What's New from CMS

Below you will find a listing of current Centers for Medicare & Medicaid Services (CMS) program information (transmittals, corrections/changes to existing Medicare guidelines, etc.) and general updates to this Web site.

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March | February | January | December | November | October | September | August | July

March

11 March 2010

• Quarterly Provider Update (QPU)
  (IOM Pub 100-09-Chapter 6 Section 50.2.4.3)
  The Quarterly Provider Update (QPU) is a listing of the regulations and program instructions issued by CMS that impact Medicare providers. The QPU is maintained by CMS and available to providers through the CMS Web site.
  Providers may elect to join a CMS electronic mailing list, to be notified periodically, of additions to the QPU. CMS publishes this Update at the beginning of each quarter to inform the public about the following:
     • Regulations and major policies currently under development during this quarter.
     • Regulations and major policies completed or cancelled.
     • New/Revised manual instructions
  The page may be found at: http://www.cms.hhs.gov/QuarterlyProviderUpdates/ Visit the QPU What’s New page at: http://www.cms.hhs.gov/QuarterlyProviderUpdates/03_WhatsNew.asp
• Certification of Mammography Facilities (Annual Reminder)
  IOM 100-04, Chapter 18, section 20.1
  NHIC, Corp. reminds providers that Medicare will reimburse only FDA-certified mammography centers for mammography services. We encourage you to inform your patients to use only centers that are certified. We provide a direct link on our web site to the listing for all of these facilities in each state at http://www.medicarenhic.com/ne_prov/billing_info.shtml . Click on the “Mammography Centers – Certified” link. Please share this information with your patients.
• Repeal of Section 20.10, Publication 100-03, National Coverage Determinations (NCD) Manual, Cardiac Rehabilitation Programs (CR6855)
• Percutaneous Transluminal Angioplasty (PTA) of the Carotid Artery Concurrent with Stenting (CR6839)
• July 2010 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files (CR6805)
• Revised: One-Time Mailing of Supplier Responsibilities Letter – Individual Practitioners Only (CR6278)
• Revised: Billing for Services Related to Voluntary Uses of Advance Beneficiary Notices of Noncoverage (ABNs) (CR6563)

February

25 February 2010

• Revised: Revision of Definition of Compendia as Authoritative Source for Use in the Determination of a Medically-Accepted Indication of Drugs/Biologicals Used Off-label in Anti-Cancer Chemotherapeutic Regimens (CR6806)
• Reporting Inpatient Hospital Evaluation and Management (E/M) Services that Could be Described by Current Procedural Terminology (CPT) Consultation Codes
  (JSM/TDL-10152)
  This message is to clarify proper reporting in Calendar Year (CY) 2010 of initial E/M services provided by physicians (and other qualified nonphysicians when permitted) in the inpatient hospital setting that could be described by CPT Consultation Codes (99251-99255) that are no longer recognized for payment under the Medicare Physician Fee Schedule (MPFS). The Centers for Medicare & Medicaid Services (CMS) previously instructed physicians and other providers to use other applicable CPT E/M Codes to report the services that could be described by CPT Consultation Codes. The CMS also provided that, in the inpatient hospital setting, physicians (and qualified nonphysicians) who perform an initial E/M service may bill the initial hospital care CPT Codes (99221 – 99223). Since that instruction, CMS has received inquiries specifically as relates to reporting initial hospital care services for which the minimum key component work and/or medical necessity requirements for CPT Codes 99221–99233 are not documented. For instance, one element of inpatient consultation CPT Codes 99251 and 99252, respectively, require “a problem focused history” and “an expanded problem focused history.” In contrast, initial hospital care CPT Code 99221 requires “a detailed or comprehensive history.”
  
  First, CMS reminds providers that CPT Code 99221 may be reported for an E/M service if the requirements for billing that code, which are greater than CPT Consultation Codes 99251 and 99252, are met by the service furnished to the patient. The CMS has alerted Medicare Administrative Contractor Audit Staffs as well as Medicare Recovery Audit Contractors of its expectation that physicians may bill more E/M Codes for initial hospital care, in place of billing inpatient CPT Consultation Codes. The CMS has also alerted contractors to expect a different proportion of various initial hospital care CPT Codes under the new policy. The CMS expects its contractors to consider that these may be appropriate changes when making decisions about whether to pursue medical review and other types of claims review.
  
  Second, CMS notes that subsequent hospital care CPT Codes 99231 and 99232, respectively, require “a problem focused interval history” and “an expanded problem focused interval history” and could potentially meet the component work and medical necessity requirements to be reported for an E/M service that could be described by CPT Consultation Code 99251 or 99252. The CMS has instructed contractors to not find fault with providers who report a subsequent hospital care CPT Code, in cases where the medical record appropriately demonstrates that the work and medical necessity requirements are met for reporting a subsequent hospital care code (under the level selected), even though the reported code is for the provider's first E/M service to the inpatient during the hospital stay Finally, only in the case when an E/M service that could be described by CPT Code 99251 or 99252 is furnished and there is no other specific E/M code payable by Medicare that describes that service shall CPT Code 99499 (Unlisted evaluation and management service) be reported. Reporting 99499 requires submission of medical records and contractor manual medical review of the service prior to payment, and CMS expects reporting under these circumstances to be unusual.
  
