II. CHANGES IN MANUAL INSTRUCTIONS: (N/A if manual is not updated) R=REVISED, N=NEW, D=DELETED
|
|
- Roderick Boone
- 5 years ago
- Views:
Transcription
1 anual ystem Pub edicare laims Processing Department of Health & Human ervices (DHH) enters for edicare & edicaid ervices () Transmittal 1888 Date: January 6, 2010 hange equest 6753 Transmittal 1879, dated December 18, 2009, is being rescinded and replaced by Transmittal The effective date was incorrect under ection on the transmittal page and in the manual text Table of ontents; the correct date is November 10, ll other material remains the same. UBJET: Positron Emission Tomography (PET) (DG) for ervical ancer. UY O HNGE: Effective for claims with dates of service on and after November 10, 2009, will end the coverage with evidence development requirements for DG PET for cervical cancer and will cover only one DG PET for cervical cancer for staging in beneficiaries with biopsy-proven tumors when the treating physician determines that the study is needed to determine the location and/or extent of the tumor for specific therapeutic purposes related to initial treatment strategy as outlined in Pub , ND anual, section NEW / EVED TEL EETVE DTE: NOVEBE 10, 2009 PLEENTTON DTE: JNUY 4, 2010 Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. ny other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents.. HNGE N NUL NTUTON: (N/ if manual is not updated) =EVED, N=NEW, D=DELETED /N/D N HPTE / ETON / UBETON / TTLE 13/Table of ontents 13/60/60.13/Billing equirements for PET cans for pecific indications of ervical ancer Performed on or fter January 28, /60/60.15/Billing equirements for - pproved linical Trials and overage With Evidence Development laims for PET cans for Neurodegenerative Diseases, Previously pecified ancer ndications, and ll Other ancer ndications Not Previously pecified 13/60/60.16/Billing and overage hanges for PET cans Effective for ervices on and fter pril 3, /60/60.17/Billing and overage for PET cans for ervical
2 ancer Effective for ervices on or fter November 10, UNDNG: ETON : or iscal ntermediaries and arriers: No additional funding will be provided by ; contractor activities are to be carried out within their operating budgets. ETON B: or edicare dministrative ontractors (s): The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the contracting officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the contracting officer, in writing or by , and request formal directions regarding continued performance requirements. V. TTHENT: Business equirements anual nstruction *Unless otherwise specified, the effective date is the date of service.
3 ttachment Business equirements Pub Transmittal: 1888 Date: January 6, 2010 hange equest: 6753 Transmittal 1879, dated December 18, 2009, is being rescinded and replaced by Transmittal The effective date was incorrect under ection on the transmittal page and in the manual text Table of ontents; the correct date is November 10, ll other material remains the same. UBJET: Positron Emission Tomography (PET) (DG) for ervical ancer EETVE DTE: NOVEBE 10, 2009 PLEENTTON DTE: JNUY 4, GENEL NOTON. Background: The enters for edicare & edicaid ervices () generated a request to reconsider section of the National overage Determinations (ND) anual to end the prospective data collection requirements (coverage with evidence development (ED)) for -18 flouro-d-glucose (DG) PET imaging for the initial anti-tumor treatment strategy for cervical cancer under certain circumstances. n the context of this document, the term DG PET includes DG PET/T. is revising Pub , ND anual, section 220.6, and Pub , laims Processing anual, chapter 13, section 60, to reflect this change. ee Pub , ND anual, section for specific coverage language, and Pub chapter 13, sections and The previously reviewed scientific literature and established coverage for DG PET for cervical cancer indications. summary of past oncologic DG PET cervical cancer indications is in the following table: Effective Date linical ondition/ndication overage January 28, 2005 January 28, 2005 Brain, cervical, ovarian, pancreatic, small cell lung and testicular cancers ll other cancers and indications not previously specified overage with evidence development (ED) for all DG PET indications except limited cervical staging conditions overage with evidence development pril 3, 2009 olid Tumors and yeloma overage for most uses related to initial management, coverage with evidence development for most uses related to subsequent management. Non-coverage for uses related to initial management of prostate cancer. B. Policy: Effective for claims with dates of service on and after November 10, 2009, will end the ED requirements and will cover only one (1) DG PET for cervical cancer under the following circumstances: or staging in beneficiaries who have biopsy proven cervical cancer when the beneficiary s treating physician determines that the DG PET study is needed to determine the location and/or extent of the tumor for the following therapeutic purposes related to initial treatment strategy:
4 To determine whether or not the beneficiary is an appropriate candidate for an invasive diagnostic or therapeutic procedure; or To determine the optimal anatomic location for an invasive procedure; or To determine the anatomic extent of tumor when the recommended anti-tumor treatment reasonably depends on the extent of the tumor. NOTE: Exception: continues to non-cover DG PET for initial diagnosis of cervical cancer related to initial treatment strategy. NOTE: The -QO modifier is no longer necessary on claims meeting the above criteria.. BUNE EQUEENT TBLE Use hall" to denote a mandatory requirement Number equirement esponsibility (place an X in each applicable column) / B D E hared-ystem aintainers OTHE Effective for claims with dates of service on or after November 10, 2009, contractors shall accept DG PET oncologic claims billed to inform initial treatment strategy for staging in beneficiaries who have biopsy-proven cervical cancer when the beneficiary s treating physician determines that the DG PET study is needed to determine the location and/or extent of the tumor as specified in Pub , section Effective for claims with dates of service on or after November 10, 2009, contractors shall return as unprocessable/return to provider claims for DG PET for cervical cancer for initial treatment strategy billed without: PET or PET/T PT code (78608, 78811, 78812, 78813, 78814, 78815, O 78816), ND -P modifier, ND D-9 cervical cancer diagnosis code. Use the following messages: Wrong/Lack of modifier: laim djustment eason ode () 4 The procedure code is inconsistent with the modifier used or a required modifier is missing. emittance dvice emark ode () Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. ubmit a new claim with the complete/correct information. E X X X X X X H H V W
