CMS has issued a memo regarding coverage of immunoassay-based fecal occult blood tests for colorectal cancer screening for Medicare beneficiaries aged 50 years and older effective Jan. 1, 2004. The test should be billed using HCPCS code G0328.
Effective April 1, 2004, CMS has changed the way reimbursement is made to independent laboratories (IL) when billing the technical component of a purchased diagnostic service. When an IL bills for the technical component (TC) of a physician pathology service purchased from a separate physician or supplier, the payment amount for the TC is based on the lower of the billed charge or the Medicare...
Effective with services received on or after April 1, 2004, Medicare will implement a new payment policy for referred lab services by an independent lab "Specialty 69--Independent Laboratory". These changes will result in the following operational differences: An independent clinical laboratory may bill only the carrier in which it is enrolled by reason of having a physical...
Effective January 1, 2004, the following changes will be made to the laboratory edit software: The following diagnosis codes are added to the list of ICD-9-CM Codes covered by Medicare for the prothrombin time (PT) and fecal occult blood test (FOBT) NCDs: 863.91 pancreas head with open wound into cavity 863.92 pancreas body with open wound into cavity 863.93...
The Medicare Claims System has been modified to allow carriers to read four modifier fields. In the past, whenever more than two modifiers were needed, they had to be placed in Item 19 (or the comments fields for electronic claims) with modifier 99 indicated on the line item following the procedure code. Effective immediately, you can submit up to four modifiers on paper claims or in the specific...
Effective January 1, 2004, laboratories should add the GY modifier to the CPT procedure codes for any service where the appropriate diagnosis for that service is on the list of diagnoses that are not covered by Medicare. In November 2002, Medicare implemented 23 national coverage determinations (NCDs) for clinical diagnostic laboratory services. These NCDs are specific down to the ICD-9-CM...
National Heritage Insurance Company revised the Local Medical Review Policy pertinent to Cytogenetic Studies. The CPT codes are: 88230, 88233, 88235, 88237, 88239, 88240, 88241, 88245, 88248, 88249, 88261, 88262, 88263, 88264, 88267, 88269, 88271, 88272, 88273, 88274, 88275, 88280, 88283, 88285, 88289, 88291 and 88299. This change is effective 10/01/2003 and expands the truncated code...
Urinalysis CPTs: 81000, 81001, 81002, 81003, 81005, 81007 and 81015 Effective for dates of service on or after 10/01/2003, the following ICD-9-CM codes were added: 277.89, 600.00-600.01, 600.10-600.11, 600.20-600.21, 600.90-600.91, 607.85, 785.52 and 788.63. This change is effective 10/01/2003 and expands the truncated code 752.8 to 752.89 Serum Magnesium CPT:...
As of this Oct. 1, 2003 all laboratory claims must contain a valid ICD-9 diagnosis code, with the service coded to the highest degree of specificity. Otherwise, they will be returned as "unprocessable." The change applies to both electronic and paper claim formats.
As a result of negotiated rule making, an NCD was developed for the diagnostic PSA test. In Program Memo AB-03-132, the CMS instructed local contractors to include a provider education article regarding diagnostic and screening PSA tests in their next regularly scheduled bulletin. The key points: Diagnostic PSA testing is subject to a national Medicare coverage policy which...
As a result of negotiated rule making, an NCD was developed for the diagnostic PSA test. In Program Memo AB-03-132, the CMS instructed local contractors to include a provider education article regarding diagnostic and screening PSA tests in their next regularly scheduled bulletin. The key points: Diagnostic PSA testing is subject to a national Medicare coverage policy which...
Effective October 1, 2003, Correct Coding Initiative (CCI) Edits Version 9.3 will be implemented. CMS implemented national CCI Edits in 1996 for the purpose of identifying and eliminating the incorrect code of medical services. New Conflicts have been added: Effective Date Standard Policy Statement 85004...