Mississippi Administrative Code › Title 3 - Office of the Attorney General › Part 1 - Division of Victim Compensation › Chapter 06 - Payment for Sexual Assault Medical Forensic Examinations › Section 3-1-06-601 - Application

Current through June 25, 2024
1. All bills submitted for payment should be
				accompanied by a copy of the State of Mississippi Crime Laboratory Sexual
				Assault Examination Form, and include a standard UB-04 form or other official
				itemized billing form. NOTE: For minor victims receiving a sexual assault
				medical forensic examination seventy-two hours or longer after the sexual
				assault, the authorized non-acute sexual assault exam form for minors >72
				hours should be submitted.
2.
				Payment may be made whether or not the victim pursues prosecution. Though it is
				strongly encouraged that the victim reports the sexual assault to law
				enforcement, reporting the assault is the victim's decision. This does not
				apply to state mandated reporting requirements for minors, vulnerable adults,
				and certain violent crimes.
3. A
				request for payment for the sexual assault medical forensic examination must
				include the International Classification of Diseases (ICD-9) code V71.5 for
				examination of the victim of sexual assault, code E960.1 for a victim of rape,
				code V71.81 when there are no forensic findings for a sexual assault exam, code
				995.53 when there are forensic findings for a sexual assault exam of a child,
				or code 995.83 when there are forensic findings for a sexual assault exam of an
				adult.
4. A request for payment for
				the sexual assault medical forensic examination must include the following
				information as applicable:
a. Physician/ARNP,
				Office or other outpatient services (CPT codes 99201-99205 for New Patient, CPT
				codes 99211-99215 for Established Patient, CPT codes 99241-99245 for office
				consultations); Emergency Department Services (CPT codes 99281-99285 for New or
				Established Patient) which include the collection of evidence
as
				needed
in the sexual assault kit.
b. Venipuncture for the collection of whole
				blood samples (CPT codes 36400, 36405, 36406, 36410, 36415).
c. Laboratory test for pregnancy (CPT codes
				84702, 84703, 81025).
d. HIV
				Testing (CPT codes 86701-86703, 86687-86689) if medically necessary.
e. Hepatitis Panel (CPT codes 80074, 86705,
				86709, 87340, 86803) if medically necessary.
f. RPR (CPT codes 86592, 86593) if medically
				necessary.
g. Herpes Simplex (CPT
				codes 86694, 86696) if medically necessary.
h. Gonorrhea culture (CPT codes 87040, 87070,
				87081, 87590, 87591, 87592) if medically necessary.
i. Chlamydia culture (CPT codes 87320, 86631,
				86632, 87110) if medically necessary.
j. Urinalysis (CPT codes 81000-81003, 81005,
				81007, 81015) if medically necessary.
k. Urine culture (CPT codes 87086, 87088) if
				medically necessary.
l. Trichomonas
				vaginalis (CPT codes 87660, 87205, 87210) if medically necessary.
m. Other laboratory tests if medically
				necessary.
n. Colposcopy (CPT
				codes 57420, 57452, 99170).
o.
				Camera/Other photography (CPT code 99199). Use of this code requires additional
				reporting information to verify that a camera/photography was used.
p. Medication for prevention of STDs,
				Hepatitis B, pregnancy, and a three-day supply of HIV prophylaxis.