Indications and Limitations of Coverage and/or Medical back to top
|
|
- Donald King
- 6 years ago
- Views:
Transcription
1 Fr services perfrmed n r after 09/15/2009 Original Determinatin Ending Date Revisin Effective Date Revisin Ending Date Indicatins and Limitatins f Cverage and/r Medical Necessity Indicatins Medicare cverage fr cataract extractin and cataract extractin with intracular lens implant is based n services that are reasnable and medically necessary fr the treatment f beneficiaries wh have a cataract, and wh meet the fllwing criteria: 1. The patient has undergne a standardized frmal measure f his visual functinal status, the results f which suggest that the patient's visual functinal status can be imprved cmmensurate with the risk f surgery by underging cataract extractin with intracular lens implant. Such testing can be perfrmed with standardized measurement tls. 2. The patient has impairment f visual functin due t cataract(s) resulting in: Decreased ability t carry ut activities f daily living such as reading, viewing televisin, driving r meeting ccupatinal r vcatinal expectatins. Snellen visual acuity f 20/40 r wrse. If there is a glare cmpnent, glare testing which reduces visual acuity t wrse than 20/40. Special situatins might arise where a patient wuld need
2 better than 20/40 visin t functin (pilts, prfessinal drivers, etc.). In these instances additinal dcumentatin shuld be available in the patient's medical recrd describing these circumstances.(see belw under Dcumentatin) 3. Other medical indicatins exist fr cataract remval such as: Clinically significant anismetrpia in the presence f a cataract. The lens pacity interferes with ptimal diagnsis r management f psterir segment cnditins. The lens causes inflammatin (phaclysis, phacanaphylaxis). The lens induces angle clsure (phacmrphic, phactpic). 4. The patient has undergne an apprpriate preperative phthalmlgic evaluatin, which generally includes a cmprehensive phthalmlgic exam and either: an A-scan ultrasund, r partial cherence interfermetry with either keratmetry r crneal tpgraphy. Other phthalmlgic studies shuld be reserved fr special situatins, such as: B-scan fr patients with dense cataracts, which preclude visualizatin f the psterir segment f the eye including the vitreus and/r retina, but nt limited t these. Preperative Ophthalmlgic Evaluatin and Testing Rutine pre-perative phthalmlgic screening withut substantiated signs r symptms f disease is nt medically necessary. Where the nly diagnsis is cataract(s), Medicare des nt cver testing ther than ne preperative phthalmlgic evaluatin, which generally includes a cmprehensive phthalmlgic examinatin and an A-scan ultrasund r OCB
3 (when an IOL is planned). The gals f the physical examinatin f a patient whse chief cmplaint may be related t a cataract are: t diagnse r cnfirm the presence f a cataract t cnfirm that the cataract is a significant factr related t the visual impairment and symptms described by the patient t exclude r identify ther cular r systemic cnditins that might cntribute t the patient s visual impairment r affect the surgical plan r ultimate utcme. The phthalmic examinatin shuld include the fllwing cmpnents: 1. Patient histry (including patient s assessment f functinal status 2. Snellen acuity and refractin 3. Measurement f intracular pressure 4. Assessment f pupillary functin 5. Examinatin f cular mtility 6. External examinatin 7. Slit-lamp examinatin 8. Dilated examinatin f the fundus (unless cntraindicated by the anatmy f the eye) The fllwing tests are generally nt indicated in the preperative wrkup fr cataract surgery. If perfrmed, the indicatins fr their use must be dcumented in the patient s medical recrd: Cntrast sensitivity testing. Ptential visin testing. Frmal visual fields. Flurescein angigraphy. External phtgraphy. Crneal pachymetry/specular micrscpy. Specialized clr visin tests. Electrphysilgic tests. The maximum interval between the preperative examinatin and the date f surgery shuld be n greater than 3 mnths. Patients shuld be educated t cntact the phthalmlgist if they have a
4 change in visual symptms during the interval between the preperative examinatin and the surgery. Cntraindicatins The fllwing are cntraindicatins t surgery fr visually impairing cataract except as nted abve: Glasses r visual aids prvide satisfactry functinal visin. The patient s lifestyle is nt cmprmised by the cataract. The patient is unable t underg surgery because f cexisting medical r cular cnditins. The patient des nt desire surgery. Surgery will nt imprve visual functin. A legal cnsent cannt be btained. Limitatins All f the patient selectin criteria utlined in the Indicatins and Limitatins f Cverage and/r Medical Necessity sectin f this plicy have nt been met (e.g., best crrected visual acuity f less than 20/40). Preperative testing perfrmed in excess f the guidelines utlined in the Indicatins and Limitatins Cverage and/r Medical Necessity sectin f this plicy will be cnsidered nt medically necessary. It is expected that mre than ne A-scan r OCB per year wuld generally nt be medically necessary. Ophthalmic bimetry fr lens pwer calculatin shuld nt be perfrmed unless a decisin t remve the cataract has been made by the patient and the surgen. If the bimetry is perfrmed by an ptmetrist, he/she shuld d s in crdinatin with the perating surgen s that nly ne prcedure is necessary. If bimetry is repeated by the perating surgen due t the inadequacy f the study, the riginal eye care physician/prvider shuld anticipate nt being reimbursed fr the study. B-scans perfrmed withut dcumented evidence f a dense
