99199
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- When billing for denial of related physician services on a Part B claim, enter '99199-related to Topical HBO' in the comment/narrative field (Loop 2400 or SV101-7 for the 5010A1 837P Item 19 and in Item 19 for paper claims).
- Reference CMS guidance: Change Request 10220, Transmittal 203, Transmittal 3921, and Internet-Only Manual Pub 100-04 Claims Processing Manual Chapter 32 Section 30.2 for policy authority and specific procedural/billing instructions.
- Recommended (per ACOG guidance cited in the CPB) components of prenatal care that women considering home birth should be offered (not described as coverage documentation requirements): 'group B Strep screening and treatment, genetic screening, as well as HIV screening.'
- No specific documentation requirements are stated in this Clinical Policy Bulletin.
Key Coverage Criteria
- Topical oxygen therapy for chronic wounds is not covered by a National Coverage Determination; coverage determination is made by the local Medicare Administrative Contractor (MAC).
- None — Aetna considers planned deliveries at home and associated services not medically appropriate.
- Coverage of home births will be considered when mandated by law under plans subject to state mandates.
- Coverage for complementary and alternative testing and therapies varies across plans. Please refer to the customer's benefit plan document for coverage details.
- For information on Acupuncture and Biofeedback, refer to the applicable Cigna Coverage Policies.
- None explicitly stated in this document as covered. (No section labelled 'Covered Indications' or phrases such as 'Medicare covers...' were found in the provided text.)
20 Active Policies
AMBETTER-CP.MP.130 — Fertility Preservation
AETNA-CPB-0329 — Home Births
A56025 — Billing and Coding: Topical HBO and Physician Related Service Billing and Coding Guidelines
CIGNA-0557 — COVID-19: In Vitro Diagnostic Testing - (0557)
CIGNA-EN0086 — Complementary and Alternative Medicine - (EN0086)
Related Codes
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