August Medicare Transmittals and Other Updates

on Tuesday, 27 August 2019. All News Items | Outpatient Services | Miscellaneous | Medicare Coverage | Coding | Billing


Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment

Quarterly update.

October Quarterly Update to 2019 Annual Update of HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement

Updates the lists of HCPCS codes that are subject to the consolidated billing provision of the SNF Prospective Payment System (PPS).

Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) Updates for Fiscal Year (FY) 2020

Changes from IPF Final Rule applicable to discharges occurring from October 1, 2019, through September 30, 2020 (FY 2020).

International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs) – January 2020 Update

Relevant NCD coding changes for:

  • NCD20.7 Percutaneous Transluminal Angioplasty
  • NCD110.18 Aprepitant
  • NCD110.23 Stem Cell Transplantation
  • NCD150.3 Bone Mineral Density Studies
  • NCD220.4 Mammography
  • NCD220.13 Percutaneous Image-Guided Breast Biopsy
  • NCD270.3 Blood Derived-Products for Chronic, Non-Healing Wounds

Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - October 2019 Update

Claim Status Category and Claim Status Codes Update

Healthcare Provider Taxonomy Codes (HPTCs) October 2019 Code set Update



Documentation of Medical Necessity of the Home Visit; and Physician Management Associated with Superficial Radiation Treatment - REVISED

Removes the requirement that the medical record show a home visit was medically necessary instead of an office or outpatient visit and allows billing E/M codes (99211, 99212, and 99213) for levels I through III with modifier 25 when performed for the purpose of reporting physician work associated with radiation therapy planning, radiation treatment device construction, and radiation treatment management when performed on the same date of service as superficial radiation treatment delivery.

Oxygen Policy Update

Implements a new policy and coding for oxygen content.

Instructions for Use of Informational Remittance Advice Remark Code Alert on Laboratory Service Remittance Advices

To assist in reminding laboratories of their reporting obligations, the following new alert RARC code will appear on remittances:

  • N817: ALERT-Applicable laboratories are required to collect and report private payor data and report that data to CMS between January 1, 2020 - March 31, 2020

Bypassing Payment Window Edits for Donor Post-Kidney Transplant Complication Services

Manual Update to Sections 1.2 and 10.2.1 in Chapter 18 of the Medicare Claims Processing Manual

Adds a link to the current influenza codes and payment rates.



Medicare Coverable Services for Integrative and Non-pharmacological Chronic Pain Management

Given the issues associated with using opioids for acute and chronic pain, this article summarizes some other treatment options to consider when you treat Medicare patients for chronic pain.

New Medicare Beneficiary Identifier (MBI) Get It, Use It – REISSUED

Use MBIs now for all Medicare transactions.

New Documentation Requirements for Filing Medicare Cost Reports

The FY 2019 Medicare IPPS final rule changed the required supporting documentation that providers must submit with the Medicare cost report.



Decision Memo for Chimeric Antigen Receptor (CAR) T-cell Therapy for Cancers (CAG-00451N)

Posted final decision memo.

Medicare Press Releases



Medicare Fast Facts

Medicare Fast Facts resources this month include:

  • Ambulance Fee Schedule and Medicare Transports
  • Skilled Nursing Facility 3-Day Rule Billing

Skilled Nursing Facility 3-Day Rule Billing

MLN Fact Sheet

Ambulance Fee Schedule and Medicare Transports Booklet

MLN Booklet



FY 2020 Coding Updates

ICD-10-CM Coding Guidelines -

ICD-10-CM (Diagnosis Codes) -

ICD-10-PCS (Procedure Codes) -

2020 Advance Beneficiary Notice (ABN) Forms

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