Wednesday, February 01, 2012
A Los Angeles federal judge has tentatively blocked Medi-Cal reimbursement cuts to doctors and other providers who treat low-income patients.
U.S. District Court Judge Christina A. Snyder ruled today that the state cannot reduce payments by 10 percent to Medi-Cal doctors, dentists, ambulance services and other providers. The tentative decision comes after Snyder previously blocked cuts to hospital-based nursing units and some pharmacists.
Monday, January 16, 2012
Palmetto GBA has completed the HERmark assessment and determined that the test meets criteria for analytical and clinical validity, and clinical utility as a reasonable and necessary Medicare benefit. Effective December 9, 2011, Palmetto GBA will reimburse services for HERmark.
Medicare Part A and Part B MAC for Jurisdiction 1
Monday, January 16, 2012
Palmetto GBA has completed the Afirma assessment and determined that the test meets criteria for analytical and clinical validity, and clinical utility as a reasonable and necessary Medicare benefit. Effective January 1, 2012, Palmetto GBA will reimburse Afirma services. Palmetto GBA expects this test will be performed once in a patient's lifetime.
Medicare Part A and Part B MAC for Jurisdiction 1
Thursday, December 29, 2011
Palmetto is currently updating the MolDx program to reflect the following suggestions from the laboratory industry:
• Test Registration: They are simplifying the Z-Code process to capture only critical basic, demographic and general test descriptions. Specific test elements will only be required as part of the tech assessment process. This change will help participating laboratories control confidential data submitted to Palmetto GBA for coverage determinations.
Thursday, December 29, 2011
Effective for dates of service on or after January 1, 2012, reimbursement and documentation requirements for CT scans performed on the same date have been updated for Multiple (Different) Anatomic Sites, Same Anatomic Site(s)/Repeat CT and Different Anatomic Site(s) Same Date. For second and subsequent sessions performed on same day, enter the CPT code(s) and time of the initial and repeat CT scans in the Remarks field (Box 80)/Reserved for Local Use field (Box 19) of the claim.
Source: General Medicine | December 2011 | Bulletin 450
Thursday, December 29, 2011
Effective retroactively for dates of service on or after June 1, 2011, modifier 90 (reference [outside] laboratory) is an allowed modifier for HCPCS code G0434 (drug screen, other than chromatographic; any number of classes, by CLIA waived test or moderate complexity test). The Department of Health Care Services (DHCS) had recognized this as a billing issue and is taking corrective action.
An Erroneous Payment Correction (EPC) will be issued to providers whose claims were inappropriately denied. Providers do not need to re-bill.
Source: General Medicine | December 2011 | Bulletin 450
Thursday, December 29, 2011
The 2012 updates to the CPT-4 and HCPCS Level II codes will become effective for Medicare on January 1, 2012. The Medi-Cal and Family PACT Programs have not yet adopted the 2012 CPT-4 and 2012 HCPCS updates. Providers should not use the 2012 codes to bill for Medi-Cal and Family PACT services until notified to do so in future Medi-Cal Updates.
Source: General Medicine | December 2011 | Bulletin 450
Friday, November 18, 2011
CMS has directed Palmetto GBA to expand the J1 Molecular Diagnostic Services Program (MolDx) to identify and establish coverage and reimbursement for molecular diagnostic tests. The MolDx program is powered by the McKesson Diagnostics ExchangeTM to enable standardized, time bound test registration and coverage determination processes.
Friday, November 18, 2011
Palmetto GBA will roll out the MolDx Program in phases to facilitate the process for laboratory service providers. Please plan to submit only the basic components listed on the spreadsheet for Z-Code application.
The following items need to be completed; the license agreement and Z-Code application form.
• Within one business week, Palmetto will email an application receipt notice to you
• Within 30 business days of a valid submission, Palmetto will send email notification with your Z-Code assignment
Friday, November 18, 2011
Effective for dates of service on or after December 1, 2011, AlloMap® Molecular Expression Testing will be added as a new Medi-Cal benefit. CPT-4 code 86849 (unlisted immunology procedure) can be used for the purpose of billing for AlloMap® Molecular Expression Profiling testing. Reimbursement for the service requires providers document on the claim form or on an attachment all of the following nine criteria:
• The patient is between 6 months and 5 years post heart transplant.
• The patient has no acute signs or symptoms of heart failure.
Friday, November 18, 2011
The 2011 updates to the CPT and Healthcare Common Procedure Coding System (HCPCS) National Level II codes will be effective for Medi-Cal for dates of service on or after December 31, 2011.