5 cataract r that the cataract precluded visualizatin f the psterir segment f the eye including the vitreus and/r retina will be cnsidered nt medically necessary. Secnd-eye Surgery: The fllwing is taken frm Cataract in the Adult Eye published as a Preferred Practice Pattern by the American Academy f Ophthalmlgy: Surgery shuld nt be perfrmed in bth eyes at the same time because f the ptential fr bilateral visual lss. Cnsideratin f the apprpriate interval between the first-eye surgery and secnd-eye surgery is influenced by several factrs: the patient's visual needs, the patient's preferences, visual acuity r functin in the secnd eye, the medical and refractive stability f the first eye, the need t develp bincular visin and symptmatic anismetrpia as well as lgistical cncerns f the patient in traveling back and frth t the physician's ffice. The patient and the phthalmlgist shuld discuss the benefit, risk and timing f secnd-eye surgery when they have had the pprtunity t evaluate the results f surgery n the first eye. Prir t perfrming surgery n the secnd eye, the patient's first eye shuld have a stable pstperative refractin and the patient shuld perceive imprved functin, and sufficient time shuld have elapsed t evaluate and treat early pstperative cmplicatins, such as endphthalmitis. The patient needs sufficient time t assess the results f his r her first-eye surgery t determine the need and apprpriate timing fr surgery in the secnd eye. Cverage Tpic Diagnstic Tests and X-Rays Dctr Office Visits Outpatient Hspital Services Surgical Services
6 Cding Infrmatin Bill Type Cdes: Cntractrs may specify Bill Types t help prviders identify thse Bill Types typically used t reprt this service. Absence f a Bill Type des nt guarantee that the plicy des nt apply t that Bill Type. Cmplete absence f all Bill Types indicates that cverage is nt influenced by Bill Type and the plicy shuld be assumed t apply equally t all claims. 999x Nt Applicable Revenue Cdes: Cntractrs may specify Revenue Cdes t help prviders identify thse Revenue Cdes typically used t reprt this service. In mst instances Revenue Cdes are purely advisry; unless specified in the plicy services reprted under ther Revenue Cdes are equally subject t this cverage determinatin. Cmplete absence f all Revenue Cdes indicates that cverage is nt influenced by Revenue
7 Cding Infrmatin Cde and the plicy shuld be assumed t apply equally t all Revenue Cdes. CPT/HCPCS Cdes REMOVAL OF SECONDARY MEMBRANOUS CATARACT (OPACIFIED POSTERIOR LENS CAPSULE AND/OR ANTERIOR HYALOID) WITH CORNEO-SCLERAL SECTION, WITH OR WITHOUT IRIDECTOMY (IRIDOCAPSULOTOMY, IRIDOCAPSULECTOMY) REMOVAL OF LENS MATERIAL; ASPIRATION TECHNIQUE, 1 OR MORE STAGES REMOVAL OF LENS MATERIAL; PHACOFRAGMENTATION TECHNIQUE (MECHANICAL OR ULTRASONIC) (EG, PHACOEMULSIFICATION), WITH ASPIRATION REMOVAL OF LENS MATERIAL; PARS PLANA APPROACH, WITH OR WITHOUT VITRECTOMY REMOVAL OF LENS MATERIAL; INTRACAPSULAR REMOVAL OF LENS MATERIAL; INTRACAPSULAR, FOR DISLOCATED LENS REMOVAL OF LENS MATERIAL; EXTRACAPSULAR (OTHER THAN 66840, 66850, 66852) EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (ONE STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION), COMPLEX, REQUIRING DEVICES OR TECHNIQUES NOT GENERALLY USED IN ROUTINE CATARACT SURGERY (EG, IRIS EXPANSION DEVICE, SUTURE SUPPORT FOR INTRAOCULAR LENS, OR PRIMARY POSTERIOR CAPSULORRHEXIS) OR PERFORMED ON PATIENTS IN THE AMBLYOGENIC DEVELOPMENTAL STAGE INTRACAPSULAR CATARACT EXTRACTION WITH
8 Cding Infrmatin INSERTION OF INTRAOCULAR LENS PROSTHESIS (1 STAGE PROCEDURE) EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1 STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION) ICD-9 Cdes that Supprt Medical Necessity It is the prvider s respnsibility t select cdes carried ut t the highest level f specificity and selected frm the ICD-9-CM cde bk apprpriate t the year in which the service is rendered fr the claim(s) submitted NONSENILE CATARACT UNSPECIFIED - UNSPECIFIED CATARACT Diagnses that Supprt Medical Necessity N/A ICD-9 Cdes that DO NOT Supprt Medical Necessity All thse nt listed under the ICD-9 Cdes that Supprt Medical Necessity sectin f this plicy. ICD-9 Cdes that DO NOT Supprt Medical Necessity Asterisk Explanatin Diagnses that DO NOT Supprt Medical Necessity Cnditins that are nt listed in the "ICD-9-CM Cdes that Supprt Medical Necessity" sectin f this plicy.
9 General Infrmatin Dcumentatin Requirements 1. All dcumentatin must be maintained in the patient s medical recrd and available t the cntractr upn request. 2. Every page f the recrd must be legible and include apprpriate patient identificatin infrmatin (e.g., cmplete name dates f service(s)). The recrd must include the physician r nn-physician practitiner respnsible fr and prviding the care f the patient. Dcumentatin supprting medical necessity (e.g., ffice/prgress ntes) f the cataract surgery must cntain: - Visual acuity (best crrected Snellen chart); - Symptmatlgy; - The use f cnservative treatment including current refractin is n lnger satisfactry; - Degree f functinal impairment (This can be in any frm; e.g., narrative r assessment tl as lng as it supprts hw the cataract affects the patient s ADLs.)
10 General Infrmatin 3. The submitted medical recrd shuld supprt the use f the selected ICD-9-CM cde(s). The submitted CPT/HCPCS cde shuld describe the service perfrmed.
