California Work Comp News, Issues,
Articles Daily
November 25, 2014: Article :
82486 / G0431 Urine Drug Screen Billing and
Payments –Issue To Rest


November 24, 2014: Educational WC: Underpaid
Billing Codes and Those Paid Fee Schedule!
***

November 21, 2014: Paper: WC: MPNs, Interpreters
and Ancillary Services When They Apply

November 21, 2014: Recent Significant Panel
Decision Regarding Untimely URs

November 18, 2014: Article:
IBR Decisions Telling Insurance Companies and
Providers That Their Wrong In Their Bill Reviews and
Payments

November  17, 2014: Article:
WC: Ghost Laws, Shadow Laws, Ego Laws, Time to Put
Away Childish Things

November 17, 2014: Article:
Misreading The Law UR Resubmission, UR Good for
12 Months --Unless...

November 13, 2014: (Causation  by default
(MPN?)):  "[W]here there has been an admission to or a
determination of industrial injury to at least one body part

November 12, 2014: Recent Posts on IBR Decisions:
Including determination of billing 99358 under 2014
RBRVS based Physician Fee Schedule will be applicable for
services rendered on or after January 1, 2014.

November 11, 2014: Education: Provider and
Collection Dispute Course and Lien issues offered
for: Providers, Adjusters, Bill Review Companies;
Defense Attorneys; Applicant Attorneys; Lien
Representatives and Collections Companies

November 11, 2014: Article WC: When Adjusters /
Defense Attorneys -- Do Not Have To Pay-

November 07, 2014: DWC Closes Door on Untimely
Response to Second Reviews to WCAB - Sanctions -
Added to the now insurmountable number of uncollectable
dispute files, in addition to the defective URs, (where the
provider treated after UR denial and UR
CALIFORNIA WORKERS COMPENSATION COLLECTIONS PUBLICATIONS AND
INFORMATION FOR MEDICAL PROVIDERS AND LIEN CLAIMANTS
All States Work Comp News,
Issues, Articles Daily
November 20, 2014: Illinois Case Law:
As the Commission applied the incorrect
legal standard, we vacate that portion of
its decision and remand for further
proceedings on this issue. There is no
absolute requirement that an award of the
type sought here be supported by the
testimony of a physician, so long as
competent evidence establishes the
reasonableness and necessity of the award.

November 20, 2014: Idaho Case Law:
Pursuant to Idaho Code § 72-701, a
claimant must give notice of an accident
within 60 days and make her claim for
compensation within one year. Notice
must be in writing, but may be excused
where it is demonstrated that employer
had knowledge of the accident within 60
days of the occurrence of the same.

November 20, 2014: Connecticut Case
Law:As we pointed out in O’Connor v.
Med-Center Home Healthcare, Inc., 4954
CRB-5-05-6 (July 17, 2006), “[t]here are
few principles of jurisprudence more
fundamental than the principle that a
trier of fact must be the one party
responsible for finding the truth amidst
conflicting claims and evidence

November 20, 2014: Arkansas Case Law:
The employee must prove by a
preponderance of the evidence that any
medical treatment requested is both
reasonable and necessary. . What
constitutes reasonably necessary medical
treatment under the statute is a question
of fact for the Commission.

November 07, 2014: MFDR:
November 4, 2013 Urine Drug Screen
disputed amount $638.00 determined due
under fee schedule $349.81
Recent En Banc Decision on QME Process

Panel Decision:
"...when the Order Dismissing had been served on lien
claimant. It was therefore not clear whether the
Petition was timely filed." (Report, pp. 1-2.)

Panel Decision:
Kunz and Tapia cases really focus on evidence of what the
lien claimant usually accepts

Panel Decision:
"Here, we conclude that the defendant's UR process suffers
from material procedural defects that undermine the integrity
of the UR decision because the UR physicians were not
provided with adequate medical records."
Panel Decision:
sanctions: litigating a lien to the point of setting it for
trial without submitting any evidence in support thereof
Recent En Banc Decision on QME Process

Panel Decision:
"...when the Order Dismissing had been served on lien
claimant. It was therefore not clear whether the
Petition was timely filed." (Report, pp. 1-2.)

Panel Decision:
Kunz and Tapia cases really focus on evidence of what the
lien claimant usually accepts

Panel Decision:
"Here, we conclude that the defendant's UR process suffers
from material procedural defects that undermine the integrity
of the UR decision because the UR physicians were not
provided with adequate medical records."

