John Moody's Healthcare Compliance Issues Page

John Moody's
Healthcare Compliance Issues Page
(Last Updated 4/21/08 at 10:15 a.m.)

** John's Company - Healthcare Revenue Integrity Consulting **

Table of Contents

Outpatient Prospective Payment System (OPPS; APC)04/18/08

New ABN Guidelines/Forms03/20/08

HIPAA Information04/27/07

Hospital Issues03/15/08

Laboratory Issues 04/18/08

National Coverage Determinations (non-Lab)/Clinical Trials 04/04/08

Other Resources on the Web04/21/08

Additional Healthcare Compliance Links10/30/06

APC OUTPATIENT PROSPECTIVE PAYMENT SYSTEM INFORMATION
CMS Hospital OPPS Overview Web Site R1492CP (Tranmsittal 1492) New HCPCS Codes for April 2008 Update Iss Dt 04/18/08 Eff Dt: 04/01/08 Impl Dt: 04/07/08 R1487CP (Transmittal 1487) April 2008 Update of the Hospital Outpatient Prospective Payment System (OPPS) (See also MM5999) Iss Dt 04/08/08 Eff Dt: 04/01/08 Impl Dt: 04/07/08 R1483CP (Transmittal 1483) April 2008 Integrated Outpatient Code Editor (I/OCE) Specifications Version 9.1 (See also MM5969) Iss Dt 03/25/08 Eff Dt: 04/01/08 Impl Dt: 04/07/08 R1478CP (Transmittal 1478) Additional Clarification to Chapter 17, Section 40, Regarding Processing of Drug Claims with the JW Modifier (See also MM5923) (See also JA5923) Iss Dt 03/14/08 Eff Dt: 01/01/08 Impl Dt: 04/14/08 R85BP (Transmittal 85) Psychological and Neuropsychological Tests NOTE: This transmittal replaces Pub. 100-02, Transmittal 55, which was issued on September 29, 2006. The manual instruction has been modified in Section 80.2 to correct the Social Security Act reference from 1861(s)(2)(C) to 1861(s)(3). All other information remains the same. Iss Dt 02/29/08 Eff Dt: 01/01/06 Impl Dt: 12/28/06 R1470CP (Transmittal 1470) Update to Audiology Policies (See also R84BP) (See also MM5717) (See also JA5717) Iss Dt 02/29/08 Eff Dt: 04/01/08 Impl Dt: 04/07/08 R1461CP (Transmittal 1461) Clarification to CR 5744 - Payment Allowance Update for the Influenza Virus Vaccine CPT 90660 and Further Instruction Regarding the Pneumococcal Vaccine CPT 90669 (See also MM5910) (See also JA5910) Iss Dt 02/22/08 Eff Dt: 01/01/08 Impl Dt: 03/24/08 R1464CP (Transmittal 1464) Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 14.1, Effective April 1, 2008.Iss Dt 02/22/08 Eff Dt: 04/01/08 Impl Dt: 04/07/08 R1430CP (Transmittal 1430) Use of HCPCS V2787 When Billing Approved Astigmatism-Correcting Intraocular Lens (A-CIOLs) in Ambulatory Surgery Centers (ASCs), Physician Offices, and Hospital Outpatient Departments (HOPDs) (See also MM5853) Iss Dt 02/01/08 Eff Dt: 01/01/08 Impl Dt: 03/03/08 R1433CP (Transmittal 1433) Smoking and Tobacco Use Cessation Counseling Billing Code Update (See also MM5878) Iss Dt 02/01/08 Eff Dt: 01/01/08 Impl Dt: 07/07/08 R1417CP (Transmittal 1417) January 2008 Update of the Hospital Outpatient Prospective Payment System (OPPS) (See also MM5912) (See also R82BP) (See also R1445CP) Iss Dt 01/18/08 Eff Dt: 01/01/08 Impl Dt: 01/07/08 R1419CP (Transmittal 1419) January 2008 Integrated Outpatient Code Editor (I/OCE) Specifications Version 9.0 NOTE: This transmittal, rescinds and replace Transmittal 1403 date December 28, 2007. Due to late legislation, changes were made to the Brachytherapy and Radiopharmaceutical codes that resulted in an SI change from K to H for dates of service 1/1/08 to 6/30/08. All other information remains the same. (See also MM5865) Iss Dt 01/18/08 Eff Dt: 01/01/08 Impl Dt: 01/07/08 R1416CP (Transmittal 1416) Clarification of Bone Mass Measurement (BMM) Billing Requirements Iss Dt 01/18/08 Eff Dt: 01/01/08 Impl Dt: 02/20/08 R1414CP (Transmittal 1414) Outpatient Therapy Caps without KX Modifier Exceptions Start January 1, 2008 Iss Dt 01/17/08 Eff Dt: 01/01/08 Impl Dt: 01/25/08 R1383 (Transmittal 1383) Adjustment to Payment under Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System for Partial Device Credit Replaces Transmittal 1297 Iss Dt 04/28/07 Eff Dt 07/27/07 SE0746 Coding for Polypectomy Performed During Screening Colonoscopy or Flexible Sigmoidoscsopy Iss Dt 11/08/07 CY2008 HOPPS Final Rule Federal Register version published 11/27/07 is here CY2008 HOPPS Files are here 11/01/06 R1370CP (Transmittal 1370)2008 Healthcare Common Procedure Coding System (HCPCS) Annual Update Iss Dt 11/02/07 Eff Dt 01/01/08 Impl Dt 01/07/08 R1357CP (Transmittal 1357) Payment: Allowances for the Influenza Virus Vaccine and the Pneumococcal Vaccine When Payment is Based on 95 Percent of the Average Wholesale Price (AWP) (See also MM5744) Iss Dt 10/26/07 Eff Dt 09/01/07 Impl Dt 11/26/07 R1342CP (Transmittal 1342) October 2007 Integrated Outpatient Code Editor (I/OCE) Specifications Version 8.3 (See also MM5723) Iss Dt 09/21/07 Eff Dt 10/01/07 Impl Dt 10/01/07 R1339CP (Transmittal 1339) Magnetic Resonance Imaging (MRI) Procedures (See also MM5677) Iss Dt 09/21/07 Eff Dt 10/01/07 Impl Dt 10/01/07 R1336CP (Transmittal 1336) October 2007 Update of the Hospital Outpatient Prospective Payment System (OPPS): Summary of Payment Policy Changes (See also MM5718) Iss Dt 09/14/07 Eff Dt 10/01/07 Impl Dt 10/01/07 R1330CP (Transmittal 1330) Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 13.3, Effective October 1, 2007 (See also MM5703) Iss Dt 08/31/07 Eff Dt 10/01/07 Impl Dt 10/01/07 R1315CP (Transmittal 1315) Clarification of Percutaneous Transluminal Angioplasty (PTA) Billing Requirements Issued in CR 3811 Iss Dt 08/10/07 Eff Dt 03/17/05 Impl Dt 10/01/07 R1301 (Transmittal 1301) Revised Information on PET Scan Coding (See also MM5665) Iss Dt 07/20/07 Impl Dt 01/07/08 R916CP (Transmittal 916) Reporting of Type of Bill (TOB) 12X for Billing of Diagnostic Mammographies (See also MM5050) Iss Dt 04/28/07 REVISED 07/27/07 R1301CP (Transmittal 1301) Revised Information on PET Scan Coding Iss Dt 07/20/07 Impl Dt 01/07/08 CMS1392P Proposed to HOPPS and CY2008 Payment Rates Iss Dt 07/16/07 R1278CP (Transmittal 1278)Update to Pub. 100-04, Chapter 18, Section 10 for Part B influenza Billing (See also MM5511) Iss Dt 06/29/07 Eff Dt 07/30/07 MM5660 Percutaneous Transluminal Angioplasty (PTA) (See also R71NCD) Iss Dt 06/29/07 Eff Dt 07/30/07 R1271CP (Transmittal 1271) Vagus Nerve Stimulation (VNS) for Resistant Depression (See also MM5612) (See also R70NCD) Iss Dt 06/22/07 Eff Dt 07/23/07 R1259CP (Transmittal 1259) July 2007 Update of the Hospital Outpatient Prospective Payment System (OPPS): Summary of Payment Policy Changes (See also MM5623) Iss Dt 06/01/07 Eff Dt 07/01/07 R1248CP (Transmittal 1248) Revisions, in the Medicare Claims Processing Manual, to Section 40, titled, "Discarded Drugs and Biologicals," and Section 100.2.9, titled, "Submission of Claims With the Modifier JW, 'Drug Amount Discarded/Not Administered to Any Patient.' Iss Dt 05/25/07 Eff Dt 07/01/07 R1255 (Transmittal 