(Medicare Claims Processing Manual)

A. A physician specialty association will submit a specialty code request to the Director, Division of Practitioner Services, Center for Medicare Management, Centers for Medicare & Medicaid Services, Mail Stop C4 -01-26, 7500 Security Blvd., Baltimore, MD 2 1244.  Medicare contractors shall not add any specialty codes to the list.  They must send all requests for expansion of the specialty code list to the Director, Division of Practitioner Services, at the address above.   B. When considering a request for expanding the specialty code list for physician and non-physician practitioners, CMS will take into consideration the following:    Whether the requested specialty has the authority to bill Medicare independently;    The requesters stated reason or purpose for the code;    Evidence that the practice pattern of the specialty is markedly different from that of the dominant parent specialty;    Evidence of any specialized training and/or certification required;    Whether the specialty treats a significant volume of the Medicare population;    Whether the specialty is recognized by another organization, such as the American Board of Medical Specialties; and    Whether the specialty has a corresponding Healthcare Provider Taxonomy Code.  Physicians may not have a specialty code of 70 (single or multi -specialty Clinic or Group Practice.)  Contractors must contact physicians whose records indicate specialty code 70 and require the physicians to update their enrollment records by submitting a  CMS -8551 with a specialty that is valid for a physician.   10.8.1 - Assigning Specialty Codes by A/B MACs (B) and DME MACs  Physicians are allowed to choose a primary and a secondary specialty code.  If the A/B MAC (B) and DME MAC provider file can accommodate only one specialty code, the A/B MAC (B) or DME MAC assigns the code that corresponds to the greater amount of allowed charges.  For example, if the practice is 50 percent ophthalmology and 50 percent otolaryngology, the A/B MAC (B)/DME MAC compares the total allowed charges for the previous year for ophthalmology and otolaryngology services.  They assign the code that cor responds to the greater amount of the allowed charges.  10.8.2 - Physician Specialty Codes (Rev.  12231, Issued:  08-31-23, Effective: 01- 01-24, Implementation:  01-02-24)  Code  Physician Specialty  01 General Practice  02 General Surgery  03 Allergy/Immunology  04 Otolaryngology  05 Anesthesiology  06 Cardiology  07 Dermatology  08 Family Practice  09 Interventional Pain Management  10 Gastroenterology  11 Internal Medicine  12 Osteopathic Manipulative Medicine  13 Neurology  14 Neurosurgery  16 Obstetrics/Gynecology  17 Hospice and Palliative Care  18 Ophthalmology  19 Oral Surgery (dentists only)  20 Orthopedic Surgery  21 Cardiac Electrophysiology  22 Pathology  23 Sports Medicine  Code  Physician Specialty  24 Plastic and Reconstructive Surgery  25 Physical Medicine and Rehabilitation  26 Psychiatry  27 Geriatric Psychiatry  28 Colorectal Surgery (formerly proctology)  29 Pulmonary Disease  30 Diagnostic Radiology  33 Thoracic Surgery  34 Urology  35 Chiropractic  36 Nuclear Medicine  37 Pediatric Medicine  38 Geriatric Medicine  39 Nephrology  40 Hand Surgery  41 Optometry  44 Infectious Disease  46 Endocrinology  48 Podiatry  66 Rheumatology  70 Single or Multispecialty Clinic or Group Practice  72 Pain Management  76 Peripheral Vascular Disease  77 Vascular Surgery  78 Cardiac Surgery  79 Addiction Medicine  81 Critical Care (Intensivists)  82 Hematology  83 Hematology/Oncology  84 Preventive Medicine  85 Maxillofacial Surgery  86 Neuropsychiatry  90 Medical Oncology  91 Surgical Oncology  92 Radiation Oncology  93 Emergency Medicine  94 Interventional Radiology  98 Gynecological/Oncology  99 Unknown Physician Specialty  C0 Sleep Medicine  C3 Interventional Cardiology  C5 C6 C7 C8 Dentist  Hospitalist  Advanced Heart Failure and Transplant Cardiology Medical Toxicology  Code  Physician Specialty  C9 Hematopoietic Cell Transplantation and Cellular Therapy  D3 Medical Genetics and Genomics  