Iowa Medicaid CY2022 Addendum B — CPT/Dental Code and Modifier Listings
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Provides an enumerated list of CPT (and dental D) procedure codes with modifier placeholders for Iowa Medicaid CY2022; intended for providers billing Iowa Medicaid. This excerpt contains code/modifier listings only and does not include coverage criteria, prior authorization rules, or payment amounts.
No material clinical or coverage changes in this revision.
Coverage Notes and Criteria
Coverage notes for listed codes
This segment is an informational listing of procedure codes with modifier placeholders; it does not contain medical necessity criteria or coverage rules.
Modifier enumeration
This section enumerates modifiers associated with procedure codes for claim submission; it contains no medical necessity criteria.
Code list (informational)
Informational list of procedure codes and modifier placeholders; no coverage criteria are specified here.
Coding list (no coverage criteria)
Coding entries only — this excerpt provides code/modifier listings and no clinical guidance or coverage rules.
Coverage stance for code list excerpt
This excerpt contains only enumerated codes and modifier placeholders and does not state coverage criteria or clinical requirements.
Code listing (informational)
Reference listing of HCPCS/G-series codes with modifier placeholders; no medical necessity or coverage limits are included.
Procedure and Modifier Listings
| 0624T | Procedure code listed with modifier placeholder |
| 0625T | Procedure code listed with modifier placeholder |
| 10004 | Procedure code listed with modifier placeholder |
| 11000 | Procedure code listed with modifier placeholder |
| 12001 | Procedure code listed with modifier placeholder |
| 13100 | Procedure code listed with modifier placeholder |
| 15002 | Procedure code listed with modifier placeholder |
| 17000 | Procedure code listed with modifier placeholder |
| 19000 | Procedure code listed with modifier placeholder |
| 2000F | Procedure code listed with modifier placeholder |
| 45563 | Procedure code listed with modifier reference |
| 45800 | Procedure code listed with modifier reference |
| 46020 | Procedure code listed with modifier reference |
| 46200 | Procedure code listed with modifier reference |
| 47380 | Procedure code listed with modifier reference |
| 50010 | Procedure code listed with modifier reference |
| 51500 | Procedure code listed with modifier reference |
| 52240 | Procedure code listed with modifier reference |
| 53200 | Procedure code listed with modifier reference |
| 54000 | Procedure code listed with modifier reference |
| 59871 | Procedure code listed with placeholder modifier |
| 59897 | Procedure code listed with placeholder modifier |
| 60000 | Procedure code listed with placeholder modifier |
| 61000 | Procedure code listed with placeholder modifier |
| 64400 | Procedure code listed with placeholder modifier |
| 72100 | Procedure code listed with placeholder modifier |
| 73700 | Procedure code listed with placeholder modifier |
| 72195 | Procedure code listed with modifier placeholder |
| 72200 | Procedure code listed with modifier placeholder |
| 73000 | Procedure code listed with modifier placeholder |
| 73700 | Procedure code listed with modifier placeholder |
| 77047 | Procedure code listed with modifier placeholder |
| 80047 | Procedure code listed with modifier placeholder |
| 82930 | Procedure code listed with modifier placeholder |
| 83491 | Procedure code listed with modifier placeholder |
| 83500 | Procedure code listed with modifier placeholder |
| 9007F | Modifier indicator shown |
| 90281 | Modifier indicator shown |
| 90619 | Vaccine/procedure code modifier indicator shown |
| 92002 | Ophthalmology/optometry code modifier indicator shown |
| 92502 | Hearing/vestibular code modifier indicator shown |
| 92920 | Cardiology/interventional code modifier indicator shown |
| 93248 | Cardiac monitoring code modifier indicator shown |
| 93701 | Cardiac catheterization code modifier indicator shown |
| 99202 | Evaluation and management code modifier indicator shown |
| 99421 | Digital E/M/remote code modifier indicator shown |
| C5274 | HCPCS C-code listed with modifier placeholder |
| D0120 | Dental procedure code listed with modifier placeholder |
| E0100 | Durable medical equipment/service code listed with modifier placeholder |
| G0008 | HCPCS G0008 (modifier placeholder shown in document) |
| G2012 | HCPCS G2012 (modifier placeholder shown in document) |
Billing and Provider Guidance
Code listing header — CPT/D codes with modifier placeholders
Iowa Medicaid Addendum B lists CPT and dental (D) codes with modifier fields shown as 'Modifier = .'; this header notes the code copyrights and the effective update date of January 1, 2022. No prior authorization rules are specified in this header excerpt.
