medicare bulletin - april 2015 15 kentucky & ohio part b ... claim submission ... 81400 f13b,...

Reaching Out to the Medicare

Community

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BMedicare BulletinJurisdiction 15

APRIL 2015 • WWW.CGSMEDICARE.COM

© 2015 Copyright, CGS Administrators, LLC.

www.cgsmedicare.com

Medicare BulletinJurisdiction 15

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Bold, italicized material is excerpted from the American Medical Association Current Procedural Terminology CPT codes. Descriptions and other data only are copyrighted 2009 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.

MEDICARE BULLETIN • GR 2015-04 APRIL 2015 2

Articles contained in this edition are current as of February 28, 2015.

KENTUCKY ONLY

CGS - J15 Part B: 2015 Travel Allowance Fees 3

OHIO ONLY

CGS - J15 Part B: 2015 Travel Allowance Fees 3

KENTUCKY & OHIO

AdministrationQuarterly Provider Update 6Stay Informed and Join the CGS ListServ Notification Service 7MM8993: Healthcare Provider Taxonomy Codes (HPTC s) April 2015 Code Set Update 31

Credentialing & EnrollmentMM9011: Incorporation of Revalidation Policies into Pub. 100-08, “Program Integrity Manual (PIM),” Chapter 15 37

Coverage, LCDs, & NCDsSolesta™ Treatment for Fecal Incontinence 3Fecal Microbiota Transfer 7Clinical Questions and Requests: Whom to Contact at CGS 8MM8954: Percutaneous Image-guided Lumbar Decompression (PILD) for Lumbar Spinal Stenosis (LSS ) 16

ICD-10MM8867: International Classification of Diseases, Tenth Revision (ICD -10) Limited End to End Testing with Submitters for 2015 10MM8583 Revised: International Classification of Diseases, Tenth Revision (ICD -10) Limited End to End Testing with Submitters for 2015 15SE1408 Revised: Medicare Fee-For-Service (FFS) Claims Processing Guidance for Implementing International Classification of Diseases, 10th Edition (ICD -10) – A Re-Issue of MM 7492 28

Fee Schedules & ReimbursementBundled, Inactive, and Non-Payable Codes for 2014: Medicare Physician Fee Schedule Database 12MM9084: April 2015 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files 19MM8999 Revised: Calendar Year (CY ) 2015 Update for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DME POS) Fee Schedule 33

Laboratory & PathologyMolecular Diagnostic Tests (MDTs) Article Updates 4Molecular Pathology (MoPath): 2015 MoPath Tier 2 Reimbursement 5MM9035: Healthcare Common Procedure Coding System (HC PCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) Edits 20MM9066 Revised: Clinical Laboratory Fee Schedule – Medicare Travel Allowance Fees for Collection of Specimens 26

NEWS FLASH

News Flash Items 38

http://go.cms.gov/MLNGenInfo

http://go.cms.gov/MLNGenInfo

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This newsletter should be shared with all health care practitioners and managerial members of the provider/supplier staff. Newsletters issued after January 1997 are available at no cost from our website at http://www.cgsmedicare.com. © 2015 Copyright, CGS Administrators, LLC.

MEDICARE BULLETIN • GR 2015-04 APRIL 2015

RETURN TO TABLE OF CONTENTS

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Kentucky Only

CGS - J15 Part B: 2015 Travel Allowance Fees

Procedure Code Fee Amount Effective DateP9603 1.03 01/01/2015P9604 10.30 01/01/2015

Ohio Only

CGS - J15 Part B: 2015 Travel Allowance Fees

Procedure Code Fee Amount Effective DateP9603 1.03 01/01/2015P9604 10.30 01/01/2015

Kentucky & Ohio

Solesta™ Treatment for Fecal Incontinence

CGS considers Solesta™ as medically appropriate for the FDA-approved indication of fecal incontinence when all of the following criteria are met:

yy Patient is 18 years or older;

yy Has a documented history of fecal incontinence for at least 12 months;

yy Documentation supports the patient has tried and failed conservative therapy (e.g., diet, fiber, anti-motility medications);

yy Documentation supports ≥4 fecal incontinence episodes over a 14-day period; and

yy The beneficiary does NOT have any of the following conditions:

y� Active inflammatory bowel disease;

y� Immunodeficiency disorders or ongoing immunosuppressive therapy;

y� Previous radiation treatment to the pelvic area;

y� Significant mucosal or full thickness rectal prolapse;

y� Active anorectal conditions including: abscess, fissures, sepsis, bleeding, proctitis, or other infections;

y� Anorectal atresia, tumors, stenosis or malformation;

y� Rectocele;

y� Rectal varices;

y� Presence of existing implant (other than Solesta) in anorectal region;

y� Allergy to hyaluronic acid based products (e.g., Synvisc, Synvisc-One, Hyalgan, Supartz, Euflexxa, Orthovisc);

y� Grade IV hemorrhoids; and

y� History of anorectal surgery within the previous 12 months.

Other uses of Solesta™ will be considered investigational and will be denied accordingly.

Frequency

If coverage criteria are met, CGS will allow the services based on the FDA-recommended dose of 4 sub-mucosal injections for an initial treatment and 4 sub mucosal injections for

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repeat therapy no less than 4 weeks after the initial treatment. Treatment exceeding the FDA recommendations will be denied.

Claim Submission

yy Submit charges for the drug Solesta™ (dextromer/hyaluronic acid copolymer implant) with HCPCS code L8605 (Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, anal canal, 1 ml, includes shipping and necessary supplied).

yy For dates of service prior to 1/1/2015, submit charges for the sub-mucosal injection using CPT code 46999 (unlisted procedure, anus). For dates of service on or after 1/1/2015, submit CPT code 0377T (Anoscopy with directed submucosal injection of bulking agent for fecal incontinence, using products such as NASHA/Dx (Solesta®)). As with all other anoscopy services, this code is reported only once per session.

Orders and Signatures

Please note that all services ordered or rendered to Medicare beneficiaries must be signed. While orders for diagnostic tests do not have to be signed, either the order must have a signature or the intent to order the specific test must be clearly documented in the medical record, and that must be signed. One or the other must be signed.

Guidelines regarding signature requirements are located in the CMS Medicare Program Integrity Manual (Pub. 100-08), chapter 3, section 3.3.2.4, (http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/pim83c03.pdf) “Signature Requirements.” Information is also available in CMS MLN Matters article MM6698 (http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM6698.pdf), “Signature Requirements for Medical Review Purposes.”

Kentucky & Ohio

Molecular Diagnostic Tests (MDTs) Article Updates

Several changes have been made to the coverage articles below, primarily to the correct codes for reporting these services. In most cases, the articles were updated to refer to unlisted CPT code 81479 (unlisted molecular procedure) instead of CPT code 84999 (unlisted chemistry procedure). There are a few tests that have a specific CPT code for dates of service on or after 10/1/2014, instead of the unlisted CPT code. All articles are housed in the Centers for Medicare & Medicaid Services (CMS) Medicare Coverage Database:

yy Kentucky: http://www.cms.gov/medicare-coverage-database/search/search-results.aspx?SearchType=Advanced&CoverageSelection=Local&ArticleType=Ed&s=22&DateTag=C&kq=true&bc=IAAAAAAAAAAAAA%3d%3d&

yy Ohio: http://www.cms.gov/medicare-coverage-database/search/search-results.aspx?SearchType=Advanced&CoverageSelection=Local&ArticleType=Ed&s=42&DateTag=C&kq=true&bc=IAAAAAAAAAAAAA%3d%3d&

yy Tip: search by document ID, such as “A53191”

A53191 MoPath: Afirma™ Assay by Veracyte Update-as of 10/01/2014 use CPT code 81479 instead of CPT code 84999

A53194 MoPath: bioTheranostics Cancer TYPE ID® Update- as of 10/01/2014 use CPT code 81479 instead of CPT code 84999

A53612 MoPath: ThxID™ BRAF V600/K Test Coding and Billing Guidelines-as of 10/01/2014 use CPT code 81210 instead of CPT code 84999

A53195 MoPath: cobas® 4800 BRAF V600 Test Billing/Coding Guidelines- as of 10/01/2014 use CPT code 81210 instead of CPT code 84999

A53205 MoPath: Vectra™ DA Coding and Billing Guidelines- as of 10/01/2014 use CPT code 81479 instead of CPT code 84999


http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/pim83c03.pdf

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/pim83c03.pdf

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM6698.pdf



http://www.cms.gov/medicare-coverage-database/search/search-results.aspx?SearchType=Advanced&CoverageSelection=Local&ArticleType=Ed&s=22&DateTag=C&kq=true&bc=IAAAAAAAAAAAAA%3d%3d&






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A53204 MoPath:therascreen® KRAS PCR Kit Billing/Coding Guidelines-use CPT code 81275 as of 10/01/2014 instead of CPT code 84999

A53197 MoPath: Corus® CAD Test Coding and Billing Guidelines - as of 10/01/2014 use CPT 81479 instead of CPT code 84999

A53198 MoPath: HERmark® Assay by Monogram Update - as of 10/01/2014 use CPT code 81479 instead of CPT code 84999

A53200 MoPath: Oncotype DX® Breast Cancer Assay Billing and Coding Guidelines –use CPT code 81519 as of 01/01/2015 instead of CPT code 84999

A53201 MoPath: Oncotype DX® Colon Cancer Coding and Billing Guidelines -as of 10/01/2014 use CPT code 81479 instead of CPT code 84999

A53202 MoPath: Progensa® PCA3 Assay Coverage Update - as of 10/01/2014 use CPT code 81479 instead of CPT code 84999

A53248 MoPath: ResponseDX Tissue of Origin® Test-use CPT code 81504 as of 01/01/2015 instead of CPT code 84999

Kentucky & Ohio

Molecular Pathology (MoPath): 2015 MoPath Tier 2 Reimbursement

As per Change Request (CR) 8517, CMS released the 2015 clinical laboratory fee schedule for tests reported with Tier 1 CPT codes. The following table includes the fees established for Tier 2 covered tests. Please note that the table is sorted by CPT code and then in alphabetical order per gene. For Tier 2 codes, multiple genes are listed under a single code. The required identifier assigned and submitted with each test enables CGS to apply the appropriate fee for the specific test performed.

Important: Before you submit claims for molecular pathology tests, reference the “Descriptor” (column 2, in the following table). This column lists key components needed to adjudicate the claim. To submit claims for MoPath services, enter the appropriate descriptor as follows:

yy Electronic claims: Loop 2400, NTE02, or SV101-7 field

yy Paper claims: Item 19

Claims submitted without the required descriptor information will be “returned as unprocessable” (rejected) (remark code MA130). These claims cannot be appealed; correct the claims to include required information and resubmit as new claims.

