November Medicare Transmittals and Other Updates

on Tuesday, 27 November 2018. All News Items | Outpatient Services | Miscellaneous | Coding | Billing





January 2019 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files


Update to Medicare Deductible, Coinsurance and Premium Rates for 2019


International Classification of Diseases, Tenth Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs) – REVISED

A maintenance update of ICD-10 conversions and other coding updates specific to national coverage determinations (NCDs) as a result of newly available codes, coding revisions to NCDs released separately, or coding feedback received.


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




Incomplete Colonoscopies Billed with Modifier 53 for Critical Access Hospital (CAH) Method II Providers

Implements the payment methodology for incomplete colonoscopy procedures (Healthcare Common Procedure Coding System (HCPCS) codes 44388, 45378, G0105, and G0121 with a modifier 53) for CAH Method II providers.


Correction to Common Working File (CWF) Informational Unsolicited Response (IUR) 7272 for Intervening Stay

Correction to edit for IPPS hospital claim with patient discharge status code ‘61’ (Discharged/transferred within this institution to a hospital-based Medicare approved swing bed) and a home health claim is received with an admission date equal to or within 3 days of the history IPPS claim’s discharge date and there is an intervening swing bed claim in history.


Hospital and Critical Access Hospital (CAH) Swing-Bed Manual Revisions

Clarifies policies related to hospitals and CAHs with respect to services furnished to swing-bed patients, including policies related to pass-through reimbursement for Certified Registered Nurse Anesthetist (CRNA) services.


Update to Bone Mass Measurements (BMM) Code 77085 Deductible and Coinsurance

Instructs contractors to waive deductible and coinsurance for BMM code 77085.


Removal of the Provider Requirement for Reporting on an Institutional Claim a Value Code (VC) 05 - Professional Component-Split Implementation

Removes editing for the requirement of value code 05 on an institutional claim.


User CR: Fiscal Intermediary Shared System (FISS) - Implementation of the Molecular Diagnostic Services (MolDX)

Adds a MolDX test identification (ID) field to FISS so providers will be able to input a unique test ID into their claims at the detail line level.


Common Working File (CWF) Provider Queries National Provider Identifier (NPI) and Submitter Identification (ID) Verification

The Common Working File (CWF) will require verification of the National Provider Identifier (NPI) and Submitter Identification (ID) when Medicare Part A providers request Medicare beneficiary eligibility and entitlement data via the CWF provider inquiry screens.




CMS finalizes Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System changes for 2019 (CMS-1695-FC)


Final Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2019




Medicare Fast Facts

Medicare Fast Facts resources this month include:

  • Cochlear Devices Replaced Without Cost
  • Reporting Changes in Ownership
  • Ophthalmology Services: Questionable Billing and Improper Payments


November Patients Over Paperwork Newsletter

Updates on the Administration’s ongoing work to reduce administrative burden and improve the customer experience for beneficiaries.


Medicare Billing: Form CMS-1450 and the 837 Institutional Educational Booklet


CERT Article on Patient Discharge Codes




Medicare Letter to Clinicians

Outlines how the agency is reducing burden through reform of documentation and coding requirements.


Contract Award for A/B MAC Jurisdiction 8

On November 1, 2018, CMS awarded Wisconsin Physicians Service Government Health Administrators (WPS) (the incumbent contractor for this A/B MAC jurisdiction) a new contract for the administration of Medicare Part A and Part B Fee-for-Service (FFS) claims in the states of Indiana and Michigan.

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