Procedure code list (partial) — codes shown with 'Modifier = .'
This section provides a sequential listing of CPT and HCPCS procedure codes where each code line includes a modifier placeholder shown as 'Modifier = .'; the excerpt does not include prior authorization, billing instructions, or coverage criteria.
Procedure code / modifier list (excerpt) — 'Modifier = .' entries
Procedure codes in this excerpt are presented with an explicit modifier field indicated as 'Modifier = .', signifying a modifier entry is referenced for claim submission; no specific modifier values or authorization guidance are provided here.
Codes and modifiers listing (no authorization guidance)
This portion lists procedure and HCPCS/CPT codes followed by a modifier placeholder 'Modifier = .' for each code; the excerpt does not state prior authorization, denial risk, documentation, or step therapy requirements.
Procedure code and modifier list — modifier placeholder for each code
A sequential list of CPT/HCPCS procedure codes is shown with each entry including 'Modifier = .' indicating a modifier field is present; no prior authorization or billing rules are specified in this excerpt.
Codes list — modifier indicated ('.')
This chunk enumerates procedure codes with the modifier placeholder '.' after each code, indicating a modifier field is referenced for billing; the excerpt contains no prior authorization or documentation requirements.
Code list (partial) — CPT/HCPCS codes with modifier placeholders
The document continues an enumerated list of CPT/HCPCS codes with modifier placeholders ('Modifier = .') for billing reference; this partial extract does not include coverage criteria or prior authorization instructions.
Procedure code modifier list (partial) — modifier field shown
Multiple CPT/HCPCS procedure codes are presented with a modifier field shown as 'Modifier = .' adjacent to each code; the excerpt is informational and does not include authorization or documentation directives.
Code listing (partial) — mixed CPT and HCPCS codes with modifier placeholders
This portion lists a mixed set of CPT/HCPCS/service codes (e.g., 99326–99399, 99401–99499, A-/B-/C-codes) each followed by 'Modifier = .'; the excerpt serves as a billing reference only and does not provide prior authorization steps.
Code list with modifier placeholders — modifier field present
HCPCS/CPT and other codes in this segment are shown with 'Modifier = .' indicating a modifier field is present or to be specified per code; no prior authorization or clinical requirements are provided in this excerpt.
E-series HCPCS codes listing — modifier placeholders
E-series HCPCS codes are enumerated with an associated modifier placeholder ('Modifier = .') for each listed E-code; this listing is informational and contains no authorization guidance.
G-series HCPCS/G-code listing — modifier indicated
G-series HCPCS codes are listed with 'Modifier = .' shown for each code, indicating where a modifier value is recorded for billing; the excerpt provides no prior authorization or documentation instructions.
Procedure code list — modifier indicated
A continued enumeration of HCPCS/CPT procedure codes shows a modifier field indicated as 'Modifier = .' for each code; this excerpt is a billing reference and does not include prior authorization rules.
Code list (modifiers) — HCPCS/J/K/L codes with modifier placeholders
This section enumerates J-, K-, L- and other HCPCS codes with an associated modifier placeholder (shown as '.') for Iowa Medicaid billing; no prior authorization, denial risk, or documentation requirements are specified in the excerpt.
Definitions and Notes
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