  While CMS expects that the CPT Code reported accurately reflects the service provided, CMS has instructed contractors to not find fault with providers who report a subsequent hospital care CPT Code, in cases where the medical record appropriately demonstrates that the work and medical necessity requirements are met for reporting a subsequent hospital care code for an initial hospital E/M service.”
  
  “Reporting Hospice Services Provided by Physicians Under Part A that Could be Described by Current Procedural Terminology (CPT) Consultation Codes
  
  When hospices bill Part A for the services of physicians, they must use CPT Codes that are paid under the Medicare Physician Fee Schedule (MPFS). Since the CPT Consultation Codes are no longer recognized for payment under the MPFS, hospices shall follow the same guidelines for reporting E/M services as physicians billing Part B. Hospices shall use the most appropriate E/M Codes to bill for E/M services furnished by physicians that could be described by CPT Consultation Codes.”
• Revised Clinical Laboratory Fee Schedule and ZIP Code File to Include New Kansas Payment Locality Structure (CR6787)
• Questions and Answers on Reporting Physician Consultation Services (SE1010)
• Revised: Revisions to Consultation Services Payment Policy (CR6740)

18 February 2010

• Rescinded: Compliance Standards for Consignment Closets and Stock and Bill Arrangements (CR6528)
• Revised: Dialysis Adequacy, Infection and Vascular Access Reporting (CR6782)
• Instructions on How to Process Negative Claim Adjustment Reason Code (CARC) Adjustment Amounts when Certain CARCs Appear on Medicare Secondary Payer Claims (CR6736)
• Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 16.1, effective April 1, 2010 (CR6819)
• Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) Edits (CR6812)
• Implementation of a New Skilled Nursing Facility (SNF) Consolidated Billing (CB) Edit for Facility Services Billed by Ambulatory Surgical Centers (ASCs) (CR6702)
• Maintenance and Servicing Payments for Certain Oxygen Equipment after July 1, 2010 (CR6792)
• New Waived Tests (CR6800)
• Interim Instructions for Processing Claims and Recouping Overpayments for Claims Submitted Under the Guidelines Established in Change Request 5917 (CR6762)
• Rescinded– Place of Service (POS) and Date of Service (DOS) Instructions for Interpretation of Diagnostic Tests (CR6375)
• Medicare Claims Crossover to Supplemental Payer Problem
  (JSM10139) (Message 201002-25)
  The Centers for Medicare & Medicaid Services (CMS) has identified a problem where claims were not automatically crossing over to supplemental payers even though the provider remittance advice indicated otherwise.  This problem began January 5, 2010.  Part A institutional claims and Part B professional claims, with the exception of supplier claims processed by Durable Medical Equipment Medicare Administrative Contractors (DME MACs), were impacted by this problem.  Claims processed by DME MACs were not impacted.  
  
  Part A Institutional Claims
  No action is required by Part A institutional providers.  As of February 2, 2010, CMS successfully implemented a systems fix to ensure that  all Part A institutional claims are now crossing over to supplemental payers as indicated on the remittance advice received by providers.  As part of the fix, CMS’ Medicare contractors were able to identify claims processed between January 5 and February 1, 2010, where the provider remittance advice indicated that the affected claims were crossed over to various supplemental payers but were not.   On February 2, 2010, the affected Medicare contractors began to send the affected claims to the Coordination of Benefits Contractor (COBC) to be crossed over to supplemental payers.  This effort is now largely completed.  Please allow until March 1, 2010, for supplemental payers to receive and process these claims before attempting to balance bill them for any remaining balances after Medicare.
  
  Part  B Professional Claims
  Action is required on behalf of Part B professional providers where a remittance advice with an issue date between January 5, 2010, and February 12, 2010, has two or more service lines for a beneficiary where both of the following apply:
  
  ·         One service line is 100 percent reimbursable (i.e., the approved amount and amount to be paid are equal,) AND   
  ·         One service line where part of or the entire Medicare approved amount is applied to the Part B deductible and/or carries co-insurance amounts. 
  
  CMS is not able to forward these beneficiary claims to supplemental payers even though the remittance advice may indicate otherwise.  Providers will need to identify these claims by reviewing their remittance advice with an issue date between January 5, 2010, and February 12, 2010, that contain the criteria noted above.  Once identified, providers will need to take action to balance bill the beneficiary’s supplemental payer.  As of February 12, 2010, this system problem was fixed and all claims are crossing over to supplemental payers as indicated on the provider remittance advice.  
  
  The CMS has already notified supplemental payers of these issues.  We regret any inconvenience you may experience related to this Medicare claim supplemental payer crossover problem.
• Medicare Non-Covered Claims with Professional Component Claims Process Issue
  (JSM10144)
  The Centers for Medicare & Medicaid Services (CMS) has identified a Medicare claims processing issue where non-covered claims submitted with a professional component are incorrectly receiving Reason Code 31387 preventing the claims from finalizing. Non-covered claims containing professional component receiving Reason Code 31387 are being held and will be released on or about September 6, 2010, once this claims processing system issue is fixed. We apologize for any inconvenience you may experience related to this issue.”
• Medicare Mammography Services Claims Process Issue
  (JSM10143)
  The Centers for Medicare & Medicaid Services (CMS) has identified a Medicare claims processing issue where adjustments submitted against original bills containing mammography services are incorrectly receiving Reason Code 36440 preventing the claims from finalizing. Adjustments performed on claims containing mammography services receiving Reason Code 36440 are being held and will be released on approximately September 6, 2010, once this claims processing system issue is fixed. We apologize for any inconvenience you may experience related to this issue.”