5 Number equirement esponsibility (place an X in each applicable column) / B D E hared-ystem aintainers OTHE 16 - lert: ee our Web site, mailings, or bulletins for more details concerning this policy/procedure/decision or DG PET oncologic cervical cancer claims for initial treatment strategy for dates of service November 10, 2009, through January 3, 2010, contractors shall not search their files. However, contractors shall adjust claims brought to their attention. E X X X H H V W. POVDE EDUTON TBLE Number equirement esponsibility (place an X in each applicable column) / B D E hared-ystem aintainers OTHE provider education article related to this instruction will be available at shortly after the is released. You will receive notification of the article release via the established "LN atters" listserv. ontractors shall post this article, or a direct link to this article, on their Web site and include information about it in a listserv message within one week of the availability of the provider education article. n addition, the provider education article shall be included in your next regularly scheduled bulletin. ontractors are free to supplement LN atters articles with localized information that would benefit their provider community in billing and administering the edicare program correctly. E X X X H H V W V. UPPOTNG NOTON. or any recommendations and supporting information associated with listed requirements, use the box below: Use "hould" to denote a recommendation. X-ef equirement Number ecommendations or other supporting information:
6 B. or all other recommendations and supporting information, use this space: N/ V. ONTT Pre-mplementation ontact(s): tuart aplan, coverage, , Pat Brocato-imons, coverage, , Yvette ousar, practitioner claims processing, , Bill uiz, institutional claims processing, , ntoinette Johnson, institutional claims processing, , Post-mplementation ontact(s): Os V. UNDNG. or iscal ntermediaries (s), egional Home Health ntermediaries (HHs), and/or arriers: No additional funding will be provided by ; contractor activities are to be carried out within their operating budgets. B. or edicare dministrative ontractors (s): The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the contracting officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the contracting officer, in writing or by e- mail, and request formal directions regarding continued performance requirements.
7 edicare laims Processing anual hapter 13 - adiology ervices and Other Diagnostic Procedures Table of ontents (ev. 1888, ) Billing equirements for - pproved linical Trials and overage With Evidence Development laims for PET cans for Neurodegenerative Diseases, Previously pecified ancer ndications, and ll Other ancer ndications Not Previously pecified Billing and overage hanges for PET cans Effective for ervices on or fter pril 3, Billing and overage for PET cans for ervical ancer Effective for ervices on or fter November 10, 2009
8 Billing equirements for PET cans for pecific ndications of ervical ancer for ervices Performed on or fter January 28, 2005 (ev. 1888; ssued: , Effective date: ; mplementation Date: ) ontractors shall accept claims for these services with the appropriate PT code listed in section efer to Pub , section , for complete coverage guidelines for this new PET oncology indication. The implementation date for these PT codes will be pril 18, lso see section 60.17, of this chapter for further claims processing instructions for cervical cancer indications Billing equirements for - pproved linical Trials and overage With Evidence Development laims for PET cans for Neurodegenerative Diseases, Previously pecified ancer ndications, and ll Other ancer ndications Not Previously pecified (ev. 1888; ssued: , Effective date: ; mplementation Date: ) - arriers and s Effective for services on or after January 28, 2005, contractors shall accept and pay for claims for PET scans for lung cancer, esophageal cancer, colorectal cancer, lymphoma, melanoma, head & neck cancer, breast cancer, thyroid cancer, soft tissue sarcoma, brain cancer, ovarian cancer, pancreatic cancer, small cell lung cancer, and testicular cancer, as well as for neurodegenerative diseases and all other cancer indications not previously mentioned in this chapter, if these scans were performed as part of a -approved clinical trial. (ee Pub , ND anual, sections and ) ontractors shall also be aware that PET scans for all cancers not previously specified at Pub , ND anual, section , remain nationally non-covered unless performed in conjunction with a -approved clinical trial. - arriers Only arriers shall pay claims for PET scans for beneficiaries participating in a -approved clinical trial submitted with an appropriate PT code from section , of this chapter and the -Q (tem or ervice Provided in a edicare pecified tudy) modifier. - s Only n order to pay claims for PET scans on behalf of beneficiaries participating in a -approved clinical trial, s require providers to submit claims with D-9 code V70.7 in the second diagnosis position on the (UB-04), or the electronic equivalent, with the appropriate principal diagnosis code and an appropriate PT code from section Effective for PET scan claims for dates of service on or after January 28, 2005, s shall accept claims with the -Q modifier on other than inpatient claims.