CSHCN Services Program Benefits to Change for Outpatient Behavioral Health Services Information posted November 10, 2009
CSHCN Services Prgram Benefits t Change fr Outpatient Behaviral Health Services Infrmatin psted Nvember 10, 2009 Effective fr dates f service n r after January 1, 2010, benefit criteria fr utpatient behaviral
More informationBenefits for Anesthesia Services for the CSHCN Services Program to Change Effective for dates of service on or after July 1, 2008, benefit criteria
Benefits fr Anesthesia Services fr the CSHCN Services Prgram t Change Effective fr dates f service n r after July 1, 2008, benefit criteria fr anesthesia will change fr the Children with Special Health
More informationNIA Magellan 1 Spine Care Program Interventional Pain Management Frequently Asked Questions (FAQs) For Medicare Advantage HMO and PPO
NIA Magellan 1 Spine Care Prgram Interventinal Pain Management Frequently Asked Questins (FAQs) Fr Medicare Advantage HMO and PPO Questin GENERAL Why is Flrida Blue implementing a Spine Management prgram
More informationCardiac Rehabilitation Services
Dcumentatin Guidance N. DG1011 Cardiac Rehabilitatin Services Revisin Letter A 1.0 Purpse The Centers fr Medicare and Medicaid Services (CMS) has detailed specific dcumentatin requirements fr Cardiac Rehabilitatin
More informationRelated Policies None
Medical Plicy MP 3.01.501 Guidelines fr Cverage f Mental and Behaviral Health Services Last Review: 8/30/2017 Effective Date: 8/30/2017 Sectin: Mental Health End Date: 08/19/2018 Related Plicies Nne DISCLAIMER
More informationSolid Organ Transplant Benefits to Change for Texas Medicaid
Slid Organ Transplant Benefits t Change fr Texas Medicaid Infrmatin psted February 13, 2015 Nte: All new and updated prcedure cdes and their assciated reimbursement rates are prpsed benefits pending a
More informationContinuous Positive Airway Pressure (CPAP) and Respiratory Assist Devices (RADs) including Bi-Level PAP
Cntinuus Psitive Airway Pressure (CPAP) and Respiratry Assist Devices (RADs), Including Bi-Level PAP Benefit Criteria t Change fr Texas Medicaid Effective March 1, 2017 Overview f Benefit Changes Benefit
More informationPROVIDER ALERT. Comprehensive Diagnostic Evaluation (CDE) Guidelines to Access the Applied Behavior Analysis (ABA) Benefit.
Cmprehensive Diagnstic Evaluatin (CDE) Guidelines t Access the Applied Behavir Analysis (ABA) Benefit May 5, 2017 Clinical infrmatin that utlines medical necessity is required t supprt the need fr initial
More informationNational Imaging Associates, Inc. (NIA) Frequently Asked Questions (FAQ s) For PA Health & Wellness Providers
Natinal Imaging Assciates, Inc. (NIA) Frequently Asked Questins (FAQ s) Fr PA Health & Wellness Prviders Questin GENERAL Why is PA Health & Wellness implementing a Medical Specialty Slutins Prgram? Answer
More informationNational Imaging Associates, Inc. (NIA) Frequently Asked Questions (FAQs) For Louisiana Healthcare Connections Providers
Natinal Imaging Assciates, Inc. (NIA) Frequently Asked Questins (FAQs) Fr Luisiana Healthcare Cnnectins Prviders Questin GENERAL Why did Luisiana Healthcare Cnnectins implement a Medical Prgram? Answer
More informationStructured Assessment using Multiple Patient. Scenarios (StAMPS) Exam Information
Structured Assessment using Multiple Patient Scenaris (StAMPS) Exam Infrmatin 1. Preparing fr the StAMPS assessment prcess StAMPS is an assessment mdality that is designed t test higher rder functins in
More informationCLINICAL MEDICAL POLICY
Plicy Name: Plicy Number: Respnsible Department(s): CLINICAL MEDICAL POLICY Supervised Exercise Therapy fr Peripheral Artery Disease (PAD) MP-077-MD-DE Medical Management Prvider Ntice Date: 01/15/2019
More informationBariatric Surgery FAQs for Employees in the GRMC Group Health Plan
Bariatric Surgery FAQs fr Emplyees in the GRMC Grup Health Plan Gergia Regents Medical Center and Gergia Regents Medical Assciates emplyees and eligible dependents wh are in the GRMC Grup Health Plan (Select
More informationNational Imaging Associates, Inc. (NIA) Frequently Asked Questions (FAQs) For Managed Health Services (MHS)
Questin GENERAL Why did MHS implement a Medical Specialty Slutins Prgram? Natinal Imaging Assciates, Inc. (NIA) Frequently Asked Questins (FAQs) Fr Managed Health Services (MHS) Answer Effective Nvember
More informationo Procedures performed o Diagnoses Identified o Certain devices/equipment/supplies acquired for patient
Image Surce: https://s-media-cache-ak0.pinimg.cm/736x/7c/29/91/7c2991805f004e1ca05e42a79883f4a7.jpg 6/30/2017 Curse Objectives A Practical Guide t Cding fr Audilgists in 2017 Megan Keirans, AuD University
More informationWound Care Equipment and Supply Benefits to Change for Texas Medicaid July 1, 2018
