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    the medical reviewer of the day   
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Resources for calculating payment
 

Questions? Ask MRT
Reviewer of the day:
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Current resource
Prior resource
 
Examples of calculating the payment for various provider types
Maximum payment amount for OSC

 
2009 Current Resources effective 7/1/09
For OAR 436-009 rules
The Federal Register
ASA Relative Value Guide
Current Procedural Terminology (CPT®) codes/CPT® Assistant
ICD-9-CM Code Book
Ambulatory Surgical Center (ASC) Codes
NUBC-04
HCPCS Coding System
 
 
The Federal Register
Addendum B provides the relative value unit (RVUs) and related information used in determining medical services payments for health care providers. Addendum C lists codes with Interim RVUs.

Download Vol. 73. No. 224, November 19, 2008, go to the Centers for Medicare and Medicare Services, click on PDF format and scroll down to page 220.
This file is very large and may take time to download.

Order a hardcopy online,
or call the Government Printing Office Bookstore at 1-866-512-1800.
Ask for the Federal Register, Vol. 73, No. 224, November 19, 2008.
The American Society of Anesthesiology Relative Value Guide (ASA)
Provides RVUs and related information used in determining medical services payments for anesthesia providers. Ask for the 2009 Relative Value Guide.

To order the ASA Relative Value Guide, contact:
American Society of Anesthesiologists
520 N. Northwest Highway
Park Ridge, IL 60068-2573
Phone: 847-825-5586
Current Procedural Terminology (CPT®)/CPT® Assistant
Provides codes, descriptions, and guidelines for medical service providers to use in billing for their services. Ask for CPT® 2009.

To order the CPT® 2009 or the CPT Assistant, contact:
American Medical Association
515 North State Street
Chicago, IL 60610
Phone: 800-621-8335
 
ICD-9-CM Code Book
Provides codes and description to use for diagnosis and categorizing disease and injuries. Check out the free on-line ICD-9 search.
 
Ambulatory Surgical Center (ASC) Medicare ASC groups
These files contain the procedure codes which may be performed in an ASC under the Medicare program as well as the ASC payment group assigned to each of the procedure codes.

Note: These files contain material copyrighted by the American Medical Association. The downloadable zipped files are very long, use caution when printing.

ASC Approved HCPCS Codes and Payment Rates

(Use the 2006 ASC approved HCPCS codes and payment rates link.)

Note: See OAR 436-009-0022(3) for newly assigned codes or codes that are assigned to a different ASC payment group.

If you have questions about the information contained in this document, please contact the medical reviewer of the day, 503-934-6049.
 
NUBC-04
For hospital billing, this replaces the UB-92.

To order the NUBC UB-04 Data Specifications Manual, contact:
National Uniform Billing Committee
American Hospital Association
29th Floor
One North Franklin
Chicago, IL 60606
Phone: 312-422-3390
Ask to: Become a subscriber of the NUBC UB-04 Specifications Manual
 
Healthcare Common Procedure Coding System
To order the Healthcare Common Procedure Coding System, 12/21/2006, contact:
National Technical Information Service
Springfield, VA 22161
Phone: 800-621- 8335
Online link

 

If you have questions about this Web page, please contact the medical reviewer of the day, 503-934-6049.

 

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