9 NOTE: Effective for services on or after January 1, 2008, -Q0 (investigational clinical service provided in a clinical research study that is in an approved clinical research study) replaces the -Q modifier Billing and overage hanges for PET cans Effective for ervices on or fter pril 3, 2009 (ev. 1888; ssued: , Effective date: ; mplementation Date: ). ummary of hanges Effective for services on or after pril 3, 2009, edicare will not cover the use of DG PET imaging to determine initial treatment strategy in patients with adenocarcinoma of the prostate. edicare will also not cover DG PET imaging for subsequent treatment strategy for tumor types other than breast, cervical, colorectal, esophagus, head and neck (non-n/thyroid), lymphoma, melanoma, myeloma, non-small cell lung, and ovarian, unless the DG PET is provided under the coverage with evidence development (ED) paradigm (billed with modifier - Q0, see section of this chapter). Last, edicare will cover DG PET imaging for initial treatment strategy for myeloma. or further information regarding the changes in coverage, refer to Pub , ND anual, section B. New odifiers for PET cans Effective for claims with dates of service on or after pril 3, 2009, the following modifiers have been created for use to inform for the initial treatment strategy of biopsy-proven or strongly suspected tumors or subsequent treatment strategy of cancerous tumors: P -Positron Emission Tomography (PET) or PET/omputed Tomography (T) to inform the initial treatment strategy of tumors that are biopsy proven or strongly suspected of being cancerous based on other diagnostic testing. hort descriptor: PET tumor init tx strat P - Positron Emission Tomography (PET) or PET/omputed Tomography (T) to inform the subsequent treatment strategy of cancerous tumors when the beneficiary's treatment physician determines that the PET study is needed to inform subsequent anti-tumor strategy. hort descriptor: P - PET tumor subsq tx strategy. Billing hanges for /B s, s and arriers
10 Effective for claims with dates of service on or after pril 3, 2009, contractors shall accept DG PET claims billed to inform initial treatment strategy with the following PT codes ND modifier P: 78608, 78811, 78812, 78813, 78814, 78815, Effective for claims with dates of service on or after pril 3, 2009, contractors shall accept DG PET claims with modifier P for the subsequent treatment strategy for solid tumors using a PT code above ND an D-9 cancer diagnosis code. ontractors shall also accept DG PET claims billed to inform initial treatment strategy or subsequent treatment strategy when performed under ED with one of the PET or PET/T PT codes above ND modifier -P O modifier -P ND an D-9 cancer diagnosis code ND modifier -Q0 (nvestigational clinical service provided in a clinical research study that is in an approved clinical research study). NOTE: or institutional claims continue to use diagnosis code V70.7 and condition code 30 on the claim. D. edicare ummary Notices, emittance dvice emark odes, and laim djustment eason odes Effective for dates of service on or after pril 3, 2009, contractors shall return as unprocessable/return to provider claims that do not include the -P modifier with one of the PET/PET/T PT codes listed in subsection. above when billing for the initial treatment strategy for solid tumors in accordance with Pub , ND anual, section n addition, contractors shall return as unprocessable/return to provider claims that do not include the -P modifier with one of the PT codes listed in subsection. above when billing for the subsequent treatment strategy for solid tumors in accordance with Pub , ND anual, section The following messages apply: -laim djustment eason ode 4 the procedure code is inconsistent with the modifier used or a required modifier is missing. -emittance dvice emark ode Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. ubmit a new claim with the complete/correct information. -emittance dvice emark ode 16 - lert: ee our Web site, mailings, or bulletins for more details concerning this policy/procedure/decision. lso, effective for claims with dates of service on or after pril 3, 2009, contractors shall return as unprocessable/return to provider DG PET claims billed to inform initial treatment strategy or subsequent treatment strategy when performed under ED without one of the
11 PET/PET/T PT codes listed in subsection. above ND modifier P O modifier P ND an D-9 cancer diagnosis code ND modifier Q0. The following messages apply to return as unprocessable claims: -laim djustment eason ode 4 the procedure code is inconsistent with the modifier used or a required modifier is missing. -emittance dvice emark ode Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. ubmit a new claim with the complete/correct information. -emittance dvice emark ode 16 - lert: ee our Web site, mailings, or bulletins for more details concerning this policy/procedure/decision. Effective pril 3, 2009, contractors shall deny claims with D-9 diagnosis code 185 for DG PET imaging for the initial treatment strategy of patients with adenocarcinoma of the prostate. ontractors shall also deny claims for DG PET imaging for subsequent treatment strategy for tumor types other than breast, cervical, colorectal, esophagus, head and neck (non- N/thyroid), lymphoma, melanoma, myeloma, non-small cell lung, and ovarian, unless the DG PET is provided under ED (submitted with the -Q0 modifier) and use the following messages: -edicare ummary Notice edicare does not support the need for this service or item -laim djustment eason ode 50 - These are non-covered services because this is not deemed a 'medical necessity' by the payer. - ontractors shall use Group ode O (ontractual Obligation) f an BN is provided with a G modifier indicating there is a signed BN on file, contractors shall use Group ode P (Patient esponsibility) and the liability falls to the beneficiary. f an BN is provided with a GZ modifier indicating no BN was provided, contractors shall use Group ode O (ontractual Obligation) and the liability falls to the provider Billing and overage hanges for PET cans for ervical ancer Effective for ervices on or fter November 10, 2009 (ev. 1888; ssued: , Effective date: ; mplementation Date: ). Billing hanges for /B s, s, and arriers Effective for claims with dates of service on or after November 10, 2009, contractors shall accept DG PET oncologic claims billed to inform initial treatment strategy; specifically for
12 staging in beneficiaries who have biopsy-proven cervical cancer when the beneficiary s treating physician determines the DG PET study is needed to determine the location and/or extent of the tumor as specified in Pub , section EXEPTON: continues to non-cover DG PET for initial diagnosis of cervical cancer related to initial treatment strategy. NOTE: Effective for claims with dates of service on and after November 10, 2009, the Q0 modifier is no longer necessary for DG PET for cervical cancer. B. edicare ummary Notices, emittance dvice emark odes, and laim djustment eason odes dditionally, contractors shall return as unprocessable /return to provider for DG PET for cervical cancer for initial treatment strategy billed without the following: one of the PET/PET/ T PT codes listed in above ND modifier P ND an D-9 cervical cancer diagnosis code. Use the following messages: - laim djustment eason ode 4 the procedure code is inconsistent with the modifier used or a required modifier is missing. - emittance dvice emark ode Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. ubmit a new claim with the complete/correct information. - emittance dvice emark ode 16 - lert: ee our Web site, mailings, or bulletins for more details concerning this policy/procedure/decision.