Panel Decision:
sanctions: litigating a lien to the point of setting it for
trial without submitting any evidence in support thereof
Panel Decision:
"Compensable consequences" doctrine. Under this doctrine,
where a subsequent injury is the consequence of an original
industrial  injury, the subsequent injury is considered to relate
back to the original injury

F Panel Decision:
Appeals Board States When SCIF can use Blue Cross PPO discount
WCAB Published Significant Panel Decision: An expedited
hearing may be requested and conducted under Labor Code section
5502(b)(2) and Administrative Director Rule 9767.6(c) to
determine whether the employee must treat in the employer’s
medical provider network during the 90-day delay

Panel Decision:
Here, applicant's attorney barely manages to squeeze the petition
for reconsideration into 25 pages, but he does so only by
violating the 12-point font size requirement (§§ 10845(a),
10205.12(a)(5) [formerly, § 10232(a)(5)1) and possibly by
violating the line- spacing requirement as well (§§ 10845(a),
10205.12(a)(11) [formerly, § 10232(a)(1 1)]).
Panel Decision:
Lien claimant did not file the Petition for Reconsideration within
25 days of the decision (20 days per Labor Code section 5903,
plus 5 days for mailing per Code of Civil Procedure section 1013).
Panel Decision:
The WCJ's determination "must be based on admitted evidence in
the record."

Labor Code section 5313 requires the WCJ to "make and file
findings upon all facts involved in the controversy

Panel Decision:
“It appears that lien claimant does not fully  understand its
evidentiary burden. Under Labor Code section 5705, "The burden
of proof rests upon the party or lien claimant holding the
affirmative of the issue."
Panel Decision:
"...we strongly admonish applicant's counsel for citing medical
reports that are not in evidence, thereby failing to "fairly state
all of the material evidence relative to the point or points at issue
[,]"
Panel Decision
Order of Dismissal Lien Served by Defense and not Board Held
Invalid Order for Dismissal.
Panel Decision:
Sanctions for Lien Claimant withdrawing DOR
Panel Decision:
"Finally, we note that Labor code section 4907 will be expanded
on January 01, 2013. Beginning on that date, a Lien
Representative may lose the privilege of practicing before the
WCAB..."
: Panel Decision:
Lien claimants offered no evidence of the OMFS for the
services provided to treat applicant's industrial injury.
Panel Decision: Evidence:
However, while a party's failure to lay a foundation, to
authenticate, and to corroborate documentary evidence with
oral testimony may affect the weight and substantiality of the
evidence, these possible deficiencies do not necessarily render
that evidence inadmissible.

Panel Decision:
Additionally, even if lien claimant's assertion about lack of
notice were correct, lien claimant's skeletal petition for
reconsideration would still be "unsupported by specific
references to the record and to the principles of law involved"
and thus subject to dismissal. (Cal. Code Regs., tit. 8, § 10846.)
Panel Decision:
"... the petition fails to identify what "good cause" petitioners
contend supports rescission of the WCJ's Order. The petitions
are also unverified."
Panel Decision:
Moreover, although the presumption of proper mail service
may be rebutted by evidence that the Findings and Order was
not in fact mailed as declared by the proof of service  a bare
declaration of non-receipt is insufficient to overcome proof
of service.g
Panel Decision:
Sanctions-- Lien claimant for failure to respond to NOI
: Panel Decision:
Labor Code section 5502(b) establishes issues which require
expedited hearing. As of 2012,these issues did not include MPN
issues or issues regarding attorney's fees. However, because the case
is now off calendar, defendant's Petition for Removal is moot, and
we deny it.

Panel Decision:
"With regard to the defendant's contention that the lien claimant's
attorney did not state under penalty of perjury that the attorney
was appearing on no other matters on that date and that the entire
time was spent at the Pomona Board exclusively waiting for the
defendant to appear in this matter,
the defendant cites no legal authority that in order for the court to
award costs that said Petition must include such a declaration."

Panel Decision:
“…affirmative burden of proving all of the elements  necessary to
establishment of its lien and all relevant issues, including that the
lien was for properly  provided services and that the claim is
industrially related.”  “…also require that lien claimant prove that
the treatment rendered was reasonable and necessary to cure or
relieve the effects of the injury.”

Panel Decision:
“…defendant unreasonably delayed applicant's referral to his
treating spinal surgeon for a surgical consultation and unreasonably
delayed provision of spinal surgery.”
Panel Decision:
However, we note that, although lien claimant filed a Request to be
Available by Phone for the November 21, 2012 lien conference,
there is no indication in the record that the WCJ granted that
request. Notifying an opposing party, or even the WCAB, of
unavailability does not in itself excuse  failure to appear.

Panel Decision:
The verified petition for reconsideration is impermissibly skeletal,
contrary to California Code of Regulations, title 8, section 10846.
It is unsupported by specific references to the record and to the
principles of law involved.
Panel Decision:
"In order to have been "prior timely payments," the payments
would have had to be made prior to 8:30 a.m. on the date of the
lien conference"
Panel Decision:
Lien claimant's excuse for failing to obtain permission and for
filing duplicate documents is that it assumed that the documents  
would be discarded, and it contends that it was not aware of a
provision that would impose sanctions for that behavior.

Panel Decision:
However, we determine that lien claimant may have
misunderstood the language and effect of the Order quoted
above. As such, lien claimant may have been objecting to the
Notice and seeking reconsideration if the Order of Dismissal was
in effect
.