HCPCS Descriptor Allowed81400 ACE, idv $82.5881400 F13B, V34L $64.2581400 F2, 1199G>A $70.2081400 F5, HR2 $58.8481400 F7, R353Q $64.5281400 FGB, -455G>A $70.2081400 HPA, antigen ea $46.4681400 IL28B, rs12979860 $55.2381400 SERPINE1, 4G $58.8481401 ABL1, T315I $153.0181401 CBFB_MYH11, cv $138.8281401 CCND1_IGH, ta majbp qual qual $93.9481401 E2A_PBX1, ta qual quan, $105.3081401 EML4_ALK, ta $128.48


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HCPCS Descriptor Allowed81401 ETV6_RUNX1, ta qual quan $90.3181401 EWSR1_ERG, ta qual quan $151.4281401 EWSR1_FLI1, ta qual quan $162.8581401 EWSR1_WT1, ta qual quan $203.8481401 F11, cv $75.8881401 FIP1L1_PDGFR, qual quan $90.8281401 FOXO1_PAX3, ta, qual quan $120.7581401 FOXO1_PAX7, ta, qual quan $120.7581401 MUTYH, cv $105.8181401 PAX8_PPARG, ta $54.1981401 RUNX1_RUNX1T1, ta qual quan $106.0581401 TPMT, cv $111.6181401 TYMS $169.1081401 VWF, cv $278.1881402 IGH_BCL2, majbpr_mcrbp qul_qun $123.3681402 KIT, cv $98.1381403 ABL1 $156.8981403 CEBPA, fgs $235.5481403 EPCAM, kfv $93.9481403 F8, intron 1 and 22a $81.0581403 IDH1, exon 4 $67.7081403 IDH1_ IDH2, exon 4 panel $135.4081403 IDH2, exon 4 $67.7081403 JAK2, exon 12 and 13 $109.1481403 RET, kfv $93.9481403 VHL, dup_del $83.6081403 VWF, tsa 2A, 2B, 2M $300.0381404 CDKN2A, fgs $373.1481404 KIT, tga $213.4781404 NRAS, exon 1, 2 $148.0481404 PDGFRA, tsa $111.4481404 PRSS1, fgs $248.7681404 RET, cv $94.9781404 VHL, fgs $639.9681405 MEN1, fgs $426.3281405 RET, tsa $379.4781405 VWF, tsa 2N $278.1881406 RET, fgs $384.51

Kentucky & Ohio

Quarterly Provider Update

The Quarterly Provider Update is a comprehensive resource published by the Centers for Medicare & Medicaid Services (CMS) on the first business day of each quarter. It is a listing of all nonregulatory changes to Medicare including transmittals, manual changes, and any other instructions that could affect providers. Regulations and instructions published in the previous quarter are also included in the update. The purpose of the Quarterly Provider Update is to:

yy Inform providers about new developments in the Medicare program;


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yy Assist providers in understanding CMS programs and complying with Medicare regulations and instructions;

yy Ensure that providers have time to react and prepare for new requirements;

yy Announce new or changing Medicare requirements on a predictable schedule; and

yy Communicate the specific days that CMS business will be published in the Federal Register.

To receive notification when regulations and program instructions are added throughout the quarter, go to https://www.cms.gov/Regulations-and-Guidance/Regulations-and-Policies/QuarterlyProviderUpdates/CMS-Quarterly-Provider-Updates-Email-Updates.html to sign up for the Quarterly Provider Update (electronic mailing list).

We encourage you to bookmark the Quarterly Provider Update website at https://www.cms.gov/Regulations-and-Guidance/Regulations-and-Policies/QuarterlyProviderUpdates/index.html and visit it often for this valuable information.

If you have any questions, please contact a CGS Customer Service Representative by calling the CGS Provider Contact Center at 1.866.276.9558 and choose Option 1.

Kentucky & Ohio

Stay Informed and Join the CGS ListServ Notification Service

The CGS ListServ Notification Service is the primary means used by CGS to communicate with Medicare providers. This is a free email notification service that provides you with prompt notification of Medicare news including policy, benefits, claims submission, claims processing and educational events. Subscribing for this service means that you will receive information as soon as it is available, and plays a critical role in ensuring you are up-do-date on all Medicare information.

Consider the following benefits to joining the CGS ListServ Notification Service:

yy It’s free! There is no cost to subscribe or to receive information.

yy You only need a valid e-mail address to subscribe.

yy Multiple people/e-mail addresses from your facility can subscribe. We recommend that all staff (clinical, billing, and administrative) who interact with Medicare topics register individually. This will help to facilitate the internal distribution of critical information and eliminates delay in getting the necessary information to the proper staff members.

To subscribe to the CGS ListServ Notification Service, go to http://www.cgsmedicare.com/medicare_dynamic/ls/001.asp and complete the required information.

Kentucky & Ohio

Fecal Microbiota Transfer

CGS has received inquiries into the coverage of fecal microbiota transfer (FMT) for the treatment of Clostridium difficile infection (CDI). After review of current literature, CGS has determined the following:

Effective for dates of service BEFORE January 1, 2015:

FMT is a non-covered service at this time as a statutorily excluded service. Any other services performed that are related to the FMT procedure will also be denied as non-covered, including but not limited to anoscopy and donor specimen.


https://www.cms.gov/Regulations-and-Guidance/Regulations-and-Policies/QuarterlyProviderUpdates/CMS-Quarterly-Provider-Updates-Email-Updates.html

https://www.cms.gov/Regulations-and-Guidance/Regulations-and-Policies/QuarterlyProviderUpdates/CMS-Quarterly-Provider-Updates-Email-Updates.html

https://www.cms.gov/Regulations-and-Guidance/Regulations-and-Policies/QuarterlyProviderUpdates/index.html

https://www.cms.gov/Regulations-and-Guidance/Regulations-and-Policies/QuarterlyProviderUpdates/index.html

http://www.cgsmedicare.com/medicare_dynamic/ls/001.asp

http://www.cgsmedicare.com/medicare_dynamic/ls/001.asp

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Health care providers are not required to submit claims to Medicare for statutorily non-covered services; however, you may choose to submit claims (e.g., at the patient’s request). Claims for FMT must include:

yy CPT code 44799

yy HCPCS modifier GY (statutorily non-covered service)

yy The appropriate ICD-9-CM code(s)

yy The name of the test, “FMT”

y� Electronic Claims: Loop 2400, NTE02, or SV101-7 field

y� Paper Claims: Block 19

Effective for dates of service ON or AFTER January 1, 2015:

Fecal bacteriotherapy or fecal microbiota transplant (FMT) may be considered medically necessary as a treatment for recurrent or relapsing Clostridium difficile infection (CDI) as indicated by a positive C. difficile toxin stool test and defined as one of the following:

yy At least 3 episodes of mild to moderate CDI and failure of a 6-8 week taper with vancomycin with or without an alternative antibiotic (e.g., rifaximin, nitazoxanide), or

yy At least two episodes of severe CDI resulting in hospitalization and associated significant morbidity, or

yy Moderate CDI not responding to standard therapy (vancomycin) for at least a week, or

yy Severe fulminant C. difficile colitis with no response to standard therapy after 48 hours.

CGS considers FMT investigational for any other indication (e.g., Crohn’s disease or inflammatory bowel disease, irritable bowel syndrome, and intestinal dysbiosis).

Claims for FMT must include:

yy The appropriate ICD-9 code. At this time, ICD-9 code 008.45 (intestinal infections due to clostridium difficile) is the only diagnosis code that will be considered for coverage; all other indications for these procedures will be denied as investigational.

yy HCPCS code G0455 (Preparation with instillation of fecal microbiota by any method, including assessment of donor specimen)

Reference:

yy Definition of “reasonable and medically necessary”: Social Security Act, section 1862(a)(1)(A) (http://www.ssa.gov/OP_Home/ssact/title18/1862.htm#title-bar)

yy Exception to mandatory claim submission for “statutorily excluded services”: CMS MLN Matters article SE0908, “Mandatory Claims Submission and Its Enforcement” (http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE0908.pdf)

Kentucky & Ohio

Clinical Questions and Requests: Whom to Contact at CGS

1. [email protected]: This email was created to assist Medicare providers with clinical questions. For the timeliest response, we recommend that you email this address rather than an email directly to the Medical Directors. The CMD.Inquiry mailbox is monitored regularly, whereas our Medical Directors travel frequently and may not be in a position to view their email as often.

- Please allow 14 business days for a response


http://www.ssa.gov/OP_Home/ssact/title18/1862.htm#title-bar

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE0908.pdf



mailto:[email protected]

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MEDICARE LEARNING NETWORK®: A Valuable Educational Resource!

2. When requesting clinical coverage of a drug or service, we ask that the information be faxed directly to our policy team at 1.615.664.5971. Include the following information with your request:

a. Name of requestor

b. Address, phone, fax, and Email address

c. Brief summary of request

d. Supporting Documentation

> If this documentation is to large to fax please mail to: Attention: Part B Medical Review Attn: Tracey Loftis, RN Two Vantage Way Nashville, TN 37228

Please allow 45 days for a response

3. All other inquiries must be sent to Customer Service for tracking/routing:

a. Part A Contact information:

> http://www.cgsmedicare.com/parta/cs/contact_info.html

> Provider Contact Center: 1.866.289.6501

b. Part B Contact Information:

> http://www.cgsmedicare.com/partb/cs/index.html

> Provider Contact Center: 1.866.276.9558

c. Home Health & Hospice Contact Information:

> http://www.cgsmedicare.com/hhh/cs/telephone_numbers.html

> Home Health and Hospice Complex Inquiries: 1.877.299.4500

d. DME MAC Jurisdiction C Contact Information:

> http://www.cgsmedicare.com/jc/cs/contactinfo.html

> Provider Customer Service Calls: 1.866.270.4909

The Medicare Learning Network® (MLN), offered by

the Centers for Medicare & Medicaid Services (CMS), includes a variety of

educational resources for health care providers. Access Web-based training courses, national provider conference calls, materials from past conference calls,

MLN articles, and much more. To stay informed about all of the CMS MLN products, refer to http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-

MLN/MLNProducts/Downloads/MailingLists_FactSheet.pdf and subscribe to the CMS electronic mailing lists.

Learn more about what the CMS MLN offers at http://www.cms.gov/Outreach-and-Education/

Medicare-Learning-Network-MLN/MLNGenInfo/index.html on the

CMS website.


http://www.cgsmedicare.com/parta/cs/contact_info.html

http://www.cgsmedicare.com/partb/cs/index.html

http://www.cgsmedicare.com/hhh/cs/telephone_numbers.html

http://www.cgsmedicare.com/jc/cs/contactinfo.html

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/MailingLists_FactSheet.pdf




http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNGenInfo/index.html



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Kentucky & Ohio

MM8867: International Classification of Diseases, Tenth Revision (ICD-10) Limited End to End Testing with Submitters for 2015

The Centers for Medicare & Medicaid Services (CMS) has issued the following Medicare Learning Network® (MLN) Matters article. This MLN Matters article and other CMS articles can be found on the CMS website at: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/2015-MLN-Matters-Articles.html

MLN Matters® Number: MM8867Related CR Release Date: January 20, 2015Related CR Transmittal #: R1451OTNRelated Change Request (CR) #: CR 8867 Effective Date: September 12, 2014 - for MACs and CEDI (non-systems change requirements) (Note: This is the due date of the first MAC and CEDI requirement); January 26, 2015 - for FISS and CEDI coding for January Testing Week; April 27, 2015 - for FISS and CEDI coding for April Testing Week; July 20, 2015 - for FISS and CEDI coding for July Testing Week.

Implementation Date: January 5, 2015 - for FISS and CEDI coding for January Testing Week; February 16, 2015 - for MAC requirements for the January 15 testing. This is the due date of the last MAC deliverable.; April 6, 2015 - for FISS and CEDI coding for April Testing Week; May 18, 2015 - for MAC requirements for the April 15 testing. This is the due date of the last MAC deliverable.; July 6, 2015 - for FISS and CEDI coding for July Testing Week; August 10, 2015 - for MAC requirements for the July 15 testing. This is the due date of the last MAC deliverable.

Provider Types Affected

This MLN Matters® Article is intended for providers and clearinghouses wishing to submit test claims with ICD-10 codes to Medicare Administrative Contractors (MACs).

What You Need to Know

Change Request (CR) 8867 directs MACs to test with a limited number of providers and clearinghouses to ensure claims with ICD-10 codes can be processed from submission to remittance. This additional testing effort will help ensure a successful transition to ICD-10.

The Centers for Medicare & Medicaid Services (CMS) defines successful end-to-end testing as being able to demonstrate that:

yy Testing entities are able to successfully submit ICD-10 claims to the shared systems,

yy Software changes made to support ICD-10 result in appropriately adjudicated claims based on the pricing data employed for testing purposes; and

yy Remittance advices are produced.

Make sure your billing staffs are aware of this update.

