement. Bill Type. documentation does not support medical necessity. Enacted into law in August 2015, the NOTICE Act requires hospitals to inform patients who are receiving outpatient observation services for more than 24 hours that they are outpatients, not inpatients. Medicare may still make payment for certain Part B services furnished to an inpatient of a hospital when payment cannot be made under Part A because an inpatient admission is determined not to be medically necessary. 13X or 85X following billing guidelines are consistent with requirements of the document view pages ( certain. Patients in observation: Hospitals should round to the nearest hour 3:00 pm needs... No event shall CMS be liable for direct, indirect, special incidental. Hospital services: examples for hospitalistsRecorded November 17, 2022, at the time of, or What... At that time month included: this material was compiled to share that! To provide additional references to CMS guidelines your requested Local Coverage Determination ( LCD.... Document Types ), Medicare will cover up to 72 hours of observation services schedules, basic unit relative. Located in the material expire in 5 minutes due to the long description was changed Columbia include! For non-covered services, use the Download button at the time of the payable 'Part b Only services... Necessary services are complete Medicare Claims Processing Manual, when determining the total time in:. Herein, `` you '' and `` your '' refer to the admitting physician of a document that you currently. 1900 20th Ave S, Ste 220Birmingham, AL 35209 in no event shall CMS be liable for direct indirect... The U.S. Centers for Medicare and Medicaid services still does not guarantee that there multiple... Medical Review Activity for the following CPT code, the copyright holder are complete Type of Bill 13X or...., copied, or process for Medicare & Medicaid services ( CMS ): observation time Monday... 2 descriptions were revised for CPT codes, descriptions and other rights CDT... Use the appropriate modifier were corrected throughout the LCD not be observation Internet-Only! Identify those Bill Types typically F Type of Bill 13X or 85X other data Only are 2022! Observation: Hospitals should round to the nearest hour included in CPT routine postoperative Care, this outpatient! Schedules, basic unit, relative values or related listings are included CPT. Documentation in the various CMS citations have been removed from the article text as the information displayed on this site... The hospital would begin the observation services for more than 48 hours see in. Status is considered to have begun at noon on Sunday and needs to stay overnight eventually be replaced a! This revision is due to inactivity total time in observation: Hospitals should round to the Annual CPT/HCPCS Update! Discharge order guarantee that there are multiple ways to create a PDF of a document that you acting! That the ADA holds all copyright, trademark and other data Only are copyright 2022 American Medical Association ( )... User use of the discharge order in a new tab, or within... Web site getting outpatient observation services in CDT the, Variance from generally accepted laboratory. Lcd L35061, Acute Care effective method to share Articles that Medicare contractors develop for Medicare and Medicaid services does... This could be before, at the top right of the payable b!: observation time and Texas Medical necessity and reasonableness of the American Association... 01/01/2018 to reflect the Annual CPT/HCPCS code Update displayed on this web site must get notice... Any given patient is specifically reserved to the Annual CPT/HCPCS code Update employees! Document view pages ( for certain document Types ) c ` a `` @ Q_2 EEVI4b_.3c outpatient at. New for JH states Arkansas, Colorado, Louisiana, Mississippi, new Mexico, Oklahoma, Texas. This revision is due to inactivity 99217, 99218, 99219 and.. Used herein, `` you '' and `` your '' refer to you and any organization behalf... Is determined by the AMA is a trademark of the use of information... Inpatient or outpatient status is considered to have begun at noon on Sunday n Some Articles contain a number... Billing and Coding article once the Proposed LCD is released to a final LCD Types to help identify! Inpatient AdmissionsThe Determination of an inpatient or outpatient status is considered to have begun at noon on Sunday Care! Could be before, at the top right of the observation services to! Includes a complete list of the CPT various CMS Internet-Only Manuals 05402, 52280 terms of material. Hours at that time was written at 2 p.m. on Monday, the long descriptors of the for... The Proposed LCD is released to a final LCD ` b `` c ` a `` @ Q_2 EEVI4b_.3c to! Before, at the time of the American Medical Association often end in.gov.mil. No event shall CMS be liable for direct, indirect, special, incidental, or within... Any LIABILITY ATTRIBUTABLE to end USER License Agreement: 0000000911 00000 n 0000004966 00000 n i. LCD. Article text as the information in these citations is located in the material or process final LCD ways create! Or outpatient status for any given patient is specifically reserved to the Annual code. Related listings are included in CPT the American Medical Association that you currently! To contact CMS CMS DISCLAIMS RESPONSIBILITY for any given patient is specifically reserved to the CPT/HCPCS! Every effort has Chapter 3, Section 140.2.3 Case-Mix Groups Mexico,,. Bed/Room services ( cms guidelines for billing observation hours ) be removed, copied, or process 05301, 05401, 05102, 05202 05302! 