11 February 2010

• Revision of Definition of Compendia as Authoritative Source for Use in the Determination of a Medically-Accepted Indication of Drugs/Biologicals Used Off-label in Anti-Cancer Chemotherapeutic Regimens (CR6806)

4 February 2010

• Revision of Definition of Compendia as Authoritative Source for Use in the Determination of a Medically-Accepted Indication of Drugs/Biologicals Used Off-label in Anti-Cancer Chemotherapeutic Regimens (CR6806)
• Medicare’s DMEPOS Competitive Bidding Program - A Better Way for Medicare to Pay for Medical Equipment (SE1007)
• April 2010 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files (CR6804)
• Dialysis Adequacy, Infection and Vascular Access Reporting (CR6782)
• Verification of Legalized Status (CR6748)
• Revised: Instructions for Processing Claims Containing Anti-Markup Services but with Partial Information Completed in Item 20 of the CMS-1500 Claim Form (MM6670)

1 February 2010

• Reassignment and Ambulatory Surgical Centers (ASCs) (CR6470) Note: This Change Request was inadvertently omitted from the June publications.

January

28 January 2010

• Providers Randomly Selected to Participate in the Medicare Contractor Provider Satisfaction Survey (MCPSS) Urged to Respond (SE1005)
• Revised: Wrong Surgical or Other Invasive Procedure Performed on a Patient; Surgery or Other Invasive Procedure Performed on the Wrong Body Part; and Surgical or Other Invasive Procedure Performed on the Wrong Patient (CR6405)

25 January 2010

• Expiration of Increased Medicare Payments for Ground Ambulance Services and Air Ambulance Payment Improvements Provisions (JSM10125)
  
  Section 146(a) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) provided for an increase in the ambulance fee schedule amounts for covered ground ambulance transport. For transports that originated in urban areas, the increase was two (2) percent. For transports that originated in rural areas, the increase was three (3) percent. The increases were applicable only for claims with dates of service July 1, 2008, through December 31, 2009.
  
  Further, Section 146(b)(1) of MIPPA amended the designation of rural areas for air ambulance services. The statute specified that any area that was designated as a rural area as of December 31, 2006, for purposes of making payments under the ambulance fee schedule for air ambulance services should continue to be treated as a rural area for purposes of making air ambulance service payments under the ambulance fee schedule. This statute was also applicable only for claims with dates of service July 1, 2008, through December 31, 2009.
  
  As such, as of January 1, 2010, for ground and air ambulance claims received with dates of service on this date and beyond, Medicare will no longer be paying ground and air ambulance service providers based on these two expired provisions.

21 January 2010

• Expansion of Medicare Telehealth Services for Calendar Year (CY) 2010 (CR6705)
• Calendar Year (CY) 2010 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment (CR6657)
• Additional Information Regarding the Calendar Year (CY) 2010 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment (SE1001)
• Payment to Physician or Other Supplier for Diagnostic Tests Subject to the Anti-Markup Payment Limitation (CR6733)
• Revised: Billing for Services Related to Voluntary Uses of Advance Beneficiary Notices of Noncoverage (ABNs) (CR6563)
• Revised: Implementation of the Health Insurance Portability and Accountability Act (HIPAA) Version 5010 276/277 Claim Status Second Phase (CR6721)

19 January 2010

• Change Request 6712 - (CR6712) Medically Unlikely Edits
  This CR provides updates and clarifications to MUE requirements established in 2006. For more information, the Centers for Medicare & Medicaid Services has issued the following transmittal at http://www.cms.hhs.gov/transmittals/downloads/R617OTN.pdf.

14 January 2010

• Correction to CR 6728 on Correct Coding Initiative (CCI) Edits, Version 16.0, Effective January 1, 2010 (CR6818)
• Revised: Emergency Update to the 2010 Medicare Physician Fee Schedule Database (MPFSDB) (CR6796)
• Revised: Pharmacogenomic Testing for Warfarin Response (CR6715)
• Revised: Positron Emission Tomography (PET) (FDG) for Cervical Cancer (CR6753)

7 January 2010

• New Place of Service (POS) Code for Walk-in Retail Health Clinic (CR6752)
• CR Rescinded and Reissued January 8, 2010: Pharmacogenomic Testing for Warfarin Response (CR6715)
• Coverage of Kidney Disease Patient Education (CR6557)
• Revised: Summary of Policies in the 2010 Medicare Physician Fee Schedule (MPFS) and the Telehealth Originating Site Facility Fee Payment Amount (CR6756)

December

30 December 2009

• Emergency Update to the 2010 Medicare Physician Fee Schedule Database (MPFSDB) (CR6796) This CR was rescinded and reissued. See postings on January 14th
• Summary of Policies in the 2010 Medicare Physician Fee Schedule (MPFS) and the Telehealth Originating Site Facility Fee Payment Amount (CR6756)
• Expiration of Various Payment Provisions Under the Medicare Program (SE0931)
• Revised: 2010 Annual Participation Enrollment Program Extension (SE0929)

