knowledge/lexical/codes
Source: knowledge/lexical/codes.parquet. Source vintage: Package vintage 2026-10-01; source path partition not dated; inspect record and rule clocks separately. Grain: Packaged source record; inspect schema and linked world method before aggregation. Snapshot: 7a53af6a9beb58928d4a64dc92db09c9db65433f9909f1a10d16e302adaf86ba.
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| node_id UInt32 | code Utf8 | text Utf8 | __row_id Int64 |
|---|---|---|---|
| 3321 Filter to this value Explore graph node | contraceptive assessment and consultation services Filter to this value | contraceptive assessment and consultation services
disposition: payable
effective date: July 1, 2025 Filter to this value | 270 |
| 3324 Filter to this value Explore graph node | HIV pre- and -post exposure prophylaxis assessment and consultation services Filter to this value | HIV pre- and -post exposure prophylaxis assessment and consultation services disposition: payable effective date: July 1, 2025 | 271 |
| 3430 Filter to this value Explore graph node | Advance Directives Filter to this value | Advance Directives
who may perform: Participating Providers Filter to this value | 272 |
| 3600 Filter to this value Explore graph node | T1015 Filter to this value | T1015 criteria: Only one medical and one behavioral encounter may be submitted per date of service, unless a service authorization has been approved. criteria: Wrap payment is zero because Other Payor payment > Base Rate criteria: along with one or more pertinent procedure codes that identify each criteria: along with one or more pertinent procedure codes that identify each specific service provided during the visit criteria: along with one or more pertinent procedure codes that identify each specific service provided during the visit. criteria: billed with the T1015 along with the specific modifiers for participating Medicaid FQHC/RHCs criteria: including HI and SC modifiers, when appropriate, as defined in Clinical Coverage Policy No: 1D-4 Attachment A criteria: including HI and SC modifiers, when appropriate, as defined in Clinical Coverage Policy No: 1D-4 Attachment A to bill for Core Services. criteria: services are medically necessary and rendered to MA beneficiaries under 21 years of age who are experiencing weight management problems criteria: submitted with just the T1015 disposition: not-reimbursable disposition: payable disposition: payable-with-criteria effective date: August 1, 2024 effective date: December 1, 2024 effective date: July 1, 2023 effective_date: not-stated highmark code-disposition criteria: billed with the T1015 along with the specific modifiers for participating Medicaid FQHC/RHCs highmark code-disposition criteria: services are medically necessary and rendered to MA beneficiaries under 21 years of age who are experiencing weight management problems highmark code-disposition criteria: submitted with just the T1015 highmark code-disposition disposition: not-reimbursable highmark code-disposition disposition: payable-with-criteria medicaid-nc code-disposition code: T1015 medicaid-nc code-disposition criteria: billed by FQHC or RHC for core services medicaid-nc code-disposition criteria: including HI and SC modifiers, when appropriate, as defined in Clinical Coverage Policy No: 1D-4 Attachment A medicaid-nc code-disposition criteria: including HI and SC modifiers, when appropriate, as defined in Clinical Coverage Policy No: 1D-4 Attachment A to bill for Core Services. medicaid-nc code-disposition disposition: payable medicaid-nc code-disposition disposition: payable-with-criteria medicaid-nc code-disposition effective-date: July 1, 2023 medicaid-nc code-disposition effective-date: not-stated medicaid-nh code-disposition criteria: along with one or more pertinent procedure codes that identify each medicaid-nh code-disposition criteria: along with one or more pertinent procedure codes that identify each specific service provided during the visit medicaid-nh code-disposition criteria: submitted with only the medical encounter code medicaid-nh code-disposition disposition: not-reimbursable medicaid-nh code-disposition disposition: payable-with-criteria medicaid-nv code-disposition integral-to-other-service: Drug and vaccine administration costs medicaid-nv code-disposition integral-to-other-service: Pharmaceutical items medicaid-nv code-disposition not-reimbursable: Room and board or other unallowable facility costs medicaid-nv code-disposition prior-authorization-required: false payable-with-criteria: true payable-with-criteria: when appropriate, as defined in Clinical Coverage Policy No: 1D-4 Attachment A payable: true | 273 |
| 3604 Filter to this value Explore graph node | 99381 Filter to this value | 99381 criteria: if the appropriate evaluation and management code and EP modifier are submitted disposition: payable-with-criteria highmark code-disposition criteria: if the appropriate evaluation and management code and EP modifier are submitted highmark code-disposition disposition: payable-with-criteria medicaid-md code-disposition disposition: payable-with-criteria | 274 |
| 3607 Filter to this value Explore graph node | 99391-99385 Filter to this value | 99391-99385 criteria: if the appropriate evaluation and management code and EP modifier are submitted disposition: payable-with-criteria | 275 |
| 3610 Filter to this value Explore graph node | 99395 Filter to this value | 99395 code-disposition: payable-with-criteria criteria: No other E&M service can be billed same DOS. criteria: Periodic EPSDT exam for a well child, a child with an acute illness, or a CSHCN; age 18 through 20. No other E&M service can be billed same DOS. criteria: cannot bill for a problem-oriented and preventive visit for the same participant, on the same day. criteria: if the appropriate evaluation and management code and EP modifier are submitted disposition: payable disposition: payable-with-criteria highmark code-disposition criteria: if the appropriate evaluation and management code and EP modifier are submitted highmark code-disposition disposition: payable-with-criteria medicaid-hi code-disposition code-disposition: payable-with-criteria medicaid-hi code-disposition criteria: No other E&M service can be billed same DOS. medicaid-hi code-disposition criteria: Periodic EPSDT exam for a well child, a child with an acute illness, or a CSHCN; age 18 through 20. No other E&M service can be billed same DOS. medicaid-hi code-disposition disposition: payable-with-criteria medicaid-md code-disposition disposition: payable-with-criteria | 276 |
| 3640 Filter to this value Explore graph node | G0402 Filter to this value | G0402 disposition: payable-with-criteria effective date: not-stated hcsc code-disposition disposition: payable-with-criteria hcsc code-disposition effective date: not-stated hcsc code-disposition payable-with-criteria: limited to new beneficiary during the first 12 months of Medicare enrollment. payable-with-criteria: limited to new beneficiary during the first 12 months of Medicare enrollment. | 277 |
| 3643 Filter to this value Explore graph node | G0438 Filter to this value | G0438 disposition: payable-with-criteria effective date: not-stated hcsc code-disposition disposition: payable-with-criteria hcsc code-disposition effective date: not-stated hcsc code-disposition payable-with-criteria: performed on patients that have been enrolled with Medicare for more than one year, including new or established patients. payable-with-criteria: performed on patients that have been enrolled with Medicare for more than one year, including new or established patients. | 278 |
| 3646 Filter to this value Explore graph node | G0439 Filter to this value | G0439 disposition: payable-with-criteria effective date: not-stated hcsc code-disposition disposition: payable-with-criteria hcsc code-disposition effective date: not-stated hcsc code-disposition payable-with-criteria: occurs one year after the patient initial visit. payable-with-criteria: occurs one year after the patient initial visit. | 279 |