ICD-10-CM Diagnosis Codes
ICD-10-PCS Procedure Codes
CPT® Procedure Codes
HCPCS Supply/DME Codes
ICD-9-CM Diagnosis Codes
Place of Service Codes
UB04 Condition Codes
UB04 Revenue Codes
The "incident to" provision also applies to coverage for psychological services furnished "incident to" the professional services of non-physician practitioners listed in this policy.
The training requirements and state licensure or authorization of individuals who perform psychological services are intended to ensure an adequate level of expertise in the cognitive skills required for the performance of diagnostic and therapeutic psychological services. Therefore, only the types of individuals listed later in this policy are considered qualified to perform medically necessary psychological services addressed in this policy. Delegation of diagnostic and therapeutic psychological services to personnel not performing within the scope of practice as authorized by state law, under the "incident to" provision, would bypass the safeguards afforded by professional credentialing and state licensure requirements. Such delegated services under the "incident to" provision would be inappropriate, unreasonable, and medically unnecessary, and therefore not covered by Medicare.
Jurisdiction "8" Notice:
Jurisdiction "8" comprises the states of Indiana and Michigan. WPS is responsible for claims payment and Local Coverage Determination (LCD) development for this jurisdiction. This LCD was created as a part of the legacy transition (7/16/2012 - 8/20/2012); and, is a consolidation of the previous legacy contractors' policies. Coverage of each LCD begins when the state/contract number combination officially is integrated into the Jurisdiction. On the CMS MCD, this date is known as either the Original Effective Date or the Revision Effective Date. The following table details the official effective dates for each state/contract number combination.
ST Legacy A
J "8" MAC A
J "8" MAC B
IN NGS: 00630 WPS: 08102 08/20/12 MI WPS: 00953 WPS: 08202 07/16/12 IN NGS: 00130 WPS: 08101 07/23/12 MI NGS: 00452 WPS: 08201 07/23/12
Title XVIII of the Social Security Act section 1862 (a)(1)(A). This section allows coverage and payment of those services that are considered to be medically reasonable and necessary.
Title XVIII of the Social Security Act section 1862 (a)(7). This section excludes routine physical examinations and services
Title XVIII of the Social Security Act section 1833 (e). This section prohibits Medicare payment for any claim which lacks the necessary information to process the claim.
§1861 (s) of the Social Security Act.
Medicare Benefit Policy Manual CMS Pub 100-2, 15, §50
Fed Reg., November 1, 2001
60.1 - Incident to Physician's Professional Services (Rev. 17, 06-18-04)
60.3 - Incident to Physician's Service in Clinic (Rev. 17, 06-18-04)
10.4 - Items 14-33 - Provider of Service or Supplier Information (Rev. 148, 04-23-04)
MCM Transmittal No. 1463, 1794, Section 2050.2, 2050.3, 2050.4; MCM 2050, 2050.1; 2070, 2390; 3060
IL CIC7, 11/04/96;
Contractor Name(Contractor Number) - Contractor Info
Wisconsin Physicians Service Insurance Corporation (05102)
Wisconsin Physicians Service Insurance Corporation (05202)
Wisconsin Physicians Service Insurance Corporation (05302)
Wisconsin Physicians Service Insurance Corporation (05402)
Wisconsin Physicians Service Insurance Corporation (08102)
Wisconsin Physicians Service Insurance Corporation (08202)
Carrier Medical Directors,
Medicare Benefit Policy Manual
Advisory Committee Meeting Notes
Wisconsin: 2/12/2010 Illinois: 1/13/2010 Michigan: 1/27/2010 Minnesota: 1/14/2010 J-5 MAC
(IA, KS, MO, NE)
Open LCD meeting Date:
Start Date of Comment Period
End Date of Comment Period
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.12 - Hospital Inpatient (Medicare Part B only)
13 - Hospital Outpatient
85 - Critical Access Hospital
0900 - Behavioral Health Treatment/Services - General Classification
0901 - Behavioral Health Treatment/Services - Electroshock Treatment
0914 - Behavioral Health Treatment/Services - Individual Therapy
0915 - Behavioral Health Treatment/Services - Group Therapy
0916 - Behavioral Health Treatment/Services - Family Therapy
0918 - Behavioral Health Treatment/Services - Testing
Mental, psychoneurotic and personality disorders
Note: ICD-9 codes must be coded to the highest level of specificity.