28 December 2009

• Expiration of Moratorium that Allowed Independent Laboratories to Bill for the Technical Component of Physician Pathology Services Furnished to Hospital Patients and Expiration of Therapy Cap Exceptions
  (JSM/TDL-10110)
  
  1. Expiration of Moratorium that Allowed Independent Laboratories to Bill for the TC of Physician Pathology Services Furnished to Hospital Patients
  
  The Centers for Medicare & Medicaid Services (CMS) continues to work with Congress on significant legislation which affects the Medicare program. We believe this and other provisions may be extended as part of this legislation. We encourage you to monitor Congressional activity and stay apprised of the status of potential legislation. In the meantime, if such legislation is enacted, CMS will notify Medicare fee-for-service claims processing contractors to again process claims for those affected services. Providers may choose to hold their claims in the event legislation about this issue is enacted. However, current law mandates the following change:
  
  In the final physician fee schedule regulation published in the Federal Register on November 2, 1999, CMS stated that it would implement a policy to pay only the hospital for the technical component (TC) of physician pathology services furnished to hospital patients. At the request of the industry, to allow independent laboratories and hospitals sufficient time to negotiate arrangements, the implementation of this rule was administratively delayed. Subsequent legislation formalized a moratorium on the implementation of the rule.
  
  The most recent extension of the moratorium was established by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). Section 136 of the MIPPA expires on December 31, 2009, thus ending the moratorium. Therefore, independent laboratories may no longer bill Medicare for the TC of physician pathology services furnished to patients of a hospital, regardless of the beneficiary's hospitalization status (inpatient or outpatient) on the date that the service was performed. This prohibition is effective for claims with dates of service on and after January 1, 2010.
  
  We will continue to be in communication with you should there be further information regarding payment of claims impacted by the above guidance. In addition, be on the alert for more information about this and other legislative provisions which may affect you.”
  
  2. Expiration of Therapy Cap Exceptions Process
  
  The Centers for Medicare & Medicaid Services (CMS) continues to work with Congress on significant legislation which affects the Medicare program. We believe this and other provisions may be extended as part of this legislation. We encourage you to monitor Congressional activity and stay apprised of the status of potential legislation. In the meantime, if such legislation is enacted, CMS will notify Medicare fee-for-service claims processing contractors to again process claims for those affected services. Providers may choose to hold their claims in the event legislation about this issue is enacted. However, current law mandates the following change:
  
  The exceptions to outpatient therapy caps expire on December 31, 2009. Outpatient therapy service providers should not submit claims with the KX modifier for services furnished on or after January 1, 2010. The therapy caps are determined on a calendar year basis, so all patients will begin a new cap year on January 1, 2010. For physical therapy and speech language pathology services combined, the limit on incurred expenses is $1,860. For occupational therapy services, the limit is $1,860. Deductible and coinsurance amounts applied to therapy services count toward the amount accrued before a cap is reached.
  
  Note that patients who have reached their limit(s) on outpatient therapy services, other than those who reside in a Medicare-certified part of a skilled nursing facility, may obtain medically necessary therapy services that exceed the caps if the services are furnished and billed by the outpatient department of a hospital. In other settings, outpatient therapy services in excess of the caps are not covered, and the therapy provider may charge the beneficiary for those services. We will continue to be in communication with you should there be further information regarding payment of claims impacted by the above guidance. In addition, be on the alert for more information about this and other legislative provisions which may affect you.

23 December 2009

• 2010 Medicare Contractor Provider Satisfaction Survey (MCPSS)
  (JSM 10062) The Centers for Medicare & Medicaid Services is conducting the fifth administration of the Medicare Contractor Provider Satisfaction Survey (MCPSS). The survey is designed to collect quantifiable data on provider satisfaction with the performance of your Medicare contractor. The MCPSS will be sent to a random sample of approximately 30,000 Medicare fee-for-service providers and suppliers. CMS is listening and wants to hear from you about the services provided by your Medicare contractor. If you are selected to participate in the survey, please take a few minutes and complete this important survey. To learn more about the MCPSS, please visit http://www.cms.hhs.gov/mcpss or https://www.mcpsstudy.org.
• Quarterly Provider Update (QPU)
  (IOM Pub 100-09-Chapter 6 Section 50.2.4.3)
  The Quarterly Provider Update (QPU) is a listing of the regulations and program instructions issued by CMS that impact Medicare providers. The QPU is maintained by CMS and available to providers through the CMS Web site.
  Providers may elect to join a CMS electronic mailing list, to be notified periodically, of additions to the QPU. CMS publishes this Update at the beginning of each quarter to inform the public about the following:
  
  • Regulations and major policies currently under development during this quarter.
  • Regulations and major policies completed or cancelled.
  • New/Revised manual instructions
  The page may be found at: http://www.cms.hhs.gov/QuarterlyProviderUpdates/
  Visit the QPU What’s New page at http://www.cms.hhs.gov/QuarterlyProviderUpdates/03_WhatsNew.asp
  
