Changes to Certification Requirements
Posted 04/20/12
Effective April 1, 2012, HealthChoice discontinued the certification requirement for the professional component of specific CT scans, MRIs, and x-rays. The CPT codes affected are:
| CPT Code | Modifier | CPT Code | Modifier | CPT Code | Modifier |
| 70332 | 26 | 70553 | 26 | 72142 | 26 |
| 70450 | 26 | 71250 | 26 | 72146 | 26 |
| 70460 | 26 | 71260 | 26 | 72147 | 26 |
| 70470 | 26 | 71270 | 26 | 72148 | 26 |
| 70480 | 26 | 71275 | 26 | 72149 | 26 |
| 70481 | 26 | 72125 | 26 | 72156 | 26 |
| 70482 | 26 | 72126 | 26 | 72157 | 26 |
| 70486 | 26 | 72127 | 26 | 72158 | 26 |
| 70487 | 26 | 72128 | 26 | 73221 | 26 |
| 70488 | 26 | 72129 | 26 | 73222 | 26 |
| 70540 | 26 | 72130 | 26 | 73223 | 26 |
| 70542 | 26 | 72131 | 26 | 76499 | 26 |
| 70543 | 26 | 72132 | 26 | 78491 | 26 |
| 70551 | 26 | 72133 | 26 | 78492 | 26 |
| 70552 | 26 | 72141 | 26 | 78608 | 26 |
Effective July 1, 2012, HealthChoice will require certification through the HealthChoice Health Care Management Division (HCMD) for the following procedure in office and facility settings:
| CPT Code | Description |
| 28890 | Extracorporeal shock wave, high energy, performed by a physician, requesting anesthesia other than local, including ultrasound guidance, involving the plantar fascia |
Other services that require certification through HCMD include, but are not limited to:
- Non-emergency ground or air ambulance
- Mental health outpatient services
- Speech therapy for ages 17 and younger
- Physical medicine
- Chiropractic care
- Durable medical equipment
- Hospice
- Home health care
- Botox treatment
- TMD treatment
- Oral surgery
To request certification, contact the Health Care Management Division at 1-405-717-8879 or toll-free 1-800-543-6044. ext. 8879. If you have questions, please contact the Network Management/Provider Relations Division at 1-405-717-8790 or toll-free 1-800-543-6044. Email inquiries can be sent to oseegibproviderrelations@sib.ok.gov.
Last Modified on 04/25/2012