1255) Guidelines for Payment of Diabetes Self-Management Training (DSMT) (Replaces Transmittal 1158) (See also R72BP) Iss Dt 05/25/07 Eff Dt 07/02/07 R1243 (Transmittal 1243) Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 13.2, Effective July 1, 2007. (See also MM5604) Iss Dt 05/18/07 Eff Dt 07/02/07 R1236 (Transmittal 1236) Bone Mass Measurements (BMMs) (See also R70BP) (See also R69NCD) (See also MM5521) Iss Dt 05/11/07 Eff Dt 07/02/07 R1234CP (Transmittal 1234) Update of HCPCS Codes for Hemophilia Clotting Factors (Replaces 1222) 04/27/07 Eff. Dt. 01/01/07 Impl. Dt. 10/02/07 R1212CP (Transmittal 1212)Requirement for Providing Route of Administration Codes for Erythropoiesis Stimulating Agents (ESAs) 03/30/07 Impl. Dt. 06/29/07 R1209CP (Transmittal 1209) April 2007 Update of the Hospital Outpatient Prospective Payment System (OPPS): Summary of Payment Policy Changes (See also MM5544) 03/21/07 Impl. Dt. 04/01/07 R1198 (Transmittal 1199) April 2007 Outpatient Prospective Payment System (OPPS) Outpatient Code Editor (OCE) Specifications Version 8.1 (See also MM5522) 03/09/07 Impl. Dt. 04/01/07 R1183CP (Transmittal 1183) Infrared Therapy Devices (Replaces Transmittal 1127) 02/09/07 R1165CP (Transmittal 1165) Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) Edits (See also MM5457) 01/26/07 Impl. Dt. 04/02/07 R1164CP (Transmittal 1164) Coding Change for Lumbar Artificial Disc Replacement (LADR) (See also MM5462) 01/26/07 Impl. Dt. 03/13/07 R1160CP (Transmittal 1160) Colorectal Cancer Screening Flexible Sigmoidoscopy and Colonoscopy Coinsurance Payment Change (See also MM5387) 01/19/07 Impl. Dt. 07/02/07 R1158CP (Transmittal 1158) Guidelines for Payment of Diabetes Self-Management Training (DSMT) 01/19/07 Impl. Dt. 07/01/07 R2560TN (Transmittal 2560) Payment Allowances for the Influenza Virus Vaccine (CPT 90655, 90656, 90657, and 90658) and the Pneumococcal Vaccine (CPT 90732) When Payment is Based on 95 Percent of the Average Wholesale Price (AWP) (See also MM5365) 12/29/06 R1140CP (Transmittal 1140) Medicare Payment for Preadministration-Related Services Associated with IVIG Administration (See also MM5428 - REVISED) 12/22/06 R1139CP (Transmittal 1139) January 2007 Update of the Hospital Outpatient Prospective Payment System (OPPS): Summary of Payment Policy Changes and OPPS PRICER Logic Changes and Instructions for Updating the Outpatient Provider Specific File (OPSF) 12/22/06 CMS QUICK REFERENCE INFORMATION: MEDICARE IMMUNIZATION BILLING(Flu, PPV, and HBV) 12/18/06 R1130CP (Transmittal 1130) January 2007 Outpatient Prospective Payment System (OPPS) Outpatient Code Editor (OCE) Specifications Version 8.0 12/15/06 R178PI (Transmittal 178) Medically Unlikely Edits (MUEs) (See also MM5402) 12/08/06 R1125CP (Transmittal 1125) Fee Schedule Update for 2007 for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (See also MM5417) 12/08/06 R1118CP (Transmittal 1118) Reasonable Charge Update for 2007 for Splints, Casts, Dialysis Supplies, Dialysis Equipment, and Certain Intraocular Lenses (See also MM5382) 11/24/06 R1113CP (Transmittal 1113) Implementation of an Ultrasound Screening for Abdominal Aortic Aneurysms (AAA) (See also MM5235) 11/17/06 R1103CP (Transmittal 1103) Reporting and Payment of No-Cost Devices Furnished by Outpatient Prospective Payment System (OPPS) Hospitals (See also MM5263) 11/03/06 CY2007 HOPPS Final Rule CY2007 HOPPS Files are here 11/01/06 R1070CP (Transmittal 1070)New 2007 Current Procedural Terminology (CPT) Mammography Codes (See also MM5327) 09/29/06 R1060CP (Transmittal 1060) October 2006 Update of the Hospital Outpatient Prospective Payment System (OPPS): Summary of Payment Policy Changes (See also MM5304) 09/18/06 R1045CP (Transmittal 1045) October 2006 Outpatient Prospective Payment System (OPPS) Outpatient Code Editor (OCE) Specifications Version 7.3 (See also MM5244) 09/01/06 R1042CP (Transmittal 1042) Clarification on Billing Requirements for Percutaneous Transluminal Angioplasty (PTA) Concurrent With the Placement of an Investigational or FDA-Approved Carotid Stent (Replaces Transmittal 911) 08/25/06 R1041CP (Transmittal 1041) Change in Healthcare Common Procedure Coding System (HCPCS) for Renal Dialysis Facilities and Hospitals Billing for End Stage Renal Disease (ESRD) Related Epoetin Alfa (EPO) Effective January 1, 2007 (See also MM5216) 08/25/06 R1019CP (Transmittal 1019) Outpatient Therapy - Additional DRA Mandated Service Edits 08/03/06 R1004CP (Transmittal 1004) Non-Application of Deductible for Colorectal Cancer Screening Tests (See also MM5127) 07/21/06 R970CP (Transmittal 970) July 2006 Update of the Hospital Outpatient Prospective Payment System (OPPS): Summary of Payment Policy Changes 05/30/06 R962 (Transmittal 962) July 2006 Outpatient Prospective Payment System Code Editor (OPPS OCE) Specifications Version 7.2 (See also MM5121) 05/26/06 SE0635 Processing of Outpatient Prospective Payment System (OPPS) Claims with Certain Drug Administration Code Pairs (See also MM4388) 05/19/06 MM4380 - Billing Clarification for J2505 Pegfilgrastim 05/12/06 MM5037 - Reporting of Diagnosis Code V06.6 on Influenza Virus and/or Pneumococcal Pneumonia Virus (PPV) Vaccine Claims and Acceptance of Current Procedural Terminology (CPT) Code 90660 for the Reporting of the Influenza Virus Vaccine 04/28/06 Eff 10/01/06 R902CP (Transmittal 902) Hospital Outpatient Prospective Payment System (OPPS) Manual Revision: Clarification of Coding and Payment for Drug Administration (See also MM4388) 04/7/06 MM5022 - Clarification on Billing Requirements for Percutaneous Transluminal Angioplasty (PTA) Concurrent with the Placement of an FDA-approved Carotid Stent (See also R1042CP Transmittal 1042) (See also R53NCD Transmittal 53) 04/21/06 MM4401 - Cardiac Rehabilitation Programs (See also R909CP Transmittal 909) (See also R52NCD Transmittal 52) 04/21/06 MM3811 Expansion of Coverage for Percutaneous Transluminal Angioplasty (PTA) REVISED 04/3/06 MM4385 - Payment of Federally Qualified Health Centers (FQHCs) for Diabetes Self- Management Training (DSMT) Services and Medical Nutrition Therapy (MNT) Services - Effective 6/29/06 03/31/06 MM4365 - Expansion of Glaucoma Screening Services 03/24/06 MM5011 April 2006 Update of the Hospital Outpatient Prospective Payment System (OPPS): Summary of Payment Policy Changes (See also R896CP Transmittal 896) 03/24/06 MM4240 Guidelines for Payment of Vaccine (Pneumococcal Pneumonia Virus, Influenza Virus, and Hepatitis B Virus) Administration REVISED 03/17/06 Billing for Implantable Automatic Defibrillators for Beneficiaries in a Medicare Advantage (MA) Plan and Use of the QR Modifier to Identify Patient Registry Participation REVISED 03/08/06 MM4360 - April 2006 Outpatient Prospective Payment System Code Editor (OPPS