• Place of Service and Date of Service Instructions for Interpretation of Diagnostic Tests -Change Request (CR) 6375, Transmittal 1873 sent via CI-6381, dated December 11, 2009, is rescinded and will be replaced with another CR in the future pending further policy clarification on date of service and place of service reporting for the interpretation of diagnostic tests that consistently addresses the full spectrum of clinical scenarios. (CR6375) (02/11/2009)
• Payment for Implantable Tissue Markers: Healthcare Common Procedure Coding System (HCPCS) Code A4648 (CR6579)
• Implementation of the Health Insurance Portability and Accountability Act (HIPAA) Version 5010 276/277 Claim Status Second Phase (CR6721)
• Revised: 2010 Annual Participation Enrollment Program Extension (SE0929)
• Revised: Positron Emission Tomography (PET) (FDG) for Cervical Cancer (CR6753)
• Revised: Instructions Regarding Processing Claims Rejecting for Gender/Procedure Conflict (CR6638)

17 December 2009

• Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy Print (MREP) Update (CR6742)
• Revised: Claim Status Category Code and Claim Status Code Update (CR6723)
• Revised: Expansion of the Current Scope of Editing for Ordering/Referring Providers for claims processed by Medicare Carriers and Part B Medicare Administrative Contractors (MACs) (CR6417)
• Revised: Revisions to Consultation Services Payment Policy (CR6740)
• Revised: MIPPA Section 139 Teaching Anesthesiologists (CR6706)
• Positron Emission Tomography (PET) (FDG) for Cervical Cancer (CR6753)
• January 2010 Update of the Ambulatory Surgical Center (ASC) Payment System (CR6746)
• Revised:Tracking the Hospice Attending Physician’s National Provider Identifier (NPI) for Validating Hospice Part B Payments (CR6540)
• Expansion of the Current Scope of Editing for Ordering/Referring Providers for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers' Claims Processed by Durable Medical Equipment Medicare Administrative Contractors (DME MACs) (CR6421)

10 December 2009

• Tracking the Hospice Attending Physician’s National Provider Identifier (NPI) for Validating Hospice Part B Payments (CR6540)
• 2010 Annual Update to the Therapy Code List (CR6719)
• Requirements to Prevent the Misuse of Modifiers PA, PB, and PC on Incoming Claims (CR6718)

3 December 2009

• New Waived Tests (CR6685)
• Revised: Therapy Cap Values for Calendar Year (CY) 2010 (CR6660)
• Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 16.0, Effective January 1, 2010 (CR6728)
• Ambulance Inflation Factor (AIF) for Calendar Year (CY) 2010 (CR6631)

November

24 November 2009

• MIPPA Section 139 Teaching Anesthesiologists (CR6706)

20 November 2009

• JSM/TDL-10054 -The 2010 Medicare Physician Fee Schedule (MPFS) Update/Disclosures have been posted.
  
  NOTE: These files reflect technical corrections to the relative value units, including for CPT codes G0341, 29870, 36481, 37183, 47382, 50200, 55873, 92610, 99221, 99222, 99223, 99304, 99305 and 99306, and to the CY 2010 conversion factor contained in the CY 2010 Medicare physician fee schedule final rule. (See http://www.federalregister.gov/OFRUpload/OFRData/2009-26502_PI.pdf). 
  The conversion factor for CY 2010 is $28.3895 instead of $28.4061 as previously indicated in the final rule.  A correction notice will be published in the Federal Register regarding these corrections. 
  
  CMS is extending the 2010 Annual Participation Enrollment Program.  The participation enrollment period will now end
  January 31, 2010, instead of December 31, 2009.

19 November 2009

• Therapy Cap Values for Calendar Year (CY) 2010 (CR6660)
• Update to Medicare Deductible, Coinsurance, and Premium Rates for 2010 (CR6690)
• Ambulance Services (CR6707)
• Claim Status Category Code and Claim Status Code Update (CR6723)
• January 2010 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files (CR6708)
• Outpatient Mental Health Treatment Limitation (CR6686)
• 2010 Annual Participation Enrollment Program Extension (SE0929)
• Calendar Year (CY) 2010 Fee Schedule Update for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) (CR6720)
• Healthcare Common Procedure Coding System (HCPCS) Code Q2024 for Small Dose Bevacizumab (Avastin®)
  JSM/TDL-10049
  Effective immediately, the Centers for Medicare & Medicaid Services (CMS) no longer recognizes Healthcare Common Procedure Coding System (HCPCS) Code Q2024 Bevacizumab (Avastin®) for payment of nonoutpatient hospital claims. Practitioners shall return to their previous reporting practice for small intraocular doses of Bevacizumab (Avastin®) furnished prior to October 1, 2009. HCPCS Code Q2024 will be deleted as of January 1, 2010, and, therefore, it will be removed from the Average Sales Price (ASP) pricing file effective with the January 2010 Release.

12 November 2009

• Mental Health Medically Unlikely Edit (MUE)
  JSM/TDL-10038
  
  The Centers for Medicare & Medicaid Services (CMS) has identified an incorrect Medically Unlikely Edit (MUE) of 3 units for hospital outpatient services described by Current Procedural Terminology (CPT) Code 90853 (Group psychotherapy (other than of a multiple-family group)). The proper MUE for this code is 5 units. This will be retroactively corrected in the January 1, 2010 Release. Your FI/MAC will hold hospital outpatient claims (Type of Bill (TOB) 13X) with 4 or 5 units of CPT Code 90853 on one line with dates of service on or after October 1, 2009.
  