Panel Decision:
Pre-trial orders regarding evidence, discovery, trial setting,
venue, or similar issues - such as the orders here - are non-final
interlocutory orders that do not determine any substantive right
of the parties. Accordingly, the Petition, to the extent it seeks
reconsideration, must be dismissed
New En Banc Decision:
Mercy is an “air carrier that may provide air transportation”
within the meaning of the preemption provision of the ADA.?

Panel Decision:
Lien claimant's excuse for failing to obtain permission and for
filing duplicate documents

Panel Decision:
However, we determine that lien claimant may have
misunderstood the language and effect of the Order

Panel Decision:
Pre-trial orders regarding evidence, discovery, trial setting,
venue, or similar issues -
Panel Decision:
Appeals agrees with Lien Claimant there was no intention to
cause unreasonable or unnecessary delay, and not motivated by
bad faith reduce sanctions from$2,500.0 to $500.00 still
unnecessary hearing.

Panel Decision:
The Court does not believe relief should be granted per CCP
473.If the WCAB does determine that relief should be granted,
as CCP 473 includes mandatory costs and sanctions, the
matter should be returned to the trial level for the award of
same.
Panel Decision:
Treatment outside MPN allowed whenLack of Notice that
results in a neglect or refusal to provide reasonable medical
treatment renders the employer or insurer liable for
reasonable medical treatment self-procured by the
employee." (71 Cal.Comp.Cases at1435.)

Panel Decision:
Notice of Intent not a final Order and not subject to Petition
for Reconsideration unless order served by Court

Panel Decision:
There are no citations to any evidence or actual testimony,
as required by WCABRule 10842.

Panel Decision:
The supplemental response shall only address evidence and
issues raised in lien claimant's Answer, and shall not address
any other evidence or raise any other issues, and must befiled
within fifteen (15) days, plus an additional five (5) days for
mailing
Panel Decision:
Treatment outside MPN allowed when Lack of Notice that
results in a neglect or refusal to provide reasonable
En Banc Decision:
Where a medical-legal lien claim for copy costs was filed
before January 1, 2013, and after January 1, 2013 it was
withdrawn and re-filed as a petition for costs under Labor
Code section 5811, the Appeals Board held:
Panel Decision:
A failure to fairly state all of the material evidence may be a
basis for denying the petition." (Cal. Code Regs., tit. 8, § 10842.

Panel Decision
Lien Claimant ordered to pay $10,030.25 in cost and sanctions

Panel Decision: NOI:
A letter that is properly addressed and mailed is presumed to be
received, and a bare statement of non-receipt is insufficient to
overcome proof of service. . Additionally, even if lien
claimant's assertion about lack of notice were correct, lien
claimant's skeletal petition for reconsideration would still be
"unsupported by specific references to the record and to the
principles of law involved" and thus subject to dismissal. (Cal.
Code Regs., tit. 8, § 10846.)

Panel Decision MPN Issue:
The record reflects a neglect or refusal to provide reasonable
medical treatment because defendant did not carry its burden of
proving that such treatment was properly available to applicant
through its MPN. For that reason, defendant is liable for the
cost of the reasonable medical treatment self-procured by
applicant.
Panel Decision:
As discussed above, section 4600(a) imposes a mandatory duty
to timely provide reasonably required medical treatment. The
Labor Code does not permit a defendant to bury its head in the
sand in order to dodge its obligations.

Panel Decision:
A medical provider lien claimant can no longer present a
prima facie case merely by demonstrating that the treatment
giving rise to the lien claim was for an alleged
industrial injury. To the contrary, the present rule of law is
that Lien Claimants have the burden of proof on their lien
claims, including the burden to demonstrate every
element necessary for recovery unless that element was
previously adjudicated or admitted by the employer.
Panel Decision:
It is also recommended that petitioner be admonished not to file
Petitions for Reconsideration and mislabel them as
Objection-other and to comply with Reg. 10842.
Panel Decision:
The language of the statute is mandatory concerning the
payment of an activation fee by the lien claimant at the lien
conference, and the sanction of dismissal of the lien with
prejudice should the lien claimant fail to pay the fee or show
proof of such payment at the lien conference.

Panel Decision:
“____________ have violated a number of important WCAB
Rules in the underlying proceedings and in the Petition for
Reconsideration, making the imposition of Labor Code section
5813 sanctions appropriate in this case.”
Panel Decision:
as CCP 473 includes mandatory costs and sanctions, the matter
should be returned to the trial level for the award of same.

Panel Decision:
Defendants allege that the Qualified Medical Examiner should
not have his charges adjudicated in the absence of a lien.
Panel Decision:
but none of the evidence submitted is evidence that applicant
received notice or that lien
claimants received notice.
WCAB Post En Banc Decision:
Bengals are exempted by section 3600.5(b) from the provisions
of California’s workers’ compensation law,

Panel Decision:
Lien Claimant contends it was error to dismiss its lien solely for
failure to pay the lien activation fee which it described as a
technicality. This contention is frivolous in light of the express
language of Labor Code section 5903.06 (a) (1), (a) 2 and (a)
(4).
Panel Decision:
Additionally, it is unclear why lien claimants have raised Code
of Civil Procedure section 473.Claims of mistake, inadvertence,
surprise, or excusable neglect under Code of Civil Procedure
section 473 cannot be used as a basis for avoiding dismissal.