OCE) Specifications Version 7.1 (See also R888CP Transmittal 888) 03/10/06 MM4301 - Hospital Billing for Take-Home Drugs 03/03/06 MM4252 - Outpatient Prospective Payment System (OPPS) Hospital Emergency Room Services Exceeding 24 Hours 03/03/06 MM4115 - Therapy Caps To Be Effective January 1, 2006REVISED 03/03/06 MM4333 - Medicare Part B Drug Pricing Update - Payment Limit for J7620 (Albuterol and Ipratropium Bromide, Non-compounded) 02/17/06 MM4364 - Therapy Caps Exception ProcessREVISED 02/15/06 MM4324 - Change in the Long Descriptor for HCPCS Code Q4080 02/10/06 MM4240 - Guidelines for Payment of Vaccine (Pneumococcal Pneumonia Virus, Influenza Virus, and Hepatitis B Virus) Administration 02/10/06 MM4270 - Update of Radiopharmaceutical Imaging Agents Healthcare Common Procedure Coding System (HCPCS) Codes Applicable to Positron Emission Tomography (PET) Scan Services 02/03/06 MM4308 - Quarterly Update to Correct Coding Initiative (CCI) edits, Version 12.1, Effective April 1, 2006 02/01/06 MM4243 - Use of 12X Type of Bill (TOB) for Billing Screening Mammography, Screening Pelvic Examinations, and Screening Pap Smears 02/01/06 MM4273 - Modification to QR Modifier Edit for Automatic Implantable Cardiac Defibrillator (ICD) Services 01/27/06 MM4085 - Coverage and Billing for Ultrasound Stimulation for Nonunion Fracture Healing 01/20/06 MM3384 Autologous Blood-Derived Products for Chronic, Non-Healing Wounds 01/20/06 MM3640 Update to Billing Requirements for Positron Emission Tomography (PET) Scans for Dementia and Neurodegenerative Diseases and Update for Special Payment Procedures for all PET Scan Services Performed in Critical Access Hospitals 01/19/06 MM3816 New Requirements for Low Vision Rehabilitation Demonstration Billing 01/18/06 MM SE0578 Providing Medicare with Data for Certain Implantable Cardioverter Defibrillators (ICDs) 01/18/06 MM4017 Billing for Devices Under the Hospital Outpatient Prospective Payment System (OPPS) 01/12/06 MM4250 January 2006 Update of the Hospital Outpatient Prospective Payment System (OPPS): Summary of Payment Policy Changes and OPPS PRICER Logic Changes 01/03/06 R804CP (Transmittal 804) [Replaces Transmittal 786] January 2006 Update of the Hospital Outpatient Prospective Payment System (OPPS): Summary of Payment Policy Changes, OPPS PRICER Logic Changes, and Instructions for Updating the Outpatient Provider Specific File (OPSF) 01/03/06 R787CP (Transmittal 787) January 2006 Update of the Hospital Outpatient Prospective Payment System (OPPS) Manual Instruction: Changes to Coding and Payment for Observation MM 4259 12/16/05 R785CP (Transmittal 785) January 2006 Update of the Hospital Outpatient Prospective Payment System (OPPS) Manual Instruction: Changes to Coding and Payment for Drug Administration -- MANUALIZATION 12/16/05 R784CP (Transmittal 784) January 2006 Outpatient Prospective Payment System Code Editor (OPPS OCE) Specifications Version 7.0 12/16/05 CY2006 HOPPS Final Rule (Published at Fed Reg on 11-02-05) 11/02/05 R691CP (Transmittal 691) October 2005 Update of the Hospital Outpatient Prospective Payment System (OPPS) Replaces Transmittal 662, dated August 26, 2005 09/30/05 R683CP (Transmittal 683) October 2005 Outpatient Prospective Payment System Code Editor (OPPS OCE) Specifications Version 6.3 Replaces Transmittal 664, dated August 30, 2005 09/22/05 R673CP (Transmittal 673) Manual Update on Medical Nutrition Therapy (MNT) Services - Manualization (MM4007 Related Medicare Matters Article) 09/09/05 R671CP (Transmittal 671) Updated Manual Instructions for the Medicare Claims Processing Manual, Regarding Smoking and Tobacco-Use Cessation Counseling Services Effective 10/01/05 09/09/05 Transmittal 664 Rescinded, See Transmittal 683 above Transmittal 662 Rescinded, see Transmittal 691 above R660CP (Transmittal 660) Replaced by R664CP (Transmittal 664) above R658 (Transmittal 658) Billing for Devices Under the Hospital Outpatient Prospective Payment System (OPPS) 08/26/05 SE0553 New Guidance Regarding HCPCS Code G0297 08/12/05 MM3796 Cochlear Implantation Note: This article was revised on August 1, 2005, to correct the statement in item 3 at the top of page 3 to reflect the correct usage of the QV modifier. 08/03/05 R628CP (Transmittal 628) Radiopharmaceutical Diagnostic Imaging Agents Codes Applicable to PET Scan Services Performed on or After January 28, 2005 07/29/05 Hospital OPPS CY2006 Proposed Rule 07/18/05 MM3847 REVISED New Healthcare Common Procedure Coding System (HCPCS) Drug Codes 07/05/05 R600CP (Transmittal 600) New Healthcare Common Procedure Coding System (HCPCS) Drug Codes Replaced Transmittal 580 06/30/05 R599CP (Transmittal 599) July 2005 Update of the Hospital Outpatient Prospective Payment System (OPPS) Replaced Transmittal 585 06/30/05 CMS Releases New Educational Guide on Remittance Advice (RA) Notices 06/23/05 MM3905 (Revised) Update of Healthcare Common Procedure Coding System (HCPCS) Codes and File Names, Descriptions, and Instructions for Retrieving the 2005 Ambulatory Surgical Center (ASC) HCPCS Additions, Deletions, and Master Listing Note: This article was revised on June 23, 2005, to correct a typographic error in the table of codes being added to the ASC list. The original article showed HCPCS code of 33312 (insertion of pulse generator) and that code should have been 33212. The table has been corrected to show 33212. We regret the error. 06/23/05 MM3742 (Revised) Anti-Cancer Chemotherapy for Colorectal Cancer Note: This article was revised on June 21, 2005, to reflect a revision to CR3742. The CR was revised to show that Medicare fiscal intermediaries (FIs) will implement the change on or before July 5, 2005, instead of April 18, 2005. The effective date of CR3742 and all other information remains the same, but providers should take note that their Medicare FI may not be ready to process claims in accordance with CR3742 until July 5, 2005. 