Ins 3.65(2)(h)1. 1. Level 1 codes which are the CPT-4 codes.

Ins 3.65(2)(h)2. 2. Level 2 codes which are codes for procedures for which there are no CPT-4 codes.

Ins 3.65(2)(h)3. 3. Levels 1 and 2 modifiers.

Ins 3.65(2)(i) (i) “Health care provider” has the meaning given in s. 632.725 (1), Stats.

Ins 3.65(2)(j) (j) “ICD-9-CM codes” means the disease codes in the international classification of diseases, 9th revision, clinical modification published by the U.S. department of health and human services.

Ins 3.65(2)(k) (k) “Medicare” means Title XVIII of the federal social security act.

Ins 3.65(2)(L) (L) “Medical assistance” means Title XIX of the federal social security act.

Ins 3.65(2)(m) (m) “Revenue codes” means the codes which are included in the Wisconsin uniform billing manual and which are established for use by institutional health care providers by the national uniform billing committee.

Ins 3.65 Note Note: The publications and forms referred to in subsection (2) may be obtained as follows:HCFA-1500 form and instructions

Ins 3.65 Note From the U.S. Government Printing Office, 710 North Capitol Street NW, Washington, DC 20401, all of the following:

Ins 3.65 Note HCPCS codes

Ins 3.65 Note ICD-9-CM codes

Ins 3.65 Note HCFA-1450 form and instructions

Ins 3.65 Note From the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611, both of the following:

Ins 3.65 Note CDT-1 codes

Ins 3.65 Note ADA dental claim form and CDT-1 User’s Manual

Ins 3.65 Note From Order Department: OP054192, the American Medical Association, P. O. Box 10950, Chicago, IL 60610: CPT-4 codes

Ins 3.65 Note From the American Psychiatric Association, 1400 K Street, NW, Washington, DC 20005: DSM-III-R codes

Ins 3.65 Note From the Wisconsin Hospital Association, 5721 Odana Road, Madison, WI 53719: Wisconsin Uniform Billing Manual and revenue codes

Ins 3.65(3) (3) Use of hcfa-1500 form.

Ins 3.65(3)(a) (a) Required users; instructions. For providing a health insurance claim form directly to a patient or filing a claim with an insurer on behalf of a patient, all of the following health care providers shall use the format of the HCFA-1500 form, following HCFA’s instructions for use:

Ins 3.65(3)(a)1. 1. A nurse licensed under ch. 441, Stats.

Ins 3.65(3)(a)2. 2. A chiropractor licensed under ch. 446, Stats.

Ins 3.65(3)(a)3. 3. A physician, podiatrist or physical therapist licensed under ch. 448, Stats.

Ins 3.65(3)(a)4. 4. An occupational therapist, occupational therapy assistant or respiratory care practitioner certified under ch. 448, Stats.

Ins 3.65(3)(a)5. 5. An optometrist licensed under ch. 449, Stats.

Ins 3.65(3)(a)6. 6. An acupuncturist licensed under ch. 451, Stats.

Ins 3.65(3)(a)7. 7. A psychologist licensed under ch. 455, Stats.

Ins 3.65(3)(a)8. 8. A speech-language pathologist or audiologist licensed under subch. II of ch. 459, Stats., or a speech and language pathologist licensed by the department of public instruction.