January

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1 January 2017 Jean C. Russell, MS, RHIT Richard Cooley, BA, CCS Matthew H. Lawney MSPT, MBA, CHC,

2 2 Payment Basics Agenda Medicare/ Medicaid Code & Payment Changes 2017 Drugs Vaccines Self Administered Drugs Drug Wastage Billing units

3 3 Outpatient Payment Medicare Outpatient Drugs, biologicals and vaccines are paid under APCs Over 1200 drugs, biologicals and vaccines are identified by HCPCS code Roughly 380 are paid while the rest are packaged or non-covered Paid drugs are Status G (pass-through), K (nonpass through), or L and F (reasonable cost)

4 4 Medicare IP Some Drugs paid in addition to DRGs Report clotting factors Use rev code 636 Report Vaccines Use rev code 636 Use bill type 12x (inpatient part B) rather than type 11x (inpatient bill) Chapter 18, Preventative Services, Medicare Claims Processing Manual, website: Guidance/Guidance/Manuals/Downloads/clm104c18.pdf

5 5 Medicare C-APCs Exclusions Some services are paid in addition to Comprehensive APCs Pass-through drugs, biologicals, and devices Pneumococcal, influenza, and hepatitis B vaccines and administrations Services assigned to OPPS status indicator F (certain CRNA services, Hepatitis B vaccines and corneal tissue acquisition); Services assigned to OPPS status indicator L (influenza and pneumococcal pneumonia vaccines)

6 6 NYS Medicaid Medicaid APG- CLASS PHARMACOTHERAPY Report drug HCPCS on claim Paid by weight x rate (based on rate code) index.htm Most OP drugs billed under 1432 Clinic ER Carve-out drugs reported separately

7 7 Carve Outs- Never Pay APGs APG APG Desc APG Type Alternative Payment Available* Date added to Never Pay List 430 Class I Chemotherapy Drugs Drug Yes carve out 12/1/ Class II Chemotherapy Drugs Drug Yes carve out 12/1/ Class III Chemotherapy Drugs Drug Yes carve out 12/1/ Class IV Chemotherapy Drugs Drug Yes carve out 12/1/ Class V Chemotherapy Drugs Drug Yes carve out 12/1/ Class VI Chemotherapy Drugs Drug Yes carve out 1/1/ CLASS VII CHEMOTHERAPY DRUGS Drug Yes carve out 1/1/ CLASS XIII COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY Drug Yes carve out 7/1/ MINOR CHEMOTHERAPY DRUGS Drug Yes carve out 7/1/ _pay_list.htm

8 8 Combine Two Lists Never Pay APGs Convert to CPT/HCPCS **- Refer to "Never Pay Procedures" list to verify whether a procedure of APG 385 has alternative payment available or not. Keep only the HCPCS/CPTs included in the procedure list for APG 385 Never Pay Procedures Column for Alternative Payment Available

9 9 Never Pay Procedures

10 10 Carve Outs Report as referred ambulatory- no rate code Report with National Drug Code (NDC) NDC maintained by pharmacist in formulary Report with Acquisition Cost

11 11 25x Rev Codes 250 General Pharmacy 251 Generic Drugs Pharmacy 252 Nongeneric Drugs Pharmacy 253 Take Home Drugs Pharmacy 254 Drugs Incident To Other Diagnostic Services 255 Drugs Incident To Radiology 256 Experimental Drugs 257 Nonprescription Drugs 258 IV Solutions Pharmacy 259 Other Pharmacy 636- Drugs Requiring Detailed Coding 637- Self-Administrable Drugs