Background

The International Classification of Disease, Tenth Revision, (ICD-10) must be implemented by October 1, 2015. While system changes to implement this project have been completed and tested in previous releases, the industry has requested the opportunity to test with CMS.

CR8867 will allow a small subset of submitters to test with MACs and the Common Electronic Data Interchanges (CEDIs) in three testing periods to demonstrate to the industry that CMS systems are ready for the ICD-10 implementation. MACs and CEDI shall conduct three limited End-to-End testing weeks with a small subset of submitters.

To facilitate this testing, CR8867 requires MACs to do the following:

yy Conduct limited end-to-end testing with submitters in three testing periods; January 2015, April 2015 and July 2015. Test claims will be submitted January 26 – 30, 2015, April 27 – May 1, 2015, and July 20 – 24, 2015.


http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/2015-MLN-Matters-Articles.html

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/2015-MLN-Matters-Articles.html

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yy Each MAC (and CEDI with assistance from DME MACs) will select 50 submitters for each MAC Jurisdiction supported to participate in the end-to-end testing. The Railroad Retirement Board (RRB) contractor will also select 50 submitters. Testers will be selected randomly from a list of volunteers. At least five, but not more than fifteen of the testers will be a clearinghouse, and submitters should be a mix of provider types.

yy MACs and CEDIs will post a volunteer form to their website to collect volunteer information with which to select volunteers.

y� Form verifies testers are ready to test, meet the requirements to test, and collect data about the tester. (How they submit claims, what types of claims they will submit, and so forth.)

y� MACs and CEDIs will post the form to their website by March 13, 2015, for the July 2015 testing.

y� Volunteers must submit completed forms to the MACs and CEDIs by April 17, 2015, for the July 2015 testing.

yy By May 8, 2015, for the July 2015 testing, the MACs and CEDIs (for the DME MACs) will notify the volunteers that they have been selected to test and provide them with the information needed for the testing, such as:

y� How to submit test claims (for example, what test indicators should be set);

y� What dates of service may be used for testing;

y� How many claims may be submitted for testing (Test claims volume is limited to a total of 50 claims for the entire testing week, submitted in no more than three files);

y� Request for National Provider Identifiers (NPIs) and Health Insurance Claim Numbers (HICNs) that will be used in testing (no more than five NPIs and 10 HICNs per submitter);

y� Notice that if more than 50 claims are submitted, they may not be processed;

y� Notice that claims submitted with NPIs or HICNs not previously submitted for testing, likely will not be completed; and

y� Notice of potential Protected Health Information (PHI) on test remittances not submitted (and instructions to report PHI found to the MAC).

yy MACs and CEDIs (for the DME MACs) will collect information from the testers after they have been notified of their selection, using a form provided by CMS. This form will specifically request the Health Insurance Claim Numbers (HICNs), Provider Transaction Access Number (PTANs), and National Provider Identifiers (NPIs) the tester will use during testing. Testers shall submit these forms back to the MAC/CEDI by February 20, 2015, for the April 2015 testing, and by May 29, 2015, for the July 2015 testing. Notification will warn testers that if forms are not received timely, they may lose their opportunity to test.

yy Testers selected in the January 2015 Testing may participate in the April 2015 testing, and may submit an additional 50 test claims using the same HICNs and NPIs provided previously. MACs shall send a reminder to the January 2015 testers of this option 30 days prior to the start of the April 2015 testing, using language provided by CMS.

yy Testers selected in the January 2015 and April 2015 Testing may participate in the July 2015 testing, and may submit an additional 50 test claims using the same HICNs and NPIs provided previously. MACs shall send a reminder to the January 2015 and April 2015 testers of this option 30 days prior to the start of the July 2015 testing, using language provided by CMS.

yy MACs and CEDI will work with the testers selected to ensure they are prepared to test, and understand the requirements for testing.


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yy MACs and CEDI will instruct the testers to submit up to a total of 50 test claims during the testing period. This may be submitted in one to three files, but the total number of test claims cannot exceed 50.

yy CEDI will instruct suppliers to submit claims with ICD-10 code with Dates of Service October 1, 2015, through October 15, 2015. They may also submit claims with ICD-9 codes with Dates of Service before October 1, 2015.

y� MACs will instruct testers to submit test claims with ICD-10 code with Dates of Service on or after October 1, 2015. They may also submit test claims with ICD-9 codes with Dates of Service before October 1, 2015.

y� MACs and CEDIs will be prepared to support increased call volume from testers during the testing window, and up to 2 weeks following the receipt of the ERAs from testing.

y� MACs and CEDIs will provide information to the testers on who to contact for testing questions. This may be separate contacts for front end questions and remittance questions.

y� MACs and CEDIs will post an announcement about the testing to their websites. The announcement will be provided by CMS.

Additional Information

The official instruction, CR8867 issued to your MAC regarding this change is available at http://www.cms.hhs.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1451OTN.pdf on the CMS website.

You may also want to review MLN Matters® Article SE1409, which discusses ICD-10 testing. That article is available at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1409.pdf on the CMS website.

If you have any questions, please contact your MAC at their toll-free number. That number, as well as your MAC’s website address, is available at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/index.html under - How Does It Work.

Kentucky & Ohio

Bundled, Inactive, and Non-Payable Codes for 2014: Medicare Physician Fee Schedule Database

The Centers for Medicare & Medicaid Services (CMS) designates the status of HCPCS and CPT codes in the Medicare Physician Fee Schedule Database (MPFSDB). The status of codes may be updated periodically throughout the year and when the calendar year changes. Codes designated as Status A are active codes, are separately payable under the Medicare Physician Fee Schedule (assuming any existing coverage criteria are met), and have associated Relative Value Units (RVUs) and payment amounts. The list of Status A codes is extensive, and these codes are not listed in this publication.

yy Status B codes are bundled. Payment for these services is always included in payment for other services not specified. There are no RVUs or payment amounts for these codes, and separate payment is not made.

yy Status C codes are priced by each contractor. CGS establishes RVUs and payment amounts for these services, generally on an individual basis, based on review of documentation (such as operative reports).

yy Status E codes are excluded from the MPFS by regulation. There are no RVUs or payment amounts for these codes, and separate payment is not made.


http://www.cms.hhs.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1451OTN.pdf

http://www.cms.hhs.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1451OTN.pdf

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1409.pdf


http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/index.html


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yy Status I codes are not valid for Medicare purposes. Medicare uses another CPT or HCPCS code for reporting these services.

yy Status J codes are anesthesia services. Reimbursement for anesthesia services is based on the anesthesia fee schedule (not the Medicare Physician Fee Schedule), and there are no RVUs or payments contained in the MPFSDB for these services.

yy Status M codes are measurement codes and are used for reporting purposes only. There are no RVUs or payment amounts for these codes, which include Quality Data Codes (QDCs) associated with the Physician Quality Reporting System.

yy Status N codes are always non-covered. There are no RVUs or payment amounts for these codes, and separate payment is not made.

yy Status P codes are bundled/excluded codes. There are no RVUs or payment amounts for these codes, and separate payment is not made.

yy Status Q codes are therapy functional reporting codes. There are no RVUs or payment amounts for these codes, and separate payment is not made.

yy Status R codes have restricted coverage, and special instructions may apply. Refer to the CMS National Coverage Determinations (NCDs) and the CGS website and LCDs for more information.

yy Status T codes are only paid separately if there are no other physician services payable under the MPFS billed on the same date of service by the same provider. If any other services payable under the MPFS are billed on the same date of service by the same provider, these services are bundled into payment for the physician service.

yy Status X codes are statutorily excluded from coverage under the physician fee schedule. These codes represent items or services that are not included in the statutory definition of “physician services” for fee schedule purposes. There are no RVUs or payment amounts for these codes, and separate payment is not made under the physician fee schedule. Status X codes may be payable under a different fee schedule; this list includes codes that are payable under the ambulance fee schedule and clinical laboratory fee schedule.

Status B codes are bundled. Payment for these services is always included in payment for other services not specified. There are no RVUs or payment amounts for these codes, and separate payment is not made.

Table of Status B Codes for 2014

Status C codes are priced by each contractor. CGS establishes RVUs and payment amounts for these services, generally on an individual basis, based on review of documentation (such as operative reports).

Table of Status C Codes for 2014

Status E codes are excluded from the MPFS by regulation. There are no RVUs or payment amounts for these codes, and separate payment is not made.

Table of Status E Codes for 2014

Status I codes are not valid for Medicare purposes. Medicare uses another CPT or HCPCS code for reporting these services.

Table of Status I Codes for 2014

Status J codes are anesthesia services. Reimbursement for anesthesia services is based on the anesthesia fee schedule (not the Medicare Physician Fee Schedule), and there are no RVUs or payments contained in the MPFSDB for these services


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Table of Status J Codes for 2014

Status M codes are measurement codes and are used for reporting purposes only. There are no RVUs or payment amounts for these codes, which include claims-based reporting codes for therapy services and Quality Data Codes (QDCs) associated with the Physician Quality Reporting System.

Table of Status M Codes for 2014

Status N codes are always non-covered. There are no RVUs or payment amounts for these codes, and separate payment is not made.

Table of Status N Codes for 2014

Status P codes are bundled/excluded codes. There are no RVUs or payment amounts for these codes, and separate payment is not made.

Table of Status P Codes for 2014

Status Q codes are codes are therapy functional reporting codes. There are no RVUs or payment amounts for these codes, and separate payment is not made.

Table of Status Q Codes for 2014

Status R codes have restricted coverage, and special instructions may apply. Refer to the CMS National Coverage Determinations (NCDs) and the CGS website and LCDs for more information.

Table of Status R Codes for 2014

Status T codes are only paid separately if there are no other physician services payable under the MPFS billed on the same date of service by the same provider. If any other services payable under the MPFS are billed on the same date of service by the same provider, these services are bundled into payment for the physician service.

Table of Status T Codes for 2014

Status X codes are statutorily excluded from coverage under the physician fee schedule. These codes represent items or services that are not included in the statutory definition of “physician services” for fee schedule purposes. There are no RVUs or payment amounts for these codes, and separate payment is not made under the physician fee schedule. Status X codes may be payable under a different fee schedule; this list includes codes that are payable under the ambulance fee schedule and clinical laboratory fee schedule.

Table of Status X Codes for 2014

CPT Code Modifier CPT Code Modifier CPT Code Modifier HCPCS Code Modifier Status15850 92944 99090 A4262 B20930 93740 99091 A426320936 93770 99100 A427022841 94005 99116 A430036000 94150 99135 A455036416 94150 26 99140 G026938204 94150 TC 99288 Q303190885 96040 99339 R007690887 96902 9934090889 97010 9935892352 97602 9935992353 98960 9936392354 98961 99364


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CPT Code Modifier CPT Code Modifier CPT Code Modifier HCPCS Code Modifier Status92355 98962 9936692358 99000 9936792371 99001 9936892531 99002 9937492532 99024 9937792533 99050 9937992534 99051 9938092605 99053 9944692606 99056 9944792618 99058 9944892921 99060 9944992925 99070 9948592929 99071 9948692934 99078 9948792938 99080 99489

Kentucky & Ohio

MM8583 Revised: International Classification of Diseases, Tenth Revision (ICD-10) Limited End to End Testing with Submitters for 2015

The Centers for Medicare & Medicaid Services (CMS) has revised the following Medicare Learning Network® (MLN) Matters article. This MLN Matters article and other CMS articles can be found on the CMS website at: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/2015-MLN-Matters-Articles.html

MLN Matters® Number: MM8583 RevisedRelated CR Release Date: February 4, 2015Related CR Transmittal #: R567PI

Related Change Request (CR) #: CR 8583 Effective Date: April 1, 2015Implementation Date: April 6, 2015

Note: This article was revised on February 9, 2015, to reflect the revised CR8583 issued on February 4. In the article, the CR release date, transmittal number, and the Web address for accessing the CR are revised. All other information remains the same.