Wund Care Equipment and Supply Benefits t Change fr Texas Medicaid July 1, 2018 Infrmatin psted May 11, 2018 Nte: Texas Medicaid managed care rganizatins (MCOs) must prvide all medically necessary, Medicaid-cvered
More information2018 CMS Web Interface
CMS Web Interface Diabetes Mellitus (DM) Cmpsite (All r Nthing Scring) DM-2 (NQF 0059): Diabetes: Hemglbin A1c (HbA1c) Pr Cntrl (>9%) DM-7 (NQF Measure Steward: NCQA CMS Web Interface V2.1 Page 1 f 26
More informationACRIN 6666 Screening Breast US Follow-up Assessment Form
Screening Breast US Fllw-up Assessment Frm N. Instructins: The frm is cmpleted at 12, 24 and 36 mnths pst initial n study mammgraphy and ultrasund by the Radilgist r RA. Reprt all interim infrmatin related
More information1.11 INSULIN INFUSION PUMP MANAGEMENT INPATIENT
WOMEN AND NEWBORN HEALTH SERVICE CLINICAL GUIDELINES SECTION A: GUIDELINES RELEVANT TO OBSTETRICS AND GYNAECOLOGY 1 STANDARD PROTOCOLS 1.11 INSULIN INFUSION PUMP MANAGEMENT - INPATIENT Authrised by: OGCCU
More informationHealth Screening Record: Entry Level Due: August 1st MWF 150 Entry Year
Health Screening Recrd: Entry Level MIDWIFERY EDUCATION PROGRAM HEALTH SCREENING REQUIREMENTS (Rev. June 2017) 1. Hepatitis B: Primary vaccinatin series (3 vaccines 0, 1 and 6 mnths apart), plus serlgic
More informationPodcast Transcript Title: Common Miscoding of LARC Services Impacting Revenue Speaker Name: Ann Finn Duration: 00:16:10
Pdcast Transcript Title: Cmmn Miscding f LARC Services Impacting Revenue Speaker Name: Ann Finn Duratin: 00:16:10 NCTCFP: Welcme t this pdcast spnsred by the Natinal Clinical Training Center fr Family
More informationAssessment Field Activity Collaborative Assessment, Planning, and Support: Safety and Risk in Teams
Assessment Field Activity Cllabrative Assessment, Planning, and Supprt: Safety and Risk in Teams OBSERVATION Identify a case fr which a team meeting t discuss safety and/r safety planning is needed r scheduled.
More informationGUIDANCE DOCUMENT FOR ENROLLING SUBJECTS WHO DO NOT SPEAK ENGLISH
GUIDANCE DOCUMENT FOR ENROLLING SUBJECTS WHO DO NOT SPEAK ENGLISH Aurra Health Care s Research Subject Prtectin Prgram (RSPP) This guidance dcument will utline the prper prcedures fr btaining and dcumenting
More informationObesity/Morbid Obesity/BMI
Obesity/mrbid besity/bdy mass index (adult) Obesity/Mrbid Obesity/BMI Definitins and backgrund Diagnsis cde assignment is based n the prvider s clinical judgment and crrespnding medical recrd dcumentatin
More informationLEVEL OF CARE GUIDELINES: INTENSIVE BEHAVIORAL THERAPY/APPLIED BEHAVIOR ANALYSIS FOR AUTISM SPECTRUM DISORDER HAWAII MEDICAID QUEST
OPTUM LEVEL OF CARE GUIDELINES: INTENSIVE BEHAVIORAL THERAPY / APPLIED BEHAVIOR ANALYSIS FOR AUTISM SPECTRUM DISORDER HAWAII MEDICAID QUEST LEVEL OF CARE GUIDELINES: INTENSIVE BEHAVIORAL THERAPY/APPLIED
More informationContinuous Quality Improvement: Treatment Record Reviews. Third Thursday Provider Call (August 20, 2015) Wendy Bowlin, QM Administrator
Cntinuus Quality Imprvement: Treatment Recrd Reviews Third Thursday Prvider Call (August 20, 2015) Wendy Bwlin, QM Administratr Gals f the Presentatin Review the findings f Treatment Recrd Review results
More information2017 CMS Web Interface
CMS Web Interface Diabetes Mellitus (DM) Cmpsite (All r Nthing Scring) DM-2 (NQF 0059): Diabetes: Hemglbin A1c (HbA1c) Pr Cntrl (>9%) DM-7 (NQF 0055): Diabetes: Eye Exam Measure Steward: NCQA Web Interface
More information2017 CMS Web Interface
CMS Web Interface PREV-5 (NQF 2372): Breast Cancer Screening Measure Steward: NCQA Web Interface V1.0 Page 1 f 18 11/15/2016 Cntents INTRODUCTION... 3 WEB INTERFACE SAMPLING INFORMATION... 4 BENEFICIARY
More informationMethadone Maintenance Treatment for Opioid Dependence
POLICY STATEMENT Methadne Maintenance Treatment fr Opiid Dependence APPROVED BY COUNCIL: May 2010 PUBLICATION DATE: Dialgue, Issue 2, 2010 Disclaimer: As f May 19, 2018 physicians n lnger require an exemptin
More informationAppendix C. Master of Public Health. Practicum Guidelines
Appendix C Master f Public Health Practicum Guidelines 0 Gergia State University, Schl f Public Health Master f Public Health Practicum Guidelines Fr mre infrmatin, cntact Jessica Hwell Pratt, MPH Practicum
More informationIowa Early Periodic Screening, Diagnosis and Treatment Care for Kids Program Provider Training
Iwa Early Peridic Screening, Diagnsis and Treatment Care fr Kids Prgram Prvider Training The Early Peridic Screening, Diagnsis and Treatment (EPSDT) Care fr Kids prgram is Iwa s Medicaid prgram fr children.
More informationOTHER AND UNSPECIFIED DISORDERS
OPTUM COVERAGE DETERMINATION GUIDELINE OTHER AND UNSPECIFIED DISORDERS Guideline Number: BH727OUD_102017 Effective Date: Octber, 2017 Table f Cntents Page INSTRUCTIONS FOR USE... 1 BENEFIT CONSIDERATIONS...