Panel Decision:
Labor Code section 4620 defines "medical-legal expenses" as
any costs and expenses incurred by or on behalf of any party for
X-rays, laboratory fees, other diagnostic tests, medical reports,
medical records, medical testimony, and needed, interpreter's
fees, for the purpose of proving or disproving a contested claim.
(Lab. Code § 4620.)
Panel Decision:
“…lien claimant is not required to pay a lien activation fee
prior to a 2013 lien trial where: (1) the declaration of readiness
(DOR) is filed prior to January 1, 2013; (2) the lien conference
takes place prior to January 1, 2013; and (3) the lien trial takes
place in 2013, without any intervening 2013 lien conference."

Panel Decision:
Petitioner has not provided any specific examples of alleged
error by the WCJ and has failed to
cite to the record in any way whatsoever.
Panel Decision:
The [WCAB] shall not designate a party or lien claimant, or
their attorney or agent of record, to serve any final order,
decision, or award relating to a submitted disputed
issue."

Panel Decision:
(1) a claim for medical-legal expenses may not be filed as a
petition for costs under section 5811.

Panel Decision:
In her Report, the WCJ stated that lien claimant consistently
argued that the settlement agreement did not address the entire
lien
Panel Decision:
The undersigned is perplexed as to why a member of the bar
would rely on a letter to which there was no response by the
Workers Compensation Appeals Board to assume or presume
that no appearance was required when Notice of Hearing was
sent and received.


Panel Decision:
Have to Love Judge Thompsons’ Humor in this decision: “So
what shall we do when faced with a “bogus” Declaration of
Readiness” (DOR)?

Penal Decision:
In order to obtain an order pursuant to section 4903.6LC must
file a petition specifying the  medical information to be
provided and the relevance of that information to the proof of
the reasonableness and necessity of the services that are the
subject of LC's lien.\

Panel Decision:
More important, his allegation of "technical difficulties" in
paying the lien activation fee, without reference to any
specifics or evidence to support the allegation, is the same
thing as outright misrepresentation.
Panel Decision:
The mailing of an item to a correct address creates a
presumption that that document was received. (Evid. Code see.
641.) However, the presumption is rebuttable, and in my view
was properly rebutted by the timely objection to the second
transmittal of the document, supported by a sworn declaration
of the mail clerk for Frontline's representative, Controlled
Health

Panel Decision:
The undersigned is perplexed as to why a member of the bar
would rely on a letter to which there was no response by the
Workers Compensation Appeals Board to assume or presume
that no appearance was required when Notice of Hearing was
sent and received.
Panel Decision:
Here, Lopez withdrew its lien prior to the date of the Martinez
decision, and there is no evidence that the lien has otherwise
been dismissed. Although Lopez's petition for costs must be
dismissed, it can  reinstate its lien and pay the lien activation
fee prior to the conference scheduled..."

Panel Decision:
Meanwhile, on January 1, 2013, section 4903.6(d) became
operative. That section provides: "With the exception of a lien
for services provided by a physician as defined in Section
3209.3, no lien claimant shall be entitled to any medical
information, as defined in subdivision

Panel Decision:
In Figueroa, the Board stated that '(1) the lien activation fee
must  be paid prior to the commencement of a lien conference,
which is the time that the conference is scheduled to begin, not
the time when the case is actually called
Panel Decision:
Every petition for reconsideration "shall fairly state all of the
material evidence."

Panel Decision:
Defense Not Sanctioned for not verifying Petition for Recon
and for stating he did not understand the lien issues at Trial.
Panel Decision:
While I appreciate the special concerns arising from the huge
volume of lien litigation we are experiencing, I have also considered
that it seems quite unlikely that an applicant would have their case
dismissed or a defendant suffer a default judgment in a high-money
claim under similar circumstances.

Panel Decision:
But defendant's failure to conduct utilization review does not relieve
applicant of the evidentiary burden of showing, by a preponderance
of the evidence, that the requested medical treatment is reasonably
required to cure or relieve the effects of his injury.

Panel Decision:
The problem here is that there is no evidence that LCs received
notice of the lien conference on April 9, 2013. As the WCJ has
pointed out, LCs do not appear on the Official Address Record.
Panel Decision: In addition, we reject the petitioning lien
claimant's contention that because defendant failed to furnish
documents to lien claimant and failed to negotiate its lien,
petitioner is somehow excused from paying the lien activation
fee ("LAF"). The contention fails because the LAF is prerequisite
to invoking the jurisdiction of the WCAB to raise allegations
that defendant failed to negotiate, etc.