12 Pharmacy Changes

13 13 New Pharm Codes HCPCS SVCDESC Mcare SI Change 2017 comments J8670 Rolapitant Oral 1mg K New Valid 1/1/2017 J9034 Bendamustine HCL Inj (Bendeka) 1mg G New Valid 1/1/2017 J9145 Daratumumab Inj 10mg G New Valid 1/1/2017 J9176 Elotuzumab Inj 1mg G New Valid 1/1/2017 J9205 Irinotecan liposome Inj 1mg G New Valid 1/1/2017 J2182 Mepolizumab Inj 1mg G New Valid 1/1/2017 J9295 Necitumumab Inj 1mg G New Valid 1/1/2017 J2786 Reslizumab Inj 1mg G New Valid 1/1/2017 J9325 Talimogene Laherparepvec Inj 1M plaque forming units G New Valid 1/1/2017 J9352 Trabectedin Inj 0.1mg G New Valid 1/1/2017 C9140 Factor VIII (antihemophilic Factor recombinant) (afstyla) Inj 1iu G New Valid 1/1/2017 J7175 Factor X Inj (human) 1iu K New Valid 1/1/2017 J7202 Factor IX Albumin Fusion Protein Inj (recombinant) idelvion 1iu G New Valid 1/1/2017 J7207 Factor VIII Inj (antihemophilic Factor recombinant) pegylated 1iu G New Valid 1/1/2017 J7209 Factor VIII Inj (antihemophilic Factor recombinant) (nuwiq) 1iu G New Valid 1/1/2017 J7179 Von Willebrand Factor Inj (recombinant) (vonvendi) 1iu G New Valid 1/1/2017 J0883 Argatroban Inj 1mg (for non ESRD use) K New Valid 1/1/2017 Note change in units J0884 Argatroban Inj 1mg (for ESRD on dialysis) N New Valid 1/1/2017 Note change in units J1942 Aripiprazole Lauroxil Inj 1mg G New Valid 1/1/2017 J0570 Buprenorphine Implant 74.2mg G New Valid 1/1/2017 J7342 Ciprofloxacin Otic suspension Instillation 6mg G New Valid 1/1/2017 J7322 Hyaluronan or Derivative Hymovis for intra articular Inj 1mg G New Valid 1/1/2017 J2840 Sebelipase Alfa Inj 1mg G New Valid 1/1/ Influenza virus vaccine, quadrivalent (cciiv4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 ml dosage, for intramuscular use L New Valid 1/1/ Hzv vacc recombinant im njx E1 New Valid 1/1/ Riv4 vacc recombinant dna im L New Valid 1/1/2017

14 14 Deleted Pharm HCPCS HCPCS SVCDESC Mcare SI Replace with C9476 Daratumumab Inj 10mg D Invalid 12/31/2016 to report use J9145 C9477 Elotuzumab Inj 1mg D Invalid 12/31/2016 to report use J9176 C9474 Irinotecan liposome Inj 1mg D Invalid 12/31/2016 to report use J9205 C9473 Mepolizumab Inj 1mg D Invalid 12/31/2016 to report use J2182 C9475 Necitumumab Inj 1mg D Invalid 12/31/2016 to report use J9295 C9481 Reslizumab Inj 1mg D Invalid 12/31/2016 to report use J2786 Q9981 Rolapitant Oral 1mg D Invalid 12/31/2016 to report use J8670 C9480 Trabectedin Inj 0.1mg D Invalid 12/31/2016 to report use J9352 C9137 Factor VIII PEGylated Inj 1iu D Invalid 12/31/2016 to report use J7207 C9138 Factor VIII Nuwiq Inj 1iu D Invalid 12/31/2016 to report use J7209 C9139 Factor IX Albumin Fusion ProteinIdelvion 1iu D Invalid 12/31/2016 to report use J7202 C9121 Argatroban Inj 5mg D Invalid 12/31/2016 to report see J0883, J0884 C9470 Aripiprazole Lauroxil Inj 1 mg D Invalid 12/31/2016 to report use J1942 C9461 Choline C 11 diagnostic study dose D Invalid 12/31/2016 to report use A9515 C9479 Ciprofloxacin Otic Suspension Instillation 6mg D Invalid 12/31/2016 to report use J7342 J0760 Colchicine Inj 1mg D Invalid 12/31/2016 C9458 Florbetaben f18 Dx per dose up to 8.1mci D Invalid 12/31/2016 to report use Q9983 C9459 Flutemetamol f18 Dx per dose up to 5mci D Invalid 12/31/2016 to report use Q9982 J1590 Gatifloxacin Inj 10mg D Invalid 12/31/2016 Q9980 Hyaluronan Genvisc 850 Intra Articular Inj 1mg D Invalid 12/31/2016 C9471 Hyaluronan Hymovis intra articular Inj 1mg D Invalid 12/31/2016 to report use J7322 C9478 Sebelipase Alfa Inj 1mg D Invalid 12/31/2016 to report use J2840 C9472 Talimogene Laherparepvec Inj 1 million pfu D Invalid 12/31/2016 to report use J9325