More informationDiabetes Mellitus Lab Tests (Screening, Diagnosis & Monitoring)
Rule Categry: Medical ` Ref: N: 2013-MN-0012 Versin Cntrl: Versin N. 1.1 Effective Date: December 2013 Revisin Date: December 2014 Diabetes Mellitus Lab Tests (Screening, Diagnsis & Mnitring) Adjudicatin
More informationUNM SRMC SLEEP MEDICINE CLINICAL PRIVILEGES.
Initial privileges (initial appintment) Renewal f privileges (reappintment) Expansin f privileges (mdificatin) INSTRUCTIONS All new applicants must meet the fllwing requirements as apprved by the UNM SRMC
More informationPROCEDURAL SAFEGUARDS NOTICE PARENTAL RIGHTS FOR PRIVATE SCHOOL SPECIAL EDUCATION STUDENTS
PROCEDURAL SAFEGUARDS NOTICE PARENTAL RIGHTS FOR PRIVATE SCHOOL SPECIAL EDUCATION STUDENTS INTRODUCTION This ntice prvides an verview f the parental special educatin rights, smetimes called prcedural safeguards
More informationHearing Service Fees and Fee Codes Effective: January 01, 2019
Hearing Fees and Fee Cdes Effective: January 01, 2019 The WCB will fund the fllwing hearing services fr claims accepted fr traumatic and ccupatinal nise induced hearing: Fee cde 200 - Full audilgical assessment.
More informationLower Extremity Amputation (LEA) Considerations / Issues
Lwer Extremity Amputatin (LEA) Cnsideratins / Issues Prviding Te Fillers can be an advantageus resurce fr yur patient and business but it als cmes with certain cnsideratins. Please review this list belw
More informationHEDIS. Healthcare Effectiveness Data & Information Set (HEDIS ) QUALITY MANAGEMENT PROGRAM SECTION 8
HEDIS Healthcare Effectiveness Data & Infrmatin Set (HEDIS ) The HEDIS â audit cntains a cre set f perfrmance measures that prvide infrmatin abut custmer satisfactin, specific health care measures, and
More informationFee Schedule - Home Health Care- 2015
Fee Schedule - Hme Health Care- 2015 01/01/2015 1600 E Century Ave Ste 1 PO Bx 5585 Bismarck ND 58506-5585 www.wrkfrcesafety.cm Cpyright Ntice The five character cdes included in the Nrth Dakta Fee Schedule
More informationWHAT IS HEAD AND NECK CANCER FACT SHEET
WHAT IS HEAD AND NECK CANCER FACT SHEET This infrmatin may help answer sme f yur questins and help yu think f ther questins that yu may want t ask yur cancer care team; it is nt intended t replace advice
More informationP02-03 CALA Program Description Proficiency Testing Policy for Accreditation Revision 1.9 July 26, 2017
P02-03 CALA Prgram Descriptin Prficiency Testing Plicy fr Accreditatin Revisin 1.9 July 26, 2017 P02-03 CALA Prgram Descriptin Prficiency Testing Plicy fr Accreditatin TABLE OF CONTENTS TABLE OF CONTENTS...
More informationMEASURE #10: PLAN OF CARE FOR MIGRAINE OR CERVICOGENIC HEADACHE DEVELOPED OR REVIEWED Headache
MEASURE #10: PLAN OF CARE FOR MIGRAINE OR CERVICOGENIC HEADACHE DEVELOPED OR REVIEWED Headache Measure Descriptin All patients diagnsed with migraine headache r cervicgenic headache wh had a headache management
More informationCoding. Training Guide
Cding (Specialty Hspital) Visin 4.3 (January 2013) Training Guide SurceMedical VisinSH Cding Learning Center f Excellence Last change made: January 2013 2013 Surce Medical Slutins, Inc. All Rights Reserved.
More informationCONSENT FOR KYBELLA INJECTABLE FAT REDUCTION
CONSENT FOR KYBELLA INJECTABLE FAT REDUCTION INSTRUCTIONS This is an infrmed cnsent dcument which has been prepared t help yur Dctr infrm yu cncerning fat reductin with an injectable medicatin, its risks,
More information2017 CMS Web Interface
CMS Web Interface CARE-2 (NQF 0101): Falls: Screening fr Future Fall Risk Measure Steward: NCQA Web Interface V1.0 Page 1 f 18 11/15/2016 Cntents INTRODUCTION... 3 WEB INTERFACE SAMPLING INFORMATION...
More informationFolotyn (pralatrexate)
Fltyn (pralatrexate) Line(s) f Business: HMO; PPO; QUEST Integratin Akamai Advantage Original Effective Date: 10/01/2015 Current Effective Date: 01/01/2018TBD03/01/2017 POLICY A. INDICATIONS The indicatins
More informationDental Benefits. Under the TeamstersCare Plan, you and your eligible dependents have three basic options when you need dental care.
Dental Benefits Under the TeamstersCare Plan, yu and yur eligible dependents have three basic ptins when yu need dental care. Optin #1: TeamstersCare Dentists. Yu can use ur in-huse Charlestwn, Chelmsfrd,
More informationHIP REPLACEMENT SURGERY (ARTHROPLASTY)
Prtcl: ORT015 Effective Date: June 1, 2017 HIP REPLACEMENT SURGERY (ARTHROPLASTY) Table f Cntents Page COMMERCIAL & MEDICAID COVERAGE RATIONALE... 1 MEDICARE COVERAGE RATIONALE... 3 U.S.FOOD AND DRUG ADMINISTRATION
More informationEAGLE CARE A SPORT CLUB CONCUSSION MANAGEMENT MODEL
EAGLE CARE A SPORT CLUB CONCUSSION MANAGEMENT MODEL Cncussin awareness has increased significantly in recent years. The Natinal Cllegiate Athletic Assciatin (NCAA), Natinal Athletic Trainers Assciatin
More informationCorporate Governance Code for Funds: What Will it Mean?