Transmittal 2127 Date: DECEMBER 29, 2010
anual ystem Pub 100-04 edicare laims Processing Department of ealth & uman ervices (D) enters for edicare & edicaid ervices () Transmittal 2127 Date: DEEBE 29, 2010 hange equest 7262 UBJET: edical Nutrition
More informationDepartment of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 2212 Date: May 5, 2011
anual ystem Pub 100-04 edicare laims Processing Department of ealth & uman ervices (D) enters for edicare & edicaid ervices () Transmittal 2212 Date: ay 5, 2011 hange equest 7128 Transmittal 2154, dated
More informationCMS Manual System. Pub Medicare Claims Processing. Change Request 7580
anual ystem Pub 100-04 edicare laims Processing Department of ealth & uman ervices (D) enters for edicare & edicaid ervices () Transmittal 2337 Date: October 28, 2011 hange equest 7580 UBJET: New nfluenza
More informationTransmittal 166 Date: April 18, 2014
S anual System Pub 100-03 edicare National overage Determinations Department of Health & Human Services (DHHS) enters for edicare & edicaid Services (S) Transmittal 166 Date: April 18, 2014 hange Request
More informationDepartment of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 1550 Date: July 18, 2008
anual ystem Pub 100-04 edicare laims Processing Department of ealth & uman ervices (D) enters for edicare & edicaid ervices () Transmittal 1550 Date: July 18, 2008 hange equest 6061 UBJT: larifications
More informationTransmittal 130 Date: January 14, 2011
anual ystem Pub 100-03 edicare National overage Determinations Department of ealth & uman ervices (D) enters for edicare & edicaid ervices () Transmittal 130 Date: January 14, 2011 hange equest 7235 UBJET:
More informationTransmittal 190 Date: February 5, SUBJECT: Screening for the Human Immunodeficiency Virus (HIV) Infection
anual ystem Pub 100-03 edicare National overage Determinations Department of ealth & uman ervices (D) enters for edicare & edicaid ervices () Transmittal 190 Date: February 5, 2016 hange Request 9403 UBJET:
More informationDepartment of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 2693 Date: May 2, 2013
anual ystem Pub 100-04 edicare laims Processing Department of Health & Human ervices (DHH) enters for edicare & edicaid ervices () Transmittal 2693 Date: ay 2, 2013 hange equest 8249 NOTE: This Transmittal
More informationDepartment of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 2824 Date: November 22, 2013
anual ystem Pub 100-04 edicare laims Processing Department of ealth & uman ervices (D) enters for edicare & edicaid ervices () Transmittal 2824 Date: November 22, 2013 hange equest 8473 UBJET: New nfluenza
More informationDepartment of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 2816 Date: November 15, 2013
S anual System Pub 100-04 edicare laims Processing Department of ealth & uman Services (DS) enters for edicare & edicaid Services (S) Transmittal 2816 Date: November 15, 2013 hange equest 8484 SUBJET:
More informationDepartment of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 262 Date: January 29, 2016
CS anual System Pub 100-06 edicare Financial anagement Department of Health & Human Services (DHHS) Centers for edicare & edicaid Services (CS) Transmittal 262 Date: January 29, 2016 Change Request 9355
More informationCMS Manual System Pub Medicare National Coverage Determinations
CMS Manual System Pub. 100-03 Medicare National Coverage Determinations Department of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 9 Date: APRIL 1, 2004 CHANGE
More informationLinks in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Jurisdiction Oregon. Retirement Date N/A
Local Coverage Determination (LCD): Circulating Tumor Cell Marker Assays (L35096) Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Contractor Information
More informationPOSITRON EMISSION TOMOGRAPHY (PET)
Status Active Medical and Behavioral Health Policy Section: Radiology Policy Number: V-27 Effective Date: 08/27/2014 Blue Cross and Blue Shield of Minnesota medical policies do not imply that members should
More informationContractor Name: Novitas Solutions, Inc. Contractor Number: Contractor Type: MAC B. LCD ID Number: L34834 Status: A-Approved
LCD for Blood Glucose Monitoring in a Skilled Nursing Facility (SNF) (L34834) Contractor Name: Novitas Solutions, Inc. Contractor Number: 12502 Contractor Type: MAC B LCD ID Number: L34834 Status: A-Approved
More informationInspire Medical Systems. Physician Billing Guide
Inspire Medical Systems Physician Billing Guide 2019 Inspire Medical Systems Physician Billing Guide This Physician Billing Guide was developed to help providers correctly bill for Inspire Upper Airway
More informationJurisdiction New Mexico. Retirement Date N/A
Local Coverage Determination (LCD): Chiropractic Services (L34816) Contractor Information Contractor Name Novitas Solutions, Inc. opens in new Contract Number 04212 Contract Type A and B MAC J - H LCD
More informationPhysician s Compliance Guide
Physician s Compliance Guide Updates to this guide will be posted on the Optum website and can be found at: http://www.optumcoding.com/product/updates/2013pcg/pcg13 Please use the following password to
More informationCorporate Medical Policy
Corporate Medical Policy Intensity Modulated Radiation Therapy (IMRT) of Head and Neck File Name: Origination: Last CAP Review: Next CAP Review: Last Review: intensity_modulated_radiation_therapy_imrt_of_head_and_neck
More informationRe: Comments on Proposed Decision Memorandum (CAG-00065R2) Positron Emission Tomography (NaF-18) to Identify Bone Metastasis of Cancer
1300 North 17 th Street Suite 900 Arlington, Virginia 22209 Tel: 703.841.3200 Fax: 703.841.3392 www.medicalimaging.org October 15, 2015 CAGInquiries@cms.hhs.gov Tamara Syrek Jensen, Esq. Director, Coverage
More informationMedicare Claims Processing Manual Chapter 5 - Part B Outpatient Rehabilitation and CORF/OPT Services
Medicare Claims Processing Manual Chapter 5 - Part B Outpatient Rehabilitation and CORF/OPT Services Transmittals for Chapter 5 Table of Contents (Rev. 3454, 02-04-16) 10 - Part B Outpatient Rehabilitation
More informationLumify. Lumify reimbursement guide {D DOCX / 1
Lumify Lumify reimbursement guide {D0672917.DOCX / 1 {D0672917.DOCX / 1 } Contents Overview 4 How claims are paid 4 Documentation requirements 5 Billing codes for ultrasound: Non-hospital setting 6 Billing
More informationCorporate Policies. Corporate Billing and Collection Policy Section:
MedStar Health Title: Purpose: Corporate Policies Corporate Billing and Collection Policy Section: To ensure uniform management of the MedStar Health Corporate Billing and Collection Program for all MedStar
More informationElectrical Stimulation Device Used for Cancer Treatment
Electrical Stimulation Device Used for Cancer Treatment OPTUNE (NOVOTTF 100A SYSTEM) For any item to be covered by The Health Plan, it must: 1. Be eligible for a defined Medicare or The Health Plan benefit
More informationUpdates and Clarifications to the Hospice Policy Chapter of the Benefit Policy Manual. Compliance for Hospice Providers Revised September 2014
Compliance Update National Hospice and Palliative Care Organization Regulatory & Compliance www.nhpco.org/regulatory Updates and Clarifications to the Hospice Policy Chapter of the Benefit Policy Manual
More informationNo An act relating to health insurance coverage for early childhood developmental disorders, including autism spectrum disorders. (S.