Panel Decision:"lien conference was due to inadvertence
/miscalendaring, relief should be granted pursuant to L. C. Section
§5506 and/or CCP § 473. However, these code sections only
apply to default judgments being entered against a party for its
failure to: appear. In this case, a default judgment (Order of
Dismissal)"

Panel Decision: However, our NIT was issued because lien
claimants filed a skeletal Petition for Reconsideration failing to
provide a statement of facts, to raise issues of contention, to
make arguments of law upon which reconsideration was sought,
or to identify the individual filing the Petition for
Reconsideration.

Panel Decision:We note, however, that the order does not
specify that Greenway's lien was dismissed with prejudice. Because
this case concerns a filing fee and not an activation fee, upon
return to the trial level Greenway may re-file its lien, provided  
that it does so within three years from the date that services were
provided and contemporaneously pays the required lien filing fee.
(Lab. Code, § 4903.5(a).)
Panel Decision:
Essentially, lien claimant contends that its failure to appear at the
April 15, 2013 lien conference was due to inadvertence because it
had miscalendared this matter.

Panel Decision: In addition, we reject the petitioning lien
claimant's contention that because defendant failed to furnish
documents to lien claimant and failed to negotiate its lien.*
Panel Decision: -17
However, procedural rules, such as the service of orders under
Rule 10500, serve the convenience of the WCAB and they do
not  deprive it of the power to disregard violations where there is
no substantial prejudice to the parties."

Panel Decision:
In addition, we reject the petitioning lien claimant's contention
that because defendant failed to furnish documents to lien
claimant and failed to negotiate its lien, petitioner is somehow
excused from paying the lien activation fee ("LAF").

Panel Decision:
provides no evidence that it actually attempted to pay the fee, It
provides no evidence as to the exact problems encountered when
it allegedly tried to pay the lien activation fee. Further, lien
claimant has had ample opportunity to pay the fee since January
1, 2013.

August 29, 2013: Injunction for Dismissals 01/2014 that do not
show a lien fee dismissed by operation of law Scheduled Oct 24
2013;
What it means if rant and what it means if denied.
Panel Decision:
"due to human error" and that its lien representative was at the
Marina Del Ray District Office on the day of trial but failed to
sign in "for reason unknown." However, we find that the claim
of "human error ... for reason unknown" does not  rise to the
level of good cause." 21

Panel Decision:
Due process simply requires notice and an opportunity to be
heard. If a party does not take advantage of that opportunity,
then it waives its right to be heard.
Panel Decision:
From Recent Panel Decision: Because lien claimant did not have
a lien in ADJ7541189, the order dismissing a (nonexistent) lien
has no effect and lien claimant is not aggrieved by the WCJ's
Order

Panel Decision:
Petition falls within Appeals Board Rule 10561, subdivisions
(b)(2), (b)(5), and (b)(6) because it was filed without justification,
appears to contain multiple material misrepresentations, and
takes positions that are indisputably without merit. -25
Panel Decision:
It is clear under [section 4903.8(e),  that if the lien is filed after
January 1, 2013 and violates this section it is invalid.
Panel Decision:
Finally, we admonish petitioner that his failure to adhere to the
form requirements of petitions for reconsideration is conduct
that is unacceptable. With respect to the form of the Petition,
Panel Decision:
If Dismissed by Operation of Law cannot be with prejudice:

Panel Decision:
No Letter of Rep -Petition  for Recon Dismissed as filed by a
NON-Party

Case Law, The Case That Changed Everything for Providers
at the WCAB, must be read and Known
Panel Decision: - AME-Medical Leag
Communications with AMEs are governed by Labor Code section
4062.3 and WCAB Rule 35. "If an agreed medical evaluator is
selected.., the parties shall agree on what information is to be
provided to the agreed medical evaluator." "All communications
with an agreed medical evaluator... shall be in writing and shall be
served on the opposing party 20 days in advance of the
evaluation.

Panel Decision:
lien claimant never mentions the issue of whether lien claimant
met its burden to show that its medical services were medically
reasonable and necessary

Panel Decision:
The WCJ further found that applicant did not receive notice of
defendant's Medical
Provider Network [MPN] prior to her injury and that a letter
sent to applicant on May 4, 2010 did not comply with MPN
notice requirements.

Panel Decision:
Petition for Costs Medical Legal
Panel Decision:
sanctionable conduct includes "using any language in any pleading or
other document [.. .] where the language or gesture impugns the
integrity of the Workers' Compensation Appeals Board or its
Commissioners,
judges, or staff.

Panel Decision:
Petitioner argues that due to an EAMS scheduled maintenance
Petitioner was unable,to pay the activation fee. Although Petitioner
states their inability to pay the activation fee due to regularly
scheduled maintenance, Petitioner offers no offer of proof of this
in the Petition.
Panel Decision:
Finally, it is noted that the record contains no requests for
authorization regarding the treatment at issue. In order to meet its
burden of proof, Lien Claimant must show that authorization for
the treatment was properly requested.