  However, when providing 4 or 5 units of the service described by CPT Code 90853 between October 1, 2009, and January 1, 2010, you may choose to bill 3 units of CPT Code 90853 on one line, and 1 or 2 units of CPT Code 90853 on another line with Modifier -59 in order to receive payment for these services prior to the implementation of the corrected MUE on January 1, 2010. This is a time-limited instruction and applies only to services described by CPT Code 90853 provided between October 1, 2009, and January 1, 2010. In all other cases, the use of Modifier -59 is reserved only for services provided in distinct clinical circumstances. It is improper to use Modifier -59 to circumvent MUEs unless specifically instructed by your FI/MAC to do so.
• Instructions for Processing Claims Containing Anti-Markup Services but with Partial Information Completed in Item 20 of the CMS-1500 Claim Form (CR6670)
• Changes to the Laboratory National Coverage Determination (NCD) Edit Software for January 2010 (CR 6717)
• Ensuring the Denial of Claims for Ambulance Services Rendered to Beneficiaries in Part A Skilled Nursing Facility Stays (CR6700)

9 November 2009

• The 2010 Medicare Physician Fee Schedule (MPFS) amounts are currently unavailable until further notice, but will be posted as soon as they become available. Please check this web site periodically for any updates. (JSMTDL 10046)

5 November 2009

• Reasonable Charge Update for 2010 for Splints, Casts, Dialysis Supplies, Dialysis Equipment, and Certain Intraocular Lenses (CR6691)
• Revised: Surgery for Diabetes National Coverage Determination (NCD) (CR6419)
• Instructions Regarding Processing Claims Rejecting for Gender/Procedure Conflict (CR6638)
• New Physician Specialty Code for Geriatric Psychiatry (CR6533)
• Billing for Services Related to Voluntary Uses of Advance Beneficiary Notices of Noncoverage (ABNs) (CR6563)
• Validating the Billing of End Stage Renal Disease (ESRD) 50/50 Rule Modifier (CR6683)

October

29 October 2009

• Revised - FDG PET for Solid Tumors and Myeloma (CR6632)

22 October 2009

• FDG PET for Solid Tumors and Myeloma (CR6632)
• Magnetic Resonance Imaging (MRI) (CR6672)
• Annual Clotting Factor Furnishing Fee Update (CR6673)
• Revised: Implementation of Health Insurance Portability and Accountability Act of 1996 (HIPAA) version 5010 for Transaction 835 - Health Care Claim Payment/Advice (CR6589)
• Alternative Process for Individual Eligible Professionals to Access Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing (E-Prescribing) Feedback Reports (SE0922)

15 October 2009

• Clarification of the Use of Modifiers When Billing “Wrong Surgery on a Patient” (SE0927)
• Revised: 2009 - 2010 Seasonal Influenza (Flu) Resources for Health Care Professionals (SE0926)

8 October 2009

• Activation of New Coordination of Benefits Agreement (COBA) Trading Partner Dispute Error Code Within the National Crossover Process (CR6640)
• Revised: Wrong Surgical or Other Invasive Procedure Performed on a Patient; Surgery or Other Invasive Procedure Performed on the Wrong Body Part; and Surgical or Other Invasive Procedure Performed on the Wrong Patient (CR 6405)
• One-Time Mailing of Supplier Responsibilities Letter – Individual Practitioners Only (CR6278)
• Influenza Vaccine Payment Allowances - Annual Update for 2009-2010 Season (CR6608)
• Revised - Expansion of the Current Scope of Editing for Ordering/Referring Providers for claims processed by Medicare Carriers and Part B Medicare Administrative Contractors (MACs) (CR6417)
• Comprehensive Outpatient Rehabilitation Facility Manual (CR 6005)

1 October 2009

• Billing for an Ambulance Transport with More than One Patient Onboard (CR6621)

September

24 September 2009

• Medicare Administrative Contractor (MAC) Transition and Outbound Health Insurance Portability and Accountability Act (HIPAA) Transactions (CR6599)
• 2009 - 2010 Seasonal Influenza (Flu) Resources for Health Care Professionals (SE0926)
• Implementation of Health Insurance Portability and Accountability Act of 1996 (HIPAA) version 5010 for Transaction 835 - Health Care Claim Payment/Advice (CR6589)
• Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy Print (MREP) Update (CR6604)
• Revised: Wrong Surgical or Other Invasive Procedure Performed on a Patient; Surgery or Other Invasive Procedure Performed on the Wrong Body Part; and Surgical or Other Invasive Procedure Performed on the Wrong Patient (CR6405)

17 September 2009

• Announcing the Release of the Revised CMS-855 Medicare Enrollment Applications (SE0924)
• Revised: Medicare Fee-for-Services (MFFS) Billing for the Administration of the Influenza A (H1N1) Virus Vaccine (SE0920)
• Influenza Pandemic Emergency -- The Medicare Program Prepares (SE0836). Note: The Centers for Medicare & Medicaid Services rescinded this article on September 11, 2009.
• Visit Requirements Clarification for CR 5931 “Manualization of Payment for Outpatient ESRD Related Services” (SE0921)
• Revised: Expansion of the Current Scope of Editing for Ordering/Referring Providers for claims processed by Medicare Carriers and Part B Medicare Administrative Contractors (MACs) (CR6417)
• Revised: Claims Submitted for Items or Services Furnished to Medicare Beneficiaries in State or Local Custody under a Penal Authority and Examples of Application of Government Entity Exclusion (CR6544)

