State Agencies | Online Services

Billing Codes

When billing BCMH, coding should conform to American Medical Association current procedural terminology (CPT).  Some coverage limitations are detailed below.

Allergy Services

Allergy evaluations should be billed to BCMH using CPT codes 95004-95075.


When billing for anesthesia, providers should bill the appropriate CPT anesthesia code using the modifier that best describes the service which was provided and report the actual anesthesia time in minutes.  The following modifiers are payable by BCMH:
-AA, -AD, -QK, -QX, -QY, -QZ.

Assistant at Surgery

When billing as an assistant at surgery, providers must bill using the surgical procedure code followed by the modifier 80.  Assistants at surgery must be prior approved, along with the surgeon, in order to be paid.

Chemotherapy Treatments

Chemotherapy codes listed in the current CPT listing are payable through BCMH.

Dental Services

The current ADA listing for general and oral surgical dental services are payable through BCMH, using a “D” prefix (D0110-D9999).

Dialysis Services

Hemodialysis and peritoneal dialysis services may be billed under the codes listed in the current CPT listing and are payable through BCMH.


The codes listed in the current CPT listing are payable through BCMH and include recording, interpretation and report by a physician.


Gastroenterology services should be billed using the codes listed in the current CPT listing.

Orthodontic Services

The method of payment for orthodontia services, Orthodontia by Phase, uses ADA codes D8050, D8070, D8080, D8090.  Prior approval is required and billing codes/instructions are supplied with each approval.

Physical Medicine

The following codes are payable through BCMH.

Physical therapy evaluations

97001-97002 Basic Service

Occupational therapy evaluations      

97003, 97004 Basic Services

Occupational therapy

97530 Major Service

Prosthetic Check-out

97762 Major Service

Psychological Evaluation

The procedure codes, Z0802-Z0819, are not payable by BCMH.  Only code 90817 (psychological evaluation, up to six hours is payable.

Public Health Nurse Services

Public health nurse services should be billed using code 99539.  This code is billed in 15-minute increments of service.


Radiology services should be billed under the codes listed in the current CPT listing.  When billing for both the professional and technical components, no modifier should be used.  The modifiers 26 (professional component only) and TC (technical component only) are payable through BCMH.

Special Formula

Special Formula must be billed to BCMH on a CMS 1500 billing form.  At this time, NO special formula is able to be billed using the Point-of-sale, or POS, system.  The following boxes on the CMS1500 form must be completed (click here for a completed sample form):

1A:    Insured’s ID Number
2:      Patient’s Name (Last name, First name)
21:    Diagnosis code
24A:  Date of Service
24D:  BCMH-assigned NS code is placed in the CPT/HCPCS box
24F:  Charges
24G:  Units (1 Unit = 100 calories of the special formula)
24J:   Rendering Provider ID#
28:    Total Charge
29:    Amount Paid by Insurance (enter 0 if no payment received)
30:    Balance Due
33     Billing Provider Address and Phone Number
33A:  National Provider Identifier
33B:  Additional Provider Number, if applicable

All special formulas on the BCMH formulary have been assigned an “NS code”, and this NS code must be listed in box 24D of the CMS 1500 form in order to receive payment.  

For the most complete list of the BCMH formulary, including "NS codes", click BCMH nutritional supplements.

If you need instructions for billing Medicaid for special formula, please click here.

Speech and Hearing

The following codes are payable through BCMH: 

Speech, language/hearing (limit one per year)

92506 Basic Service

Speech, language/hearing therapy

92507 Major Service

Speech, language/hearing therapy group, 2 or more individuals

92508 Major Service

Complex dynamic pharyngeal and speech evaluation by cine or video recording   

70371 Basic Service

Aural rehabilitation following cochlear implant

92601-92604 Basic Service

Speech auditometry, threshold

92555 Basic Service

Speech audiometry, threshold and speech discrimination

92556 Basic Service


Surgeries should be billed using the codes in the current CPT listing.  BCMH will recognize a modifier of 50 to indicate a bilateral procedure.  An operative report should be included with invoices for surgical services.

Vision Care

The following codes are payable through BCMH:

Eyeglass frames

V2020; V2025

Contact lenses


Prosthetic eye, plastic, stock


Prosthetic eye, plastic, custom


Prosthetic eye, not otherwise classified  



Use appropriate HCPCS codes     

Visit Codes

  • Hospital visits, including critical care, are payable only if inpatient hospital days are authorized through BCMH.
  • The number of hospital visits payable through BCMH to any one physician will not exceed the number of hospital days authorized. 



Psychiatric consults (physician)    


  •  These codes payable only for children with selected conditions.


Hemophilus influenza vaccine for eligible patients


Hepatitis B vaccine for eligible patients


Pneumococcal vaccine for eligible patients


Influenza virus vaccine

*Some codes within this series may be non-convered.



Last Updated: 6/29/2017