• TB Dispensary Code Guidelines

    TB Dispensary Procedure Codes

    • H0033-15 (8-22min) DOT
    • H0033-30 (23-37min) DOT
    • H0033-45 (38-52min) DOT
    • H0033-60 (53-60min) DOT
    • 90401 (8-22min) Symptom & Treatment Monitoring
    • 90402 (23-37min) Symptom & Treatment Monitoring
    • 90403 (38-52min) Symptom & Treatment Monitoring
    • 90404 (53-60min) Symptom & Treatment Monitoring
    • S9445 (8-22min) Patient Education & Anticipatory Guidance
    • S9445 (23-37min) Patient Education & Anticipatory Guidance
    • S9445 (38-52min) Patient Education & Anticipatory Guidance
    • S9445 (53-60min) Patient Education & Anticipatory Guidance
    • 86580 TB Skin Test
    • 86580NB Results of TB Skin Test
    • TB101 Sputum Obtained in the Home
    • 87806 HIV Rapid Screening Test
    • T1017NB for Non-Billable time (15 Minutes =1 unit)

    Important: For TB Dispensary clients, in the financial record the Payor class of “User Defined” and the Insurance Co. Number of “TB Dispensary”. In the Policy # field enter the WEDDS number

    Rules to follow for codes (H0033, 99401, 99402, 99403, 99404, S9445)

    • Services are limited to a total of 60 minutes per day
    • H0033 can be used with all the codes
    • 99401, 99402, 99403, 99404 cannot be used in conjunction with S9445

    Good Example: Mary had DOT for 32 minutes (H0033-30), Sputum in the Home 5 minutes (87806), and Patient Education for 15 minutes (S9445-15), for a total of 50 minutes of service. Document each procedure in your encounter with the minutes. At the end of the day you will bring over your time from encounters into Time & Effort. Note: that the time for code H0033-30 you documented 32 minutes, that time will pull over into Time & Effort, however only 30 minutes is used for billing.

    Poor Example: Mary had Symptom & Treatment for 45 minutes (99403) and Patient Education for 30 minutes (S9445-30). This would be an error, these two services cannot happen on the same day and the duration of service is over 60 minutes. These services would be denied payment.

    For all encounters document the number of minutes in the “minutes field” and the number of units in the “units field”. At the end of the day you will need to bring over your encounter time in Time & Effort.



    TB Medicaid Procedures

    • H0033-15 (8-22min) DOT
    • H0033-30 (23-37min) DOT
    • H0033-45 (38-52min) DOT
    • H0033-60 (53-60min) DOT
    • 90401 (8-22min) Symptom & Treatment Monitoring
    • 90402 (23-37min) Symptom & Treatment Monitoring
    • 90403 (38-52min) Symptom & Treatment Monitoring
    • 90404 (53-60min) Symptom & Treatment Monitoring
    • S9445 Education and Anticipatory Guidance (for MA this is a flat rate & 1 unit)
    • 86580 TB Skin Test
    • 86580NB Results of TB Skin Test
    • TB101 Sputum Obtained in the Home
    • 87806 HIV Rapid Screening Test
    • T1017A for Assessment (15 Minutes =1 unit)
    • T1017P for Planning (15 Minutes =1 unit)
    • T1017D for Discharge (15 Minutes =1 unit)
    • T1017O for Ongoing (15 Minutes =1 unit)
    • T1017H for Health Check (15 Minutes =1 unit)
    • T1017NB for Non-Billable time (15 Minutes =1 unit)

    Important: For TB Medicaid clients, in the financial record the Payor class of “Medicaid” and the Insurance Co. Number of “Forward Health”

    Rules to follow for codes (H0033, 99401, 99402, 99403, 99404, S9445)

    • H0033 can be used with all the codes, and is limited to 12 units per day (15 minutes=1 unit)
    • 99401, 99402, 99403, 99404 (limited to quantity of 1 a day), cannot be used in conjunction with S9445

    Note: S9445 is a fixed fee code in the Medicaid program and is not based on 15 minutes units

    Good Example: Mary had a Sputum test (TB101), DOT for 30 minutes (H0033-30), and Patient Education (S9445). Document you minutes for each procedure.

    Good Example: Mary had DOT for 32 minutes (H0033-30), Sputum in the Home 5 minutes (87806), and Patient Education for 15 minutes (S9445), for a total of 50 minutes of service. Document each procedure in your encounter with the minutes. Note: that the time for code H0033-30 you documented 32 minutes, that time will pull over into Time & Effort, however only 30 minutes is used for billing.

    Poor Example: Mary had a Sputum test (TB101), DOT for 15 minutes (H0033-15), Symptom & Treatment Monitoring for 45 minutes (99403), and Patient Education (S9445). This would be denied for payment because you cannot have 99403 and S9445 done on the same date of service.

    At the end of the day you will bring over your time from encounters into Time & Effort.