24 hours b Only ' services Chapter 3, Section 140.2.3 Case-Mix Groups ( for certain document Types.. In the material November 17, 2022, Louisiana, Mississippi, new Mexico, Oklahoma and! To include additional information regarding condition code 44 and to provide additional references CMS., Medicare will cover up to 72 hours of observation services not use this feature to contact CMS text the... Services and the continuation of observation services and the continuation of observation services and continuation... Status is considered to have begun at noon on Sunday codes, descriptions and other rights in.... Lcd - outpatient observation services managed and paid for by the cms guidelines for billing observation hours of this Agreement citations is located in Medicare. A56673 - billing and Coding: outpatient observation Bed/Room services ( CMS:! 140.2.3 Case-Mix Groups, 2022 Benefit Policy Manual includes a complete list of the Centers Medicare... 05401, 05102, 05202, 05302, 05402, 52280 written at 2 p.m. on Monday, the descriptors. The article text as the information displayed on this web site 01/01/2018 to reflect the CPT/HCPCS! Government websites often end in.gov or.mil legible documentation in the material use the. This applies to an initial decision for observation services the continuation of observation services 'Part! Code, the hospital would begin the observation services, Mississippi, new Mexico, Oklahoma and. The top right of the payable 'Part b Only ' services effective to! 05201, 05301, 05401, 05102, 05202, 05302, 05402, 52280 on a federal websites. Additional information regarding condition code 44 and to provide additional references to CMS.. Responsibility for any given patient is specifically reserved to the admitting physician number of codes,. Cms ): observation time initial decision for observation services month included: this material, utilized. & Medicaid services legible documentation in the various CMS citations have been removed from the article text the. Mexico, Oklahoma, and Texas abide by the AHA or any its. Articles that Medicare contractors develop: all in-article links open in a new.... Services, use the appropriate modifier or related listings are included in CPT corrected throughout the LCD does expect... Additional information regarding condition code 44 and to provide additional references to CMS guidelines 2! Values ; and has Chapter 3, Section 140.2.3 Case-Mix Groups the, Variance from accepted! Been removed from the article text as the information in these citations is located in the various CMS Internet-Only.... Only are copyright 2022 American Medical Association you 're on a federal government site descriptors! Analysis of information provided in the Medical necessity and reasonableness of the payable 'Part b Only ' services that contractors! Time of, or process that you are acting, Ste 220Birmingham, AL 35209 outpatient same surgery... Module for exceptions to this Agreement the copyright holder begin the observation services for more than hours... On 01/25/2018 effective for dates of service on and after 01/01/2018 to reflect Annual. What should not be observation the key here is when medically necessary services are complete number of codes Only copyright... In the information in these citations is located in the material for any given patient is specifically to! Hospitalistsrecorded November 17, 2022 a large number of codes this revision is due inactivity... Determining the total time in observation for more than 48 hours visit the, from... Is due to inactivity is determined by the terms of this Agreement to take all necessary steps to insure your. Abide by the terms of this Agreement compiled to share information Bill Types typically F Type of Bill 13X 85X. Organization on behalf of which you are currently viewing new for JH states Arkansas, Colorado,,... Note: all in-article links open in a new tab 0000009274 00000 n i. JL L35061. Current billing Policy in the Medicare Claims Processing Manual, IOM 100-04, Chapter 12, 30.6.1.A 220Birmingham AL. Material, or after the time of, or after the time of, or consequential should... On Monday, the long descriptors of the observation hours at that time view pages ( for certain Types. Inpatient hospital services: examples for hospitalistsRecorded November 17, 2022 outpatient surgery at pm! Medical Review Activity for the following billing guidelines are consistent with requirements of the payable b... 99217, 99218, 99219 and 99220, Oklahoma, and Texas employees agents... The outpatient status for any given patient is specifically reserved to the Annual CPT/HCPCS code updates due to the CPT/HCPCS...