No. 158. An act relating to health insurance coverage for early childhood developmental disorders, including autism spectrum disorders. (S.223) It is hereby enacted by the General Assembly of the State
More informationLocal Coverage Determination (LCD) for Chiropractic Services (L34816) (Posted for Notice)
Local Coverage Determination (LCD) for Chiropractic Services (L34816) (Posted for Notice) Print Contractor Information Contractor Name Novitas Solutions, Inc. Contractor Numbers 04911, 07101, 07102, 07201,
More informationLocal Coverage Determination for Colorectal Cancer Screening (L29796)
Page 1 of 15 Home Medicare Medicaid CHIP About CMS Regulations & Guidance Research, Statistics, Data & Systems Outreach & E People with Medicare & Medicaid Questions Careers Newsroom Contact CMS Acronyms
More informationMedicare Myths-Busters: Dispelling Common Compliance Misconceptions. Learner Objectives. Learner Objectives
Medicare Myths-Busters: Dispelling Common Compliance Misconceptions Rick Gawenda, PT President Gawenda Seminars & Consulting, Inc. September 30, 2017 Learner Objectives Identify the supervision requirements
More informationREPORTING POSTOPERATIVE PAIN PROCEDURES IN CONJUNCTION WITH ANESTHESIA
Committee of Origin: Economics (Approved by the ASA House of Delegates on October 17, 2007 and last updated on September 2, 2008) ASA has recently received reports of payers inappropriately bundling the
More informationDEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services News Flash Looking for the latest Medicare Fee-For-Service (FFS) information? Then subscribe to a Medicare FFS Provider
More informationLocal Coverage Article for Chiropractic Services (A47798) Contractor Information. Article Information. Contractor Name. Contractor Numbers
Local Coverage Article for Chiropractic Services (A47798) Print Contractor Information Contractor Name Novitas Solutions, Inc. Contractor Numbers 12501, 12502, 12101, 12102, 12201, 12202, 12301, 12302,
More information32 CFR (a)(4), (a)(6)(iii), and (a)(6)(iv)
CHAPTER 15 SECTION 1 ISSUE DATE: November 6, 2007 AUTHORITY: 32 CFR 199.14(a)(4), (a)(6)(iii), and (a)(6)(iv) I. APPLICABILITY This policy is mandatory for the reimbursement of services provided either
More informationChapter 18 Section 2. EXPIRED - Department Of Defense (DoD) Cancer Prevention And Treatment Clinical Trials Demonstration
s And Pilot Projects Chapter 18 Section 2 EXPIRED - Department Of Defense (DoD) Cancer Prevention And Treatment Clinical Trials 1.0 PURPOSE The purpose of this demonstration is to improve TRICARE-eligible
More informationProfessional CGM Reimbursement Guide
Professional CGM Reimbursement Guide 2015 TABLE OF CONTENTS Coding, Coverage and Payment...2 Coding and Billing...2 CPT Code 95250...3 CPT Code 95251...3 Incident to Billing for Physicians..............................................
More informationContractor Information. LCD Information. Local Coverage Determination (LCD): Hospice - Neurological Conditions (L31537) Document Information
Local Coverage Determination (LCD): Hospice - Neurological Conditions (L31537) Contractor Information Contractor Name Palmetto GBA opens in new window LCD Information Document Information Contract Number
More informationOncologic Applications of PET Scanning
6.01.26 Oncologic Applications of PET Scanning Section 6.0 Radiology Subsection Effective Date February 15, 2015 Original Policy Date January 26, 2009 Next Review Date December 2015 Description Positron
More informationFoundational funding sources allow BCCHP to screen and diagnose women outside of the CDC guidelines under specific circumstances in Washington State.
Program Description The Breast, Cervical and Colon Health Program (BCCHP) screens qualifying clients for breast cancer. The program is funded through a grant from the Centers for Disease Control and Prevention
More informationWellness Along the Cancer Journey: Healthy Habits and Cancer Screening Revised October 2015 Chapter 7: Cancer Screening and Early Detection of Cancer
Wellness Along the Cancer Journey: Healthy Habits and Cancer Screening Revised October 2015 Chapter 7: Cancer Screening and Early Detection of Cancer Healthy Habits and Cancer Screening Rev 10.20.15 Page
More informationSelect the Print Complete Record, Add to Basket or Record Buttons to print the record, to add it to your basket or to the record.
