General Guidelines

(1) Guidelines define items that are necessary to appropriately interpret and report the procedures and services contained in a particular section and provide explanations regarding terms that apply only to a particular section. (2) The Guidelines found in the editions of Current Procedural Terminology (CPT®) and the Medicare RBRVS: The Physicians’ Guide in effect on the date of service according to the effective date of the rate tables applies to the following: General Medicine (includes Evaluation and Management), General Surgery, Neurosurgery, Orthopedic Surgery, Chiropractic, Physical and Occupational Therapy, Home Health Care, Home Infusion, Ambulatory Surgical Centers and Outpatient Hospital Services, Radiology, Clinical Psychological, and Pathology. Codes of dental terminology prescribed by the American Dental Association, including the terminology updates and revisions issued in the future by the American Dental Association shall be used for all Dentistry services. (3) In addition to the Guidelines found in the CPT® book and the Medicare RBRVS: The Physicians’ Guide, the following Medical Fee Schedule Rule Guidelines also apply. For a Tennessee claim, whenever a conflict exists between these Medical Fee Schedule Rules and any other state fee schedule, rule or regulation, these Rules shall govern. (4) Urine drug screens (UDS) shall be reimbursed using CPT® codes 80305-80307 for presumptive testing and HCPCS codes G0480-G0483 or G0659 for definitive testing. UDS using CPT® codes 80320-80377 are not reimbursable under the fee schedule. The physician note shall specify exactly which drugs are to be tested and why. The frequency of urine drug screens should be in accord with the most recent version of the Department of Health Tennessee Chronic Pain Guidelines, Clinical Practice Guidelines for the Outpatient Management of Chronic Non-Malignant Pain.