The fees listed are only applicable to patients who are admitted to the unit and have been
designated as high risk and are payable only to the physician in charge of the patient. The
Concurrent Care fee for ICU, fee code 51790, may also be claimed by a second obstetrical
specialist sharing in the on-going care of the patient.
DIAGNOSTIC AND THERAPEUTIC SERVICES
This section of the Schedule identifies the amounts payable for miscellaneous professional
services. Designation of site for claiming the service is based on where the procedure is
performed rather than where it is interpreted.
f a procedure is performed in a hospital and is listed both in this section and the In-Hospital
Diagnostic Section, it must be claimed using the fee code listed in the In-Hospital Diagnostic
Section.
When a procedure(s) is the sole reason for a visit, no consultation or visit fees should be
charged. However, fee code 54000 may be claimed, unless stated otherwise.
Billing rules for immunization of beneficiaries who belong to target populations designated by
the DHCS are as follows:
(a) visit for assessment plus single immunization - claim visit fee only,
(b) visit for assessment plus two immunizations - claim visit fee plus one unit of fee code
54656,
(c) visit for immunization against influenza and pneumococcal disease - claim one unit of
54650 and one unit of 54656,
(d) visit for immunization against influenza only - claim one unit of fee code 54650, and
(e) visit for immunization against pneumococcal disease only - claim one unit each of fee
codes 54000 and 54658.
