Chapter 18: Naturopathic Physicians
Billing & Payment Policies for Healthcare Services provided to Injured Workers and Crime Victims
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Effective July 1, 2012 |
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Table of contents
Payment policies:
Naturopathic office visits
More info:
Related topics
Definitions
Established patient:
One who has received professional services from the physician, or another physician of the same specialty who belongs to the same group practice, within the past three years.
L&I uses the CPT® definition for established patients. Refer to a CPT® book for complete code descriptions, definitions, and guidelines.
New patient:
One who hasn’t received any professional services from the physician, or another physician of the same specialty who belongs to the same group practice, within the past three years.
L&I uses the CPT® definitions for new patients. Refer to a CPT® book for complete code descriptions, definitions, and guidelines.
Payment policy: Naturopathic office visits
Who must perform these services to qualify for payment
Naturopathic physicians must perform these services to qualify for payment.
Services that can be billed
For initial office visits, these local billing codes can be billed:
- 2130A (Routine examination, history, and/or treatment – routine procedure – and submission of a report), which has a maximum fee of $116.21,
- 2131A (Extended office visit including treatment – report required), which has a maximum fee of $168.23, and
- 2132A (Comprehensive office visit including treatment – report required in addition to the report of accident), which has a maximum fee of $257.88.
Note: To determine whether or not a visit is an “initial” office visit, see the definition of new patient in “Definitions” at the beginning of this chapter.
For follow up office visits, these local billing codes can be billed:
- 2133A (Routine office visit including evaluation and/or treatment), which has a maximum fee of $68.07, and
- 2134A (Extended office visit including treatment – report required), which has a maximum fee of $140.01.
Note: To determine whether or not a visit is a “follow up” office visit, see the definition of established patient in “Definitions” at the beginning of this chapter.
Services that aren't covered
The insurer won’t pay naturopathic physicians for services that aren’t specifically allowed, including consultations.
Link: For details about payment criteria and documentation requirements for case management services, see the payment policies for “Case management services” in Chapter 10: Evaluation and Management.
Requirements for billing
When billing for services, naturopathic physicians should use:
- The local codes listed in this payment policy (under “Services that can be billed”) to bill for office visit services,
- CPT® codes 99367 and 99441-99444 to bill case management services, and
- The appropriate HCPCS codes to bill for miscellaneous materials and supplies.
Link: For details about payment criteria and documentation requirements for case management services, see the payment policies for “Case management services” in Chapter 10: Evaluation and Management.
Links: Related topics
| If you’re looking for more information about… | Then go here: |
| Administrative rules for naturaopathic physicians. |
Washington Administrative Code (WAC) 296-23-205: http://apps.leg.wa.gov/wac/default.aspx?cite=296-23-205 WAC 296-23-215: http://apps.leg.wa.gov/wac/default.aspx?cite=296-23-215 |
| Becoming an L&I provider | L&I’s website: www.Lni.wa.gov/ClaimsIns/Providers/Becoming/default.asp |
| Billing instructions and forms | Chapter 2: Information for All Providers |
| Fee schedules for all healthcare services | L&I’s website: http://feeschedules.Lni.wa.gov |
Need more help? Call L&I’s Provider Hotline at 1-800-848-0811.
CPT® codes and descriptions only are © 2011 American Medical Association