15 15 Payment For Drugs, Biologicals and Radiopharmaceuticals Packaging threshold increases $ $ $ $ $110 Payments will continue at average sales price (ASP) plus 6% for all separately payable drugs, biologicals and radiopharmaceuticals

16 16 Pass-Through Drugs Temporary at least 2 to not more than 3 year pass-through of cost for new drugs Quarterly updates used to get as close as possible to full 3 years 17 pass-through drugs and biologicals will expire 23 new pass-through drugs for total pass-through drugs and biologicals for 2017

17 17 Drugs with Expired Pass-thru Status

18 Pass-Thru Drugs More on Table 36 or 2017 OPPS FR

19 19 Changed to Paid Status HCPCS SVC DESC Oct 16 Jan 17 J0130 Abciximab Inj 10mg N K J1826 Interferon Beta 1A Inj 30mcg E K J9218 Leuprolide Acetate Inj 1mg N K J7505 Muromonab CD3 ParEnteral 5mg E K J9351 Topotecan Inj 0.1mg N K J7182 Factor VIII recomb novoeight Inj 1iu E K J0583 Bivalirudin Inj 1mg N K J1730 Diazoxide Inj up to 300mg N K J1455 Foscarnet Sodium Inj 1000mg N K J1460 Gamma Globulin Inj IM 1cc N K J1560 Gamma Globulin Inj IM >10cc N K J2260 Milrinone Lactate Inj 5mg N K J2265 Minocycline Hydrochloride Inj 1mg N K J2515 Pentobarbital Sodium Inj 50mg N K J2730 Pralidoxime Chloride Inj up to 1g N K

20 20 Changed to Non-Paid Status HCPCS SVC DESC Oct 16 Jan 17 J8520 Capecitabine Oral 150mg K N J8521 Capecitabine Oral 500mg K N J0132 Acetylcysteine Inj 100mg K N J7336 Capsaicin 8% Patch 1cm2 K N J0720 Chloramphenicol Sodium Inj up to 1gm K N J0725 Chorionic Gonadotropin Inj 1000u K N J0833 Cosyntropin Inj NOS 0.25mg K N J1160 Digoxin Inj up to 0.5mg K N J0887 Epoetin Beta ESRD Use 1mcg K N J1330 Ergonovine Maleate Inj up to 0.2mg K N J1447 Tbo Filgrastim Inj 1mcg G N J2020 Linezolid Inj 200mg K N J2800 Methocarbamol Inj up to 10ml K N J7508 Tacrolimus Ext Release Oral 0.1mg G N J3145 Testosterone Undecanoate Inj 1mg G N J3489 Zoledronic Acid Inj NOS 1mg K N

21 21 Beware Description Changes Description HCPCS 2017 SI Description HCPCS 2017 SI Argatroban Inj 5mg C9121 D Argatroban Inj 1mg (for non ESRD use) J0883 K Argatroban Inj 1mg (for ESRD on dialysis) J0884 N Description HCPC S 2017 SI Change Comment Bendamustine HCL Inj (Treanda) 1mg J9033 K Desc change Bendamustine HCL Inj (Bendeka) 1mg J9034 G New Valid 1/1/2017 Change for 2017 use J9033 for Treanda, use J9034 for Bendeka

22 22 Vaccines

23 23 Vaccine Changes To M status change HCPCS SVC DESC Oct 16 Jan Meningococcal recombinant protein and outer membrane vesicle vaccine K M Meningococcal recombinant lipoprotein vaccine, serogroup B, 3 dose schedule K M BCG Vacc Percut K M Meningococcal Vacc SC K M Meningococcal Vacc IM K M

24 24 New Vaccines Codes was approved by CPT editorial Panel, released in July 2016 and in the CPT 2017 book These vaccines have been approved, but are not in the CPT manual. They are awaiting FDA approval

25 25 New FDA Approval Both these codes have had their lightening bolt removed to indicate that they have been FDA approved was approved in June was approved in November 2015