This MLN Matters® Article is intended for physicians, providers and suppliers submitting claims to Medicare Administrative Contractors (MACs), including Durable Medical Equipment (DME) MACs, for services to Medicare beneficiaries.


This article is based on Change Request (CR) 8583, which instructs MACs and Zone Program Integrity Contractors (ZPICs) to produce pre-payment review Additional Documentation Requests (ADRs) that state that providers and suppliers have 45 days to respond to an ADR issued by a MAC or a ZPIC. Failure to respond within 45 days of a pre-payment review ADR will result in denial of the claim(s) related to the ADR. Make sure your billing staffs are aware of these changes.

Background

In certain circumstances, CMS review contractors (MACs, ZPICs, Recovery Auditors, the Comprehensive Error Rate Testing contractor and the Supplemental Medical Review Contractor) may not be able to make a determination on a claim they have chosen for review


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based upon the information on the claim, its attachments or the billing history found in claims processing system (if applicable) or Medicare’s Common Working File (CWF).

In those instances, the CMS review contractor will solicit documentation from the provider or supplier by issuing an ADR. The requirements for additional documentation are as follows:

yy The Social Security Act, Section 1833(e) - Medicare contractors are authorized to collect medical documentation. The Act states that no payment shall be made to any provider or other person for services unless they have furnished such information as may be necessary in order to determine the amounts due to such provider or other person for the period with respect to which the amounts are being paid or for any prior period.

yy According to the “Medicare Program Integrity Manual,” Chapter 3, Section 3.2.3.2, (Verifying Potential Errors and Tracking Corrective Actions),when requesting documentation for pre-payment review, the MAC and ZPIC shall notify providers that the requested documentation is to be submitted within 45 calendar days of the request. The reviewer should not grant extensions to the providers who need more time to comply with the request. Reviewers shall deny claims for which the requested documentation was not received by day 46.


The official instruction, CR 8583, issued to your MAC regarding this change, is available at http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R567PI.pdf on the Centers for Medicare & Medicaid Services (CMS) website.

If you have any questions, please contact your MAC at their toll-free number. That number is available at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/index.html under - How Does It Work.

Kentucky & Ohio

MM8954: Percutaneous Image-guided Lumbar Decompression (PILD) for Lumbar Spinal Stenosis (LSS)


MLN Matters® Number: MM8954Related CR Release Date: January 30, 2015Related CR Transmittal #: R3175CPRelated Change Request (CR) #: CR 8954

Effective Date: January 1, 2015Implementation Date: March 2, for local system edits; July 6, 2015 for Medicare Shared System edits


This MLN Matters® Article is intended for physicians, other providers, and suppliers who submit claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.


Change Request (CR) 8954 is a follow-up to CR8757, Transmittal 2959 and Transmittal 167 (Percutaneous Image-guided Lumbar Decompression (PILD) for Lumbar Spinal Stenosis (LSS)). CR8757 was effective on January 9, 2014, and provided for percutaneous image-guided decompression (PILD) when provided in a clinical study through Coverage with Evidence Development (CED) for beneficiaries with LSS.


http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R567PI.pdf



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Background

CR8954 provides additional direction specifically for PILD, procedure code G0276, when performed in a randomized, blinded clinical trial ONLY, for claims with dates of service on or after January 1, 2015. Healthcare Common Procedure Coding System (HCPCS) G0276 - Blinded procedure for lumbar stenosis, percutaneous image-guided lumbar decompression (PILD), or placebo control, performed in an approved coverage with evidence development (CED) clinical trial, is to be used only when the CED PILD trial is blinded, randomized, and controlled and contains a placebo procedure control arm. It appears in the January 2015 updates of the Medicare Physician Fee Schedule Database and the Integrated Outpatient Code Editor (IOCE).

Payment for HCPCS G0276 under the hospital Outpatient Prospective Payment System (OPPS) is available in the latest OPPS Addendum B at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Addendum-A-and-Addendum-B-Updates.html on the Centers for Medicare & Medicaid Services (CMS) website.

ALL PILD for LSS claims with dates of service December 31, 2014, and earlier, should be processed with procedure code 0275T ONLY and are not subject to reprocessing regardless of the type of trial in which the services were rendered.

Note: Beginning with PILD for LSS claims with dates of service on and after January 1, 2015, there are 2 distinct procedure codes that are to be used: G0276 for clinical trials that are blinded, randomized, and controlled, and contain a placebo procedure control arm (use this CR 8954 for claims processing instructions), and 0275T for all other clinical trials (use CR 8757 for claims processing instructions).

CR 8954 does not replace but rather is in addition to CR 8757. The MLN Matters® article related to CR8757 is available at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8757.pdf on the CMS website.

Medicare will accept HCPCS code G0276 for PILD for LSS claims received with dates of service on and after January 1, 2015, when those services are provided in a blinded, randomized, controlled trial with a placebo procedure control arm under CED only.

Billing Requirements

Claims for PILD for LSS with dates of service on and after January 1, 2015, will be accepted when billed in a place of service (POS) 22 (outpatient) or 24 (ambulatory surgical center), using HCPCS G0276, along with:

yy ICD-9 diagnosis range 724.01-724.03, or,

yy ICD-10 diagnosis range M48.05-M48.07 (when ICD-10 is implemented)

Only when billed with:

yy Diagnosis code ICD-9 V70.7 (ICD-10 Z00.6) (once ICD-10 is implemented) either in the primary/secondary positions;

yy Modifier -Q0; and

yy An 8-digit clinical trial identifier number listed on the CMS CED website.

Medicare will return claims for PILD for LSS claims, HCPCS G0276, as unprocessable when billed with a diagnosis code other than 724.01-724.03 (ICD-9), or, M48.05-M48.07 (ICD-10) (when ICD-10 is implemented) using:

yy Claim Adjustment Reason Code (CARC) B22: “This payment is adjusted based on the diagnosis.”

yy Remittance Advice Remark Code (RARC) N704: “Alert: You may not appeal this decision but can resubmit this claim/service with corrected information if warranted.”

yy Group Code-Contractual Obligation (CO).


http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Addendum-A-and-Addendum-B-Updates.html

http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Addendum-A-and-Addendum-B-Updates.html



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Medicare will return PILD for LSS claims, HCPCS G0276, as unprocessable when billed in a POS other than 22 or 24 using:

yy CARC 58: “Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service.”

yy RARC N704: “Alert: You may not appeal this decision but can resubmit this claim/service with corrected information if warranted.”

yy Group Code- CO.

Medicare will return PILD for LSS claims, HCPCS G0276, as unprocessable if they do not contain the required clinical trial diagnosis code V70.7 (ICD-9) or Z00.6 (ICD-10) (once ICD-10 is implemented) in either the primary/secondary positions with the following:

yy CARC B22: “This payment is adjusted based on the diagnosis.”

yy RARC M76: “Missing/incomplete/invalid diagnosis or condition”


yy Group Code- CO.

Medicare will return PILD for LSS claims, HCPCS G0276, as unprocessable when billed without a -Q0 modifier with the following:

yy CARC 4: “The procedure code is inconsistent with the modifier used or a required modifier is missing.”

yy RARC N657: “This should be billed with the appropriate code for these services.”


yy Group Code – CO.

Also, remember that you must submit the numeric, 8-digit clinical trial identifier number in the electronic 837P in Loop 2300 REF02 (REF01=P4) or preceded by “CT” when placed in Field 19 of paper claim form CMS-1500. This requirement is further discussed in MLN Matters® Article MM8401 available at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8401.pdf on the CMS website.

For hospital outpatient procedures on type of bill (TOB) 13X or 85X, on or after January 1, 2015, Medicare will allow payment for PILD for LSS, HCPCS G0276, along with:

yy ICD-9 diagnosis range 724.01-724.03; or,

yy ICD-10 diagnosis range M48.05-M48.07 (once ICD-10 is implemented)

Only when billed with:

yy Diagnosis code ICD-9 V70.7 (ICD-10 Z00.6) (once ICD-10 is implemented) and condition code 30 either in the primary/secondary positions;

yy Modifier -Q0; and

yy An 8-digit clinical trial identifier number listed on the CMS CED website.

For hospital outpatient procedures on TOB 13X or 85X, on or after January 1, 2015, MACs will line-level deny claims for PILD for LSS, HCPCS G0276, along with:

yy ICD-9 diagnosis range 724.01-724.03; or,

yy ICD-10 diagnosis range M48.05-M48.07 (once ICD-10 is implemented);

When billed without diagnosis code ICD-9 V70.7 (ICD-10 Z00.6) (once ICD-10 is implemented) and condition code 30 either in the primary/secondary positions, Modifier -Q0, or an 8-digit clinical trial identifier number listed on the CMS CED website, with the following:




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yy CARC: 50 - These are non-covered services because this is not deemed a “medical necessity” by the payer.

yy RARC N386 - This decision was based on a National Coverage Determination (NCD). An NCD provides a coverage determination as to whether a particular item or service is covered. A copy of this policy is available at http://www.cms.hhs.gov/mcd/search.asp. If you do not have Web access, you may contact the contractor to request a copy of the NCD.

yy Group Code –CO.


You can review the list of approved clinical studies related to PILD for LSS at http://www.cms.gov/Medicare/Coverage/Coverage-with-Evidence-Development/PILD.html on the CMS website.

The official instruction, CR 8954 issued to your MAC regarding this change may be viewed at http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3175CP.pdf on the CMS website.

If you have questions, please contact your MAC at their toll-free number. The number is available at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/index.html under - How Does It Work?

Kentucky & Ohio

MM9084: April 2015 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files


MLN Matters® Number: MM9084Related CR Release Date: January 30, 2015Related CR Transmittal #: R3180CP

Related Change Request (CR) #: CR 9084Effective Date: April 1, 2015Implementation Date: April 6, 2015


This MLN Matters® Article is intended for physicians, providers, and suppliers submitting claims to Medicare Administrative Contractors (MACs), including Home Health & Hospice MACs and Durable Medical Equipment MACs for services provided to Medicare beneficiaries.

Provider Action Needed

Change Request (CR) 9084 informs Medicare MACs to download and implement the April 2015 ASP drug pricing files and, if released by the Centers for Medicare & Medicaid Services (CMS), the January 2015, October 2014, July 2014, and April 2014, ASP drug pricing files for Medicare Part B drugs.

Medicare will use these files to determine the payment limit for claims for separately payable Medicare Part B drugs processed or reprocessed on or after April 6, 2015, with dates of service April 1, 2015, through June 30, 2015. MACs will not search and adjust claims that have already been processed unless you bring such claims to their attention. Make sure that your billing staffs are aware of these changes.


http://www.cms.hhs.gov/mcd/search.asp

http://www.cms.gov/Medicare/Coverage/Coverage-with-Evidence-Development/PILD.html

http://www.cms.gov/Medicare/Coverage/Coverage-with-Evidence-Development/PILD.html

http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3175CP.pdf




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Background

The Medicare Modernization Act of 2003 (MMA; Section 303(c)) revised the payment methodology for Part B covered drugs and biologicals that are not priced on a cost or prospective payment basis.

The Average Sales Price (ASP) methodology is based on quarterly data submitted to CMS by manufacturers. CMS will supply Medicare contractors with the ASP and Not Otherwise Classified (NOC) drug pricing files for Medicare Part B drugs on a quarterly basis. Payment allowance limits under the OPPS are incorporated into the Outpatient Code Editor (OCE) through separate instructions that can be located in the “Medicare Claims Processing Manual” (Chapter 4 (Part B Hospital (Including Inpatient Hospital Part B and OPPS)), Section 50 (Outpatient PRICER); see http://www.cms.gov/manuals/downloads/clm104c04.pdf on the CMS website.)