Billing Information and Restrictions
Special billing policy applies to pathology and laboratory codes as follows:
• Do not report code G0432 with codes G0433 and 86701 – 86703.
• Do not report code G0433 with codes G0432 and 86701 – 86703.
• Do not report code G0435 with codes G0432, G0433 and 86701 – 86703.
Friday, November 18, 2011
The 2011 updates to the CPT and Healthcare Common Procedure Coding System (HCPCS) National Level II codes will be effective for Medi-Cal for dates of service on or after December 31, 2011.
Billing Information and Restrictions
Special billing policy applies to radiology codes as follows:
• CPT-4 codes 76881 and 76882 are split-billable and payable to portable x-ray and podiatry providers with an approved TAR. Podiatry reimbursement is subject to the optional benefits exclusion (OBE) policy.
Source: General Medicine | November 2011 | Bulletin 449
Friday, November 18, 2011
Effective for dates of service on or after December 1, 2011, medical justification documentation for Computed Tomographic Angiography (CTA) scans (CPT codes 70496, 70498, 71275, 72191, 73206, 73706 and 74175) will no longer be required for repeat (same anatomical site) and subsequent (different anatomical site) scans occurring on the same date of service. However, the times of the initial and repeat or subsequent scan are required.
Source: General Medicine | November 2011 | Bulletin 449
Friday, November 18, 2011
The Department of Health Care Services (DHCS) has delayed the implementation of radiology rate reductions previously announced. CMS has advised that state Medicaid program changes that require a State Plan Amendment (SPA) cannot be implemented until after federal approval has been granted. When approval is received, DHCS will publish the changes.
Source: General Medicine | November 2011 | Bulletin 449
Tuesday, November 01, 2011
CMS approved California's plan to cut provider payments by 10% for most Medi-Cal providers. State officials have projected that the cuts will save $623 million. Norman Williams, a spokesperson for the state Department of Health Care Services, has stated that the cuts are retroactive to services provided on or after June 1, 2011.
Friday, October 14, 2011
Effective for dates of service on or after October 1, 2011, the policy information for the existing CTA CPT code 71275 (computed tomography angiography, chest, [noncoronary] with contrast material[s], including non-contrast images, if performed, and image postprocessing) has been updated. Also, effective for dates of service on or after October 1, 2011, the following CTA codes are Medi-Cal benefits.
Friday, September 30, 2011
Effective for dates of service 02/27/2012 and forward, Palmetto will consider "non covered" all non-standardized organ or disease-oriented panels that meet the following criteria:
1. Are non-FDA cleared laboratory developed tests (LDTs)
2. Are performed or marketed by a sole source, hospital, or reference laboratory
3. Have not received a specific AMA CPT code
4. Have not obtained an NCD or LCD coverage determination from Palmetto GBA
5. Tests that require multiple CPT codes in order to submit a claim for a single assay/test
Friday, September 30, 2011
Effective for dates of service 02/27/2012 and forward, Palmetto will consider "non covered" all molecular diagnostic tests (MDTs) that are not explicitly covered by a National Coverage Determination (NCD), a Local Coverage Determination (LCD), or by a coverage article published by Palmetto GBA. Palmetto defines a MDT as a single test (often with multiple components) that delivers one result and involves nucleic acids (DNA/RNA), proteins, enzymes and / or other metabolite detection. Their definition also applies to all tests that:
Thursday, September 29, 2011
Palmetto GBA J1 Part B Medical Review has completed the service specific complex review for radiology services (CPT codes 71010 and 71020) for February 11, 2011, through April 11, 2011, in southern California. There were 19,001 claims reviewed, out of which 8,879 claims were denied. This was a 46.3 percent charge denial rate.
The top denial reasons identified from the review are:
• 47 percent: Missing Physician order
• 27 percent: Missing or incomplete documentation for this date of service definition
• 9 percent: Missing radiology report
Thursday, September 01, 2011
This article introduces two CPT Codes to report in situ hybridization (e.g., FISH) testing for bladder tumor markers: 88120 and 88121. Palmetto GBA will only cover these tests when performed using validated assays such as the UroVysion Bladder Cancer Kit, an assay performed on urine specimens from persons with hematuria who are suspected of having bladder cancer. It also serves as an aid for initial diagnosis of bladder carcinoma and subsequent monitoring for tumor recurrence in patients previously diagnosed with bladder cancer.