Active Medical Reviews

Service Type
Code Type
Specific Code
Code Description
Review Type
Ambulance
HCPCS
A0427
ALS1, emergency
Pre-payment
and Target Probe and Educate (TPE)
Ambulance
HCPCS
A0428
BLS
Pre-payment
and TPE
Ambulance
HCPCS
A0431
Rotary wing air transport
Prepayment
Laboratory
HCPCS
G0480
Drug test definitive 1-7 classes
Post-payment
Laboratory
HCPCS
G0481
Drug test, definitive, 8-14 classes
Post-payment
Laboratory
HCPCS
G0482
Drug test, definitive, 15-21 classes
Post-payment
Laboratory
HCPCS
G0483
Drug test, definitive, 22 or more classes
Post-payment
Laboratory
CPT
80305
Drug test, presumptive; direct optical observation
Post-payment
Laboratory
CPT
80306
Drug test, presumptive; instrument-assisted
Post-payment
Laboratory
CPT
80307
Drug test, presumptive; chemistry analyzers
Post-payment
Laboratory
CPT
82542
Column chromatography, qualitative or quantitative
Post-payment
Laboratory
CPT
88305
Tissue exam by pathologist
Post-payment
Laboratory
CPT
88307
Tissue exam by pathologist
Post-payment
Laboratory
CPT
88309
Tissue exam by pathologist
Post-payment
Laboratory
CPT
88312
Special stains; group 1
Post-payment
Drugs/Biologics
HCPCS
J0897
Denosumab Injection
TPE
Drugs/Biologics
HCPCS
J0178
Aflibercept injection
TPE
Drugs/Biologics
HCPCS
J1745
Infliximab; Not Biosimil, 10mg
TPE
Drugs/Biologics
HCPCS
J2778
Ranibizumab injection
TPE
Drugs/Biologics
HCPCS
J9312
Rituximab, injection, 10 mg
TPE
Debridement
CPT
11055
Trim skin lesion
TPE
Debridement
CPT
11056
Trim skin lesions 2 to 4
TPE
Debridement
CPT
11057
Trim skin lesions over 4
TPE
Debridement
CPT
11720
Debride nail 1-5
TPE
Debridement
CPT
11721
Debride nail 6 or more
TPE
Ophthalmology
CPT
66984
Cataract surgery w/iol 1 stage
Post-payment
Radiology
CPT
71045
X-ray exam chest 1 view
Pre-payment
Radiology
CPT
71046
X-ray exam chest 2 views
Pre-payment
Radiology
CPT
77080
DXA, bone density axial
Pre-payment
Radiology
HCPCS
R0070
Transport portable x-ray
TPE
Radiology
HCPCS
R0075
Transport portable x-ray multiple
TPE
Radiology
HCPCS
Q0092
Set-up portable x-ray equipment
TPE
Therapeutic Procedures
CPT
97035 KX
Ultrasound therapy, billed above threshold
Pre-payment
Therapeutic Procedures
CPT
97110 KX
Therapeutic exercises, billed above threshold
Pre-payment
Therapeutic Procedures
CPT
97112 KX
Neuromuscular reeducation, billed above threshold
Pre-payment
Therapeutic Procedures
CPT
97113 KX
Aquatic therapy/exercises  billed above threshold
Pre-payment
Therapeutic Procedures
CPT
97116 KX
Gait training therapy billed above threshold
Pre-payment
Therapeutic Procedures
CPT
97140 KX
Manual therapy, 1/>  regions, billed above threshold
Pre-payment
Therapeutic Procedures
CPT
97150 KX
Group therapeutic procedures, billed above threshold
Pre-payment
Therapeutic Procedures
CPT
97530 KX
Therapeutic activities, billed above threshold
Pre-payment
Therapeutic Procedures
CPT
97535 KX
Self-care management training, billed above threshold
Pre-payment
Therapeutic Procedures
HCPCS
G0515 KX
Cognitive skills development billed above threshold
Pre-payment
Evaluation & Management
CPT
99204
Office/outpatient visit new
Pre-payment
Evaluation & Management
CPT
99205
Office/outpatient visit new
Pre-payment
Evaluation & Management
CPT
99211
Office/outpatient visit, established
TPE
Evaluation & Management
CPT
99212
Office/outpatient visit, established
TPE
Evaluation & Management
CPT
99213
Office/outpatient visit, established
TPE
Evaluation & Management
CPT
99214
Office/outpatient visit, established
TPE
Evaluation & Management
CPT
99215
Office/outpatient visit, established
TPE
Evaluation & Management
CPT
99222
Initial hospital care
Pre-payment
Evaluation & Management
CPT
99223
Initial hospital care
Pre-payment
Evaluation & Management
CPT
99231
Subsequent hospital care
Pre-payment and TPE
Evaluation & Management
CPT
99232
Subsequent hospital care
Pre-payment and TPE
Evaluation & Management
CPT
99233
Subsequent hospital care
Pre-payment and TPE
Evaluation & Management
CPT
99284
Emergency department visit
Pre-payment and TPE
Evaluation & Management
CPT
99285
Emergency department visit
Pre-payment and TPE
Evaluation & Management
CPT
99291
Critical care first hour
Pre-payment
Evaluation & Management
CPT
99304
Nursing facility care initial
TPE
Evaluation & Management
CPT
99305
Nursing facility care initial
TPE
Evaluation & Management
CPT
99306
Nursing facility care initial
TPE
Evaluation & Management
CPT
99308
Nursing facility care subsequent
Pre-payment
Evaluation & Management
CPT
99309
Nursing facility care subsequent
Pre-payment

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