The following table shows how the quarterly payment files will be applied:

Files Effective Dates of ServiceApril 2015 ASP and ASP NOC April 1, 2015, through June 30, 2015January 2015 ASP and ASP NOC January 1, 2015, through March 31, 2015October 2014 ASP and ASP NOC October 1, 2014, through December 31, 2014July 2014 ASP and ASP NOC July 1, 2014, through September 30, 2014April 2014 ASP and ASP NOC April 1, 2014, through June 30, 2014

Note: The absence or presence of a Healthcare Common Procedure Coding System (HCPCS) code and its associated payment limit does not indicate Medicare coverage of the drug or biological. Similarly, the inclusion of a payment limit within a specific column does not indicate Medicare coverage of the drug in that specific category. The local MAC processing the claim shall make these determinations.


The official instruction, CR 9084 issued to your MAC regarding this change is available at http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3180CP.pdf on the CMS website.


Kentucky & Ohio

MM9035: Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) Edits


MLN Matters® Number: MM9035Related CR Release Date: January 30, 2015Related CR Transmittal #: R3182CP

Related Change Request (CR) #: CR 9035Effective Date: January 1, 2015Implementation Date: April 6, 2015


This MLN Matters® Article is intended for clinical diagnostic laboratories submitting claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.


http://www.cms.gov/manuals/downloads/clm104c04.pdf





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Change Request (CR) 9035 informs MACs about the HCPCS codes for 2015 that are both subject to and excluded from CLIA edits. CR 9035 also includes the HCPCS codes discontinued as of December 31, 2014.

Make sure that your billing staffs are aware of these CLIA-related changes for 2015 and that you remain current with CLIA certification requirements.

Background

CLIA regulations require a facility to be appropriately certified for each test performed. To ensure that the Centers for Medicare & Medicaid Services (CMS) only pay for laboratory tests performed in certified facilities, each claim for a HCPCS code that is considered a CLIA laboratory test is currently edited at the CLIA certificate level.

The HCPCS codes that are considered a laboratory test under CLIA change each year, and your Medicare contractors need to be informed about the new HCPCS codes that are both subject to CLIA edits and excluded from CLIA edits.

Discontinued HCPCS Codes

The HCPCS codes listed in Table 1 below were discontinued on December 31, 2014.

Table 1: HCPCS Codes Discontinued on December 31, 2014HCPCS Code DescriptorG0417 Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any

method, 21-40 specimensG0418 Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any

method, 41-60 specimensG0419 Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any

method, >60 specimens80100 Drug screen, multiple drugs80101 Drug screen80102 Drug confirmation test80103 Tissue preparation for drug analysis80104 Drug screen, multiple drugs80152 Amitriptyline (antidepressant) level80154 Benzodiazepines level80160 Desipramine level80166 Assay of doxepin80172 Gold level80174 Imipramine level80182 Nortriptyline level80196 Salicylate (aspirin) level80440 Thyrotropin releasing hormone (TRH) (hypothalamus hormone) stimulation panel82000 Acetaldehyde blood test82003 Acetaminophen level82055 Alcohol (ethanol) level82101 Urine alkaloids level82145 Amphetamine or methamphetamine level82205 Barbiturates level82520 Cocaine (drug) level82646 Dihydrocodeinone (drug) measurement82649 Dihydromorphinone (drug) level82651 Dihydrotestosterone (DHT) level82654 Dimethadione (drug) level


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Table 1: HCPCS Codes Discontinued on December 31, 2014HCPCS Code Descriptor82666 Epiandrosterone (synthetic hormone) level82690 Ethchlorvynol (drug) level82742 Flurazepam (drug) level82953 Glucose (sugar) tolerance test82975 Glutamine (amino acid by product) level82980 Glutethimide (drug) level83008 Guanosine monophosphate (cellular chemical) level83055 Sulfhemoglobin (hemoglobin) analysis83071 Hemosiderin (hemoglobin breakdown product) level83634 Urine lactose (carbohydrate) analysis83805 Meprobamate (sedative) level83840 Methadone level83858 Methsuximide (drug) level83866 Mucopolysaccharides (protein) screening test83887 Nicotine level83925 Opiates (drug) measurement84022 Phenothiazine (drug) level84127 Stool porphyrins (metabolism substance) analysis87001 Animal inoculation, small animal with observation87620 Detection test for human papillomavirus (HPV)87621 Detection test for human papillomavirus (HPV)87622 Detection test for human papillomavirus (HPV)88343 Immunohistochemistry or immunocytochemistry, each separately identifiable antibody per

block, cytologic preparation, or hematologic smear each additional separately identifiable antibody per slide (list separately in addition to code for primary procedure)

88349 Assessment using electron microscopy

New HCPCS Codes for 2015

The HCPCS codes listed in Table 2 below are new for 2015 and are subject to CLIA edits. The list does not include new HCPCS codes for waived tests or provider-performed procedures. The HCPCS codes listed in Table 2 require a facility to have either a:

1. CLIA certificate of registration (certificate type code 9);

2. CLIA certificate of compliance (certificate type code 1); or

3. CLIA certificate of accreditation (certificate type code 3).

The following facilities are not permitted to be paid for these tests:

1. A facility without a valid, current, CLIA certificate;

2. A facility with a current CLIA certificate of waiver (certificate type code 2); or

3. A facility with a current CLIA certificate for provider-performed microscopy procedures (certificate type code 4).

Note: The HCPCS code 89337 [Frozen preservation of mature eggs] is new for 2015, is excluded from CLIA edits and does not require a facility to have any CLIA certificate.

Table 2: New HCPCS Codes Subject to CLIA Edits for 2015Note: Does not include new HCPCS codes for waived tests or provider-performed procedures.HCPCS Code DescriptorG0464 Colorectal cancer screening; stool-based dna and fecal occult hemoglobin (e.g., kras, ndrg4 and bmp3)G6030 Amitriptyline


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Table 2: New HCPCS Codes Subject to CLIA Edits for 2015Note: Does not include new HCPCS codes for waived tests or provider-performed procedures.HCPCS Code DescriptorG6031 BenzodiazepinesG6032 DesipramineG6034 DoxepinG6035 GoldG6036 Assay of imipramineG6037 NortriptylineG6038 SalicylateG6039 AcetaminophenG6040 Alcohol (ethanol) any specimen except breathG6041 Alkaloids, urine, quantitativeG6042 Amphetamine or methamphetamineG6043 Barbiturates, not elsewhere specifiedG6044 Cocaine or metaboliteG6045 DihydrocodeinoneG6046 DihydromorphinoneG6047 DihydrotestosteroneG6048 DimethadioneG6049 EpiandrosteroneG6050 EthchlorvynolG6051 FlurazepamG6052 MeprobamateG6053 MethadoneG6054 MethsuximideG6055 NicotineG6056 Opiate(s), drug and metabolites, each procedureG6057 PhenothiazineG6058 Drug confirmation, each procedure80163 Digoxin level80165 Valproic acid level80300 Drug screen80301 Drug screen80302 Drug screen80303 Drug screen80304 Drug screen80320 Alcohols levels80321 Alcohols levels80322 Alcohols levels80323 Alkaloids levels80324 Amphetamines levels80325 Amphetamines levels80326 Amphetamines levels80327 Anabolic steroids levels80328 Anabolic steroids levels80329 Analgesics levels80330 Analgesics levels80331 Analgesics levels80332 Antidepressants levels


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Table 2: New HCPCS Codes Subject to CLIA Edits for 2015Note: Does not include new HCPCS codes for waived tests or provider-performed procedures.HCPCS Code Descriptor80333 Antidepressants levels80334 Antidepressants levels80335 Antidepressants levels80336 Antidepressants levels80337 Antidepressants levels80338 Antidepressants levels80339 Antiepileptics levels80340 Antiepileptics levels80341 Antiepileptics levels80342 Antipsychotics levels80343 Antipsychotics levels80344 Antipsychotics levels80345 Barbiturates levels80346 Benzodiazepines levels80347 Benzodiazepines levels80348 Buprenorphine level80349 Cannabinoids levels80350 Cannabinoids levels80351 Cannabinoids levels80352 Cannabinoids levels80353 Cocaine level80354 Fentanyl level80355 Gabapentin level nonblood80356 Heroin metabolite level80357 Ketamine and norketamine levels80358 Methadone level80359 Methylenedioxyamphetamines levels80360 Methylphenidate level80361 Opiates levels80362 Opioids levels80363 Opioids levels80364 Opioids levels80365 Oxycodone levels80366 Pregabalin level80367 Propoxyphene level80368 Sedative hypnotics (nonbenzodiazepines) levels80369 Skeletal muscle relaxants levels80370 Skeletal muscle relaxants levels80372 Tapentadol level80373 Tramadol level80374 Stereoisomer (enantiomer) drug analysis80375 Drugs or substances measurement80376 Drugs or substances measurement80377 Drugs or substances measurement81246 Test for detecting genes associated with blood cancer81288 Test for detecting genes associated with colon cancer81313 Test for detecting genes associated with prostate cancer


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Table 2: New HCPCS Codes Subject to CLIA Edits for 2015Note: Does not include new HCPCS codes for waived tests or provider-performed procedures.HCPCS Code Descriptor81410 Test for detecting genes associated with heart disease81411 Test for detecting genes associated with heart disease81415 Test for detecting genes associated with diseases81416 Test for detecting genes associated with disease81417 Reevaluation test for detecting genes associated with disease81420 Test for detecting genes associated with fetal disease81425 Test for detecting genes associated with disease81426 Test for detecting genes associated with disease81427 Reevaluation test for detecting genes associated with disease81430 Test for detecting genes causing hearing loss81431 Test for detecting genes causing hearing loss81435 Test for detecting genes associated with colon cancer81436 Test for detecting genes associated with colon cancer81440 Test for detecting genes associated with cancer of body organ81445 Test for detecting genes associated with cancer of body organ81450 Test for detecting genes associated with blood related cancer81455 Test for detecting genes associated with cancer81460 Test for detecting genes associated with disease81465 Test for detecting genes associated with disease81470 Test for detecting genes associated with intellectual disability81471 Test for detecting genes associated with intellectual disability81519 Test for detecting genes associated with breast cancer87505 Detection test for digestive tract pathogen;87506 Detection test for digestive tract pathogen;87507 Detection test for digestive tract pathogen83006 Test for detecting genes associated with growth stimulation87623 Detection test for human papillomavirus (hpv)87624 Detection test for human papillomavirus (hpv)87625 Detection test for human papillomavirus (hpv)87806 Detection test for HIV188341 Special stained specimen slides to examine tissue88344 Special stained specimen slides to examine tissue88364 Cell examination88366 Cell examination88369 Microscopic genetic examination manual88373 Microscopic genetic examination using computerassisted technology88374 Microscopic genetic examination using computerassisted technology88377 Microscopic genetic examination manual.

On November 19, 2014, CMS released CR 8871 which mentioned that effective for services performed on or after June 2, 2014, the new HCPCS G0472, HCV screening, will be recognized as a covered service. G0472 is a code that:

yy Is considered a test under CLIA;

yy Is subject to CLIA edits; and

yy Would require a facility to have either:

y� A CLIA certificate of registration (certificate type code 9),

y� A CLIA certificate of compliance (certificate type code 1), or


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y� A CLIA certificate of accreditation (certificate type code 3).

You may want to review the related MLN Matters® Article for CR 8871 at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM8871.pdf on the CMS website.


The official instruction, CR 9035, issued to your MAC regarding this change may be viewed at http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3182CP.pdf on the CMS website.


Kentucky & Ohio

MM9066 Revised: Clinical Laboratory Fee Schedule – Medicare Travel Allowance Fees for Collection of Specimens


MLN Matters® Number: MM9066 RevisedRelated CR Release Date: February 5, 2015Related CR Transmittal #: R3189CPRelated Change Request (CR) #: CR 9066

Effective Date: January 1, 2015Implementation Date: As soon as possible, but not later than April 24, 2015

Note: This article was revised on February 13, 2015, to reflect a revised CR9066 that was issued on February 5. The CR release date, transmittal number, implementation date, and the Web address for accessing the CR are revised. All other information remains the same.