D4 Undersea and Hyperbaric Medicine           D7          Micrographic Dermatologic Surgery           D8          Adult Congenital Heart Disease          E3          Dental Anesthesiology          E4          Dental Public Health                     E5          Endodontics                      E6          Oral and Maxillofacial Pathology                      E7          Oral and Maxillofacial Radiology                      E9          Oral Medicine                      F1          Orofacial Pain                     F2          Orthodontics and Dentofacial Orthopedics    F3          Pediatric Dentistry                      F4          Periodontics                      F5          Prosthodontics   10.8.3 - Nonphysician Practitioner, Supplier, and Provider Specialty Codes (Rev. 10124, Issued: 05- 08-2020, Effective: 10 -01-2020, Implementation:10- 05-2020)  The following list of 2- digit codes and narrative describe the kind of medicine non-physician practitioners or other healthcare providers/suppliers practice.  Code  Non-physician Practitioner/Supplier/Provider Specialty  15 Speech Language Pathologists  31 Intensive Cardiac Rehabilitation  32 Anesthesiologist Assistant  42 Certified Nurse Midwife (effective July 1, 1988)  43 Certified Registered Nurse Anesthetist (CRNA)  45 Mammography Screening Center  47 Independent Diagnostic Testing Facility (IDTF)  49 Ambulatory Surgical Center  50 Nurse Practitioner  51 Medical supply company with orthotic personnel certified by an accrediting organization  52 Medical supply company with prosthetic personnel certified by an accrediting organization  53 Medical supply company with prosthetic/orthotic personnel certified by an accrediting organization  54 Medical supply company not included in 51, 52, or 53  55 Individual orthotic personnel certified by an accrediting organization  56 Individual prosthetic personnel certified by an accrediting organization  57 Individual prosthetic/orthotic personnel certified by an accrediting organization  Code  Non-physician Practitioner/Supplier/Provider Specialty  58 Medical Supply Company with registered pharmacist  59 Ambulance Service Supplier, e.g., private ambulance companies, funeral homes  60 Public Health or Welfare Agencies (Federal, State, and local)  61 Voluntary Health or Charitable Agencies (e.g., National Cancer Society, National Heart Association, Catholic Charities)  62 Psychologist (Billing Independently)  63 Portable X -Ray Supplier (Billing Independently)  64 Audiologist (Billing Independently)  65 Physical Therapist in Private Practice  67 Occupational Therapist in Private Practice  68 Clinical Psychologist  69 Clinical Laboratory (Billing Independently)  71 Registered Dietician/Nutrition Professional  73 Mass Immunization Roster Billers (Mass Immunizers have to roster bill assigned claims and can only bill for immunizations)  74 Radiation Therapy Centers  75 Slide Preparation Facilities  80 Licensed Clinical Social Worker  87 All other suppliers, e.g., Drug Stores  88 Unknown Provider  89 Certified Clinical Nurse Specialist  95 Unknown Supplier  96 Optician  97 Physician Assistant  A0 Hospital  A1 Skilled Nursing Facility  A2 Intermediate Care Nursing Facility  A3 Nursing Facility, Other  A4 Home Health Agency  A5 Pharmacy  A6 Medical Supply Company with Respiratory Therapist  A7 Department Store  A8 Grocery Store  B1 Oxygen/Oxygen Related Equipment  B2 Pedorthic Personnel  B3 Medical Supply Company with Pedorthic Personnel  B4 Rehabilitation Agency  B5 Ocularist  C1 Centralized Flu  C2 Indirect Payment Procedure  C4 Restricted Use  D1 Medicare Diabetes Preventive Program  D2 Restricted Use  Code  Non-physician Practitioner/Supplier/Provider Specialty  D5 Opioid Treatment Program  D6 Home Infusion Therapy Services  NOTE:  Specialty Code Use for Service in an Independent Laboratory .  For services performed in an independent laboratory, show the specialty code of the physician ordering the x- rays and requesting payment.  If the independent laboratory requests payment, use type of supplier code "69".   