26 Vaccine Description Changes HCPCS Short Description Rev Code Status Action Change Bendamustine HCL Inj (Treanda) Description Change for 2017 use J9033 for Treanda, use J9033 1mg 636 K change J9034 for Bendeka J1745 Infliximab Inj (not biosimilar) 10mg 636 K Description change Change for 2017 use J1745 for Not Biosimilar, see Q5102 for Biosimilar (stat E) J7340 Carbidopa 5mg/Levodopa 20mg 100ml Enteral Suspension 636 K Description change Valid 1/1/2016 Add "per 100ml" Flu Vacc Preserv Free split virus 0.25ml dosage IM 636 L Description change 2017 remove age definition, add dosage Flu Vaccine No Preserv 0.5 ml dosage IM 636 L Description change 2017 remove age definition, add dosage Description Flu Vacc 0.25 ml dosage IM 636 L change 2017 remove age definition, add dosage Flu Vacc Cell Cult Prsv Free 0.5 ml Description dosage 636 L change 2017 add dosage Flu vaccine, quadrivalent, split, 0.25 ml dosage IM 636 L Description change 2017 remove age definition, add dosage Flu vaccine, quadrivalent, split, 0.5 ml dosage IM 636 L Description change 2017 remove age definition, add dosage Description Flu Vaccine 4 val 0.25 ml dosage IM 636 L change 2017 remove age definition, add dosage Flu Vacc 4 val 0.5 ml dosage IM 636 L Description change 2017 remove age definition, add dosage Q2039 Flu Vacc Split Virus NOS IM 636 L Description change 2017 remove age definition

27 27 Other Vaccine Code Description Changes was corrected to reflect the correct age of 6 weeks to 18 months was revised to specify trivalent vaccine (different from 90674), plus dosage amount was added was modified to add Advisory Committee on Immunization MCV4 to the description

28 28 RadioPharms

29 29 Paid RadioPharm Codes HCPCS Short Description New 2017 SI A9515 Choline c 11 NI G A9517 I131 iodide cap, rx K A9530 I131 iodide sol, rx K A9543 Y90 ibritumomab, rx K A9563 P32 na phosphate K A9564 P32 chromic phosphate K A9586 Florbetapir f18 G A9587 Gallium ga 68 NI G A9588 Fluciclovine f 18 NI G A9597 PET radiopharmaceutical Dx for tumor ID NOC NI N A9598 PET radiopharmaceutical Dx for non tumor ID NOC NI N A9600 Sr89 strontium K A9604 Sm 153 lexidronam K A9606 Radium ra223 dichloride ther K Q9969 Non heu tc 99m add on/dose K Q9982 Flutemetamol f18 diagnostic NC G Q9983 Florbetaben f18 diagnostic NC G

30 30 Radiology Pass-through Three new pass through drug for 1/1/2017 Two new pass through drugs for 7/1/2016 HCPCS Short Description New 2017 SI comments Florbetaben f18 Dx per dose up to Q mci G Valid 7/1/2016 Flutemetamol f18 Dx per dose up to Q9982 5mci G Valid 7/1/2016 A9515 Choline C 11 Dx per study dose up to 20mCi New G A9587 Gallium GA 68 Dotatate Dx 0.1mCi New G Valid 1/1/2017 A9588 Fluciclovine F 18 Dx 1mCi New G Valid 1/1/2017 Valid 1/1/2017 note this same code represented TC 99M Pentetate 1mCi in 2005 and was replaced with A9539

31 31 Replaced Codes HCPCS Short Description Invalid 2017 SI comments C9458 Florbetaben f18 Dx per dose up to 8.1mci Invalid D Invalid 6/30/2016 to report use Q9983 C9459 Flutemetamol f18 Dx per dose up to 5mci Invalid D Invalid 6/30/2016 to report use Q9982

32 32 New Codes A9515 replaces C9461 A9597 and A9598 are new (7/1/2016) codes for PET imaging The code A9599 has been modified to add not otherwise specified - Radiopharmaceutical, diagnostic, for beta-amyloid positron emission tomography (pet) imaging, per study dose, not otherwise specified Two other codes, I-131 Tositumomab (Bexxar), are deleted and not replaced: A9544 and A9546

33 33 Drug Administration

34 34 Drug Administration Drug administration codes are still status S for 2017 Drug administration codes and reporting guidelines unchanged for 2017 Still excluded from the some packaging (e.g., Add on codes, cost threshold) Packaged with C-APCs Packaged for C-APC for Observation in 2016