06/21/05 R573CP (Transmittal 573) Clarifying Manual Instructions for Coding and Payment for Drug Administration Under the Hospital Outpatient Prospective Payment System (OPPS) NOTE: Transmittal 566, dated May 20, 2005, is rescinded and replaced with Transmittal 573, dated June 3, 2005. The transmittal page for Transmittal 566 listed incorrect manual sections, which had been updated. The corrected manual sections are sections 230.2.1 and 230.2.2. All other information in the instruction remains the same. 06/03/05 $572CP (Transmittal 572) July 2005 Outpatient Prospective Payment System Code Editor (OPPS OCE) Specifications Version 6.2 06/01/05 R562CP (Transmittal 562) Smoking and Tobacco-Use Cessation Counseling Services (MM3834 Related Medicare Materals Article) 05/20/05 R557CP (Transmittal 557) Rescended - See R566CP (Transmittal 566) above 05/06/05 MM3426 - Billing Requirements for Positron Emission Tomography (PET) Scans for Dementia and Neurodegenerative Diseases 04/22/05 MM3771 MMA - Clarification for Outpatient Prospective Payment System (OPPS) Hospitals Billing the Initial Preventive Physical Exam (IPPE) 04/01/05 MM3745 New HCPCS Codes for Intravenous Immune Globulin (IVIG) 04/01/05 MM3756 April 2005 Update of the Hospital Outpatient Prospective Payment System (OPPS): Summary of Payment Policy Changes R514CP (Transmittal 514) April 2005 Update of the Hospital Outpatient Prospective Payment System (OPPS): Summary of Payment Policy Changes MM3748 New Contrast Agents Healthcare Common Procedure Coding System (HCPCS) Codes Provider Types Affected 03/24/05 SE0523 Resubmission of Outpatient Prospective Payment System (OPPS) Services for Eligible Outlier Payment 03/21/05 R507CP (Transmittal 507) New Healthcare Common Procedure Coding System (HCPCS) for Intravenous Immune Globulin (IVIG) 03/18/05 R508CP (Transmittal 508) April 2005 Update of the HOPPS Rescinded - See Transmittal 514 above MM3681 Billing for Blood and Blood Products Under the Hospital Outpatient Prospective Payment System (OPPS) 03/14/05 R501CP (Transmittal 501) Bone Mass Measurements � Procedure Coding 03/11/05 R494CP (Transmittal 494) April 2005 Outpatient Prospective Payment System Code Editor (OPPS OCE) Specifications Version 6.1 03/04/05 R485CP (Transmittal 485) Calculating Payment-to-Cost Ratios (PCR) for Purposes of Determining Transitional Corridor Payments under the Outpatient Prospective Payment System (OPPS) 02/25/05 R422CP (Transmittal 422) Update to FY 2005 Wage Index for Hospital Inpatient and Outpatient PPS 12/30/04 R403CP (Transmittal 417) Initial Preventive Physical Examination (IPPE) (MM3638 Related Medicare Matters Article) 12/22/04> R403CP (Transmittal 403) January 2005 Update of the Hospital Outpatient Prospective Payment System (OPPS): Billing for Devices that do not have Transitional Pass-Through Status, and that are not Classified as New Technology Ambulatory Payment Classification (APC) Groups (MM3606 Related Medicare Matters Article) 12/17/04 R404CP (Transmittal 404) January 2005 Update of the Hospital Outpatient Prospective Payment System (OPPS): Changes to Coding and Payment for Drug Administration (MM3610 Related Medicare Matters Article) 12/17/04 R129OTN (Transmittal 129) 2005 Drug Administration Coding Revisions 12/10/04 R387CP (Transmittal 387) This instruction is to inform the fiscal intermediaries that the January 2005 Outpatient Prospective Payment System Outpatient Code Editor (OPPS OCE) Specifications have been updated with new additions, changes, and deletions. 12/03/04 R385CP (Transmittal 385) January 2005 Update of the Hospital Outpatient Prospective Payment System (OPPS): Summary of OPPS Outpatient Code Editor (OCE) Data Changes and OPPS PRICER Logic Changes; Changes to Payment for Diagnostic Mammography 12/03/04> Changes to the CY2005 Hospital OPPS 9/10/04 11/03/04 R314CP (Transmittal 314) Coverage of Percutaneous Transluminal Angioplasty (PTA)of the carotid artery 10/15/04 R19BP (Transmittal 19) Hospital Services Covered Under Part B (Outpatient Observation Services) 9/10/04 R290CP (Transmittal 290) October 2004 Update of the Hospital OPPS 8/27/04 Changes to the Hospital OPPS for Calendar Year 2005 (Proposed Changes - Comments Due 10/8/04) 8/16/04 R199CP (Transmittal 199) Medicare Need for a Specific Line Item Date of Service (LIDOS) for Each Revenue Code on ALL Outpatient and Inpatient Part B Claims 6/10/04 R197CP (Transmittal 197) HCPCS codes Q4054 and Q4055 can be billed on a 13X TOB for ESRD beneficiaries requiring EPO or Aranesp administration for ESRD related anemia in association with a hospital outpatient visit related to a medical emergency. 6/04/04 R195CP (Transmittal 195) July 2004 Update of the Hospital OPPS 6/04/04 R194CP (Transmittal 194) July 2004 Update of the Hospital OPPS: Payment for Drugs, Biologicals and Radiopharmaceuticals 6/04/04 R188CP (Transmittal 188) Hospital Outpatient Billing and Payment under OPPS for New, Unclassified Drugs or Biologicals Approved by the FDA After January 1, 2004, But Before Assignment of a Product-Specific Drug/Biological HCPCS Code 5/28/04 R186CP (Transmittal 186) July Update to the Medicare OCE Vs 19.2 For Bills From Hospitals That Are Not Paid Under OPPS 5/28/04 R174CP (Transmittal 174) Healthcare Common Procedure Coding System (HCPCS) Corrections Involving 0040T and A9603 5/07/04 R147CP (Transmittal 147) Payment for Chemotherapy Administration Services, Nonchemotherapy Drug Infusion Services, and Drug Injection Services 4/23/04 R74OTN (Transmittal 74) Emergency Correction Regarding Correction to Healthcare Common Procedure Coding System (HCPCS) Codes for Low Osmolar Contrast Material 4/23/04 R132CP (Transmittal 132) April 2004 Update of the Hospital Outpatient Prospective Payment System (OPPS) 3/30/04 R113CP (Transmittal 113) Claims Requiring Adjustment As a Result of April 2004 Changes to the Outpatient Prospective Payment System (OPPS) 2/27/04 R112CP (Transmittal 112) April 2004 Changes to the Hospital Outpatient Prospective Payment System (OPPS): Payment for Drugs, Biologicals and Radiopharmaceuticals, Generic Versus Brand Name 2/27/04 R89CP (Transmittal 89) Medicare to eliminate 90 day grace period for HCPCS code updates effective 1/1/05 2/06/04 42 CFR Part 419 Medicare Program; Hospital Outpatient Prospective Payment System; Payment Reform for Calendar Year 2004; Interim Final Rule 1/06/04 Final Rule: Changes to the Hospital OPPS and Calendar Year 2004 Payment Rates 10/31/03 A-03-076 October 2003 Update of the Hospital OPPS 8/29/03 A-03-051 July 2003 Update of the Hospital OPPS 6/13/03 A-03-050 July Medicare Outpatient Code Editor (OCE) Specifications Version 18.2 For Bills From Hospitals That Are Not Paid Under the OPPS 6/6/03 A-03-048 July Outpatient Code Editor (OCE) Specifications Version (V4.2) 6/6/03 A-03-035 Reporting of Revenue Codes Under the OPPS 5/02/03 FDA Approves Drug-Eluting Stent for Clogged Heart Arteries 4/24/03 A-03-020 April 2003 Update of the Hospital OPPS 4/2/03 A-03-026 April Outpatient Code Editor (OCE) Specifications Version (V4.1) 4/2/03 A-03-019 Reactivation of OPPS Outpatient Code Editor (OCE) Edit 15, �Service Unit Out Of Range� and Guidance on Editing for LOCM Procedures 3/14/03 Federal Register Published Changes to OPPS and CY2003 Payment Rates 2/10/03 A-03-014 Further Guidance Regarding Billing Under the OPPS 1/21/03 Calculating Provider-Specific Medicare Outpatient Cost-to-Charge Ratios (CCRs) and Instructions on Cost Report Treatment of Hospital Outpatient Services Paid on a Reasonable Cost 1/17/03 January Outpatient Code Editor (OCE) Specifications Version (V4.0) 1/17/03 A-02-129 2003 Update of the Hospital OPPS 1/3/03 AB-02-185 Deletion