Skip to Main Content Main Menu Back to National Coverage Determinations (NCDs) Alphabetical Index Select the Print Complete Record, Add to Basket or Email Record Buttons to print the record, to add it
More informationContractor Number 03201
Local Coverage Article for Bone Mass Measurements Coverage - 2012 CPT Updates (A51577) Contractor Information Contractor Name Noridian Administrative Services, LLC opens in new window Contractor Number
More informationRecommendations for cross-sectional imaging in cancer management, Second edition
www.rcr.ac.uk Recommendations for cross-sectional imaging in cancer management, Second edition Carcinoma of unknown primary origin (CUP) Faculty of Clinical Radiology www.rcr.ac.uk Contents Carcinoma of
More informationGuidance for States considering legislation
ACOG STATE LEGISLATIVE TOOLKIT: Breast Density and Screening Mandates Guidance for States considering legislation These legislative mandates are problematic: No reliable, standardized method for assessing
More informationRe: Proposed Decision Memo for Beta Amyloid Positron Emission Tomography in Dementia and Neurodegenerative Disease (CAG-00431N)
1300 North 17 th Street Suite 1752 Arlington, Virginia 22209 Tel: 703.841.3200 Fax: 703.841.3392 www.medicalimaging.org July 26, 2013 By electronic mail Louis Jacques, MD Director Coverage and Analysis
More informationChapter 15 Section 1
Chapter 15 Section 1 Issue Date: November 6, 2007 Authority: 32 CFR 199.14(a)(3) and (a)(6)(ii) 1.0 APPLICABILITY This policy is mandatory for the reimbursement of services provided either by network or
More informationBMA INFORMATION BULLETIN No. 23. International Safety Management (ISM) Code
BMA INFORMATION BULLETIN No. 23 International Safety Management (ISM) Code Guidance and instructions for Ship-owners, Managers, Masters, Bahamas Recognised Organisations and Bahamas Approved Inspectors
More informationLCD for Interferon (L29202)
LCD for Interferon (L29202) Contractor Name First Coast Service Options, Inc. Contractor Number 09102 Contractor Type MAC - Part B Contractor Information LCD ID Number L29202 LCD Information LCD Title
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
PET Scanning: Oncologic Applications Page 1 of 88 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Positron Emission Tomography (PET) Scanning: Oncologic Applications
More informationReimbursement Information for Diagnostic Ultrasound and Ultrasound-guided Procedures Commonly Performed by Otolaryngologists
GE Healthcare Reimbursement Information for Diagnostic Ultrasound and Ultrasound-guided Procedures Commonly Performed by Otolaryngologists 1 January, 2013 www.gehealthcare.com/reimbursement imagination
More informationColorectal Cancer Screening And Related Ancillary Services
Manual: Policy Title: Reimbursement Policy Colorectal Cancer Screening And Related Ancillary Services Section: Preventive Services Subsection: None Date of Origin: 11/20/2015 Policy Number: RPM046 Last
More informationCHAPTER 1 SECTION 10.1 TRICARE STANDARD - CLINICAL PREVENTIVE SERVICES TRICARE/CHAMPUS POLICY MANUAL M JUNE 25, 1999 MEDICAL SERVICES
TRICARE/CHAMPUS POLICY MANUAL 6010.47-M JUNE 25, 1999 MEDICAL SERVICES CHAPTER 1 SECTION 10.1 Issue Date: April 19, 1983 Authority: 32 CFR 199.4(e)(3)(ii) and (g)(37) I. PROCEDURE CODES 45300, 45330, 45355,
More informationProfessional CGM Reimbursement Guide
Professional CGM Reimbursement Guide 2017 TABLE OF CONTENTS Coding, Coverage and Payment...2 Coding and Billing...2 CPT Code 95250...3 CPT Code 95251...3 Incident to Billing for Physicians..............................................
More informationThe Third-Party Reimbursement Process for Orthotics
The Third-Party Reimbursement Process for Orthotics When the foot hits the ground, everything changes. We know that over 90% of the population suffers with overpronation of their feet. Implementing Foot
More informationCancer prevalence. Chapter 7
Chapter 7 Cancer prevalence Prevalence measures the number of people diagnosed with cancer who are still alive. This chapter presents current and historical statistics on cancer prevalence in Ontario.
More informationSubject Cancers in Firefighters and Fire Investigators
If a firefighter or a fire investigator is diagnosed with a prescribed on or after January 1, 1960, and meets the employment duration and additional criteria for the prescribed, then the disease is presumed
More informationRoutine Venipuncture and/or Collection of Specimens
Manual: Policy Title: Reimbursement Policy Routine Venipuncture and/or Collection of Specimens Section: Laboratory & Pathology Subsection: None Date of Origin: 1/1/2000 Policy Number: RPM012 Last Updated:
More informationMolecular Imaging and Cancer
Molecular Imaging and Cancer Cancer causes one in every four deaths in the United States, second only to heart disease. According to the U.S. Department of Health and Human Services, more than 512,000
More informationSubject: PET Scan With or Without CT Attenuation. Original Effective Date: 11/7/2017. Policy Number: MCR: 610. Revision Date(s): Review Date:
Subject: PET Scan With or Without CT Attenuation Policy Number: MCR: 610 Revision Date(s): MHW Original Effective Date: 11/7/2017 Review Date: DISCLAIMER This Molina Clinical Review (MCR) is intended to
More informationTaking Part B Therapy Beyond the $3,700 Threshold New Manual Medical Review Process Effective date October 1, 2012
Taking Part B Therapy Beyond the $3,700 Threshold New Manual Medical Review Process Effective date October 1, 2012 Presented by: Leigh Ann Frick, PT, MBA Vice President of Clinical Services Heritage Healthcare
More information2016 Dr. Douglas H. Kay CPE Symposium
GREGORY CAMERON, R.Ph ASSISTANT PROFESSOR OF PHARMACY PRACTICE FIELD COORDINATOR COMMUNITY SITES HUSSON UNIVERSITY SCHOOL OF PHARMACY November 5, 2016 Please Silence All Electronic Equipment OBJECTIVES
More informationLocal Coverage Determination for Hospice - Liver Disease (L31536)
Page 1 of 5 Centers for Medicare & Medicaid Services Print Message: If you are experiencing issues printing this page, then please click Return to Previous Page and select the 'Need a PDF?' button. You
More informationHow Many Sections Is The Cpt Manual Divided Into