35 35 Neulasta (pegfilgrastim) On- Body Injector New CPT code 96377, Application of on-body injector (includes cannula insertion) for timed subcutaneous injection Assigned APC SI of N (unconditionally packaged) Commenters complained that it is unpaid stating that this is a primary service CMS responded that no separate payment is necessary because the related service (chemotherapy administration or clinic visit) would be the primary service

36 36 Other Inj/Inf Pump Changes Status change for 96371, SC ther inf reset pump, change from status N to S for 2017 New chemo pump G-code G0498, Chemo Extend IV Infus w/pump, status S for 2017 Missed this code on our Inj/Inf code Reference Sheet Confusion on how to use this code How distinct from Whether it includes pump device CMS will provide follow-up information

37 37 Vaccination up to age 18 with Counseling

38 38 Vaccines for Children Medicaid Update December 2012: Effective for dates of service on and after January 1, 2013, billing instructions for vaccine administration for practitioner and ordered ambulatory providers have changed as follows (does not apply to clinic APG billing): Vaccines for Children Program (VFC) - Vaccine Administration For administration of vaccines supplied by VFC, including influenza and pneumococcal administration, providers will be required to bill vaccine administration code Providers must continue to bill the specific vaccine code with the SL modifier on the claim (payment for SL will be $0.00). If an administration code is billed without a vaccine code with SL, the claim will be denied. For reimbursement purposes, the administration of the components of a combination vaccine will continue to be considered as one vaccine administration. More than one vaccine administration is reimbursable under on a single date of service. Source:

39 39 Vaccines for Children Medicaid Update September 2012: Clarification of Immunization Policy and Billing Guidelines Vaccines Provided to Medicaid Enrollees under Age 19 (Excluding Influenza and Pneumococcal vaccines) o Vaccines administered to Medicaid enrollees under the age of 19 years old are supplied through the Vaccine for Children (VFC) program. o Vaccines provided through the VFC program are free. An administration fee of $17.85 is paid per vaccine dose administered. o Effective October 1, 2011, (retroactive to 12/1/08), VFC vaccines are to be billed as APG line items. o Providers should bill using the CPT code that represents the vaccine administered and append the vaccine code with the "SL" modifier (indicating State Supplied Vaccine). Only the VFC administration fee will be paid ($17.85). o Providers should not bill an additional CPT code for vaccine administration. The "SL" modifier indicates administration of a State supplied vaccine through the VFC program, and thereby generates payment of the enhanced administration fee of $17.85 Source:

40 and versus and 90472

41 and Reportable to Medicare both professionally (if in a private doctor s practice) and technically (if in a PBD) Reported per vaccine administered Reported for any age patient No counseling requirement

42 and Cannot be reported technically to Medicare, but can be reported professionally Limited to 18 years of age or younger Must provide physician or mid-level counseling in addition to the administration billed for the first component of each vaccine administered bill for each additional component

43 and Many vaccines consist of more than one component E.g., DTAP - Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), when administered to individuals younger than 7 years, for intramuscular use Reported as x 1 and x 2

44 44 Rabies

45 45 Medicare for Rabies The Average Sales Price (ASP) file for 2017 shows the per unit price as follows: Rabies ig im/sc 150 IU $ Rabies ig heat treated 150 IU $ The Medicare MUE is 20, while the typical units administered is around 12 Medicare will reimburse around $3600 for 12 units reported Plus the rabies vaccine (90675) is paid an additional $272

46 46 NYS Medicaid Rabies If the patient received treatment in the ED, the APG claim will report an E/M, which will get paid on the weight of the dx Paid on ICD-10 code Z20.3 RW= x day rate, paid around $ , 90376, not on carve out list, nor is (rabies vaccine) on the APG Fee Schedule like many other vaccines

47 47 SAD

48 48 Self Administered Drugs Self-administered drugs (SAD) are considered a statutory exclusion from Medicare benefits Reported in the non-covered portion of the outpatient bill Use Rev Code 637 for OP billing For most commercial payers report with a 250 revenue code