of Q Codes and Reactivation of CPT Codes for Hepatitis B Vaccine 12/31/02 A-02-124 Necessary Changes to Implement Special Add-On Payments for New Technologies 12/13/02 A-02-123 Hospital Billing for Immunosuppressive Drugs Furnished to Transplant Patients�ACTION 12/13/02 A-02-120 Change in Requirements for Medicare Payment for Low Osmolar Contrast Material (LOCM) Under the OPPS 11/22/02 Changes to Hospital OPPS for 2003 - Final Rule 11/1/02 AB-02-139 Additional Guidance for Applying the Medicare Self-Administered Drug Exclusion 10/11/02 A-02-098 Changes in Transitional Outpatient Payment (TOP) for 2003 10/11/02 A-02-097 Special Handling of New �K� Codes K0556, K0557, K0558, and K0559 10/11/02 A-02-087 Clarification of Provider Billing Requirements Under the OPPS 9/12/02 A-02-076 October 2002 Update to the Hospital OPPS 8/7/02 A-02-075 Admitting Diagnosis for Observation Services for the OPPS 8/7/02 A-02-074 Hospital OPPS Implementation Instructions 8/7/02 Proposed Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2003 Payment Rates; and Changes to Payment Suspension for Unified Cost Reports 7/24/02 A-02-064 Excluding Hospitals that Provide Part B Only Services to Their Inpatients from the OPPS 7/24/02 A-02-052 July Outpatient Code Editor (OCE) Specifications Version (V3.1) (Observation APC Criteria starts on page 23) 6/18/02 A-02-050 July 2002 Update to the Hospital Outpatient Prospective Payment System (OPPS) 6/17/02 A-02-026 2002 Update of the Hospital OPPS (Observation APC information starts on page 13) 3/28/02 A-02-025 April Outpatient Code Editor (OCE) Specifications Version (V3.0) (Observation APC Criteria starts on page 23) 3/27/02 Corrections to the Hospital OPPS Rates for Calendar Year 2002 and the Pro Rata Reduction on Transitional Pass-Through Payments. 2/28/02 Revised OPPS copayment amounts for certain APC groups affected by coinsurance limits. These APCs were affected by the delay in implementation of the 2002 update to the OPPS. 1/14/02 A-01-145 Delay of the 2002 Update to the Outpatient Prospective Payment System (OPPS) (CMS is retracting issued Program Memoranda A-01-139, A-01-140, and A-01- 143. The three transmittal numbers will not be re-used in the future.) 12/21/01 List of New 2002 CPT Codes 1/14/02 Changes to the Hospital Outpatient Prospective Payment System for Calendar Year 2002 11/29/01 Announcement of the Calendar Year 2002 Conversion Factor for the Hospital Outpatient Prospective Payment System and a Pro Rata Reduction on Transitional Pass-Through Payments 10/31/01 A-01-112 Removal of Category Code C1723 from the Pass-Through Device Category List Under the Hospital OPPS 9/18/01 A-01-111 Clarification of Activity Therapy (HCPC G0176)and Patient Education/Training Services (HCPC G0177)Under the Hospital OPPS 9/14/01 A-01-107 October 2001 Update to the Hospital OPPS 9/06/01 A-01-106 Instructions for Billing and Processing of Hospital Outpatient Claims Containing Charges for Epoetin Alfa (EPO),Tradenames:Epogen and Procrit 8/24/01 A-01-97 Technical Corrections Under the Hospital OPPS 8/22/01 Proposed Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2002 Payment Rates 8/21/01 A-01-101 Changes to FY2001 Hospital Inpatient and Outpatient PPS Policies As required by BBRA 1999 8/17/01 A-01-98 October Outpatient Code Editor (OCE)Specifications Version (V2.3) 8/15/01 A-01-84 Problems With Processing Certain Clinical Diagnostic Laboratory Claims and Other Claims Through the July Outpatient Code Editor (OCE) 7/13/01 A-01-80 Use of Modifier �25 and Modifier -27 in the Hospital OPPS 6/29/01 A-01-78 Special Handling of Outpatient Prospective Payment System (OPPS) Claims Containing HCPCS Code G0121 (Screening Colonoscopy) 6/27/01 A-01-73 July 2001 Update to the Hospital OPPS 6/1/01 A-01-71 Medicare Transitional Pass-Through Payments Under the Hospital OPPS for Pacemakers and Neurostimulators 5/25/01 A-01-66 July Outpatient Code Editor (OCE) Specifications Version (V2.2) 5/25/01 Update of Calendar Year 2001 Hospital Outpatient Payment Rates and Coinsurance Amounts Effective April 1, 2001 (Excel Spreadsheet) 5/04/01 A-01-51 Calculating Payment-to-Cost Ratios (PCR) for Purposes of Determining Transitional Corridor Payments Under the OPPS and Revising the Criteria Under Which a Provider May Request a Recalculation of Its Cost-to-Charge Ratio 4/13/01 A-01-50 Further Guidance Regarding Billing Under the Outpatient Prospective Payment System (OPPS) 4/12/01 A-01-41 Categories for Use in Coding Devices Eligible for Transitional Pass-Through Payments Under OPPS 1/23/01 A-01-40 Additional Information on Transitional Pass-Through Devices and Drugs 1/23/01 A-01-17 Impact of the Benefits Improvement and Protection Act on Devices Eligible for Transitional Pass-Through Payments Under the Hospital Outpatient Prospective Payment System 1/31/01 ARC Reimbursement Update - OPPS Billing Guidance April 2001 Downloadable PowerPoint file 5/18/01 Blood Product APC/HCPCS Cross-walk and Reimbursement Information (Includes C1011 description change effective 7/1/01 published in PM A-01-73.) (See disclaimer below) 6/15/01 A-01-10 Technical Corrections to the January 2001 Update: Coding Information for Hospital OPPS 1/16/01 A-01-01 January Outpatient Code Editor (OCE) Specifications Version (V2.0) 1/16/01 A-00-102 Hospital Outpatient Prospective Payment System Pass-Through Payment Corrections for Two Radiopharmaceuticals 12/29/00 A-00-98 Reporting of OPPS and Home Health Prospective Payment System (HH PPS) Data in Provider Remittance Advice Transactions 12/21/00 A-00-82 January 2001 Update: Coding Information for Hospital OPPS (See A-01-10 above for corrections.) 11/3/00 PPS for Hospital Outpatient Services for Calendar Year 2001 11/2/00 A-00-80 Notification to Outpatient Hospital Service Providers Concerning Deductible and Coinsurance Amounts on Electronic Remittance Advice Version 3051.4a 10/31/00 A-00-72 Technical Corrections to Coding Information for Hospital OPPS 10/03/00 A-00-63 Cost-to-Charge Ratios (CCRs) for Calculating Certain Payments Under the Hospital OPPS 9/08/00 A-00-61 Update 1--Coding Information for Hospital OPPS 9/06/00 Important Notice of OPPS Implementation Progress 8/22/00 A-00-53 Proper Billing of Units for Intrathecal Baclofen under OPPS 8/16/00 A-00-45 Interim Process for Certain "Inpatient Only" Code Changes 8/2/00 New List of Drugs, Biologics, Devices, and New Technology Services for OPPS 7/28/00 A-00-44 Outpatient Prospective Payment System Contingency Plans and Instructions 7/28/00 New OPPS Device Information (file) 7/27/00 A-00-40 Further Information on the Use of Modifier -25 in Reporting Hospital Outpatient Services 7/20/00 MSB-00-02 Medicare Special Bulletin A2000-2 OPPS Implementation Instructions 5/8/00 Prospective Payment System Final Rule 3/31/00

