Billing News Feb 2004



"CB" Modifier For Dialysis Services

  • February 2, 2004

CMS has issued changes to CR 2475 Transmittal AB-02-175 regarding use of the -CB modifier for dialysis services. The guidance issued on submission of the "CB" modifier is being modified to no longer require that the provider/supplier determine that the beneficiary is in a SNF Part A stay. A provider or supplier may use the "CB" modifier only...

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Medi-Cal - Reimbursement Rates

  • February 2, 2004

California Medi-Cal has established reimbursement rates for services previously listed as "By Report" for dates of service on or after October 1, 2003. Accordingly, the services listed below may now be billed electronically. The maximum reimbursement rates are as follows: CPT-4 Code Description Rate...

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NHIC - Southern California

  • February 2, 2004

NHIC in Northern California has used this modifier for some time to identify when an incorrect procedure code or modifier has been submitted and changed by us when processing the claim. Effective March 3, 2004 NHIC in Southern California will implement this practice and use CC to identify when modifiers inconsistent with a procedure or service, or...

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Lab-to-Lab Referrals

  • February 2, 2004

On February 6, 2004, the Centers for Medicare and Medicaid Services issued Transmittal 85 Change Request (CR) 3090, which provides instructions to resolve billing issues when a laboratory refers a specimen for testing by another laboratory in another Carrier's jurisdiction ("lab-to-lab referral"). CMS had previously published the instructions...

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Claim Billing Instructions Revised

  • February 2, 2004

Effective for claims received on or after April 1, 2004, the name, address, and zip code of the service location for all services other than those furnished in place of service home (12) must be entered in Item 32 of the CMS 1500 claims form (or appropriate electronic claim field). If this information is missing or incomplete, assigned claims will...

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Medicare Secondary Payer Rules

  • February 2, 2004

Outreach Hospital Laboratories will no longer be required to obtain information from beneficiaries to determine if there is another payor primary to Medicare. Medicare reform law (P.L. 108-173) prohibits the Government from requiring an outpatient hospital lab to do more in this regard than it demands of independent labs.

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NCD - Laboratory National Coverage Determination - Update

  • February 2, 2004

The following diagnosis codes are being added to the Serum Iron Studies NCD with an effective date of April 5, 2004 to the list of "ICD-9-CM Codes covered by Medicare": 403.01 Hypertensive renal disease, malignant, with renal failure 403.11 Hypertensive renal disease, benign, with renal failure 403.91 Hypertensive renal...

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