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February Medicare Transmittals

Published on 

Tuesday, February 23, 2016

 | Medicare Coverage 

Medicare transmittals from February include four transmittals based on updates to National Coverage Determinations (NCDs). As a reminder, the NCD process is described in the Medicare Program Integrity Manual, chapter 13.

National Coverage Determinations (NCDs) are developed by CMS and outline the conditions for which an item or service is considered to be covered (or not covered) by Medicare nationally. Initially a decision memorandum is posted on the CMS Web site that describes the clinical position which CMS intends to implement. CMS implements the coverage decision through transmittals generally within 180 days of the end of the calendar quarter in which the memo was posted. Implementation often includes both an update to the NCD manual and the Claims Processing Manual to provide claims processing instructions related to the new coverage requirements.

Such is the case for the February updates with a new NCD for human Papillomavirus (HPV) and a revision to the NCD for Human Immunodeficiency Virus (HIV).

February 2016 Transmittals

Screening for Cervical Cancer with Human Papillomavirus (HPV) Testing – National Coverage Determination (NCD)

  • Numbers:Transmittal R189NCD, Transmittal R3460CP, Change Request 9434,MLN Matters MM9434
  • Dates:Issued: February 5, 2016; Effective: July 9, 2015; MLN: February 18,2016;   Implementation: January 3, 2017
  • Affects: Physicians and other providers who submit claims to Medicare Administrative Contractors
  • Updates: National Coverage Determinations Manual, Chapter 1, Section 210.2.1; Medicare Claims Processing Manual, Chapter 18, Sections 30.2.1, 30.5, 30.6, 30.7, 30.8, and 30.9

Summary of Changes: The purpose of this Change Request (CR) is that CMS has determined that for dates of service on or after effective July 9, 2015, evidence is sufficient to add HPV testing under specified conditions.

Screening for the Human Immunodeficiency Virus (HIV) Infection

  • Numbers: Transmittal R190NCD; Transmittal R3461CP, Change Request 9403, MLN Matters MM9403
  • Dates: Issued: February 5, 2016; Effective: April 13, 2015; MLN: February 17, 2016; Implementation: January 3, 2017
  • Affects: Physicians, other providers, and suppliers who submit claims to Medicare Administrative Contractors
  • Updates: National Coverage Determinations Manual, Chapter 1, Section 210.7; Medicare Claims Processing Manual, Chapter 18, Sections 130.1, 130.2, 130.3, 130.4, 130.5 and 130.6

Summary of Changes: The purpose of this CR is to inform MACs that CMS has determined that the evidence is adequate to conclude that screening of HIV infection for all individuals between the ages of 15-65 years is reasonable and necessary for early detection of HIV and is appropriate for individuals entitled to benefits under Part A or enrolled in Part B.

Article Author: Debbie Rubio, BS MT (ASCP)
Debbie Rubio, BS MT (ASCP), was the Manager of Regulatory Affairs and Compliance at Medical Management Plus, Inc. Debbie has over twenty-seven years of experience in healthcare including nine years as the Clinical Compliance Coordinator at a large multi-facility health system. In her current position, Debbie monitors, interprets and communicates current and upcoming regulatory and compliance issues as they relate to specific entities concerning Medicare and other payers.

This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.