This MLN Matters® Article is intended for physicians, other providers, and suppliers submitting claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.


Change Request (CR) 9066 informs MACs about the revisions to the payment of travel allowances when billed on a per mileage basis using Health Care Common Procedure Coding System (HCPCS) Code P9603 and when billed on a flat rate basis using HCPCS Code P9604 for Calendar Year (CY) 2015. These changes are also made to Chapter 16, Section 60.2 of the “Medicare Claims Processing Manual.” Make sure that your billing staffs are aware of these changes.

Background

CR9066 revises the payment of travel allowances when billed on a per mileage basis using HCPCS Code P9603 and when billed on a flat rate basis using HCPCS Code P9604 for CY 2015. Medicare Part B, allows payment for a specimen collection fee and travel allowance, when medically necessary, for a laboratory technician to draw a specimen from either a nursing home patient or homebound patient under Section 1833(h)(3) of the Social Security Act. Payment for these services is made based on the clinical laboratory fee schedule.


http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM8871.pdf







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Travel Allowance

Payment of the travel allowance is made only if a specimen collection fee is also payable. The travel allowance is intended to cover the estimated travel costs of collecting a specimen including the laboratory technician’s salary and travel expenses. MACs have the discretion to choose either a mileage basis or a flat rate, and how to set each type of allowance. Many MACs established local policy to pay based on a flat rate basis only.

Under either method, when one trip is made for multiple specimen collections (for example, at a nursing home), the travel payment component is prorated based on the number of specimens collected on that trip, for both Medicare and non-Medicare patients, either at the time the claim is submitted by the laboratory or when the flat rate is set by the MAC.

Per Mile Travel Allowance (P9603)

The per mile travel allowance is to be used in situations where the average trip to the patients’ homes is longer than 20 miles round trip, and is to be prorated in situations where specimens are drawn from non-Medicare patients in the same trip.

The allowance per mile was computed using the Federal mileage rate of $0.575 per mile plus an additional $0.45 per mile to cover the technician’s time and travel costs. MACs have the option of establishing a higher per mile rate in excess of the minimum $1.03 per mile if local conditions warrant it (actual total of $1.025 rounded up to reflect systems capabilities). Medicare reviews and updates the minimum mileage rate throughout the year, as well as in conjunction with the Clinical Laboratory Fee Schedule (CLFS), as needed. At no time may a laboratory bill for more miles than are reasonable, or for miles that are not actually traveled by the laboratory technician.

Per Flat-Rate Trip Basis Travel Allowance (P9604)

The per flat-rate trip basis travel allowance is $10.30.


The Internal Revenue Service (IRS) determines the standard mileage rate for businesses based on periodic studies of the fixed and variable costs of operating an automobile.

The official instruction, CR9066 issued to your MAC regarding this change is available at http://www.cms.hhs.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3189CP.pdf on the Centers for Medicare & Medicaid Services (CMS) website.

If you have questions please contact your MAC at their toll-free number. The number is available at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/index.html under - How Does It Work?


http://www.cms.hhs.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3189CP.pdf

http://www.cms.hhs.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3189CP.pdf



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Kentucky & Ohio

SE1408 Revised: Medicare Fee-For-Service (FFS) Claims Processing Guidance for Implementing International Classification of Diseases, 10th Edition (ICD-10) – A Re-Issue of MM7492

The Centers for Medicare & Medicaid Services (CMS) has revised the following Special Edititon Medicare Learning Network® (MLN) Matters article. This MLN Matters article and other CMS articles can be found on the CMS website at: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/2015-MLN-Matters-Articles.html

MLN Matters® Number: SE1408 RevisedRelated CR Release Date: N/ARelated CR Transmittal #: N/A

Related Change Request (CR) #: 7492Effective Date: October 1, 2014Implementation Date: N/A

Note: This article was revised on February 20, 2015, to add a question and answer at the bottom of page 2 regarding dual processing of ICD-9 and ICD-10 codes. All other information remains the same.


This article is intended for all physicians, providers, and suppliers submitting claims to Medicare Administrative Contractors (MACs), including Home Health & Hospice MACs (HH&H MACs), and Durable Medical Equipment MACs (DME MACs)) for services provided to Medicare beneficiaries.


For dates of service on and after October 1, 2015, entities covered under the Health Insurance Portability and Accountability Act (HIPAA) are required to use the ICD-10 code sets in standard transactions adopted under HIPAA. The HIPAA standard health care claim transactions are among those for which ICD-10 codes must be used for dates of service on and after October 1, 2015. As a result of CR7492 (and related MLN Matters® Article MM7492), guidance was provided on processing certain claims for dates of service near the original October 1, 2013, implementation date for ICD-10. This article updates MM7492 to reflect the October 1, 2015, implementation date. Make sure your billing and coding staffs are aware of these changes.

Key Points of SE1408

As with ICD-9 codes today, providers and suppliers are still required to report all characters of a valid ICD-10 code on claims. ICD-10 diagnosis codes have different rules regarding specificity and providers/suppliers are required to submit the most specific diagnosis codes based upon the information that is available at the time. Please refer to http://www.cms.gov/Medicare/Coding/ICD10/index.html for more information on the format of ICD-10 codes. In addition, ICD-10 Procedure Codes (PCs) will only be utilized by inpatient hospital claims as is currently the case with ICD-9 procedure codes.

General Reporting of ICD-10

As with ICD-9 codes today, providers and suppliers are still required to report all characters of a valid ICD-10 code on claims. ICD-10 diagnosis codes have different rules regarding specificity and providers/suppliers are required to submit the most specific diagnosis codes based upon the information that is available at the time. Please refer to

General Claims Submissions Information

ICD-9 codes will no longer be accepted on claims (including electronic and paper) with FROM dates of service (on professional and supplier claims) or dates of discharge/through dates (on institutional claims) on or after October 1, 2015. Institutional claims containing ICD-9 codes


http://www.cms.gov/Medicare/Coding/ICD10/index.html

http://www.cms.gov/Medicare/Coding/ICD10/index.html

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for services on or after October 1, 2015, will be Returned to Provider (RTP) as unprocessable. Likewise, professional and supplier claims containing ICD-9 codes for dates of services on or after October 1, 2015, will also be returned as unprocessable. You will be required to re-submit these claims with the appropriate ICD-10 code. A claim cannot contain both ICD-9 codes and ICD-10 codes. Medicare will RTP all claims that are billed with both ICD-9 and ICD-10 diagnosis codes on the same claim. For dates of service prior to October 1, 2015, submit claims with the appropriate ICD-9 diagnosis code. For dates of service on or after October 1, 2015, submit with the appropriate ICD-10 diagnosis code. Likewise, Medicare will also RTP all claims that are billed with both ICD-9 and ICD-10 procedure codes on the same claim. For claims with dates of service prior to October 1, 2015, submit with the appropriate ICD-9 procedure code. For claims with dates of service on or after October 1, 2015, submit with the appropriate ICD-10 procedure code. Remember that ICD-10 codes may only be used for services provided on or after October 1, 2015. Institutional claims containing ICD-10 codes for services prior to October 1, 2015, will be Returned to Provider (RTP). Likewise, professional and supplier claims containing ICD-10 codes for services prior to October 1, 2015, will be returned as unprocessable. Please submit these claims with the appropriate ICD-9 code.

Will the Centers for Medicare & Medicaid Services (CMS) allow for dual processing of ICD-9 and ICD-10 codes (accept and process both ICD-9 and ICD-10 codes for dates of service on and after October 1, 2015)?

No, CMS will not allow for dual processing of ICD-9 and ICD-10 codes after ICD-10 implementation on October 1, 2015. Many providers and payers, including Medicare have already coded their systems to only allow ICD-10 codes beginning October 1, 2015. The scope of systems changes and testing needed to allow for dual processing would require significant resources and could not be accomplished by the October 1, 2015, implementation date. Should CMS allow for dual processing, it would force all entities with which we share data, including our trading partners, to also allow for dual processing. In addition, having a mix of ICD-9 and ICD-10 codes in the same year would have major ramifications for CMS quality, demonstration, and risk adjustment programs.

Claims that Span the ICD-10 Implementation Date

CMS has identified potential claims processing issues for institutional, professional, and supplier claims that span the implementation date; that is, where ICD-9 codes are effective for the portion of the services that were rendered on September 30, 2015, and earlier and where ICD-10 codes are effective for the portion of the services that were rendered October 1, 2015, and later. In some cases, depending upon the policies associated with those services, there cannot be a break in service or time (i.e., anesthesia) although the new ICD-10 code set must be used effective October 1, 2015. The following tables provide further guidance to providers for claims that span the periods where ICD-9 and ICD-10 codes may both be applicable.

Table A – Institutional ProvidersBill Type(s) Facility Type/Services Claims Processing Requirement

Use FROM or THROUGH Date

11X Inpatient Hospitals (incl. TERFHA hospitals, Prospective Payment System (PPS) hospitals, Long Term Care Hospitals (LTCHs), Critical Access Hospitals (CAHs)

If the hospital claim has a discharge and/or through date on or after 10/1/15, then the entire claim is billed using ICD-10.

THROUGH

12X Inpatient Part B Hospital Services

Split Claims - Require providers split the claim so all ICD-9 codes remain on one claim with Dates of Service (DOS) through 9/30/2015 and all ICD-10 codes placed on the other claim with DOS beginning 10/1/2015 and later.

FROM

13X Outpatient Hospital Split Claims - Require providers split the claim so all ICD-9 codes remain on one claim with Dates of Service (DOS) through 9/30/2015 and all ICD-10 codes placed on the other claim with DOS beginning 10/1/2015 and later.

FROM


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Table A – Institutional ProvidersBill Type(s) Facility Type/Services Claims Processing Requirement

Use FROM or THROUGH Date

14X Non-patient Laboratory Services


FROM

18X Swing Beds If the [Swing bed or SNF] claim has a discharge and/or through date on or after 10/1/2015, then the entire claim is billed using ICD-10.

THROUGH

21X Skilled Nursing (Inpatient Part A)

If the [Swing bed or SNF] claim has a discharge and/or through date on or after 10/1/2015, then the entire claim is billed using ICD-10.

THROUGH

22X Skilled Nursing Facilities (Inpatient Part B)


FROM

23X Skilled Nursing Facilities (Outpatient)


FROM

32X Home Health (Inpatient Part B)

Allow HHAs to use the payment group code derived from ICD-9 codes on claims which span 10/1/2015, but require those claims to be submitted using ICD-10 codes.

THROUGH

3X2 Home Health – Request for Anticipated Payment (RAPs)*

* NOTE - RAPs can report either an ICD-9 code or an ICD-10 code based on the one (1) date reported. Since these dates will be equal to each other, there is no requirement needed. The corresponding final claim, however, will need to use an ICD-10 code if the HH episode spans beyond 10/1/2015.

*See Note

34X Home Health – (Outpatient)


FROM

71X Rural Health Clinics Split Claims - Require providers split the claim so all ICD-9 codes remain on one claim with Dates of Service (DOS) through 9/30/2015 and all ICD-10 codes placed on the other claim with DOS beginning 10/1/2015 and later.

FROM

72X End Stage Renal Disease (ESRD)


FROM

73X Federally Qualified Health Clinics (prior to 4/1/10)

N/A – Always ICD-9 code set. N/A

74X Outpatient Therapy Split Claims - Require providers split the claim so all ICD-9 codes remain on one claim with Dates of Service (DOS) through 9/30/2015 and all ICD-10 codes placed on the other claim with DOS beginning 10/1/2015 and later.

