Kentucky Women’s Cancer Screening Program

LHD Individual Provider Contracts Training

April 10, 2012

FY 2012/KWCSP RATE SHEET

Contracted Provider Name_______________ Local Health Dept. Name_________________________

KENTUCKY WOMEN’S CANCER SCREENING PROGRAM

NEGOTIATED RATES SHEET

The list below includes the CPT code and negotiated rates for this specific KWCSP provider contract with the Local Health Department. Enter the technical and professional rates for CPT codes where it is applicable.

This list should only include the CPT codes that will be reimbursed to this contracted provider by the LHD. Use multiple copies of this form for additional codes.

The link below will take you to the current version of the Kentucky Public Health

Practice Reference. The Cancer Screening/Follow-Up Section, found in Volume 1 at this

link, is to be utilized by the provider when providing services to cancer screening

patients referred by the health department.

http://www.chfs.ky.gov/dph/info/dpqi/PHPR.htm

CPT CODE GLOBAL RATE TECHNICAL ONLY PROFESSIONAL ONLY

IF APPLICABLE, THE TOTAL NUMBER OF MAMMOGRAMS PERFORMED UNDER THE TERMS OF THIS CONTRACT SHALL NOT EXCEED _______ UNLESS AUTHORIZED BY THE HEALTH DEPARTMENT IN WRITING.

Contract Rate Sheet• Contracted Provider Name_ ______________ • Local Health Dept. Name_________________________• KENTUCKY WOMEN’S CANCER SCREENING PROGRAM• NEGOTIATED RATES SHEET• The list below includes the CPT code and negotiated rates for this

specific KWCSP provider contract with the Local Health Department. Enter the technical and professional rates for CPT codes where it is applicable.

• This list should only include the CPT codes that will be reimbursed to this contracted provider by the LHD. Use multiple copies of this form for additional codes.

• The link below will take you to the current version of the Kentucky Public Health Practice Reference. The Cancer Screening/Follow-Up Section, found in Volume 1 at this link, is to be utilized by the provider when providing services to cancer screening patients referred by the health department. http://www.chfs.ky.gov/dph/info/dpqi/PHPR.htm

Table Column Headings • CPT CODE• GLOBAL RATE• TECHNICAL ONLY• PROFESSIONAL ONLY

Changes/Additions in Body of Contract

• If a LHD adds additional language or information to the body of a contract outside of the template form, the LHD will be responsible for those additions or changes.

• Changes may be made that require more service from a provider but they must at least cover the minimum requirements listed in the PHPR Cancer Screening Follow-up Section.

Lab/Pathology

• 87621 88173• 88104 88174• 88141 88175• 88142 88305• 88143 88307• 88164 88331

Breast Surgeon

• 10021 19100 19125• 10022 19101 19126• 19000 19102 19290• 19001 19103 19291• 19030 19120 19295• Also evaluation/management and preventative

codes 99201-99396 from the PHPR Cancer Screening Follow-up Section approved codes list.

Gynecologist

• 57452 57460 57510 57522• 57454 57461 57511 58100• 57455 57500 57513 57110• 57456 57505 57520• Also evaluation/management and

preventative codes 99201-99396 from the PHPR Cancer Screening Follow-up Section approved codes list.

Radiologist

• 77052 G0202 10022 19290• 77055 G0204 19000 19291• 77056 G0206 19001 19295• 77057 76645 19030• 77031 77032 19100• 76098 76937 19102• 76942 10021 19103

Anesthesiologist

• 00400 00940

Hospital

• W0166• 77052 G0202• 77055 G0204• 77057 G0206

• Additional codes discussed on next two slides

Services performed in hospitals

CPT codes: • 00400, 00940 anesthesia• (10021-19295) breast surgeries• (57452-58100) cervical surgeries• (80000+ codes) labs/pathology

are usually billed by the provider performing the service.

Billing for Procedures Performed in Hospitals

• However, if the hospital employs the surgeons and anesthesiologists and pay them salaries, the hospital may bill for the services that these providers perform if the individual providers are not allowed to bill separately.

• When lab specimens are evaluated at the hospital lab instead of being sent out, the hospital may bill for those services.

• Only one provider may bill for each service and you will need to determine whether it should be the hospital or the physician by discussing their arrangements at contract negotiation time.