Panel Decision:
Reconsideration may be had only of a final order, decision, or
award. (Lab. Code, § 5900.)
NELAYNE VALDEZSUPREME COURT OF CALIFORNIA  -
MON Admissible of Reports outside MPN

: Panel Decision:
Between the Petition and the July 30, 2012 lien conference, we
have three purported lien representatives for a single lien claimant.
The record in this matter lacks the appropriate notice appointing
Panel Decision:
Failure of PTP to incorporate does not mean the secondary /
consultant does not get paid
: Panel Decision
Dr. Massey had not yet adopted Dr. Newman's findings does not
mean the latter physician's reports were not reasonable and
necessary at the time the expenses for the reports were incurred
Panel Decision:
As all of the requirements have been met, it is appropriate for
Dr. Newman to bill for his evaluation and reports as a
medical-legal expense, rather than services payable pursuant to
the OMFS. Here, Dr. Newman was designated by the primary
treating physician -
July 2014
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11101 59 /
17304 / 17999-59 / 111000-59
17304 / Billed as 17999
17304 and 17999 Modifier 59
17304; 17304 modifier 59;
17999 modifier 59; 17999
modifier 59
17304; 17999
17304; 17999
17304; 17999 59
17311; 17999 modifier 59
17999
17999
17999
17999
17999
17999
17999
17999
17999
17999
17999
17999 (1)
17999 (59) / 17000 (59) /
17001 (59) / 17002 (59) /
111000 959) / 11101 (59)
17999 / 17999 / 17999/ 17999/
17999
17999 / 99080 / 99085 / 99086
17999 59
17999; 99080; and 99085
17999; 99080; J3301
17999; J3301; 11901; 99080
17999-59
18860072210
20550 Modifier 51
20680 / 20680 / 20680 / 29125
22110 /22110 59 / 22116 /
22116 59 / 76001 / 64830
22554; 22851; 22851 59 –
ASC Services
22830 / 22855 / 63090 / 63091
/ 63047
22830; 22855; 63090; 63091;
63047
22842 /20936/64722
24102; 25290; 24341
24314
24314; 25290
24341 / 64718
24341 / 64718
25000 Modifier 51
25020 / 64721
25020 / 64721-51
25020 / 64727
25118 / 25118-5
25320-59 / 64772
26145
26145
26145 x 9 units  no payments
26145; 26055
26370; 26373; 26373; 20103
274 Revenue Code
27422; 29870; 29881; 29875
27570 / 29870
27570 / 29870 / 20610
27625; 29898; 20605
27685
27685 Modifier 51
29805;29821;29807;29826;
29827;29819;29999
29807 / 29823 / 29826 / A6531
29819 / 29820
29819-59 / 29820-59
29823
29823
29823
29823
29823 / 29821
29823; 29826; 29827; 23120;
20690; 29805;
29824
29825 (51)
29826
29827 / 29826 / 29822 / L8699
29846 / 64721
29870 / 27570 / 20610
29876 / 29870 / 27570
29880 / 29877 / 29874 / 29875
/ 20610
29880;29870;29871;29875
29881 / 29875
29881 / 29875 (59)
29881 / 29876
29888
29914
37720 / 76942 / 93971
37720 / 76942 / 93971
37785 / 76942 / 93971
37785 / billed at 37799
37799
37799 (37720; 76949 26 and
93971 26)
37799 (37785 / 76942-26)
37799 (37785 / 76942-26)
37799 (37785 / 76942-26)
37799 (37785 / 76942-26)
37799 (37785, 76942 26 and
93971
37799 and  99080
38779056101 / 38779175603
38779056104
38779056104 / 38779175603
38779056104 / 38779175603
38779056104 /38779175603
45861000405 NDC
49452003202 / 38779052409  
/ 62991142202
49452003202 / 38779052409
/  / 62991142202
49452003202 / 38779052409
/  / 62991142202
49452003202 / 38779052409 /
62991142202 / Compound
49452003202 / 38779052409 /
62991142202 / Compound
49452003202 / 38779052409 /
62991142202 / Compound
49452003202 / 62991142202 /
387790540
53746019405 / several more
58468009001
58468-0090-01
58468-0090-01
58468009003 (NDC) 12 units
62991140305
62991140307
62991140307
62991140706
62991140706 / 38779056104
62991140706 / 38779056104 /
3779196806 / 18860072010 /
6337004035