Crprate Gvernance Cde fr Funds: What Will it Mean? The Irish Funds Industry Assciatin has circulated a draft Vluntary Crprate Gvernance Cde fr the Funds Industry in Ireland. 1. Backgrund On 13 June 2011,
More informationReferral Criteria: Inflammation of the Spine Feb
Referral Criteria: Inflammatin f the Spine Feb 2019 1 5.7. Inflammatin f the Spine Backgrund Ankylsing spndylitis and axial spndylarthrpathy are fund in arund 0.3-1.2% f the ppulatin. Spndylarthritis encmpasses
More informationTOP TIPS Lung Cancer Update Dr Andrew Wight Consultant respiratory Physician - WUTH
Tpic Circulatin list In case f query please cntact Executive Summary TOP TIPS Lung Cancer Update Dr Andrew Wight Cnsultant respiratry Physician - WUTH All Wirral GP s JaneFletcher2@nhs.net Dear Clleagues,
More informationBreast Cancer Awareness Month 2018 Key Messages (as of June 6, 2018)
Breast Cancer Awareness Mnth 2018 Key Messages (as f June 6, 2018) In this dcument there are tw sectins f messages in supprt f Cancer Care Ontari s Breast Cancer Awareness Mnth 2018: 1. Campaign key messages
More informationPolicy Guidelines: Genetic Testing for Carrier Screening and Reproductive Planning
Plicy Guidelines: Genetic Testing fr Carrier Screening and Reprductive Planning Cntents Overview... 1 Cverage guidelines... 2 General cverage guidelines... 2 Rutine carrier screening... 2 Carrier screening
More information2017 CMS Web Interface
CMS Web Interface PREV-6 (NQF 0034): Clrectal Cancer Screening Measure Steward: NCQA Web Interface V1.0 Page 1 f 18 11/15/2016 Cntents INTRODUCTION... 3 WEB INTERFACE SAMPLING INFORMATION... 4 BENEFICIARY
More informationPhysical, Occupational, and Speech Therapy - Children (Acute and Chronic)
Physical, Occupatinal, and Speech Therapy - Children (Acute and Chrnic) Infrmatin psted May 6, 2016 Nte: This article applies t claims submitted t TMHP fr prcessing. Fr claims prcessed by a Medicaid managed
More information2018 CMS Web Interface
CMS Web Interface MH-1 (NQF 0710): Depressin Remissin at Twelve Mnths Measure Steward: MNCM CMS Web Interface V2.1 Page 1 f 27 06/25/ Cntents INTRODUCTION... 4 CMS WEB INTERFACE SAMPLING INFORMATION...
More informationA pre-conference should include the following: an introduction, a discussion based on the review of lesson materials, and a summary of next steps.
NAU Mdel Observatin Prtcl The mdel prtcl was develped with supprt and expertise frm the Natinal Institute fr Excellence in Teaching (NIET) and is based in great part n NIET s extensive experience cnducting
More informationSCALES NW HEARING PROTECTION PROGRAM
PURPOSE Expsure t excessive nise in the wrkplace can cause permanent hearing lss. The Hearing Prtectin Prgram has been established t help ensure that emplyees f Scales NW, Inc. d nt suffer health effects
More informationDrug Therapy Guidelines
Applicable Medical Benefit x Effective: 5/1/18 Pharmacy- Frmulary 1 x Next Review: 3/18 Pharmacy- Frmulary 2 x Date f Origin: 4/99 Gnadtrpin-Releasing Hrmne Agnists- Eligard, Luprn, Luprn-Dept, Luprn Dept-Ped,
More information2018 CMS Web Interface
CMS Web Interface HTN-2 (NQF 0018): Cntrlling High Bld Pressure Measure Steward: NCQA CMS Web Interface V2.0 Page 1 f 18 11/13/2017 Cntents INTRODUCTION... 3 CMS WEB INTERFACE SAMPLING INFORMATION... 4
More information2018 CMS Web Interface
CMS Web Interface MH-1 (NQF 0710): Depressin Remissin at Twelve Mnths Measure Steward: MNCM CMS Web Interface V2.0 Page 1 f 27 11/13/2017 Cntents INTRODUCTION... 4 CMS WEB INTERFACE SAMPLING INFORMATION...