APC OUTPATIENT PROSPECTIVE PAYMENT SYSTEM INFORMATION

MM3756 April 2005 Update of the Hospital Outpatient Prospective Payment System (OPPS): Summary of Payment Policy Changes

ABN INFORMATION
CMS Beneficiary Notices Initiative (BNI) ABN Forms, Instructions (Medicare Claims Processing Manual) 3/20/08 AB-02-169 Notice Requirement Related to Local Medical Review Policies (LMRP) 11/22/02 AB-02-168 ABNs and DMEPOS Refund Requirements - Implementation of Form CMS-R-131, Advance Beneficiary Notice (ABN), and of Limits on Beneficiary Liability for Medical Equipment and Supplies.(Replaces AB-02-114) 11/22/02

ABN INFORMATION

HIPAA INFORMATION
CMS HIPAA Web-Site HIPAA Healthcare EDI Code Set Lists 2/06/04 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule 1/23/04 Medicare Plan to accept HIPAA non-compliant electronic transactions after October 16 compliance deadline 9/23/03 Corrections to Health Insurance Reform: Modifications to Electronic Data Transaction Standards and Code Sets 3/10/03 Medical Privacy - National Standards to Protect the Privacy of Personal Health Information 12/4/02 August 2002 GAO Report: HIPAA Standards: Dual Code Sets Are Acceptable for Reporting Medical Procedures 8/9/02 HHS Final Changes to Privacy Rule That Protect Privacy, Access to Care 8/9/02 Final rule adopting a standard for a National Employer Identifier 5/31/02 Proposed rule retracting the adoption of the NDC code as the standard code for drugs (except for retail pharmacy transactions, where it will stay). Comment period closes on July 1. 5/31/02 AB-02-071 HIPAA Model Compliance Plan and Instructions 5/10/02 Proposed Modifications to the Privacy Rule 3/27/02 A-02-014 HIPAA Institutional 837 Health Care Claim Implementation Updates Issued 2/12/02 AB-02-020 Revised Timelines for HIPAA Requirements Issued 2/8/02 Standards for Privacy of Individually Identifiable Health Information Guidance Issued 7/06/01 Final Rule: Standards for Privacy of Individually Identifiable Health Information 12/28/00 Protecting the Privacy of Patients'Health Information: Summary of the Final Regulation 12/20/00 AB-01-132 Further Guidance Concerning Implementation of the HIPAA Transactions 9/21/01 Final Rule: HIPAA Standards for Electronic Transactions (Compliance Date is 26 months) 8/16/00 HHS Administrative Simplification Updated FAQs on Final Transaction Rule 9/17/01 Letter from HHS Secretary Thompson to NCVHS indicating intent to "pursue" modifying the EDI/Code Set standards final rule to retract the adoption of National Drug Codes (NDCs)for drug/biologics code set standard. 7/23/01 ANSI ASC X12N HIPAA (EDI)Implementation Guides 7/23/01 Technical corrections to the final rule 11/24/00 HHS HIPAA Administration Simplification Web Page 8/16/00 Health Hippo Web Site (HIPAA News, FAQs, HIPAA Law) HIPAAdvisory Web Site - Phoenix Health Systems' Site for HIPAA Information 4/27/01 HIPAA Administrative Simplification Code Sets 6/8/01