10.9 - Miles/Times/Units/Services (MTUS)  (Rev. 1970, Issued: 05- 21-10, Effective: 10 -01-2010, Implementation: 10 -04-10)  Miles/Times/Units/Services (MTUS) count and MTUS indicator fields are on Part B Physician/Supplier Claims.  These fields are documented in the CMS National Claims History Data Dictionary.   Shared systems are to put MTUS count and MTUS indicators on all claims at the line item level.   The purpose of the MTUS Count Field on the line item is to document additional information reflecting certain volumes related to indicators.  In most cases, the value in this field will be the same as in the Service Count Field on the line item; however, f or services such as anesthesia the field values will differ.  In this case, the service count field will likely contain a value of 1 for the occurrence of the surgery while the MTUS Count Field will contain the actual time units that the anesthesiologist s pent with the patient in 15 minute increments or a fraction thereof.   The purpose of the MTUS Indicator Field is to indicate what the value entered into the MTUS Count Field means.  There are 6 indicator values, as follows:   Indicator  Description  0 No allowed services  1 Ambulance transportation miles  2 Anesthesia Time Units  3 Services  4 Oxygen units  5 Units of Blood   Examples of how to code these fields are specified in 10.9.1 below.  10.9.1 - Methodology for Coding Number of Services, MTUS Count and MTUS Indicator Fields  (Rev. 1970, Issued: 05- 21-10, Effective: 10 -01-2010, Implementation: 10- 04-10)  The following instructions should be used as a guide for coding the number of services, MTUS Count and MTUS Indicator fields on the Part B Physician/Supplier Claim.  These fields are documented in the CMS National Claims History Data Dictionary as CWFB_SRVC_CNT, CWFB_MTUS_CNT, and CWFB_MTUS_IND_CD, respectively.  Services not falling into examples B, C, E, or F should be coded as shown in example D (services/pricing units).  A. No Allowed Services -  (CWFB_MTUS_IND_CD = 0)   For claims reporting no allowed services, the following example should be used to code the line item:  A total of 2 visits was reported for HCPCS code 99211:  Office or other outpatient visit for the management of an established patient.  Both services were denied.   Number of services:  2 (furnished)  MTUS (services):  0 (allowed)  MTUS indicator:  0  B. Ambulance Miles  - (CWFB_MTUS_IND_CD = 1)   For claims reporting ambulance miles, the following example should be used to code the line item:   Mileage Reporting:  A total of 10 miles (1 trip) was reported for HCPCS code A0425: Ground mileage, per statute mile.   Number of services:  10 MTUS (miles):  10 MTUS indicator:  1  C. Anesthesia Time Units  - (CWFB_MTUS_IND_CD = 2)   For claims reporting anesthesia time units in 15 -minute periods or fractions of 15-minute periods, the following example should be used to code the line item:   A total of 1 allowed service is reported for HCPCS code 00142:  Anesthesia for procedures on eye; lens surgery.  The anesthesiologist attended the patient for 35 minutes.   Number of services:  1 MTUS (time units):  23 (one decimal point implied) * MTUS indicator:  2 *Two 15- minute periods + 1/3 of a 15- minute period equals 2.3   D. Services/Pricing Units  - (CWFB_MTUS_IND_CD = 3)   For claims reporting a service or pricing unit, the following examples should be used to code the line item:  Example 1:  A total of 2 visits was reported for HCPCS code 99211:  Office or other outpatient visit for the management of an established patient.   Number of services:  2 MTUS (services):  2 MTUS indicator:  3  Example 2:  A total of 500 milligrams was administered for HCPCS code J0120:  Injection, Tetracycline, up to 250 mg.  NOTE :  The number of milligrams should not be reported in the service or MTUS fields.  Instead, report the number of pricing units.  In this case, up to 250 mg equals 1 unit/service.  Thus, 500 mg equals 2 units/services.  Number of services:  2 MTUS (services):  2 MTUS indicator:  3  Example 3:  A total of 24 cans was purchased, each containing 300 calories for HCPCS code B4150:  Enteral Formulae, 100 calories.