FROM

75X Comprehensive Outpatient Rehab facilities


FROM

76X Community Mental Health Clinics


FROM

77X Federally Qualified Health Clinics (effective 4/4/10)


FROM

81X Hospice- Hospital Split Claims - Require providers split the claim so all ICD-9 codes remain on one claim with Dates of Service (DOS) through 9/30/2015 and all ICD-10 codes placed on the other claim with DOS beginning 10/1/2015 and later.

FROM

82X Hospice – Non hospital Split Claims - Require providers split the claim so all ICD-9 codes remain on one claim with Dates of Service (DOS) through 9/30/2015 and all ICD-10 codes placed on the other claim with DOS beginning 10/1/2015 and later.

FROM

83X Hospice – Hospital Based N/A N/A85X Critical Access Hospital Split Claims - Require providers split the claim so all ICD-9 codes remain

on one claim with Dates of Service (DOS) through 9/30/2015 and all ICD-10 codes placed on the other claim with DOS beginning 10/1/2015 and later.

FROM


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Table B - Special Outpatient Claims Processing Circumstances

Scenario Claims Processing RequirementUse FROM or THROUGH Date

3-day /1-day Payment Window

Since all outpatient services (with a few exceptions) are required to be bundled on the inpatient bill if rendered within three (3) days of an inpatient stay; if the inpatient hospital discharge is on or after 10/1/2015, the claim must be billed with ICD-10 for those bundled outpatient services.

THROUGH

Table C – Professional Claims

Type of Claim Claims Processing RequirementUse FROM or THROUGH Date

All anesthesia claims

Anesthesia procedures that begin on 9/30/2015 but end on 10/1/2015 are to be billed with ICD-9 diagnosis codes and use 9/30/2015 as both the FROM and THROUGH date.

FROM

Table D –Supplier Claims

Supplier Type Claims Processing RequirementUse FROM or THROUGH Date

DMEPOS Billing for certain items or supplies (such as capped rentals or monthly supplies) may span the ICD-10 compliance date of 10/1/2015 (i.e., the FROM date of service occurs prior to 10/1/2015 and the TO date of service occurs after 10/1/2015).

FROM


You may also want to review SE1239 at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1239.pdf on the CMS website. SE1239 announces the revised ICD-10 implementation date of October 1, 2015.

You may also want to review SE1410 at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1410.pdf on the CMS website.


Kentucky & Ohio

MM8993: Healthcare Provider Taxonomy Codes (HPTCs) April 2015 Code Set Update


MLN Matters® Number: MM8993Related CR Release Date: February 20, 2015Related CR Transmittal #: R3201CPRelated Change Request (CR) #: CR 8993

Effective Date: April 1, 2015Implementation Date: As soon as April 1, 2015, but no later than July 6, 2015

Note: This article was revised on February 20, 2015, to add a question and answer at the bottom of page 2 regarding dual processing of ICD-9 and ICD-10 codes. All other information remains the same.


This MLN Matters® Article is intended for physicians, other providers, and suppliers submitting claims to Medicare Administrative Contractors (MACs), including Home Health and Hospice MACs and Durable Medical Equipment MACs for services provided to Medicare beneficiaries.








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Change Request (CR) 8993 instructs MACs to obtain the most recent Healthcare Provider Taxonomy Code (HPTC) set and use it to update their internal HPTC tables and/or reference files.

Background

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that covered entities use the standards adopted under this law for electronically transmitting certain health care transactions, including health care claims. The standards include implementation guides which dictate when and how data must be sent, including specifying the code sets which must be used. The institutional and professional claim electronic standard implementation guides (X12 837-I and 837-P) each require use of valid codes contained in the HPTC set when there is a need to report provider type or physician, practitioner, or supplier specialty for a claim.

The National Uniform Claim Committee (NUCC) maintains the HPTC set for standardized classification of health care providers, and updates it twice a year with changes effective April 1 and October 1. These changes include the addition of a new code and addition of definitions to existing codes.

You should note that:

1. Valid HPTCs are those that the NUCC has approved for current use;

2. Terminated codes are not approved for use after a specific date;

3. Newly approved codes are not approved for use prior to the effective date of the code set update in which each new code first appears; and

4. Specialty and/or provider type codes issued by any entity other than the NUCC are not valid.

CR 8993 implements the NUCC HPTC code set that is effective on April 1, 2015, and instructs MACs to obtain the most recent HPTC set and use it to update their internal HPTC tables and/or reference files. The HPTC set is available for view or for download from the Washington Publishing Company (WPC) at http://www.wpc-edi.com/codes on the Internet.

When reviewing the Health Care Provider Taxonomy code set online, you can identify revisions made since the last release by the color code:

yy New items are green;

yy Modified items are orange; and

yy Inactive items are red.


The official instruction, CR 8993, issued to your MAC regarding this change is available at http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3201CP.pdf on the Centers for Medicare & Medicaid Services (CMS) website.



http://www.wpc-edi.com/codes





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Kentucky & Ohio

MM8999 Revised: Calendar Year (CY) 2015 Update for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule


MLN Matters® Number: MM8999 RevisedRelated CR Release Date: February 6, 2015Related CR Transmittal #: R3190CP

Related Change Request (CR) #: CR 8999Effective Date: January 1, 2015Implementation Date: January 5, 2015

Note: This article was revised on February 24, 2015, to reflect the revised CR8999 issued on February 6. In the article, the CR release date, transmittal number, and the Web address for accessing the CR were updated. All other information remains the same.


This MLN Matters® Article is intended for providers and suppliers submitting claims to Medicare Administrative Contractors (MACs) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items or services paid under the DMEPOS fee schedule.


The Centers for Medicare & Medicaid Services (CMS) issued Change Request (CR) 8999 to advise providers of the CY 2015 annual update for the Medicare DMEPOS fee schedule. The instructions include information on the data files, update factors, and other information related to the update of the fee schedule. Make sure your staffs are aware of these updates.

Background

CMS updates the DMEPOS fee schedules on an annual basis in accordance with statute and regulations. The update process for the DMEPOS fee schedule is located in the “Medicare Claims Processing Manual,” Chapter 23, Section 60, which is available at http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c23.pdf on the CMS website.

Payment on a fee schedule basis is required for Durable Medical Equipment (DME), prosthetic devices, orthotics, prosthetics, and surgical dressings by Section 1834(a), (h), and (i) of the Social Security Act (the Act). Also, payment on a fee schedule basis is a regulatory requirement at 42 CFR Section 414.102 for Parenteral and Enteral Nutrition (PEN), splints, casts and Intraocular Lenses (IOLs) inserted in a physician’s office.

Key Points

Fee Schedule Files

The DMEPOS fee schedule file will be available for providers and suppliers, as well as State Medicaid Agencies, managed care organizations, and other interested parties at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSFeeSched/ on the CMS website.

Healthcare Common Procedure Coding System (HCPCS) Codes Added/Deleted

The following new codes are effective January 1, 2015:

yy A4602 in the inexpensive/routinely purchased (IN) payment category;


http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c23.pdf

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c23.pdf

http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSFeeSched

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yy The following new codes are in the prosthetics and orthotics (PO) payment category: A7048, L3981, L6026, L7259, and L8696. (Fee schedule amounts for these codes will be added to the DMEPOS fee schedule, effective January 1, 2015.); and

yy Also, code A4459 is added.

The base fee for code A4602 will be submitted to CMS by CMS contractors by April 3, 2015, for inclusion in the July 2015 DMEPOS fee schedule update.

The following codes are deleted from the DMEPOS fee schedule files effective January 1, 2015: A7042, A7043, L6025, L7260, and L7261.

For gap-filling purposes, the 2014 deflation factors by payment category are in the table below.

Factor Category0.459 Oxygen0.462 Capped Rental0.464 Prosthetics and Orthotics0.588 Surgical Dressings0.640 Parenteral and Enteral Nutrition0.963 Intraocular Lenses0.980 Splints and Casts

Specific Coding and Pricing Issues

CMS is also adjusting the fee schedule amounts for shoe modification codes A5503 through A5507 in order to reflect more current allowed service data. Section 1833(o)(2)(C) of the Act required that the payment amounts for shoe modification codes A5503 through A5507 be established in a manner that prevented a net increase in expenditures when substituting these items for therapeutic shoe insert codes (A5512 or A5513). To establish the fee schedule amounts for the shoe modification codes, the base fees for codes A5512 and A5513 were weighted based on the approximated total allowed services for each code for items furnished during the second quarter of calendar year 2004.

For 2015, CMS is updating the weighted average insert fees used to establish the fee schedule amounts for the shoe modification codes with more current allowed service data for each insert code. The base fees for A5512 and A5513 will be weighted based on the approximated total allowed services for each code for items furnished during the calendar year 2013.

The fee schedule amounts for shoe modification codes A5503 through A5507 are being revised to reflect this change, effective January 1, 2015.

Diabetic Testing Supplies (DTS)

The fee schedule amounts for non-mail order diabetic testing supplies (DTS) (without KL modifier) for codes A4233, A4234, A4235, A4236, A4253, A4256, A4258, A4259 are not updated by the covered item update for CY 2014. In accordance with Section 636(a) of the American Taxpayer Relief Act of 2012, the fee schedule amounts for these codes were adjusted in CY 2013 so that they are equal to the single payment amounts for mail order DTS established in implementing the national mail order Competitive Bidding Program (CBP) under Section 1847 of the Act.

The non-mail order payment amounts on the fee schedule file will be updated each time the single payment amounts are updated which can happen no less often than every three years as CBP contracts are re-competed. The national competitive bidding program for mail order diabetic supplies is effective July 1, 2013, to June 30, 2016.

The program instructions reviewing the changes are in Transmittal 2661, CR8204, dated February 22, 2013. The MLN Matters® article related to CR8204 is available at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM8204.pdf on the CMS website.





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Although for payment purposes the single payment amounts replace the fee schedule amounts for mail order DTS (KL modifier), the fee schedule amounts remain on the DMEPOS fee schedule file as reference data such as for establishing bid limits for future rounds of competitive bidding programs. The mail order DTS fee schedule amounts shall be updated annually by the covered item update, adjusted for Multi-Factor Productivity (MFP), which results in update of 1.5 percent for CY 2015. The single payment amount public use file for the national mail order competitive bidding program is available at http://www.dmecompetitivebid.com/palmetto/cbicrd2.nsf/DocsCat/Single%20Payment%20Amounts on the Internet.

2015 Fee Schedule Update Factor of 1.5 Percent

For CY 2015, the update factor of 1.5 percent is applied to the applicable CY 2014 DMEPOS fee schedule amounts. In accordance with the statutory Sections 1834(a)(14) and 1886(b)(3)(B)(xi)(II) of the Act, the DMEPOS fee schedule amounts are to be updated for 2015 by the percentage increase in the consumer price index for all urban consumers (United States city average) or CPI-U for the 12-month period ending with June of 2014, adjusted by the change in the economy-wide productivity equal to the 10-year moving average of changes in annual economy-wide private non-farm business Multi-Factor Productivity (MFP). The MFP adjustment is 0.6 percent and the CPI-U percentage increase is 2.1 percent. Thus, the 2.1 percentage increase in the CPI-U is reduced by the 0.6 percentage increase in the MFP resulting in a net increase of 1.5 percent for the update factor.

2015 Update to the Labor Payment Rates

The table below contains the CY 2015 allowed payment amounts for HCPCS labor payment codes K0739, L4205 and L7520. Since the percentage increase in the CPI-U for the 12-month period ending with June 30, 2014, is 2.1 percent this change is applied to the 2014 labor payment amounts to update the rates for CY 2015. The 2015 labor payment amounts in the following table are effective for claims submitted using HCPCS codes K0739, L4205 and L7520 with dates of service from January 1, 2015, through December 31, 2015.

