This temporary change requires placing the referring labs' address in field 32 on the HCFA and in loop 2010AA on the electronic format. Until further notice, physicians/suppliers must bill their local carrier for all purchased diagnostic tests/interpretations, regardless of the location where the service was furnished. The billing physician/ supplier is responsible for ensuring that the...
A reminder to all providers that item 11 must be completed on the CMS-1500 claim form. Although this information has been required by CMS, NHIC has not been screening for it. Effective December 01, 2004, NHIC will begin to audit the paper claim form for this information, and if it is missing, your claim will be rejected.
The Remittance Advice Remark Codes are maintained by CMS and updated three times per year. The June 2004 updates for the X12N 835 Health Care Remittance Advice Remark Codes and the X12N835 Health Care Claim Adjustment have been posted and are available on line at: http://www.wpc-edi.com/codes/Codes.asp The new codes will become effective on January 01, 2005. The following codes have been...
Effective for dates of service on or after December 1, 2004, reimbursement guidelines for Positron Emission Tomography (PET) scans when billed with CPT-4 code 78810 (tumor imaging, positron emission tomography [PET], metabolic evaluation) will be expanded to include the restaging of recurrence of residual thyroid cancers of follicular cell origin that have been previously treated by thyroidectomy...
NHIC often receives requests to correct a claim as a result of a billing error. Claim corrections are generally simple corrections. For example: Dates of service entered incorrectly (i.e., 09152003 instead of 09152004) Units entered as 0001 instead of 0010 Dollars entered as 2.00 instead of 200.00 To request corrections as a result of these issues,...
Effective for dates of service on or after December 1, 2004, CPT-4 code 76800 (ultrasound, spinal canal and contents) is a Medi-Cal benefit. Code 76800 is reimbursable for recipients 5 years of age or younger, for up to two procedures per calendar year for the same recipient, any provider. Additionally, code 76800 is reimbursable only when billed in conjunction with one of the following ICD-9...
Effective for dates of service on or after December 1, 2004, CPT-4 code 76604 (ultrasound, chest, B-scan [includes mediastinum] and/or real time with image documentation) is a Medi-Cal benefit. This practice is limited to four claims per year, for the same recipient, by any provider. Additional claims for this code must be accompanied with appropriate medical justification.The updated...
The Clinical Laboratory Improvement Amendments of 1988 (CLIA) regulations require a facility to be appropriately certified for each test performed. To ensure that Medicare and Medicaid only pay for laboratory tests categorized as waived complexity under CLIA in facilities with a CLIA certificate of waiver, laboratory claims are currently edited at the CLIA certificate level. Listed below are...
Beginning January 2005, Medi-Cal will be issuing new Benefits Identification Cards (BIC) with a 14-character BIC ID. A statewide phase-in process will be used to issue cards to all Medi-Cal recipients. The Department of Health Services' goal is to replace all 10-character BIC IDs by July 01, 2005.
Effective December 01, 2004, the new PO Box number for submission of paper claims and adjustments from all California workload providers is PO Box 3161. This change completes the UGS objective of having all paper claims and adjustments received in a single location to provide better control efficiency and operations effectiveness. Depending on your service area, the correct UGS PO Box...
If you discover that an overpayment of Medicare funds has occurred, you are expected to notify the program and take appropriate actions to remedy the situation. Please complete and forward the appropriate information to NHIC, your Medicare contractor. The attached form is required, or a similar document containing the following information, to accompany every unsolicited/voluntary refund so...
Collagen Crosslinks, any method The LMRP for Collagen Crosslinks has been updated to include the following changes: Added codes 252.00-252.02 and 252.08 to the "ICD-9-CM Codes that Support Medical Necessity" section of the LCD. Flow Cytometry The LMRP for Flow Cytometry (88180, 88182) has been updated to include the following changes...
Amylase The LMRP for Amylase (CPT code 82150) has been updated to include the following change: Deleted information in the Non-covered ICD-9 Codes section due to duplicative information Cytogenetic Studies The LMRP for Cytogenetic Studies (88230, 88233, 88235, 88237, 88240, 88241, 88245, 88248, 88249, 88261, 88262, 88263, 88264, 88267, 88269,...
Serum Magnesium The LMRP for Serum Magnesium (83735) has been revised. Added 5th digit to ICD-9 codes 252.00 - 252.9 Disorders of parathyroid gland Added 588.9, 588.81 and V58.66 Deleted 588.8 Revised 070.70, 070.71, 291.0, 291.1, 291.2, 291.3, 292.0, 293.0, 294.8, 294.9, 307.22, 307.51 and 760.71
All chemistries ordered for ESRD patients must be billed individually with the following modifiers: CD - AMCC test that has been ordered by an ESRD facility that is part of the composite rate CE - AMCC test that has been ordered by an ESRD facility that is a composite rate test, but is beyond the normal frequency covered under the rate and is separately reimbursable based...
The latest package of Correct Coding Initiative (CCI) edits, Version 11.0, effective January 01, 2005, will be available via the CMS Data Center (CDC). A test file will be available on or about November 01, 2004, and the final file will be available on or about November 16, 2004. Version 11.0 will include all previous versions and updates from January 01, 1996, to the present and will be...
Beneficiary signatures are required on submitted claims in item 12 of the CMS-1500 claim form. In lieu of signing the claim, the patient may sign a statement or authorization form to be retained in the provider's file indefinitely, unless revoked by the patient. The provider can then submit "signature on file" in item 12. For electronic claims submitted in ANSI 4010A1 format, submitters...
Internet access to the 2005 clinical laboratory fee schedule data file will be available after November 18, 2004, at: Payment Systems. Medicaid State agencies, the Indian Health Service, the United Mine Workers, Railroad Retirement Board, and other interested parties should use the Internet to retrieve the 2005 clinical laboratory fee schedule. It will be available in multiple formats: Excel,...
The 2004 updates to the Current Procedural Terminology – 4th Edition (CPT-4) and Healthcare Common Procedure Coding System (HCPCS) National Level II and Local Level III codes are effective for Medi-Cal for dates of service on or after October 18, 2004 and policies were published in the September Medi-Cal Update. Additional policy changes are highlighted below. Radiology Codes Requiring...
The Hospital Outpatient Prospective Payment System, Outpatient Code Editor (OCE) v5.3 has been updated with deletions and new additions. One new code was added to the list of maternity diagnoses, age 12 – 55 years old One hundred codes were removed from the list of adult diagnoses, age 15 – 124 years old One new code was added to the list of male diagnoses...