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Transmittals/MLN Matters articles: CMS posts special article on PCIP, instructs on MRI coverage, and more

Medicare Update for Physician Services, April 7, 2011

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CMS issues special article on PCIP

CMS has posted a special edition MLN Matters article on the primary care incentive payment program (PCIP). The Affordable Care Act, provides for an incentive payment for primary care services furnished on or after January 1, 2011, and before January 1, 2016, by a primary care physician or non-physician practitioner.

View the special MLN Matters article.

CMS posts special article on transforaminal epidural injection services

CMS has posted a special edition MLN Matters article on Medicare payments for transforaminal epidural injection services, in response to an OIG audit that found many documentation errors in physician claims for these services. The article discusses the OIG findings and specific coverage requirements.

View the special MLN Matters article.

CMS posts special article on place-of-service coding

CMS has released a special edition MLN Matters article on place-of-service coding, in response to an OIG audit that found many instances of physicians incorrectly coding the place-of-service code. Use of non-facility place-of-service codes in a provider-based setting will result in overpayments.

View the special MLN Matters article.

CMS instructs on advanced diagnostic imaging accreditation enrollment

On March 11, CMS issued a transmittal to set the systems parameters for the accreditation requirement for suppliers of the technical component (TC) of advanced diagnostic imaging procedures paid under the physician fee schedule. A provider submitting claims for the TC must be accredited by January 1, 2012, to be reimbursed for the claim if the service is performed on or after that date.

Effective date: June 12, 2011
Implementation date: June 12, 2011

View the transmittal.

View a related MLN Matters article.

CMS issues coverage guidance for MRIs with implanted permanent pacemakers or implantable cardioverter defibrillators

On March 4, CMS issued two transmittals to set coverage parameters for magnetic resonance imaging (MRI) in certain situations. Effective for claims with dates of service on or after February 24, 2011, CMS will allow for coverage of MRI for Medicare beneficiaries with implanted permanent pacemakers or implantable cardiac defibrillators when those beneficiaries are enrolled in clinical studies that are approved by CMS for the purpose of gaining further evidence about the utility and safety of MRI exposure.

Effective date: February 24, 2011
Implementation date: April 4, 2011

View the Claims Processing Manual transmittal.

View the National Coverage Determinations transmittal.

View a related MLN Matters article.

CMS issues special article on e-prescribing

CMS has posted a special edition MLN Matters article on the 2011 e-prescribing (or eRx) incentive program. The article explains future payment ramifications of failing to be a successful electronic prescriber.

View the special edition MLN Matters article.

CMS issues special article on drug screen testing

CMS has posted a special edition MLN Matters article to describe how clinical diagnostic laboratories should bill for HCPCS codes G0431 (drug screen, qualitative; multiple drug classes by high complexity test method [e.g., immunoassay, enzyme assay], per patient encounter) and G0434 (drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter).

View the special edition MLN Matters article.

CMS replaces transmittals

CMS rescinded and replaced several transmittals previously outlined in Medicare Update for Physician Services.

• Expansion of Medicare Telehealth Services for CY 2011 (Claims Processing Manual)
• Expansion of Medicare Telehealth Services for CY 2011 (Benefit Policy Manual)
• Waiver of Coinsurance and Deductible for Preventive Services, Section 4104 of the Patient Protection and Affordable Health Care Act (the Affordable Care Act), Removal of Barriers to Preventive Services in Medicare
• Incentive Payment Program for Primary Care Services, Section 5501(a) of the Patient Protection and Afforable Care Act (the ACA), Payment to a CAH Paid Under the Optional Method
• New Waived Tests

MLN Matters article

CMS issued several MLN Matters articles related to transmittals previously outlined in Medicare Update for Physician Services.

• Payment Update and Common Working File (CWF) Editing for Influenza Virus Vaccine and Pneumococcal Vaccine (PPV) Codes
• Primary Care Incentive Payment Program (PCIP) Eligibility for New Providers Enrolled in Medicare
• Clarification to CR No. 6686 - Outpatient Mental Health Treatment Limitation
• Annual Wellness Visit (AWV), Including Personalized Prevention Plan Services (PPPS)

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