CMS requires that (effective no earlier than July 01, 2007) the Medicare carrier standard system capture and process all diagnosis codes that are reported, up to the maximum of eight, on any claim (both electronic and paper) processed.
CMS announces the following ICD-9-CM code changes effective January 01, 2007: V58.83 (Encounter for therapeutic drug monitoring). Added to the list of ICD-9-CM codes covered by Medicare for the Prothrombin Time (190.17) NCD and ICD-9-CM codes covered by Medicare for the Partial Thromboplastin Time (190.16) NCD 783.0...
Effective April 01, 2007, CMS will install systems edits (Common Working File) to prevent improper payments to independent laboratories for the Technical Component (TC) of pathology laboratory services provided to beneficiaries during a covered inpatient hospital stay or provided on the same date of service as an outpatient service. This change applies to claims with dates of service on or after...
There is no longer a 90-day grace period. These codes are effective January 1, 2007. New Codes Category Description Code Chemistry Alpha-fetoprotein (AFP); AFP-L3 fraction isoform and total AFP (including ratio) 82107 Chemistry Lipoprotein-associated phospholipase A2, (Lp-PLA2) 83698 Molecular Diagnostics Molecular...
In accordance with the 2006 updates to the Current Procedural Terminology – 4th Edition (CPT-4 code book), the provider manual has been updated to reflect changes in reporting for codes used to bill for Pap smear tests. This section contains information to assist providers in billing for pathology procedures related to cytopathology services. Pap Smear Tests Taking a Papanicolaou...
The American College of Obstetrics and Gynecology (ACOG) recommends pregnant women be screened for HIV as part of the routine battery of prenatal blood tests. ACOG further recommends that an offer of HIV testing be repeated in the third trimester to women in areas with high HIV prevalence, women known to be at high risk for HIV infection, and women who declined testing earlier in pregnancy. The...
Beginning May 23, 2007 (May 23, 2008, for small health plans), the NPI must be used in lieu of legacy provider identifiers. Legacy provider identifiers include: Online Survey Certification and Reporting (OSCAR) system numbers National Supplier Clearinghouse (NSC) numbers Provider Identification Numbers (PINs) Unique Physician Identification Numbers (UPINs) used by...
The following list are the latest tests approved by the FDA as waived tests under CLIA. The CPT codes for the following new tests must have the modifier QW to be recognized as a waived test. CPT Code / Modifier Effective Date Description 82274QW, G0328QW March 22, 2006 immoCare Fecal Occult Blood Test...
CMS has released the October 2006 update to its Medicare National Coverage Determinations (NCDs) Manual for Clinical Diagnostic Laboratory Services. This update, requires updating of the laboratory edit module. These changes become effective for services furnished on or after October 01, 2006. Changes are being made to the NCD code lists for services furnished on or after October 01, 2006, are as...
Effective January 02, 2007, CR 5205 provides instructions for implementing the lab competitive bidding demonstration required by Section 302(b) of the Medicare Modernization Act of 2003 for services paid under the Medicare Part B. Pap smears and colorectal cancer screening tests are excluded. The project will cover demonstration tests for beneficiaries who live in demonstration...
Section 732 of the Medicare Modernization Act (MMA) extended, for 2005 and 2006, the provision of section 542 of the Benefits Improvement Act of 2000 (BIPA) that allowed certain independent laboratories to bill under the physician fee schedule for the technical component of physician pathology services furnished to patients of covered hospital. CR5210 instructs Medicare carriers to notify all...
Payment Reduction Reversed for Select Genetic Disease Lab Panels The 5 percent payment reduction that was applied to the following genetic disease tests for dates of service on January 01, 2006 through March 03, 2006 is being reversed. HCPCS Code Description Z2500 Newborn screening panel for phenylketonuria (PKU), galactosemia, primary...
An article published in the July 2006 Medi-Cal Update incorrectly stated policy. The policy should read: Codes 88184 and 88185 must be billed with modifier -TC (technical component). Providers should note that code 88145 is not a Medi-Cal benefit.
CMS- Termination of (HCPCS) Code G0107, Colorectal Cancer Screening, Fecal-Occult Blood Tests Effective January 1, 2007, HCPCS code G0107 for screening Fecal Occult Blood Tests (FOBT) is being terminated and replaced by CPT code 82270. If you use HCPCS code G0107 for FOBT on or after this date, your reimbursement could be impacted as the claim will be returned as unporcessable...
The November 2005 through February 2006 updates have been posted. New Remark Codes New Code Current Narrative N365 This procedure code is not payable. It is for reporting/information purposes only. N366 Requested information not provided. The claim will be reopened if the information previously requested...
Beginning September 2006, Medi–Cal providers will be able to register their National Provider Identifier (NPI) with the California Department of Health Services (CDHS) through an automated collection system. A new NPI Web page will appear on the Medi-Cal Web site that will contain the link to the NPI registration tool. HIPAA mandates the use of an NPI beginning May 23, 2007. Providers can...
Effective January 01, 2007 Medicare contractors will implement CCI edits that will contain a new update for Medically Unlikely Edits (MUEs). MUEs represent limits on the units of service that a healthcare provider can bill a particular CPT/HCPCS code per Medicare beneficiary per day. Claims exceeding these limits will be automatically denied. Lab and Pathology codes in the CPT 80000 series will...
Effective for dates of service on or after September 01, 2006, reimbursement of CPT-4 code 80055 (obstetric panel) is restricted to once in nine months for the same provider. The provider may be reimbursed for a second or subsequent obstetric panel within the nine-month period if there is documentation to justify medical necessity or documentation of a different pregnancy.
Medicare contractors will place a hold on Medicare payments for all claims during the last 9 days of the Federal fiscal year (September 22 through September 30, 2006). These payment delays are mandated by section 5203 of the Deficit Reduction Act of 2005. No interest will be accrued and no late penalties will be paid to an entity or individual by reason of this one-time hold on payments. All...
Form CMS-1500 (08/05) will be implemented January 02, 2007. Providers will not be mandated to use the revised Form CMS-1500 (08/05) until April 02, 2007. Providers may contact TFP Data Systems at JRMagdaleno@tfpdata.com to receive copies of the revised form. The revised implementation time line is (revised June 30, 2006): January 02, 2007: Health plans, clearinghouses, and other...