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Transmittals and MLN Matters articles: CMS posts new vaccine codes, implements CAH payments changes, and more

Medicare Weekly Update, November 23, 2010

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CMS implements new Q codes for vaccines

On November 19, CMS issued a transmittal to implement new HCPCS Q codes for 2010-2011 seasonal influenza vaccines. CMS is creating the codes in response to a program need to establish separate billing codes for each brand-name influenza vaccine product under CPT code 90658.

Effective date: October 1, 2010, unless otherwise specified
Implementation date: No later than January 3, 2011

View the transmittal.

CMS implements increased payment for CAHs

On November 19, CMS issued a transmittal to make system changes necessary for increased payment of critical access hospital (CAH) facility services. Section 3128 of the Patient Protection and Affordable Care Act, increased payment for facility services for CAHs paid under the optional method from 100% of reasonable cost to 101% of reasonable cost and increased payment for ambulance services furnished by CAHs from 100% of reasonable cost to 101% of reasonable cost, effective for services furnished on and after January 1, 2004.

Effective date: April 1, 2011
Implementation date: April 4, 2011

View the transmittal.

CMS publishes updated MPFS data file layout

On November 19, CMS issued a transmittal to provide the annual file layout for the Medicare physician fee schedule database.

Effective date: January 1, 2011
Implementation date: January 3, 2011

View the transmittal.

CMS implements new rates

On November 19, CMS issued a transmittal instructing contractors to updates their systems with new deductible, coinsurance, and premium rates.

Effective date: January 1, 2011
Implementation date: January 3, 2011

View the transmittal.

CMS implements NCCI update

On November 19, CMS issued a transmittal for the normal updae of the NCCI edits.

Effective date: January 1, 2011
Implementation date: January 3, 2011

View the transmittal.

CMS implements NCD for VAD as destination therapy

On November 19, CMS issued a transmittal to implement an NCD for ventricular assist devices (VAD) as destination therapy. Effective for claims with dates of service on or after November 19, 2010, CMS has determined that the evidence is adequate to conclude that VAD implantation as destination therapy improves health outcomes and is reasonable and necessary when the device has received FDA approval for a destination therapy indication and only for patients with NYHA Class IV end-stage ventricular heart failure who are not candidates for heart transplant and who meet all specific conditions.

Effective date: November 9, 2010
Implementation date: January 6, 2011

View the transmittal.

CMS replaces transmittal

CMS rescinded and replaced a transmittal, as follows:

• Revisions to the End Stage Renal Disease (ESRD) Medicare Benefit Policy Manual to Reflect the Implementation of the ESRD Prospective Payment System (PPS)

MLN Matters articles

CMS issued several MLN Matters articles related to transmittals previously outlined in Medicare Weekly Update.

• Waiver of Coinsurance and Deductible for Preventive Services for Rural Health Clinics (RHCs), Section 4104 of the Affordable Care Act
• Reporting of Modifiers and Revenue Codes on Claims for Therapy Services
• Update to Repetitive Billing Requirements for Institutional Claims
• Additional Editing for Disaster Related Claims
• Implementation of Edits for the Emergency Department (ED) Adjustment Policy under the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS)

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