For Dates of Service Before January 1, 2018

Procedure Codes

Wisconsin Medicaid has identified commonly used allowable procedure codes for services provided to members receiving the TB-Only Benefit. Providers are required to use the procedure code that best describes the service and level of service provided.

Procedure Code Description Allowable Providers
H0033* Oral medication administration, direct observation (one unit is 15 minutes)
  • FQHCs.
  • HealthCheck screeners.
  • Home health agencies.
  • Nurse midwives.
  • Nurse practitioners.
  • Physician assistants.
  • Physician clinics.
  • Physicians.
  • PNCC providers.
S9445** Patient education, not otherwise classified, non-physician provider, individual, per session
99401*** Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes
99402*** approximately 30 minutes
99403*** approximately 45 minutes
99404*** approximately 60 minutes
71010 Radiologic examination, chest; single view, frontal
  • Family planning clinics.
  • FQHCs.
  • HealthCheck screeners.
  • Nurse midwives.
  • Nurse practitioners.
  • Outpatient hospitals.
  • Physician assistants.
  • Physician clinics.
  • Physicians.
  • Portable X-ray providers.
  • PNCC providers.
71020 Radiologic examination, chest, two views, frontal and lateral
86480 Tuberculosis test, cell mediated immunity antigen response measurement; gamma interferon
  • FQHCs.
  • Independent laboratories.
  • Nurse practitioners.
  • Outpatient hospitals.
  • Physician assistants.
  • Physician clinics.
  • Physicians.
86481 Tuberculosis test, cell mediated immunity antigen response measurement; enumeration of gamma interferon-producing T-cells in cell suspension
  • FQHCs.
  • HealthCheck screeners.
  • Home health agencies.
  • Independent laboratories.
  • Nurse midwives.
  • Nurse practitioners.
  • Physician assistants.
  • Physician clinics.
  • Physicians.
  • PNCC providers.
86580 Skin test; tuberculosis, intradermal
  • Family planning clinics.
  • FQHCs.
  • HealthCheck screeners.
  • Independent laboratories.
  • Nurse midwives.
  • Nurse practitioners.
  • Outpatient hospitals.
  • Physician assistants.
  • Physician clinics.
  • Physicians.
  • PNCC providers.
89220 Sputum, obtaining specimen, aerosol induced technique (separate procedure)
  • FQHCs.
  • HealthCheck screeners.
  • Independent laboratories.
  • Nurse midwives.
  • Nurse practitioners.
  • Outpatient hospitals.
  • Physician assistants.
  • Physician clinics.
  • Physicians.
  • PNCC providers.
94664 Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device (94664 can be reported one time only per day of service)
  • FQHCs.
  • HealthCheck screeners.
  • Nurse midwives.
  • Nurse practitioners.
  • Outpatient hospitals.
  • Physician assistants.
  • Physician clinics.
  • Physicians.
  • PNCC providers.
99000 Handling and/or conveyance of specimen for transfer from the office to a laboratory
  • Family planning clinics.
  • FQHCs.
  • HealthCheck screeners.
  • Independent laboratories.
  • Nurse midwives.
  • Nurse practitioners.
  • Outpatient hospitals.
  • Physician assistants.
  • Physician clinics.
  • Physicians.
  • PNCC providers.

* Procedure code H0033 may be billed for the same DOS as 99401, 99402, 99403, 99404, and S9445 for symptom treatment monitoring. Procedure code H0033 is limited to 12 units per DOS. One unit is equal to 15 minutes.

** Procedure codes 99401, 99402, 99403, and 99404 are not reimbursable on the same DOS as S9445. A quantity of "1" indicates a complete service for procedure code S9445. Providers are limited to a quantity of one per day.

*** A quantity of "1" indicates a complete service for these procedure codes. Providers have a limit of one quantity per day.