Corporate Compliance

Transmittals and MLN Matters articles: CMS clarifies PET billing, posts new vaccine codes, and more

Medicare Update for Physician Services, December 2, 2010

CMS creates new Gulf oil spill condition code, modifier

On November 23, CMS posted a previously sensitive transmittal to implement a new modifier and condition code to be used by providers and suppliers to identify items or services that are provided in relation to an illness, injury, or condition caused or exacerbated by the 2010 oil spill in the Gulf of Mexico or other circumstances related to the spill, such as the subsequent clean-up activities.

Effective date: April 20, 2010
Implementation date: January 3, 2011

View the transmittal.

CMS creates physician specialty codes

On November 19, CMS issued a transmittal adding new physician specialty codes for cardiac electrophysiology and sports medicine. The new physician specialty code for cardiac electrophysiology will be 21 and the new code for sports medicine will be 23.

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

View the transmittal.

View a related MLN Matters article.

CMS clarifies PET billing

On November 19, CMS clarified a requirement regarding how to bill for positron emission tomography (PET) to identify bone metastasis of cancer in the context of a clinical trial. Previous instructions were vague and did not include proper billing and claims handling instructions for claims submitted for the professional component, technical or global components. This instruction will break down the specific claims handling instructions for claims submitted for each of these components.

Effective date: February 26, 2010
Implementation date: February 22, 2011

View the transmittal.

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.

View a related MLN Matters article.

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 New York Heart Association 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.

View a related MLN Matters article.

CMS issues special article on code freeze

CMS has posted a special edition MLN Matters article on the partial code freeze prior to ICD-10 implementation.

View the MLN Matters article.

CMS instructs on claims submitted after the provider’s death

On November 5, CMS issued a transmittal to provide guidance on how claims submitters should handle problems related to a deceased provider’s NPI. A claim submitted for a deceased provider who had an NPI will be rejected by Medicare due to NPI deactivation. When a deceased provider’s claim is rejected by a Medicare contractor because of the absence of an NPI, the claim submitter would be expected to contact the Medicare contractor to discuss payment of the claim and the provider’s death. 

Effective date: April 4, 2011, Effective for claims processed on or after this date.
Implementation date: April 4, 2011

View the transmittal.

View a related MLN Matters article.

CMS implements multiple procedure payment reduction for therapy

On November 3, CMS issued a transmittal to instruct contractors on the system changes necessary to implement a new multiple procedure payment reduction to the practice expense component of select therapy services paid under the physician fee schedule.

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

View the transmittal.

View a related MLN Matters article.

MLN Matters articles

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

CMS replaces transmittal

CMS rescinded and replaced a transmittal previously outlined in Medicare Update for Physician Services.

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