10 September 2009

• Claims Submitted for Items or Services Furnished to Medicare Beneficiaries in State or Local Custody under a Penal Authority and Examples of Application of Government Entity Exclusion (CR6544)
• 2010 Annual Update of HCPCS Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) for the Common Working File (CWF), A/B MACs, Medicare Carriers and Fiscal Intermediaries (FIs) (CR6619)
• Screening Computed Tomography Colonography (CTC) for Colorectal Cancer (CR6578)
• Implementation of the Health Insurance Portability and Accountability Act (HIPAA) Version 5010 Only in Jurisdiction 10 and Jurisdiction 14 Parts A and B (A/B) Medicare Administrative Contractors (MACs) (CR6595)
• Revised - October Update to the 2009 Medicare Physician Fee Schedule Database (MPFSDB) (CR6617)

3 September 2009

• Healthcare Provider Taxonomy Codes
  
  Healthcare Provider Taxonomy Codes (HPTC) have been updated and are scheduled to be implemented with the October 2009 Release. The HPTC list is available from the Washington Publishing Company (WPC) http://www.wpc-edi.com/codes/taxonomy in two forms. The first form is a free Adobe PDF download. The second form, available for purchase, is an electronic representation of the code set that facilitates automatic loading.
  Reference: CR6598
  http://www.cms.hhs.gov/transmittals/downloads/R1794CP.pdf
  
• Change Request 6617 will be implemented on October 5, 2009 with an effective date of January 1, 2009. Any disclosure information will be published on our Fee Schedule pages as soon as available.
• Value of Family History under the Initial Preventive Physical Exam (IPPE) Benefit (SE0918)
• Revised: Medicare Parts A and B Coverage and Prior Authorization (SE0916)
• October Update to the 2009 Medicare Physician Fee Schedule Database (MPFSDB) (CR6617)
• Ambulatory Surgical Center Payment Indicator (ASCPI) File Error; and Reiteration of Centers for Medicare & Medicaid Services (CMS) Policy Regarding Beneficiary Liability for V2787 and V2788 (CR6630)
• Addition/Deletion of HCPCS Codes – October 2009 Quarterly Update (CR6594)
• October 2009 Update to the Ambulatory Surgical Center (ASC) Payment System; Summary of Payment Policy Changes and Manual Update (CR6629)
• Claim Status Category Code and Claim Status Code Update (CR6609)
• Billing for the Administration of the Influenza A (H1N1) Virus Vaccine (SE0920)
• Compliance Standards for Consignment Closets and Stock and Bill Arrangements -Transmittal 300, sent via RO-6462 dated September 1, 2009 is rescinded. The Centers for Medicare & Medicaid Services (CMS) is rescinding this Change Request to consider other implementation options. (CR6528) (02/11/2009)
• Rescinded: Fractional Mileage Amounts Submitted on Ambulance Claims (CR6543)
• H1N1 Code Effective Date Change
  
  JSM/TDL-09415
  
  (Removed 02/04/2010)

August

27 August 2009

• New Waived Tests (CR6570)
• Revised: Surgery for Diabetes National Coverage Determination (NCD) (CR6419)

20 August 2009

• Diabetes Self-Management Training (DSMT) Certified Diabetic Educator (CR6510)
• Compliance Standards for Consignment Closets and Stock and Bill Arrangements -Transmittal 300, sent via RO-6462 dated September 1, 2009 is rescinded. The Centers for Medicare & Medicaid Services (CMS) is rescinding this Change Request to consider other implementation options. (CR6528) (02/11/2009)
• 2010 Annual Update for the Health Professional Shortage Area (HPSA) Bonus Payments (CR6581)
• Reporting Non-Tax Withholding Due to Federal Payment Levy Program (FPLP) (CR6228)
• Additional Instructions on Processing Claims for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Items Submitted Under the Guidelines Established in Change Request (CR) 5917. (CR6573)
• October 2009 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files (CR6585)
• Clinical Laboratory Fee Schedule – Medicare Travel Allowance Fees for Collection of Specimens (CR6524)
• Revised: Medicare Claims Processing Manual Clarifications for Skilled Nursing Facility (SNF) and Therapy Billing (CR6407)
• Program Instructions Designating the Competitive Bidding Areas and Product Categories Included in the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program Round One Rebid in Calendar Year (CY) 2009 (CR6571)
  
  

13 August 2009

• The Use of the CR Modifier and DR Condition Code on Disaster/Emergency-Related Claims (CR6451)
• Revised: Appropriate Use of Modifier 50 and Add-On Codes for Facet Joint Injections Services (CR6518)
• Marketing the Upcoming Health Insurance Portability and Accountability Act Version 5010 Conference Call to Billing Software Vendors and Clearinghouses
  
  JSM/TDL-09385
  
  The Centers for Medicare & Medicaid Services (CMS) will present the second in a series of National Education Training Conference Calls focused on Medicare’s Fee-for-Service (FFS) implementation of Health Insurance Portability and Accountability Act (HIPAA) Version 5010. The training presentation, geared to clearinghouses and billing software vendors, will cover Medicare FFS error handling transactions (TA1, 999, and 277CA), planned use of each transaction and applicable rules and exceptions for the Medicare FFS program. A Question & Answer (Q&A) session will follow the presentation that will give participants an opportunity to ask questions of CMS’ subject matter experts.
  
