Corporate Compliance

Transmittals and MLN Matters articles: CMS addresses modifier misuse, implements NCD for FDG PET for cervical cancer, and more

Medicare Insider, December 8, 2009

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CMS addresses misuse of modifiers -PA, -PB, and -PC

On December 4, CMS issued a transmittal to instruct contractors on the processing of claims that misuse modifier –PC. Some providers are incorrectly using the -PC modifier to represent the professional component of a service; -PC is defined as “wrong surgery on a patient.” The incorrect use of this modifier results in claims being incorrectly denied.

Effective date: January 15, 2010
Implementation date: No later than January 4, 2010.

View the transmittal.

CMS implements new coverage for FDG PET for cervical cancer

On December 4, CMS issued two transmittals to implement an NCD for FDG PET for cervical cancer. Effective for claims with dates of service on and after November 13, 2009, CMS will end the coverage with evidence development requirements for FDG PET for cervical cancer and will cover only one FDG PET for cervical cancer for staging in beneficiaries with biopsy-proven tumors when the treating physician determines that the study is needed to determine the location and/or extent of the tumor for specific therapeutic purposes related to initial treatment strategy.

Effective date: November 10, 2009
Implementation date: January 4, 2010

View the transmittal to the National Coverage Determinations Manual.

View the transmittal to the Claims Processing Manual.

CMS makes changes to appeals process for provider enrollment

On December 4, CMS issued a transmittal to make changes to the Program Integrity Manual regarding the administrative appeals process for provider enrollment.

Effective date: January 4, 2010
Implementation date: January 4, 2010

View the transmittal.

MLN Matters article

CMS released an MLN Matters article related to a transmittal previously outlined in Medicare Weekly Update.



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