HIPAA INFORMATION

Final rule adopting a standard for a National Employer Identifier 5/31/02

Proposed rule retracting the adoption of the NDC code as the standard code for drugs (except for retail pharmacy transactions, where it will stay). Comment period closes on July 1. 5/31/02

AB-02-071 HIPAA Model Compliance Plan and Instructions 5/10/02

Proposed Modifications to the Privacy Rule 3/27/02

A-02-014 HIPAA Institutional 837 Health Care Claim Implementation Updates Issued 2/12/02

AB-02-020 Revised Timelines for HIPAA Requirements Issued 2/8/02

Standards for Privacy of Individually Identifiable Health Information Guidance Issued 7/06/01

Final Rule: Standards for Privacy of Individually Identifiable Health Information 12/28/00

Protecting the Privacy of Patients'Health Information: Summary of the Final Regulation 12/20/00

AB-01-132 Further Guidance Concerning Implementation of the HIPAA Transactions

9/21/01

Final Rule: HIPAA Standards for Electronic Transactions (Compliance Date is 26 months)

8/16/00

HHS Administrative Simplification Updated FAQs on Final Transaction Rule 9/17/01

Letter from HHS Secretary Thompson to NCVHS indicating intent to "pursue" modifying the EDI/Code Set standards final rule to retract the adoption of National Drug Codes (NDCs)for drug/biologics code set standard. 7/23/01

ANSI ASC X12N HIPAA (EDI)Implementation Guides 7/23/01

Technical corrections to the final rule

11/24/00

HHS HIPAA Administration Simplification Web Page

8/16/00

Health Hippo Web Site (HIPAA News, FAQs, HIPAA Law)

HIPAAdvisory Web Site - Phoenix Health Systems' Site for HIPAA Information 4/27/01