More informationArtemis Physical Therapy Patient Information
Artemis Physical Therapy Patient Infrmatin Client Infrmatin Last Name First Name MI Address City Zip Date f Birth Female Male Emplyer (ptinal) Cntact Infrmatin Hme Phne Cell Phne Wrk Phne (ptinal) Email
More informationNoninvasive Peripheral Venous Studies
Nninvasive Peripheral Venus Studies Nridian Healthcare Slutins, LLC Please Nte: This is a Prpsed LCD. Prpsed LCDs are wrks in prgress and nt necessarily a reflectin f the current plicies r practices. Prpsed
More information2018 CMS Web Interface
CMS Web Interface PREV-12 (NQF 0418): Preventive Care and Screening: Screening fr Depressin and Measure Steward: CMS CMS Web Interface V2.1 Page 1 f 23 06/25/ Cntents INTRODUCTION... 3 CMS WEB INTERFACE
More informationDISCUSSION DRAFT DEVENTER, OCTOBER 2006 Consolidation of documents due for revision
UNION EUROPÉENNE DES MÉDECINS SPÉCIALISTES DISCUSSION DRAFT DEVENTER, OCTOBER 2006 Cnslidatin f dcuments due fr revisin ARCHIVED: GENEVA, OCTOBER 2007 REPORT OF THE UEMS SECTION OF PSYCHIATRY Quality Assurance
More informationSUFFOLK COUNTY COUNCIL. Anti- Social Behaviour Act Penalty Notice. Code of conduct
SUFFOLK COUNTY COUNCIL Anti- Scial Behaviur Act 2003 Penalty Ntice Cde f cnduct SCC Penalty Ntice Cde f Cnduct & Administrative Guidance: revised August 2014 1 Cntents 1. Legal Basis 2. Purpse f the Penalty
More informationRituxan (rituximab) Effective Date: 10/01/2015. Line(s) of Business: HMO; PPO; QUEST Integration Akamai Advantage
Rituxan (rituximab) Line(s) f Business: HMO; PPO; QUEST Integratin Akamai Advantage Effective Date: 10/01/2015 POLICY A. INDICATIONS The indicatins belw including FDA-apprved indicatins and cmpendial uses
More informationEXPLORING THE PROCESS OF ASSESSMENT AND OTHER RELATED CONCEPTS
1 SECTION 1 INTRODUCTION: EXPLORING THE PROCESS OF ASSESSMENT AND OTHER RELATED CONCEPTS The Nature Of Assessment The Definitin Of Assessment The Difference Between Testing, Measurement And Evaluatin Characteristics
More informationReference: Patient A. Brenda WXXXXX Date of Birth: 4/15/57
Reference: Patient A Brenda WXXXXX Date f Birth: 4/15/57 49 year ld white female patient presented n July 20, 2006 with chief cmplaint f stage 4 cancer, initially diagnsed in Octber, 2003 with Cervical
More informationThis standard operating procedure applies to stop smoking services provided by North 51.
Authr Name/Title Melanie McIlvar, Bid Develpment Manager Authr Signature Date: 4 th September 2017 Apprver Name/Title Jasn Shelley, Grup Directr f QA/RA Apprver Signature Date: 4 th September 2017 Issue
More informationImmunisation and Disease Prevention Policy
Immunisatin and Disease Preventin Plicy Quality Area 2: Children s Health and Safety 2.1 Each child s health is prmted 2.1.4 Steps are taken t cntrl the spread f infectius diseases and t manage injuries
More informationNational Imaging Associates, Inc. Clinical guidelines THERAPY AND REHABILITATION SERVICES (PT, OT) Original Date: October 2015 Page 1 of 34
Natinal Imaging Assciates, Inc. Clinical guidelines THERAPY AND REHABILITATION SERVICES (PT, OT) Original Date: Octber 2015 Page 1 f 34 FOR CMS (MEDICARE) MEMBERS ONLY CPT4 Cdes: Please refer t pages 30-32
More informationGuideline Number: NIA_CG_301 Last Revised Date: October 2014 Responsible Department: Implementation Date: October 2014 Clinical Operations
Natinal Imaging Assciates, Inc. Clinical guidelines PARAVERTEBRAL FACET JOINT INJECTIONS OR BLOCKS CPT Cdes: Cervical Thracic Regin: 64490 (+ 64491, +64492), 0213T (+0214T, +0215T) Lumbar Sacral Regin:
More informationAnnual Principal Investigator Worksheet About Local Context
Cmpleting the NCI CIRB Annual Principal Investigatr Wrksheet Abut Lcal Cntext and the Study-Specific Wrksheet Abut Lcal Cntext at the University f Iwa All investigatrs cnducting research with the Natinal
More informationAnnex III. Amendments to relevant sections of the Product Information
Changes t the Prduct infrmatin as apprved by the CHMP n 13 Octber 2016, pending endrsement by the Eurpean Cmmissin Annex III Amendments t relevant sectins f the Prduct Infrmatin Nte: These amendments t
More informationMeasure Specific Guidelines for Comprehensive Diabetes Care (CDC)
Measure Specific Guidelines fr Cmprehensive Diabetes Care (CDC) Descriptin: Members age 18-75 years f age with diabetes (Type 1 and Type 2)* that had all f the fllwing: *Members in hspice are excluded
More informationBenefits to Change for Diagnostic and Surgical/Reconstructive Breast Therapies and Corrective Procedures January 1, 2016
Benefits t Change fr Diagnstic and Surgical/Recnstructive Breast Therapies and Crrective Prcedures January 1, 2016 Infrmatin psted Nvember 13, 2015 Effective fr dates f service n r after January 1, 2016,
More informationThe estimator, X, is unbiased and, if one assumes that the variance of X7 is constant from week to week, then the variance of X7 is given by
ESTIMATION PROCEDURES USED TO PRODUCE WEEKLY FLU STATISTICS FROM THE HEALTH INTERVIEW SURVEY James T. Massey, Gail S. Pe, Walt R. Simmns Natinal Center fr Health Statistics. INTRODUCTION In April 97, the
More information2017 CMS Web Interface
CMS Web Interface PREV-12 (NQF 0418): Preventive Care and Screening: Screening fr Depressin and Fllw-Up Measure Steward: CMS Web Interface V1.0 Page 1 f 22 11/15/2016 Cntents INTRODUCTION... 3 WEB INTERFACE
