The following changes to the RARC and CARC codes will be effective January 1, 2009: Remittance Advice Remark Code Changes #t122008table {margin-bottom:25px;border-bottom:1px solid #ececec;} #t122008table td {border-top:1px solid #ececec;padding:7px; border:1px solid #efefef;} Code Current Narrative Medicare Initiated...
The Recovery Audit Contractors (RAC) program has proven to be successful in returning dollars to the Medicare Trust Funds and identifying monies that need to be returned to providers. It has provided CMS with a new mechanism for detecting improper payments made in the past, and has also given CMS a valuable new tool for preventing future payments. Section 302 of the Tax Relief and Health...
CMS recently announced that NHIC has been awarded a contract of up to five years for the combined administration of Part A and Part B Medicare claims payment in Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont.
This article is in response to errors noted in medical review related to coverage and frequency of Lipid Testing per National Coverage Determination (NCD) 190.23. Routine screening and prophylactic testing for lipid disorder is not covered by Medicare. While lipid screening may be medically appropriate, by statue Medicare does not pay for it. Lipid testing in asymptomatic individuals is...
CIGNA Government Services will allow KRAS Gene Mutation Testing in the care of patients with metastatic colon cancer who are being considered for an Epidermal Growth Factor Receptor inhibitor as second line therapy effective October 1, 2008. Generally these are billed by the reference lab performing the test for Medicare beneficiaries. The allowed CPT codes are 83890, 83892(2), 83898,...
The updated version of the health care transactions standard would replace Version 4010/4010A1. The new version, Version 5010, includes structural, front matter, technical, and data content improvements. Because the updated versions are more specific in requiring the data that is needed, collected, and transmitted in a transaction, their adoption would reduce ambiguities. Version 5010 would...
Effective for dates of service on or after December 1, 2008, CPT-4 code 87902 (infectious agent genotype analysis by nucleic acid [DNA or RNA]; hepatitis C virus) must be billed in conjunction with one of the following ICD-9-CM diagnosis codes: ICD-9-CM Code Description 070.41 Acute hepatitis C with hepatic coma 070...
As of January 1, 2009 the Medicare Physician Fees rise 1.1 percent; the new conversion factor is $36.0666.
Compared to the current ICD-9 classification system, ICD-10 offers more detailed information and the ability to expand specificity and clinical information in order to capture advancements in clinical medicine. ICD-10-CM/PCS consists of two parts: ICD-10-CM — The diagnosis classification system was developed by the Centers for Disease Control and Prevention for use in all...
For Bacterial Urine Culture: Add ICD-9-CM codes 038.12, 599.70, 599.71, 599.72, 780.60, 780.61, 780.62, 780.63, 780.64, 780.65, 788.91, and 788.99 to the list of ICD-9-CM codes covered by Medicare for the Urine Culture, Bacterial (190.12) NCD. Delete ICD-9-CM codes 599.7, 780.6, and 788.9 from the list of ICD-9-CM codes covered by Medicare for the Urine Culture, Bacterial (190....
These are some of the focus areas in the 2009 OIG Work plan that laboratories should be aware of: Medicare Payments for Unlisted Procedure CodesOIG will review the accuracy of Medicare payments for services billed using unlisted procedure codes. Unlisted procedure codes are not paid under the fee schedule. The Medicare contractors that process such claims suspend them for individual review...
New Codes CPT Code Description 83876 Myeloperoxidase (MPO) 83951 Oncoprotein; des-gamma-carboxy-prothrombin (DCP) 85397 Coagulation and fibrinolysis, functional study, not otherwise specified (e.g., ADAMTS-13), each analyte 87905 Infectious agent...
CMS developed the Medically Unlikely Edit (MUE) program to reduce the paid claims error rate for Part B claims. The first edits were implemented January 1, 2007. Subsequently there have been quarterly updates increasing the number of edits. CMS announces that beginning October 1, 2008, coincident with implementation of MUE version 2.3, the majority of existing MUEs will be made public and...
On August 27, 2008 CMS advised all Medicare contractors that the implementation date for mandatory use of the revised Advance Beneficiary Notice of Noncoverage (ABN) (CMS-R-131) has been extended until March 1, 2009. The revised ABN was released on March 3, 2008 and providers were authorized to begin using the notice immediately. Beginning March 1, 2009, all providers, practitioners and...
Effective for dates of service on or after October 1, 2008, the CPT-4 code range that may be billed for prenatal screening for the presence of a mutant cystic fibrosis gene is expanded from CPT-4 codes 83890 Ð 83912 to 83890 Ð 83914.
CR 6100 states that a physicianÕs signature is not required on orders for clinical diagnostic tests (including x-ray, laboratory, and other diagnostic tests) that are paid on the basis of the clinical laboratory fee schedule, the Medicare physician fee schedule, or for physician pathology services. While a physician order is not required to be signed, the physician must clearly document in...
Listed below are the latest tests approved by the FDA as waived tests under CLIA.: CPT Code Effective Date Description 87880QW June 28, 2007 PSS World Medical Select Diagnostics Strep A Twist 87880QW March 19, 2008 Jant Pharmacal Accutest Integrated Strep A Rapid Test Device...
Effective for dates of service on or after November 1, 2008, Medi-Cal policy indicates that laboratory services are paid at the least amount of the following: The amount billed The charge to the general public Medicare's maximum allowance Medi-Cal's maximum allowance In some instances, California ChildrenÕs Services (CCS) and outpatient hospital...
The purpose of this CR is to provide instructions to Carriers/AB MACs on how to process claims for diagnostic services when there is no entry for the Yes/No Indicator in either Block 20 of the CMS-1500 Form, or on the electronic format to indicate whether the diagnostic services were purchased. Carriers/AB MACs shall adjudicate a claim lacking evidence of purchased services for a diagnostic...
CMS has announced an increase of 80 cents in the per-mile travel allowance when collecting specimens from nursing home and homebound Medicare beneficiaries. Effective July 1, 2008 payment on a per-mile basis (billing code P9603) will rise to $1.035. Payment on a flat-rate basis (P9604) remains unchanged at a minimum of $9.55.