62991140706 / 38779196806
62991140706 / 3877919806 /
18860072010 / 63370004035
62991140706 / 38799056104
62991140706 /38779196806
6299114305
6299114307
63047 / 63048 / 63048 59
63091 62
63368
63650 / 63650 / 63685 / 63685
/ 63661
63650 -59
63660 / 63660 59
63685
63685 / 76496 TC
64483
64483 / 72100 / 76000 / 94760
64483 LT 1 unit and 64484
LT 1 unit
64484
64484 / 64483
64484 rt / 64484 lt
64555 59
64636
64719 51
64721
64721
64721 / 26145
64722 (59)
64830 20 / 72100 / 72148 26
64999 (63047)
76942 / Billed 99135
76942 / Billed 99135
80000 codes no bundles
80102 and 82486
80154
80154
82055 / 80299 59 / 80299 59 /
83925 59 / 83986 / 83992 /
81002 / and 80152
82055 / 82145 / 80154 /
80299-59 /82520 / 80299-59 /
83840 / 83925-59 9x2 0 /
83986 / 83992 / 81002 /80152 /
82055; 82145; 82205; 80299
(2); 82520; 83840; 83925 (3);
83986; 83986; 83992; 81002
and 80152
82145 / 82205 / 80154 / 82520
/ 83992 / 83925 / 82145 /
82055 / 82570
82145(2); 82205; 80154;
82520; 83840; 83840; 83992;
83925 (2)
82145/ 82205/ 82520 / 83840 /
83992 / 83925 / 82145 / 82055
/ 82570
82145; 82205; 80154; 82520;
83840; 83840; 83992; 83925;
83925 mod 59; 8214559;
82055 and 82570
82145; 82205; 80154; 83480;
83992; 83925 modifier 59;
82542 and 82145 modifier 59
82205 several 8000 codes
82415; 82205; 80154; 82520;
83840; 83992; 83925; 82145
82415; 82205; 80154; 82520;
83840; 83992; 83925; 82145
82415; 82205; 80154; 82520;
83840; 83992; 83925; 82145
82486
82486
82486
82486
82486
82486
82486
82486
82486
82486
82486
82486
82486
82486
82486
82486
82486
82486 (40 units)
88305
88305
88305
88305
88305
88305
90862 / 99081
90862 / billed 90841
92215
93320
93320
93320 / 5
93320 / 5
93320 / 93325
93320 / 93325
93320 / 93325
93320 / 93325
93320 / 93325
93320 / 93325
93320 / 93325
93320 / 93325 / billed = 93307
93320 and 93325  
93320; 93325
93320; 93325
93880
95831
95831
95851
95904
95904
95904
95904  /  95904
95904 (52)
95904 /95904 / 99080 / 99358
96100
96360 and 99284
96530
96530 / Billed 99214 / 96530
96530 modifier 59
97799
97799
97799
97799
97799
97799
97799
97799
97799
97799
97799 86
97799 86
97799 86
97799 Modifier 86
97799 Modifier 86
97799 Modifier 86
97799 Modifier 86
97799 Modifier 86
97799 Modifier 86
97799 modifier 86
97799 Modifier 86
97799 Modifier 86
97799 modifier 86
97799 Modifier 86
97799 modifier 86
97799 modifier 86 (exceeds
FS)
97799 modifier 86 (exceeds
FS)
97799 modifier 86 (exceeds
FS)
97799 modifier 86 (exceeds
FS)
97799 modifier 86 (exceeds
FS)
97799 modifier 86 (exceeds
FS)
97799 modifier 86 (exceeds
FS)
97799-86
97799-86
97799-86
97799-86
97799-86
97799-86
97799-86
97799-86
97799-86
97799-86
97799-86
98940
99080
99080
99080
99080
99080
99080
99080
99080
99080
99080 / 99358 / 99086
99080 86 / 99358
99081
99081
99081
99081
99085 / 99080 / 99358
99086 / 99080 / 99358
99086 / 99085 / 99080 / 17999
99199
99199 / 95934 / 95927 / 95903
99203 / 99080
99203 / 99354 / 99358 / 99080
99203 / 99354 / 99358 / 99080
99203 / Billed 99244
99203 / Billed 99244
99204 / 99358
99204 / B=33245
99205 / 99354 / 99358
99212
99212
99212
99212 / A4550 / 17999
99212 m-93 / B=99244
99212-25
99213
99213
99213
99213
99213
99213
99213
99213
99213
99213 / 99081
99213 / 99081
99213 / 99358
99213 / Billed 99214
99213 / billed as 99215
99213 /Billed 99244
99214
99214
99214
99214
99214
99214
99214
99214
99214
99214
99214
99214
99214
99214
99214
99214
99214
99214 / 99354
99214 / billed as 99215
99214 / billed as 99215
99215
99215
99215
99215
99215
99215
99215
99215
99215 – 25
99215 / 99081 / 99401
99215 / 99215  (25)
99215 / 99358
99215 / 99358 / 73130 / 76140