49 49 SAD Medicare Part B does not cover drugs that are usually (i.e., more than 50% of the time) selfadministered by the patient It is a benefit category denial and not a denial based on medical necessity An Advance Beneficiary Notice ( ABN ) is not required Therefore providers may charge the beneficiary for an excluded drug If Hospital pharmacy participates (most don t) in Part D drug plan, then some SAD may be covered

50 50 NGS SAD List Contractors (FI/MACs) must publish a list of the injectable drugs that are subject to the selfadministered exclusion on their Web site Published as an article similar to coverage decisions Link to NGS SAD list-- J1675 INJECTION, HISTRELIN ACETATE, 10 MICROGRAMS Histrelin acetate 10mg J1815 INJECTION, INSULIN, PER 5 UNITS Insulin J1817 INSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITS Insulin for administration

51 51 Part D In the event that the hospital pharmacy has a contract with the Medicare beneficiaries Part D plan, the hospital may bill the Part D plan for the SAD

52 52 SAD OIG Waiver Hospitals will not be subject to Office of Inspector General (OIG) administrative sanctions for discounting or waiving amounts Medicare beneficiaries may owe for self-administered drugs (SADs) they receive in outpatient settings when those drugs are not covered by Medicare Part B October 29,

53 53 Don t Report Admin Do not report the injection or infusion administration with the SAD list drugs

54 54 JW Update

55 55 January 1, 2017 All Medicare Providers musts use JW modifier Not new for NGS providers

56 56 Bill Correct Units and Charge To bill for any wastage that was not included in the amount administered: The amount of the drug wasted is billed on a separate claim line with the JW modifier. Units are calculated according to the applicable HCPCS code descriptor. The dollar amount must reflect the amount attributed to the wastage. You will need to calculate the dollar amounts attributed to the amount administered versus the amount wasted NGS Medicaid News and Alerts

57 57 Billing for Wastage The CMS encourages physicians, hospitals and other providers and suppliers to care for and administer to patients in such a way that they can use drugs or biologicals most efficiently When a provider must discard the remainder of a single use vial or other single use package after administering a drug or biological to a Medicare patient, the program provides payment for the amount of drug or biological discarded as well as the dose administered, up to the amount of the drug or biological as indicated on the vial or package label Medicare Claims Processing Manual Chapter 17 - Drugs and Biologicals

58 58 Wastage Document what was wasted Patient-specific documentation Single-use drugs Don t bill waste for multi-use vials OIG has recommended FIs set up an edit that looks for drug billing units equal to full vials for multi-use vial drugs

59 59 Multi Use Vials Herceptin comes in a multiuse vial of 440 milligrams Herceptin, when reconstituted with BWFI and stored properly, can be used for up to 28 days For multiuse vials, Medicare pays only for the amount administered to a beneficiary and does not pay for any discarded drug A payment for an entire multiuse vial is likely to be incorrect This audit is part of a nationwide review of the drug Herceptin Report by THE OFFICE OF INSPECTOR GENERAL- December 2012 A

60 60 JW Modifier The JW modifier is applied to the amount of drug or biological that is discarded Beware of rounding up twice for administered and wastage and overbilling Required by NYS Medicaid and some other commercial payers

61 61 NDC Review National Drug Code maintained in the formulary by the pharmacist 11 digit code represents brand (labeler), drug and dose, vial size NDC is used for billing for some payers e.g., Medicaid Periodic review is important

62 62 Billing Units Maintain Medicare billing units definition in CDM, not vial size from formulary E.g., J3246 Tirofiban HCL CDM description- Tirofiban HCL Inj 0.25mg Formulary description- Tirofiban HCL Inj 12.5mg One 12.5 mg vial = 50 billing units-- J3246 x 50 Round up partial units to whole billing units

63 63 Formulary to CDM Review Review at least annually Join Formulary to CDM Reconcile Formulary items not linked to CDM Drug CDM items with no formulary link Review multipliers

64 64 Questions and Discussion

65 65 Richard Cooley Contact Us Phone: Matthew Lawney Phone: Jean Russell Phone:

66 66

67 67 CPT Current Procedural Terminology (CPT ) Copyright 2016 American Medical Association All Rights Reserved Registered trademark of the AMA

68 68 Disclaimer Information and opinions included in this presentation are provided based on our interpretation of current available regulatory resources. No representation is made as to the completeness or accuracy of the information. Please refer to your payer or specific regulatory guidelines as necessary.