Checking Payment Eligibility of Time-Limited Service Codes
Checking health card validity and the eligibility of time-limited service codes is triggered automatically when entering a claim, booking an appointment or clicking on the the blue validate button in the Patient Profile form. After a health card number is entered, or a health card is swiped in a claim form, appointment slot, or patient profile, pressing the Tab key causes HYPEMedical to send a validation request. A response is usually returned within 1 to 2 seconds. HYPEMedical then populates patient demographics, validates the health card, and displays the eligibility status for applicable time-limited service codes.
To display eligibility for the time-limited service codes relevant to your practice, those codes must first be set up. In this context, setup means entering the word "validate" in the description field of each applicable service code's Quick Service Code setup.
Time-limited service codes
Eye exam / oculo-visual
- A110 – Periodic oculo-visual assessment, aged 19 and below
- A112 – Periodic oculo-visual assessment, aged 65 and above
- A115 – Major eye examination, aged 20–64
- A237 – Periodic oculo-visual assessment, aged 19 and below
- A239 – Periodic oculo-visual assessment, aged 65 and above
- K065 – Periodic oculo-visual assessment, aged 20–64, MCCSS-ODSP
- K066 – Periodic oculo-visual assessment, aged 20–64, MCCSS-OW
Sleep study
- J889 – Specialized Facility Therapeutic Study
- J895 – Therapeutic Study for Sleep Related Breathing Disorders
- J896 – Initial Diagnostic Study
- J897 – Repeat Diagnostic Study
Bone mineral density
- X142 – Subsequent test, low risk, one site
- X148 – Subsequent test, low risk, two or more sites
- X149 – Subsequent test, high risk, one site
- X152 – Second test, low risk, one site
- X153 – Second test, low risk, two or more sites
- X155 – Subsequent test, high risk, two or more sites
Fertility services
- B602 – Confirm patient eligibility for IVF cycle
- B603 – IVF Cycle – Bundle #1
- B604 – IVF Cycle – Bundle #2
- B605 – Confirm patient eligibility for fertility preservation cycle
- B606 – Funded oocyte fertility preservation cycle
- B607 – Funded sperm fertility preservation cycle
Time-limited service response codes
| Code | Meaning | Billing takeaway |
|---|---|---|
| 101 | No information available | No time-limited information currently available for this patient |
| 102 | Invalid FSC | The fee schedule code entered is not valid for this validation process |
| DOS & 201 | Oculo-visual assessment or major eye exam performed | Not eligible within the prescribed time frame |
| DOS & 202 | Bone mineral density measurement performed | Not eligible within the prescribed time frame |
| DOS & 203 | Sleep study performed | Not eligible within the prescribed time frame |
| DOS & 204 | Fertility service performed | Not eligible within the prescribed time frame |
| 205 | Oculo-visual minor assessment not eligible | Check major exam eligibility |
| 206 | Eligible major exam performed and limit not reached | Minor assessment eligible for payment |
| 207 | Limit of oculo-visual minor assessments reached | Minor assessment not eligible |
| DOS & 208 | Limit of complexity modifier reached | Complexity premium not eligible |
| DOS & 209 | Physician eye exam on history | Major oculo-visual examination not eligible |
| DOS & 210 | Major oculo-visual examination already performed | Major exam not eligible |
A normal PASS on the health card number and version code does not automatically make a time-limited service billable.