Corporate Compliance

Transmittals and MLN Matters articles: CMS issues supervision guidance, issues NCDs, and more

Medicare Insider, June 8, 2010

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CMS issues July OPPS billing update

On June 4, CMS issued the July update to the Claims Processing Manual to implement billing instructions for various payment policies adopted in the July 2010 OPPS update.

Effective date: July 1, 2010
Implementation date: July 6, 2010

View the transmittal.

CMS implements coverage of dermal injections for treatment of facial LDS

On June 4, CMS issue transmittals to implement coverage of dermal injections for facial lipodystrophy syndrome (LDS). Effective for claims with dates of service on and after March 23, 2010, dermal injections for facial LDS are only reasonable and necessary using dermal fillers approved by the Food and Drug Administration for this purpose, and then only in HIV-infected beneficiaries who manifest depression secondary to the physical stigma of HIV treatment.

Effective date: March 23, 2010
Implementation date: July 6, 2010

View the National Coverage Determinations Manual transmittal.

View the Claims Processing Manual transmittal.

View the related NCD.

CMS clarifies physician supervision requirements under the OPPS

On May 28, CMS issued the July update to the OPPS for the Benefit Policy Manual, in which it provides further clarification of the physician supervision requirement under the “incident to” benefit. CMS discusses supervision of diagnostic tests by non-physician practitioners and defines the term “immediately available.” The update also clarifies the credentials, knowledge, skills, ability, and privileges that the supervisory practitioner must possess in order to be qualified to perform a given service or procedure.

Effective date: July 1, 2010
Implementation date: July 6, 2010

View the transmittal.

View a related MLN Matters article.

CMS issues non-coverage determination for collagen meniscus implant

On May 28, CMS issued transmittals modifying the National Coverage Determinations Manual and the Claims Processing Manual regarding collagen meniscus implants. Effective for services performed on or after May 25, 2010, CMS concluded that the evidence demonstrates that the collagen meniscus implant does not improve health outcomes. Therefore, collagen meniscus implant is not reasonable and necessary and is non-covered.

Effective date: May 25, 2010
Implementation date: July 6, 2010

View the National Coverage Determinations Manual transmittal.

View the Claims Processing Manual transmittal.

View the related NCD.

View a related MLN Matters article.

CMS revises audiology policies

On May 28, CMS issued transmittals to make changes to audiology coverage and billing policies in the Benefit Policy Manual and the Claims Processing Manual. Audiology services must be personally furnished by an audiologist or non-physician practitioner. Physicians may personally furnish audiology services, and technicians or other qualified staff may furnish those parts of a service that do not require professional skills under the direct supervision of physicians. There will be no payment under the MPFS for audiological diagnostic tests furnished by technicians under the direct supervision of a physician if the test requires professional skills

Effective date: July 28, 2010
Implementation date: July 28, 2010

View the Benefit Policy Manual transmittal.

View the Claims Processing Manual transmittal.

View a related MLN Matters article.

CMS posts update to waived tests

On May 28, CMS issued a recurring update notification to inform contractors of new waived tests approved by the Food and Drug Administration under Clinical Laboratory Improvement Amendments of 1988.

Effective date: July 1, 2010
Implementation date: July 6, 2010

View the transmittal.

CMS issues special edition article on MAC transition

CMS has posted a special edition MLN Matters article about making the transition from a fiscal intermediary or carrier to Medicare administrative contractor (MAC).

View the special edition article.

CMS replaces transmittal



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