How Many Sections Is The Cpt Manual Divided Into Vocabulary words for This is a review students can take as many times as they would like. 6. The CPT manual is divided into how many sections? Medicine
More informationExhibit 2 RFQ Engagement Letter
Exhibit 2 RFQ 17-25 Engagement Letter The attached includes the 6 page proposed engagement letter to be used by HCC. ENGAGEMENT LETTER Dear: [Lead Counsel/Partner] We are pleased to inform you that your
More informationMeasure #250 (NQF 1853): Radical Prostatectomy Pathology Reporting National Quality Strategy Domain: Effective Clincial Care
Measure #250 (NQF 1853): Radical Prostatectomy Pathology Reporting National Quality Strategy Domain: Effective Clincial Care 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS, REGISTRY DESCRIPTION: Percentage
More informationInspire Medical Systems. Hospital Billing Guide
Inspire Medical Systems Hospital Billing Guide Inspire Medical Systems Hospital Billing Guide This Hospital Billing Guide was developed to help centers correctly bill for Inspire Upper Airway Stimulation
More informationWorkplace Health, Safety & Compensation Review Division
Workplace Health, Safety & Compensation Review Division WHSCRD Case No: WHSCC Claim No: Decision Number: 15240 Bruce Peckford Review Commissioner The Review Proceedings 1. The worker applied for a review
More informationEmployment Contract. This sample employment contract is from Self-Employment vs. Employment Status, CDHA (no date available)
Employment Contract This sample employment contract is from Self-Employment vs. Employment Status, CDHA (no date available (NOTE: This is only one example of an employment contract. This example is meant
More informationb. To facilitate the management decision of a patient with an equivocal stress test.
National Imaging Associates, Inc. Clinical guidelines EBCT HEART CT & HEART CT CONGENITAL CCTA CPT4 Codes: 75571 EBCT 75572, 75573 Heart CT & Heart CT Congenital 75574 - CCTA LCD ID Number: L33559 J K
More information1. NHS (GENERAL DENTAL SERVICES) (SCOTLAND) AMENDMENT REGULATIONS AMENDMENT NO 136 TO THE STATEMENT OF DENTAL REMUNERATION
MEMORANDUM TO NHS: PCA(D)(2017)6 DENTISTS/DENTAL BODIES CORPORATE NATIONAL HEALTH SERVICE GENERAL DENTAL SERVICES 1. NHS (GENERAL DENTAL SERVICES) (SCOTLAND) AMENDMENT REGULATIONS 2017 2. AMENDMENT NO
More informationIndex. Surg Oncol Clin N Am 16 (2007) Note: Page numbers of article titles are in boldface type.
Surg Oncol Clin N Am 16 (2007) 465 469 Index Note: Page numbers of article titles are in boldface type. A Adjuvant therapy, preoperative for gastric cancer, staging and, 339 B Breast cancer, metabolic
More informationPRIMARY INSURANCE. Subscriber Name: Subscriber ID/Policy #: Relationship to Patient: Self Wife Husband Parent Other Assignment of Insurance Benefits
PATIENT INFORMATION FORM MRN: Appt Appt Time: Last Name: Social Security #: First Name: Mid. Initial: Date of Birth: Home Address: Age: Sex: Home Address 2: Home Phone #: City, State, Zip: Work Phone #:
More informationICD-10 Open Discussion
ICD-10 Open Discussion Presentation to: Providers, Trading Partners and Billing Firms Presented by: Camillia Harris, ICD-10 Communications Lead Erica Baker, ICD-10 Communications Consultant October 29,
More informationBreast Cancer PET/CT Imaging Protocol
Breast Cancer PET/CT Imaging Protocol Scanning Protocol: Patients are scanned from the top of the neck through the pelvis. Arms-up position is used to avoid beam-hardening artifact in the chest and abdomen.
More informationHome Sleep Test (HST) Instructions
Home Sleep Test (HST) Instructions 1. Your physician has ordered an unattended home sleep test (HST) to diagnose or rule out sleep apnea. This test cannot diagnose any other sleep disorders. 2. This device
More informationJuly 20, Via Electronic Delivery
July 20, 2012 Louis B. Jacques, MD Director, Coverage and Analysis Group Centers for Medicare & Medicaid Services 7500 Security Blvd Baltimore, MD 21244 Via Electronic Delivery RE: National Oncologic PET
More informationA Bill Regular Session, 2015 SENATE BILL 717
Stricken language would be deleted from and underlined language would be added to present law. 0 State of Arkansas 0th General Assembly As Engrossed: S// H// A Bill Regular Session, SENATE BILL By: Senator
More informationCost-effectiveness of using a gene expression profiling test to aid in identifying the primary tumour in patients with cancer of unknown primary
The Pharmacogenomics Journal (2016), 1 15 2016 Macmillan Publishers Limited All rights reserved 1470-269X/16 www.nature.com/tpj ORIGINAL ARTICLE Cost-effectiveness of using a gene expression profiling
More informationPre-Claim Review Demonstration for Home Health Services in IL. Implementation Workshop Series
Pre-Claim Review Demonstration for Home Health Services in IL Implementation Workshop Series Disclaimer The information enclosed was current at the time i t was presented. Medicare policy changes frequently;
More informationReimbursement Information for Diagnostic Ultrasound and Ultrasound-guided Vascular Procedures 1
GE Healthcare Reimbursement Information for Diagnostic Ultrasound and Ultrasound-guided Vascular Procedures 1 January, 2013 www.gehealthcare.com/reimbursement This overview addresses coding, coverage,
More informationSample page. For the Physical Therapist An essential coding, billing and reimbursement resource for the physical therapist CODING & PAYMENT GUIDE
CODING & PAYMENT GUIDE 2019 For the Physical Therapist An essential coding, billing and reimbursement resource for the physical therapist Power up your coding optum360coding.com Contents Getting Started
More informationPET IMAGING (POSITRON EMISSION TOMOGRAPY) FACT SHEET
Positron Emission Tomography (PET) When calling Anthem (1-800-533-1120) or using the Point of Care authorization system for a Health Service Review, the following clinical information may be needed to
More informationFIRST COAST SERVICE OPTIONS FLORIDA MEDICARE PART B LOCAL COVERAGE DETERMINATION
FIRST COAST SERVICE OPTIONS FLORIDA MEDICARE PART B LOCAL COVERAGE DETERMINATION CPT/HCPCS Codes 72192 Computed tomography, pelvis; without contrast material 72193 with contrast material(s) 72194 without
More information4. The time limit, not less than thirty (30) calendar days, for requesting a Hearing in writing.