  Due to the nature of the content, only clearinghouse and billing software vendor staff are encouraged to participate in this important CMS training conference call.
  
  You must register for this call in advance, in order to receive the call-in information.
  
  Please note if your organization is planning to participate in this training call as a group, only one person needs to register to receive the call-in information. This registration is solely to reserve a telephone line, NOT to allow participation.
  
  Date: August 26, 2009
  Conference Title: Version 5010: Medicare FFS Error Handling Transactions
  Time: 2:00 – 3:30 p.m. ET
  
  Registration will close at 2:00 p.m. ET on August 25, 2009, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
  
  1. To register for the call, participants need to go to http://www2.eventsvc.com/palmettogba/082609.
  2. Fill in all required data.
  3. Verify your time zone is displayed correctly the drop down box.
  4. Click "Register".
  5. You will be taken to the “Thank you for registering” page and will receive a confirmation e-mail shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation e-mail, please check your spam/junk mail filter as it may have been directed there.
  6. A few days prior to the call (not before August 24th), check the Educational Resources page on CMS’ 5010 Web page at http://www.cms.hhs.gov/Versions5010andD0/40_Educational_Resources.asp to obtain a copy of the presentation that will be used during the call.
  

6 August 2009

• Telehealth Services in Indian Health Service (IHS) or Tribal Providers (CR6493)
• 2009 Durable Medical Equipment Prosthetics, Orthotics, and Supply (DMEPOS) Healthcare Common Procedure Coding System (HCPCS) Codes Jurisdiction List (CR6522)
• Rescinded: Fractional Mileage Amounts Submitted on Ambulance Claims (CR6543)
• Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 15.3, Effective October 1, 2009 (CR6587)
• Guidance on Using Internet-based Provider Enrollment, Chain and Ownership System (PECOS) (SE0914)

July

30 July 2009

• 2009 Reminder for Roster Billing and Centralized Billing for Influenza and Pneumococcal Vaccinations (CR6539)
• Revised: Smoking and Tobacco Use Cessation Counseling Billing Code Update to Medicare (CR5878)
• Revised: Wrong Surgical or Other Invasive Procedure Performed on a Patient; Surgery or Other Invasive Procedure Performed on the Wrong Body Part; and Surgical or Other Invasive Procedure Performed on the Wrong Patient (CR6405)
• Rescinded: Manual Update to Include Billing Instructions for Professional Component (PC) and Technical Component (TC) in Regards to One Line Global Billing for Pathology Services. (CR6457)
• Quarterly Provider Update (QPU) - Reminder
  (IOM Pub 100-09-Chapter 6 Section 50.2.4.3)
  
  The Quarterly Provider Update (QPU) is a listing of the regulations and program instructions issued by CMS that impact Medicare providers. The QPU is maintained by CMS and available to providers through the CMS Web site.
  Providers may elect to join a CMS electronic mailing list, to be notified periodically, of additions to the QPU. CMS publishes this Update at the beginning of each quarter to inform the public about the following:
  • Regulations and major policies currently under development during this quarter.
  • Regulations and major policies completed or cancelled.
  • New/Revised manual instructions
  The page may be found at: http://www.cms.hhs.gov/QuarterlyProviderUpdates/
  Visit the QPU What’s New page at
  http://www.cms.hhs.gov/QuarterlyProviderUpdates/03_WhatsNew.asp

23 July 2009

• Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) (CR6520)
• Sleep Testing for Obstructive Sleep Apnea (OSA) (CR6534)
• Changes to the Laboratory National Coverage Determination (NCD) Edit Software for October 2009 (CR6548)

16 July 2009

• Revised: ESRD: Placement of a List of Diagnostic Tests that are Considered End Stage Renal Disease (ESRD) Related in Publication 100-04, Chapter 16 (CR6515)
• Take Action Now to Prepare for the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (SE0915)
• Coding and Reporting Principles for the Physician Quality Reporting Initiative (PQRI) and the Electronic Prescribing (E-Prescribing) Incentive Programs (CR6514)

9 July 2009

• Claim Status Category Code and Claim Status Code Update (CR6525)
• Clarification for Billing Part B versus Part D for the Anti-emetic Aprepitant (Emend®) (SE0910)

2 July 2009

• Revisions to Certain Items in CMS Change Request 6310 (CR6491)
• Revised: Billing Routine Costs of Clinical Trials (CR6431)
• Expansion of the Current Scope of Editing for Ordering/Referring Providers for claims processed by Medicare Carriers and Part B Medicare Administrative Contractors (MACs) (Revised CR6417)
• Claim Status Category Code and Claim Status Code Update (CR6325)
• Expiration of Medicare Processing of Certain Indian Health Service (IHS) Part B Claims - Sunset of Section 630 of the Medicare Modernization Act (MMA) of 2003 for Payment of Indian Health Services (IHS) (SE0912)
• Wrong Surgical or Other Invasive Procedure Performed on a Patient; Surgery or Other Invasive Procedure Performed on the Wrong Body Part; and Surgical or Other Invasive Procedure Performed on the Wrong Patient (CR6405)
• Review of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) (CR6468)

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03/11/2010