STATE K0739 L4205 L7520 STATE K0739 L4205 L7520 STATE K0739 L4205 L7520AK $27.98 $31.88 $37.50 LA 14.86 22.14 30.05 OK 14.86 22.14 30.05AL 14.86 22.14 30.05 MA 24.81 22.11 30.05 OR 14.86 22.11 43.21AR 14.86 22.14 30.05 MD 14.86 22.11 30.05 PA 15.95 22.77 30.05AZ 18.37 22.11 36.97 ME 24.81 22.11 30.05 PR 14.86 22.14 30.05CA 22.79 36.34 42.35 MI 14.86 22.11 30.05 RI 17.70 22.79 30.05CO 14.86 22.14 30.05 MN 14.86 22.11 30.05 SC 14.86 22.14 30.05CT 24.81 22.63 30.05 MO 14.86 22.11 30.05 SD 16.60 22.11 40.18DC 14.86 22.11 30.05 MS 14.86 22.14 30.05 TN 14.86 22.14 30.05DE 27.35 22.11 30.05 MT 14.86 22.11 37.50 TX 14.86 22.14 30.05FL 14.86 22.14 30.05 NC $14.86 $22.14 $30.05 UT 14.90 22.11 46.79GA 14.86 22.14 30.05 ND 18.51 31.81 37.50 VA 14.86 22.11 30.05HI 18.37 31.88 37.50 NE 14.86 22.11 41.90 VI 14.86 22.14 30.05IA 14.86 22.11 35.97 NH 15.95 22.11 30.05 VT 15.95 22.11 30.05ID 14.86 22.11 30.05 NJ 20.04 22.11 30.05 WA 23.67 32.44 38.53IL 14.86 22.11 30.05 NM 14.86 22.14 30.05 WI 14.86 22.11 30.05IN 14.86 22.11 30.05 NV 23.67 22.11 40.96 WV 14.86 22.11 30.05KS 14.86 22.11 37.50 NY 27.35 22.14 30.05 WY 20.71 29.50 41.90KY 14.86 28.34 38.43 OH 14.86 22.11 30.05 WY 20.71 29.50 41.90

2015 National Monthly Payment Amounts for Stationary Oxygen Equipment

As part of CR8999, CMS is implementing the 2015 national monthly payment amount for stationary oxygen equipment (HCPCS codes E0424, E0439, E1390 and E1391), effective for claims with dates of service on or after January 1, 2015. Included is the updated national 2015


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monthly payment amount of $180.92 for stationary oxygen equipment codes in the DMEPOS fee schedule. As required by statute, the payment amount must be adjusted on an annual basis, as necessary, to ensure budget neutrality of the new payment class for Oxygen Generating Portable Equipment (OGPE). Also, the updated 2015 monthly payment amount of $180.92 includes the 1.5 percent update factor for the 2015 DMEPOS fee schedule. Thus, the 2014 rate changed from $178.24 to the 2015 rate of $180.92.

When updating the stationary oxygen equipment fees, corresponding updates are made to the fee schedule amounts for HCPCS codes E1405 and E1406 for oxygen and water vapor enriching systems. Since 1989, the fees for codes E1405 and E1406 have been established based on a combination of the Medicare payment amounts for stationary oxygen equipment and nebulizer codes E0585 and E0570, respectively.

2015 Maintenance and Servicing Payment Amount for Certain Oxygen Equipment

Also updated for 2015 is the payment amount for maintenance and servicing for certain oxygen equipment. Payment instructions for claims for maintenance and servicing of oxygen equipment are in Transmittal 635, CR6792, dated February 5, 2010, (see the article at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM6792.pdf) and Transmittal 717, CR6990, dated June 8, 2010, (see the related article at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM6990.pdf).

To summarize, payment for maintenance and servicing of certain oxygen equipment can occur every 6 months beginning 6 months after the end of the 36th month of continuous use or end of the supplier’s or manufacturer’s warranty, whichever is later for either HCPCS code E1390, E1391, E0433, or K0738, billed with the “MS” modifier. Payment cannot occur more than once per beneficiary, regardless of the combination of oxygen concentrator equipment and/or transfilling equipment used by the beneficiary, for any 6-month period.

Per 42 CFR Section 414.210(5)(iii), the 2010 maintenance and servicing fee for certain oxygen equipment was based on 10 percent of the average price of an oxygen concentrator. For CY 2011 and subsequent years, the maintenance and servicing fee is adjusted by the covered item update for DME as set forth in Section 1834(a)(14) of the Act. Thus, the 2014 maintenance and servicing fee is adjusted by the 1.5 percent MFP-adjusted covered item update factor to yield a CY 2015 maintenance and servicing fee of $69.76 for oxygen concentrators and transfilling equipment.

Update to Change Request (CR) 8566

Effective April 1, 2014, payment on a purchase basis was established for capped rental wheelchair accessory codes furnished for use with complex rehabilitative power wheelchairs. Such accessories are considered as part of the complex rehabilitative power wheelchair and associated lump sum purchase option set forth at 42 CFR Section 414.229(a)(5). These changes were implemented in Transmittal 1332, CR8566, dated January 2, 2014. Code E2378 is added to the list of codes eligible for payment on a purchase basis when furnished for use with a complex rehabilitative power wheelchair.


The official instruction for CR8999 issued to your MAC regarding this change is available at http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3190CP.pdf on the CMS website.












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Kentucky & Ohio

MM9011: Incorporation of Revalidation Policies into Pub. 100-08, “Program Integrity Manual (PIM),” Chapter 15


MLN Matters® Number: MM9011Related CR Release Date: February 13, 2015Related CR Transmittal #: R575PI

Related Change Request (CR) #: CR 9011Effective Date: May 15, 2015Implementation Date: May 15, 2015


This MLN Matters® Article is intended for providers and suppliers submitting claims to Medicare Administrative Contractors (MACs), including Home Health & Hospice (HH&H) MACs, for services provided to Medicare beneficiaries.


The Centers for Medicare & Medicaid Services (CMS) issued Change Request (CR) 9011 to incorporate various existing Medicare enrollment revalidation policies into Chapter 15 of the “Program Integrity Manual” (PIM).

Background

CR9011 incorporates various existing revalidation policies into the PIM. As these policies were previously established via business requirements, those business requirements are not being repeated in this article. The new polices announced in CR9011 are as follows:

yy When processing a voluntary termination of a reassignment, the MAC will contact the group to confirm that the group member’s Provider Transaction Access Number (PTAN) is being terminated from all locations and, if multiple group member PTANs exist for multiple group locations, each PTAN is terminated.

yy Many enrolled providers may actually be subparts of other enrolled providers, and some of those subparts entered their “doing business as name” as their LBN when applying for their NPIs. Once a contractor determines for certain that this situation exists, the contractor shall ask the provider to correct its NPPES information. The provider can (1) change its LBN in NPPES to read in accordance with the IRS CP-575, and (2) report its “doing business as” name in NPPES as an “Other Name” and indicate the type of other name as a “doing business as” name.


The official instruction for CR9011 issued to your MAC regarding this change is available at http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R575PI.pdf on the CMS website.



http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R575PI.pdf



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Kentucky & Ohio

News Flash Articles

yy Cervical Health Awareness Month - January is Cervical Health Awareness Month - a time to draw attention to cervical cancer, cervical cancer screening, prevention, and treatment. Read more (http://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/Health-Observance-Mesages-New-Items/2015-01-22-Cervical-Health.html?DLPage=1&DLSort=0&DLSortDir=descending) about Medicare coverage of cervical cancer screening.

yy Seasonal Flu Vaccinations - For information on coverage and billing of the influenza vaccine and its administration, please refer to MLN Matters® Article #MM8890 (http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8890.pdf), “Influenza Vaccine Payment Allowances - Annual Update for 2014-2015 Season” and MLN Matters® Article #SE1431 (http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1431.pdf), “2014-2015 Influenza (Flu) Resources for Health Care Professionals.”

Also, check out the following resources from the Centers for Disease Control and Prevention (CDC): Influenza (Flu) (http://www.cdc.gov/FLU/) Web page for the latest information on flu including the CDC 2014-2015 recommendations for the prevention and control of influenza, antiviral information, CDC flu mobile app, Q&As, toolkit for long term care employers, and other free resources. Review the CDC’s Antiviral Drugs (http://www.cdc.gov/flu/professionals/antivirals/index.htm) website for information about how antiviral medications can be used to prevent or treat influenza when influenza activity is present in your community, and view the updated “Influenza Antiviral Medications: Summary for Clinicians.” A CDC Health Update reminding clinicians about the importance of flu antiviral medications was distributed via the CDC Health Alert Network on January 9, 2015, and is available at http://emergency.cdc.gov/HAN/han00375.asp on the Internet.

yy Coding for ICD-10-CM: More of the Basics MLN Connects™ Video - In this MLN Connects™ video on Coding for ICD-10-CM: More of the Basics (https://www.youtube.com/watch?v=s86pXhhOG7c&list=UUhHTRPxz8awulGaTMh3SAkA), Sue Bowman from the American Health Information Management Association (AHIMA) and Nelly Leon-Chisen from the American Hospital Association (AHA) provide a basic introduction to ICD-10-CM coding. The objective of this video is to enhance viewers’ understanding of the characteristics and unique features of ICD-10-CM, as well as similarities and differences between ICD-9-CM and ICD-10-CM. Run time: 36 minutes.

yy February is American Heart Month – a time to raise awareness about heart disease and heart disease management and prevention strategies. Initiatives such as Million Hearts® (http://millionhearts.hhs.gov/resources/toolkits.html), a national initiative to prevent a million heart attacks and strokes by 2017, provide health care professionals and other partners with resources that you can use to help enhance your prevention efforts. Medicare provides coverage for a variety of preventive services that can help identify risk factors and provide information and tools that can assist your Medicare patients in making informed decisions about heart-healthy lifestyle choices. Read more (http://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/Health-Observance-Mesages-New-Items/2015-02-12-American-Heart-Month.html?DLPage=1&DLSort=0&DLSortDir=descending).

yy RELEASED product from the Medicare Learning Network®

y� “The 2013 Physician Quality Reporting System (PQRS)” (http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/2013-PQRS-Updates-ICN909056.pdf) Booklet, ICN 909056, Downloadable only


http://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/Health-Observance-Mesages-New-Items/2015-01-22-Cervical-Health.html?DLPage=1&DLSort=0&DLSortDir=descending









http://www.cdc.gov/FLU/

http://www.cdc.gov/flu/professionals/antivirals/index.htm

http://www.cdc.gov/flu/professionals/antivirals/index.htm

http://emergency.cdc.gov/HAN/han00375.asp

https://www.youtube.com/watch?v=s86pXhhOG7c&list=UUhHTRPxz8awulGaTMh3SAkA

https://www.youtube.com/watch?v=s86pXhhOG7c&list=UUhHTRPxz8awulGaTMh3SAkA

http://millionhearts.hhs.gov/resources/toolkits.html

http://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/Health-Observance-Mesages-New-Items/2015-02-12-American-Heart-Month.html?DLPage=1&DLSort=0&DLSortDir=descending



http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/2013-PQRS-Updates-ICN909056.pdf



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yy REVISED product from the Medicare Learning Network®

y� Updated IRF-PAI Training Manual (http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/InpatientRehabFacPPS/IRFPAI.html)

yy REVISED product from the Medicare Learning Network® (MLN)

y� “ICD-10-CM/PCS Billing and Payment Frequently Asked Questions” (http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/September-2013-ICD-10-CM-PCS-Billing-Payment-FAQs-Fact-Sheet-ICN908974.pdf) Fact Sheet (ICN 908974), Hard Copy.


http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/InpatientRehabFacPPS/IRFPAI.html

http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/InpatientRehabFacPPS/IRFPAI.html

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/September-2013-ICD-10-CM-PCS-Billing-Payment-FAQs-Fact-Sheet-ICN908974.pdf



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