99215 / 99358 / 99401 / 99080
99215-93 /99358-59 /99081
99216
99231 / billed=99244
9924 / 99080 / 95832 / 95832
99243
99243
99244
99244
99244 / 99080 / 99358
99244 / 99080 / 99358
99245 / 99080
99245 / 99358 / 99080
99245; 99080; 99358; 99354
99245; 99358; 72114; 72220
99320 / 93325
99354
99354
99354
99354
99354
99354 (1) / 99358 (12) /
99080 (2)
99354 / 99358
99358
99358
99358
99358
99358
99358
99358
99358
99358
99358
99358
99358
99358
99358
99358
99358
99358
99358
99358
99358
99358
99358 (1 unit)
99358 / 99080
99358 / B=99212
99358 / Billed 99243
99358; 99080
99371
99373
99373 / 90862
99373 / 99081
ASC  Services
ASC Facility Fees
ASC Facility Services
ASC Facility Services (25115)
ASC Service
ASC Service
ASC Service
ASC Services
ASC Surgical Services / and
81025
Compound
Compound
Compound Medication / Prialt
18860072010
Consolidation DME
DGR-472
DRG 042
DRG 454
DRG 454
DRG 454
DRG 455
DRG 455
DRG 455 / Provider Billed 454
DRG 458
DRG 459
DRG 460
DRG 460
DRG 460
DRG 460
DRG 460
DRG 460
DRG 460
DRG 460
DRG 460
DRG 460
DRG 460
DRG 460
DRG 460 – spinal implants
DRG 460 Revenue Code 274
(L0464 / L2830)
DRG 472
DRG 473
DRG 473
DRG 473
DRG 473
DRG 473
DRG 473
DRG 473
DRG 473
DRG 491
DRG 494
DRG 494
E0114 / 29881 / 29876 /
29870 / 27570 / 20610
E0215
E1399
E1399
E1399  LL (3 units)
E1399 (LL) (6)
E1399 LL
E1399 LL
E1399 LL
E1399 LL
E1399 LL
E1399 LL
E1399 LL
E1399 LL
E1399 LL
E1399 LL (7 units)
E1399 modifier LL
E1399 modifier LL (3 units)
E1399 Modifier LL 1 unit
E1399-LL
E1399-LL
E1399-LL
E1399-LL
E1399-LL
E1399-LL
E1399-LL
E1399-LL
E1399-LL
E1399-LL
EL399-LL
G0260 Modifier 50
G0431
G0431
G0431
G0431
G0431
G0431
G0431
G0431
G0431
G0431
G0431
G0431
G0431
G0431
G0431
G0431
G0431
G0431
G0431
G0431
G0431
G0431
G0431
G0431
G0431
G0431
G0431
G0431
G0431
G0431
G0431
G0431
G0431
G0431
G0431
G0431 / 82055 / 82570
G0431 / 82055 / 82570
G0431 / 82055 / 82570
G0431 / 82055 / 82570 //
Billed as: 82145 / 82205 /
80154 / 82520 / 83840 / 83992
/ 83925-59 / 82145-59 / 82055
/ 82570
G0431 / 82570 / 82055
G0431 / Billed = 82055 /
82145 / 80154 / 80299-59
/82520 / 80299-59 / 83840 /
83925-59 9x2 0 / 83986 /
83992 / 81002 /80152 /
G0431 / Billed = 82055 /
82145 / 80154 / 80299-59
/82520 / 80299-59 / 83840 /
83925-59 9x2 0 / 83986 /
83992 / 81002 /80152 /
G0431 / Billed = 82055 /
82145 / 80154 / 80299-59
/82520 / 80299-59 / 83840 /
83925-59 9x2 0 / 83986 /
83992 / 81002 /80152 /
G0431 / Billed = 82055 /
82145 / 80154 / 80299-59
/82520 / 80299-59 / 83840 /
83925-59 9x2 0 / 83986 /
83992 / 81002 /80152 /
G0431 / Billed = 82055 /
82145 / 80154 / 80299-59
/82520 / 80299-59 / 83840 /
83925-59 9x2 0 / 83986 /
83992 / 81002 /80152 /
G0431 / Billed 8000 codes
G0431 / Billed 81002 / 82055
/ 83986
G0431 / Billed 82486
G0431 / Billed at 8000 codes
G0431 / Billed at 8000 codes
G0431 / Billed several 8000
codes
G0431 / billed varies 8000
codes
L0635
L1990 / and Outlier for
Outpatient
L3908
L4360 / and Outlier for
Outpatient
L86999 / C9399
ML 102
ML 102
ML 102 / ML 104
ML 102 Billed 103
ML 102 Billed 103
ML 102-86 / billed at 103-86-
94
ML 103
ML 103
ML 103 / Billed 104
ML 103 / Billed 104-95
ML 103 / Billed 104-95
ML 103 /93/95
ML 104 (46) / 96100
ML 104 (90801 and 99358 8
units
ML 104 93 units
ML 104 94
ML 104 Modifier 94 (62
units)
ML 104 modifier 94 and 95
ML 104 Modifier 95 (23)
units
ML 104-93
ML 106 -93
ML 106 Mod 94 / ML 100
Mod 94
ML=103 reduced to ML 101
ML=104 95 (20)
ML0104 94 / 99070
ML-102
ML102-95
ML103-93
ML104 Modifies 95
NDC62991140706
Outpatient Hospital
Emergency Room Services
Outpatient Surgical Services
Revenue Code 278 HCPCS
C1713