CMS has determined that ICD-9-CM diagnosis code V76.44, Prostate cancer screening, is not appropriately included on the list of ICD-9-CM codes that are not covered by Medicare. CMS intends to modify the list of “ICD-9-CM Codes Denied” in the Laboratory NCD Coding Manual. This change affects the entire 23 negotiated clinical diagnostic laboratory NCDs. Since removal of V76.44 from the codes denied...
Claims Appeal Status Available from the Provider Telecommunications Network (PTN) and the Medi-Cal Web Site Effective August 22, 2005, providers may determine the status of their appeals using the Provider Telecommunications Network (PTN) and/or the Medi-Cal Web site. The PTN allows providers to access their appeal status. The Medi-Cal Web site allows providers to access both their appeal status...
The following tests are approved by the FDA as waived tests under the CLIA. CPT Code Modifier Effective Date Description 86318QW December 09, 2004 Germaine Laboratories, Aimstep H. pylori {whole blood} 87807QW January 28, 2005 Binax Now RSV Test (K032166/A005) 81003QW...
The ESRD 50/50 rule requires the billing laboratory to determine (for the same beneficiary on the same date-of-service): The number of AMCC tests (ordered and performed) that are included in the composite payment rate paid to the ESRD facility (or the monthly capitation payment made to the furnishing physician) The number of covered non-composite tests paid. The...
CR4031 amends payment files issued to Medicare carriers and intermediaries based upon the November 15, 2004, Final Rules for the 2005 Medicare Physician Fee Schedule Database. The changes to the fee schedule involve numerous CPT/HCPCS codes. While many of these changes are effective retroactive to January 1, 2005, please note that your carrier/FI will not reprocess claims already processed,...
The Centers for Medicare...
CR4005 announces changes to the list of codes included in the October 2005 release of the Medicare Laboratory National Coverage Determination (NCD) edit module for clinical diagnostic laboratory services. These changes are a result of new ICD-9-CM code changes that become effective October 01, 2005. Immunodeficiency Virus (HIV) Testing (Diagnosis) CMS is adding new ICD-9-CM codes...
In "mandatory assignment" situations, i.e., where payment under the Act can be made only on an assignment-related basis to the supplier, the beneficiary (or the person authorized to request payment on the beneficiary’s behalf) is not required to assign the claim to the supplier in order for an assignment to be effective. However, the beneficiary (or the person authorized to request payment on the...
The following tests are approved by the FDA as waived tests under the CLIA. Type Code New/Modified/Deactivated/Retired Current Narrative Comment Remark N345 New Date range not valid with units submitted. Not Medicare Initiated Remark N346 New Missing/...
Effective for claims with dates of service on or after April 01, 2004, Medicare carriers must use the zip code of the location where the service was rendered to determine both the carrier jurisdiction for processing the claim and the correct payment locality for any service paid under the MPFS (see the Medicare Claims Processing Manual (Pub.100-04), Chapter 1, Section 10.1.1). Since the...
Effective April 01, 2005, CMS implemented a new Common Working File (CWF) edit to check for duplicate claims for referred clinical diagnostic laboratory services and purchased diagnostic services submitted by suppliers to more than one carrier. (Per Transmittal 124, Change Request 3551) Claims submitted for referred clinical diagnostic/purchased diagnostic services will be considered...
Between May 23, 2005 and January 02, 2006 CMS claims processing systems will accept an existing legacy Medicare number and reject, as unprocessable, any claim that includes only an National Provider Identifier (NPI). Beginning January 03, 2006, and through October 01, 2006, CMS systems will accept an existing legacy Medicare number or an NPI as long as it is accompanied by an existing legacy...
A redetermination is an examination of a claim by Carrier personnel who are independent of the personnel who made the initial determination. The appellant (the individual filing the appeal) has 120 days from the date of receipt of the initial claim determination to file an appeal. A redetermination can be requested in writing or over the telephone to the local Medicare Carrier. No monetary...
Until the statewide issuance of the new 14–character Medi–Cal Benefits Identification Cards (BICs) is completed , Medi–Cal recipients will have a BIC with either a 10– or 14–character ID. The claims processing system will accept both types of BIC ID numbers until new billing requirements are implemented in late 2005 or early 2006. Eligibility Verification The eligibility...
The 2005 updates to the Current Procedural Terminology – 4th Edition (CPT–4) and Healthcare Common Procedure Coding System (HCPCS) National Level II codes will be effective for Medi–Cal for dates of service on or after November 01, 2005. The affected codes are: CPT–4 Code Additions Radiology 75960, 76077, 76510, 76820, 76821, 78811, 78812, 78813, 78814, 78815,...
Part B travel allowance for 2005 is increased to $0.855 per mile (HCPCS code P9603) and $8.55 per flat rate trip basis (P9604), under a correction announced by Medicare and retroactive to January 01. Medicare contractors aren't required to adjust travel fees already paid, but must do so for claims that clinical laboratories bring to their attention. The fee increase results from an...
At the April 25, 2005 Lab Open Door Forum CMS noted that the following guidance in the current National Correct Coding Policy Manual, Chap. 10, Pathology/Laboratory Services essentially prohibits billing for a reflexed manual WBC differential performed as a result of an abnormal or flagged automated WBC differential. "If, after a test is ordered and performed, additional related...
Providers possessing a Clinical Laboratory Improvement Amendments (CLIA) Certificate of Wavier or Provider - Performed Microscopy Procedures (PPMP) must utilize a test kit and bill the program utilizing a QW modifier with for the following codes: 80061, 80101, 81003, 81007,82010, 82044, 82055, 82120, 82273, 82274, 82465, 82523, 82570, 82679, 82947, 82950, 82951, 82952, 82985, 83001, 83002,...
CMS has released the July 2005 update to its Medicare National Coverage Determinations (NCDs) Manual for Clinical Diagnostic Laboratory Services. This update revises a number of the lab NCDs include: Thyroid Testing: 84436, 84439, 84443, 84479 added ICD-9 code 733.02 Tumor Antigen by Immunoassay CA 19-9: 86301 added ICD-9 codes 156.0 and 156.2 Hepatitis Panel:...
CMS announced the implementation of enumeration for the National Provider Identifier (NPI). The NPI is the standard unique health identifier for health care providers that was adopted by the Secretary of Health and Human Services under the Health Insurance Portability and Accountability Act of 1996. CMS’s announcement letter informs health care providers about the NPI, describes three ways to...