More informationQP Energy Services LLC Hearing Conservation Program HSE Manual Section 7 Effective Date: 5/30/15 Revision #:
QP Energy Services LLC Hearing Cnservatin Prgram HSE Manual Sectin 7 Effective Date: 5/30/15 Revisin #: Prepared by: James Aregd Date: 5/30/15 Apprved by: James Aregd Date: 5/30/15 Page 1 f 8 Cntents Sectin
More informationVCCC Research and Education Lead for Breast Cancer
VCCC Research & Educatin Lead VCCC Research and Educatin Lead fr VCCC Visin The Victrian Cmprehensive Cancer Centre (VCCC) will save lives thrugh the integratin f cancer research, educatin and clinical
More informationALCAT FREQUENTLY ASKED QUESTIONS
1. Is fasting required befre taking the Alcat Test? N. It is recmmended t drink water and t avid stimulants like caffeine prir t the test. 2. With regard t testing children, must a child be a certain age
More informationFOR RESTRICTED AOs DIPLOMA IN POLICING ASSESSMENT UNITS Banked. D/507/3718 Interview suspects in relation to priority and volume investigations
Title: D/507/3718 Interview suspects in relatin t pririty and vlume investigatins Level: 4 Credit Value: 6 GLH: 20 Learning Outcmes The learner will: 1. understand the principles f interviewing suspects
More informationQUALITY AND SAFETY MEASURES UPDATE January 2016
CLINICAL EFFECTIVENESS/SAFETY M CORE MEASURES 2015 See attached Results QUALITY AND SAFETY MEASURES UPDATE January 2016 Jint Cmmissin and CMS Cre Measure Dashbard updated with mst recent data available:
More information2017 Optum, Inc. All rights reserved BH1124_112017
1) What are the benefits t clients f encuraging the use f MAT? Withut MAT, 90% f individuals with Opiid Use Disrder (OUD) will relapse within ne year. With MAT, the relapse rate fr thse with OUD decreases
More informationTransmittal 86 Date: July 3, SUBJECT: Continuous Positive Airway Pressure (CPAP) Therapy for Obstructive Sleep Apnea (OSA)
CMS Manual System Pub 100-03 Medicare Natinal Cverage Determinatins Department f Health & Human Services (DHHS) Centers fr Medicare & Medicaid Services (CMS) Transmittal 86 Date: July 3, 2008 Change Request
More informationHearing Conservation Program
Hearing Cnservatin Prgram FOREWORD Nise-induced hearing lss (NIHL) is a permanent and irreversible ccupatinal illness due t expsure t excessive nise. The Occupatinal Safety and Health Administratin (OSHA)
More informationS.K.J Construction Ltd Groundwork & Civil Engineering
S.K.J Cnstructin Ltd Grundwrk & Civil Engineering SUBSTANCE MISUSE POLICY 1 2 SUBSTANCE MISUSE POLICY 1 INTRODUCTION Plicy Aims Frm the viewpint f health and safety at wrk, SKJ Cnstructin Ltd (the Cmpany)
More informationTEXAS-MAC - PART B-TRAILBLAZER TABLE OF CONTENTS
TABLE OF CONTENTS CPT t LCD ID... 4 L26500- Autmatic Implantable Cardiac Defibrillatr (AICD) - 4C-58AB... 14 L26529- Cardiac Catheterizatin - 4C-50AB... 23 L26534- Transthracic Echcardigraphy (TTE) - 4C-52AB...
More informationDrug Therapy Guidelines
Drug Therapy Guidelines Orencia (abatacept) Applicable Medical Benefit x Effective: 2/21/18 Pharmacy- Frmulary 1 x Next Review: 12/18 Pharmacy- Frmulary 2 x Date f Origin: 11/28/06 Pharmacy- Frmulary 3/Exclusive
More informationSubject: Panniculectomy/Removal of Redundant Skin and Subcutaneous Tissue
Medical Review Criteria Panniculectmy/ Remval f Redundant Tissue Subject: Panniculectmy/Remval f Redundant Skin and Subcutaneus Tissue Backgrund: Panniculectmy is the remval f a large fld f redundant abdminal
More informationPennsylvania Guidelines on the Use of Opioids to Treat Chronic Noncancer Pain
Pennsylvania Guidelines n the Use f Opiids t Treat Chrnic Nncancer Pain Chrnic pain is a majr health prblem in the United States, ccurring with a pintprevalence f abut ne-third f the US ppulatin.(1) Mre
More informationPatient Name: Address City State Zip Code. H. Phone W. Phone Cell Phone
Name yu prefer t g by: Address City State Zip Cde H. Phne W. Phne Cell Phne Email Address: Sex: M F Date f Birth Age Marital Status: M S D W Spuse s Name if Married: Scial Security # Referred by: Persn
More information1100 Marie Mount Hall College Park, Maryland Tel: (301) Fax: (301)
UNIVERSITY SENATE 1100 Marie Munt Hall Cllege Park, Maryland 20742-7541 Tel: (301) 405-5805 Fax: (301) 405-5749 http://www.senate.umd.edu March 31, 2017 Jrdan Gdman Chair, University Senate 2208G Physical
More informationLTCH QUALITY REPORTING PROGRAM
4 LTCH QUALITY REPORTING PROGRAM GENERAL INFORMATION...3 LTCH FACILITY-LEVEL QUALITY MEASURE REPORT...5 LTCH PATIENT-LEVEL QUALITY MEASURE REPORT...18 LTCH REVIEW AND CORRECT REPORT...23 09/2018 v1.04
More informationDRAFT Policy for the Management of Ear Wax
Clinical Cmmissining Grup (CCG) Treatment Plicy NHS Birmingham and Slihull Clinical Cmmissining Grup NHS Sandwell and West Birmingham Clinical Cmmissining Grup DRAFT Plicy fr the Management f Ear Wax 1
More informationSection 6 Students School District No. 71 (Comox Valley)
Sectin 6 Students Schl District N. 71 (Cmx Valley) Administrative Prcedure 6011 MR2 Allergies and Anaphylaxis 1. Intrductin The Bard f Educatin expects schls t reasnably accmmdate students with medically
More informationACSQHC National Consensus Statement: Essential Elements for High Quality End-oflife Care in Acute Hospitals.
27 March 2014 Prfessr Debra Picne Chief Executive Officer Australian Cmmissin n Safety and Quality in Health Care c/ Ms Jennifer Hill, Senir Prject Officer Level 5, 255 Elizabeth Street SYDNEY NSW 2000
More information