Knowledge Base Article

MEDICARE TRANSMITTALS – RECURRING UPDATES

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

Quarterly update.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM11406.pdf

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).

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM11381.pdf

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).

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM11420.pdf

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

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM11392.pdf

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

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM11422.pdf

Claim Status Category and Claim Status Codes Update

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM11393.pdf

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

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM11418.pdf

OTHER MEDICARE TRANSMITTALS

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.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM11273.pdf

Oxygen Policy Update

Implements a new policy and coding for oxygen content.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10837.pdf

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

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM11369.pdf

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

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM11312.pdf

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.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM11403.pdf

MEDICARE SPECIAL EDITION ARTICLES

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.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE19008.pdf

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

Use MBIs now for all Medicare transactions.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE18006.pdf

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.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE19015.pdf

MEDICARE COVERAGE UPDATES

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

Posted final decision memo.

https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=291

Medicare Press Releases

MEDICARE EDUCATIONAL RESOURCES

Medicare Fast Facts

Medicare Fast Facts resources this month include:

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

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Fast-Facts.html?DLSort=1&DLEntries=10&DLPage=1&DLSortDir=descending

Skilled Nursing Facility 3-Day Rule Billing

MLN Fact Sheet

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/SNF3DayRule-MLN9730256.pdf

Ambulance Fee Schedule and Medicare Transports Booklet

MLN Booklet

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Medicare-Ambulance-Transports-Booklet-ICN903194.pdf

OTHER MEDICARE UPDATES

FY 2020 Coding Updates

ICD-10-CM Coding Guidelines - https://www.cdc.gov/nchs/icd/icd10cm.htm

ICD-10-CM (Diagnosis Codes) - https://www.cms.gov/Medicare/Coding/ICD10/2020-ICD-10-CM.html

ICD-10-PCS (Procedure Codes) - https://www.cms.gov/Medicare/Coding/ICD10/2020-ICD-10-PCS.html

2020 Advance Beneficiary Notice (ABN) Forms

https://www.cms.gov/Medicare/Medicare-General-Information/BNI/ABN.html