SUBJECT: SECTION: CREDENTIALING POLICY NUMBER: CR-05B EFFECTIVE DATE: 04/13 Applies to all products administered by The Plan except when changed by contract Application When the Corporate Credentialing
More information1. Laterality, Primary Site E:Lateral & Site conflict Laterality (295) = 0 _ 2 Primary Site (291) = C711 Date of Diagnosis (283) =
Follow-up, Data Quality and Utilization Lesson 8 Page 5: Correcting the Edits Report Instructions: Use the spaces provided to fix the edit by providing the valid value for the incorrect data item. This
More informationGlucose Monitors Policy Pearls
Glucose Monitors Policy Pearls Length: 20:31 Date Recorded: 1.1.17 Hello and welcome to Medicare Minute MD, a video and podcast series produced by the DME MACs for the benefit of physicians and healthcare
More informationFDA acts on cancer drug shortages
FDA acts on cancer drug shortages Partially in response to recent shortages of such critically needed cancer drugs as doxorubicin hydrochloride liposomal injection (Doxil) and methotrexate, the FDA has
More informationSubject Cancers in Firefighters and Fire Investigators
If a full-time, part-time or volunteer firefighter or a fire investigator suffers from and is impaired by one of the prescribed s described below, and meets the conditions related to duration of employment
More informationENROLMENT FORM. Title: First Name: Surname: Postal Address: Postcode: Emergency Contact: Relationship: Phone: What is your main fitness goal?
ENROLMENT FORM Personal Information Title: First Name: Surname: Date of Birth: Sex: Female Male Postal Address: Postcode: Phone: Home: Work: Mobile: Email: Preferred method of contact: Letter Phone Email
More informationApplicant Information.
Applicant Information. Please complete this application in its entirety. The application deadline is Tuesday, December 5, 2016. Applicants will be notified of their status by early-january. Please note,
More informationJurisdiction Georgia. Retirement Date N/A
If you wish to save the PDF, please ensure that you change the file extension to.pdf (from.ashx). Local Coverage Determination (LCD): Surgery: Injections of the Spinal Canal (L32112) Contractor Information
More information2015 Reimbursement Information for Mammography, CAD and Digital Breast Tomosynthesis 1
GE Healthcare 2015 Reimbursement Information for Mammography, CAD and Digital Breast Tomosynthesis 1 April, 2015 www.gehealthcare.com/reimbursement This advisory addresses Medicare coding, coverage and
More informationPOLICIES & PROCEDURES
Policy Name: Page 1 of 7 I. POLICY Evidence-based clinical research regarding influenza has shown that the best method for prevention and control of seasonal influenza is vaccination. The purpose of this
More informationCANCER INCIDENCE AND SURVIVAL STATISTICS FOR NORTHERN IRELAND
12 March 2019 CANCER INCIDENCE AND SURVIVAL STATISTICS FOR NORTHERN IRELAND 1993-2017 Official Statistics on cancers diagnosed in Northern Ireland during 1993-2017 were published today. This release provides
More informationOutpatient Therapy Functional Reporting Requirements. Provider Types Affected
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services The Centers for Medicare & Medicaid Services (CMS) is launching a new instrument for 2013 called the MAC Satisfaction Indicator
More informationNHS: 2005 PCA(D)11 abcdefghijklm
NHS: 2005 PCA(D)11 abcdefghijklm = eé~äíü=aéé~êíãéåí= = aáêéåíçê~íé=çñ=mêáã~êó=`~êé=~åç=`çããìåáíó=`~êé= = mêáã~êó=`~êé=aáîáëáçå= = pí=^åçêéïdë=eçìëé= = oéöéåí=oç~ç= = bafk_rode= = ben=pad= Dear Colleague
More informationSection 8 Administrative Plan (revised January 2000) Chapter 22 # page 1
Appeals/Grievance Procedures General Policy Both applicants and tenants of the Section 8 Program have the right to appeal certain decisions rendered by the HA which directly affect their admission to,
More informationAppendix C NEWBORN HEARING SCREENING PROJECT
Appendix C NEWBORN HEARING SCREENING PROJECT I. WEST VIRGINIA STATE LAW All newborns born in the State of West Virginia must be screened for hearing impairment as required in WV Code 16-22A and 16-1-7,
More informationDELTA DENTAL PREMIER
DELTA DENTAL PREMIER PARTICIPATING DENTIST AGREEMENT THIS AGREEMENT made and entered into this day of, 20 by and between Colorado Dental Service, Inc. d/b/a Delta Dental of Colorado, as first party, hereinafter
More informationReimbursement Information for Diagnostic Musculoskeletal Ultrasound and Ultrasound-guided Procedures 1
GE Healthcare Reimbursement Information for Diagnostic Musculoskeletal Ultrasound and Ultrasound-guided Procedures 1 January, 2013 www.gehealthcare.com/reimbursement This overview addresses coding, coverage,
More information