HIPAA Administrative Simplification Code Sets 6/8/01

LABORATORY COMPLIANCE ISSUES
CMS Website: Clinical Laboratory Information for Medicare FDA Clinical Laboratory Improvement Act (CLIA) Web Site Added 12/20/06 R35SOMA (Transmittal R35) Revisions to Chapter 6 - �Special Procedures for Laboratories� Iss Dt 04/18/08 Eff Dt: 04/18/08 Impl Dt: 04/18/08 R331OTN (Transmittal R331) Clinical Laboratory Fee Schedule - Implementation of Section 113 of the Medicare, Medicaid and State Children�s Health Insurance Program (MMSCHIP) Extension Act of 2007 (See also MM5987) Iss Dt 04/11/08 Eff Dt: 04/01/08 Impl Dt: 05/12/08 R330OTN (Transmittal 330) Extension of Reasonable Cost Payment for Clinical Lab Tests Furnished by Hospitals with Fewer Than 50 Beds in Qualified Rural Areas Iss Dt 04/04/08 Eff Dt: 06/30/08 Impl Dt: 07/07/08 R1477CP (Transmittal 1477) New Waived Tests (See also MM5913) (See also JA5913) Iss Dt 03/14/08 Eff Dt: 04/01/08 Impl Dt: 04/07/08 R1471CP (Transmittal 1471) Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) Edits (See also MM5926) (See also JA5926) Iss Dt 02/29/08 Eff Dt: 01/01/08 Impl Dt: 04/07/08 R1451CP (Transmittal 1451) New Automated Test for the AMCC Panel Payment Algorithm (See also R83BP) (See also MM5874) Iss Dt 02/15/08 Eff Dt: 07/01/08 Impl Dt: 07/07/08 R1440CP (Transmittal R1440) [INDEPENDENT LABS] Medicare, Medicaid, and SCHIP Extension Act of 2007 Changes to Independent Laboratory Billing for the Technical Component of Physician Pathology Services (See also MM5943) Iss Dt 02/07/08 Eff Dt: 01/01/08 Impl Dt: 03/07/08 R56DEMO (Transmittal 56) Implementation of Laboratory Competitive Bidding Demonstration (See also MM5772) Iss Dt 02/01/08 Eff Dt: 01/01/08 Impl Dt: 07/07/08 R1412CP (Transmittal 1412) Reporting of Hematocrit or Hemoglobin Levels on All Claims for the Administration of Erythropoiesis Stimulating Agents (ESAs), Implementation of New Modifiers for Non-ESRD Indications, and Reporting of Hematocrit/Hemoglobin Levels on all Non-ESRD, Non-ESA Claims Requesting Payment for Anti-Anemia Drugs (See also MM5699) Iss Dt 01/11/08 Clarified 2/15/08 Eff Dt: 01/01/08 Impl Dt: 04/07/08 R80BP (Transmittal 80) Requirements for Ordering and Following Orders for Diagnostic Tests Transmittal 79 was rescinded on December 19, 2007, and is being replaced at this time with Transmittal 80. Iss Dt 01/11/08 Eff Dt: 01/01/03 Impl Dt: 11/19/07 R1400CP (Transmittal 1400) 2008 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment (See also MM5813) Iss Dt 12/20/07 Eff Dt 01/01/08 Impl Dt 01/07/08 R1346CP (Transmittal 1346) New Waived Tests Iss Dt 09/28/07 Eff Dt 10/01/07 Impl Dt 10/01/07 R1319CP (Transmittal 1319) Date of Service for Laboratory Specimens (See also MM5573) Iss Dt 08/17/07 Eff Dt 01/01/07 Impl Dt 01/01/08 R1244 (Transmittal 1244) New Waived Test Iss Dt 05/18/07 Eff. Dt. 07/02/07 R1197CP (Transmittal 1195) New Waived Tests (See also MM5482) 3/09/07 R1148CP (Transmittal 1148) Tax Relief and Health Care Act of 2006 Changes to Independent Laboratory Billing for the Technical Component (TC) of Physician Pathology Services 01/05/07 R1115CP (Transmittal 1115) New Waived Tests (See also MM5404) 11/24/06 R1062CP (Transmittal 1062) Termination of Healthcare Common Procedure Coding System (HCPCS) Code G0107, Colorectal Cancer Screening, Fecal Occult Blood Test (FOBT), 1-3 Simultaneous Determinations 09/22/06 R1046CP (Transmittal 1046) Independent Laboratory Billing for the Technical Component (TC) of Physician Pathology Services (See also MM5210) 09/01/06 R1048CP (Transmittal 1048) New Waived Tests 09/01/06 MM5113 Healthcare Common Procedure Coding System (HCPCS) Correction for the Caffeine Halothane Contracture Test for Malignant Hyperthermia Susceptibility (See Also Transmittal 984) Posted 06/16/06 Effective Date 10/02/06 R903CP (Transmittal 903) Payment for Blood Clotting Factors Administered to Hemophilia Inpatients EFFECTIVE 07/14/06 04/14/06 MM4101 - Repeat Tests for Automated Multi-Channel Chemistries for End Stage Renal Disease (ESRD) Beneficiaries 03/10/06 MM4321 - Healthcare Common Procedure Coding System (HCPCS) Codes Subject to, and Excluded from Clinical Laboratory Improvement Amendments (CLIA) Edits 02/17/06 MM4311 - Revision for Payment for Blood Clotting Factor Administered to Hemophilia Inpatients 02/01/06 MM3984 New Waived Tests Approved by the Food and Drug Administration (FDA) Under Clinical Laboratory Improvement Amendments (CLIA) of 1988 (Eff 10/1/05) 08/23/05 American Red Cross Coding and Reimbursement Resources 06/28/05 American Red Cross Blood Reimbursement Overview 06/28/05 R538CP (Transmittal 358) Automated Multi-Channel Chemistry (AMCC) for Continuous Ambulatory Peritoneal Dialysis (CAPD) and Non-CAPD Patients (Internet Manual Correction) 06/03/05 R538CP (Transmittal 538) New Waived Tests - July 1, 2005 04/29/05 MM3681 Billing for Blood and Blood Products Under the Hospital Outpatient Prospective Payment System (OPPS) 03/14/05 R496CP (Transmittal 496) Billing for Blood and Blood Products Under the Hospital Outpatient Prospective Payment System (OPPS) 03/04/05 R469CP (Transmittal 469) New Waived Tests - April 1, 2005 02/04/05 R456CP (Transmittal 456) Independent Laboratory Billing for the Technical Component (TC) of Physician Pathology Services Furnished to Hospital Patients (Supplemental to Change Request 3467) (MM3675 Related Medicare Matters Article) 01/27/05 R457CP (Transmittal 457) Diabetes Screening Tests 01/28/05 R446CP (Transmittal 446) Diabetes Screening Tests 01/21/05 R405CP (Transmittal 405) Emergency Change to Carrier Instructions for the End Stage Renal Disease (ESRD) 50/50 Rule Implementation (MM3609 Related Medicare Matters Article) 12/17/04 R408CP (Transmittal 408) Cardiovascular Disease Screening (MM 3411 Related Medicare Matters Article) 12/17/04 HHS-OIG Advisory Opinion No. 04-16 Concerning proposal to provide lab employees and related equipment/supplies at no cost to dialysis facilities for specimen preparation for delivery to lab 11/24/04 R17MSP (Transmittal 17) Clarification for CR3064. Related to CMS is no longer requiring hospital labs or independent labs to collect MSP information in order to bill Medicare for reference lab services, where there is no face-to-face encounter with a beneficiary 7/16/04 R216CP (Transmittal 216) Manualization of INR Monitoring 6/25/04 R198CP (Transmittal 198)End Stage Renal Disease (ESRD) Reimbursement for Automated Multi-Channel Chemistry Test(s)(Replaces Transmittal 164) 6/04/04 Outpatient Clinical Laboratory Tests Furnished By Hospitals With fewer Than 50 Beds In Qualified Rural Areas 2/13/04 R85CP (Transmittal 85) Transmittal updating the claims processing rules for processing claims submitted by independent clinical diagnostic laboratories when the claim is for a service refered by one laboratory to another 2/06/04 A-03-080 End Stage Renal Disease (ESRD) Reimbursement for Automated Multi-Channel Chemistry (AMCC) Tests 9/22/03 AB-03-132 Guidelines for Medicare Part-B Laboratory Testing (includes important information about diagnostic and screening prostate specific antigen testing and date of service for laboratory testing) 8/22/03 AB-03-127 Payment for the Fecal Leukocyte Examination Under a Clinical Laboratory Improvement Amendments of 1988 (CLIA) Certificate for Provider-Performed Microscopy (PPM) Procedures During CY 2003 8/22/03 AB-03-076 Remittance Advice Message for Denial of Clinical Diagnostic Laboratory Services Denied Due to Frequency Edits 5/23/03 AB-03-054 Diagnosis Code for Screening Pap Smear and Pelvic Examination Services 5/02/03 A-03-33 End Stage Renal Disease (ESRD) Reimbursement for Automated Multi-Channel Chemistry (AMCC) Tests 5/02/03 A-03-056 New Waived Tests - March 21, 2003 5/02/03 AABB blood product reimbursement web site for hospitals 4/04/03 AB-03-021 Additional Documentation Requests (ADR) Requirements for Ordering Providers of Laboratory Services 2/14/03 AB-02-177 Independent Laboratory Billing for the Technical Component (TC) of Physician Hospital Services to Hospital Patients 12/20/02 AB-02-163 2003 Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment Method 11/8/02 Payment for New Clinical Laboratory Tests for 2003 9/20/02 American Red Cross Department of Reimbursement Policy and Provider Support Website 8/8/02 Blood and Blood Component Hospital Billing Codes HM 2-20 (Effective 1/1/2003) 11/13/02 Medicare Hospital Outpatient Payment Update HM 2-8 (Effective 4/1/2002) 8/8/02 Revenue Code Changes Affecting Blood and Blood Products Announced (HM 2-14) 8/8/02 ARC and Reimbursement: Blood and Blood Product Coding for CY 2002 (HM 2-1) (Effective 1/1/2002) 8/8/02 National Coverage Determinations (NCD) Related PMs and Final Rule CMS Laboratory National Coverage Determinations (NCDs) Website"> 3/15/04 R1050CP (Transmittal 1050) Changes to the Laboratory National Coverage Determination (NCD) Edit Software for October 2006 (See also MM5293) 09/07/06 MM4328 - Changes to the Laboratory National Coverage Determination (NCD) Edit Software for April 2006 02/17/06 MM4005 Changes to the Laboratory National Coverage Determination (NCD) Edit Software for October 2005 08/23/05 R28NCD (Transmittal 28) Update of Laboratory NCDs to Reference New Screening Benefits 02/11/05 R17-NCD (Transmittal 17) Manualization of the Negotiated Clinical Diagnostic Laboratory National Coverage Determinations 7/17/04 AB-03-053 Availability of Online Screens for the Laboratory National Coverage Determinations (NCDs) (for Carriers and FIs) 5/02/03 AB-02-030 Administrative Policies Related to Processing Claims for Clinical Diagnostic Laboratory Services 3/5/02 AB-02-087 Delay in Enforcement of NCDs for Clinical Laboratory Services 6/26/02 AB-02-110 Implementation of National Coverage Determinations Regarding Clinical Diagnostic Laboratory Services 7/31/02 AB-02-129 Claims Processing Requirements for Clinical Diagnostic Laboratory Services Based on the Negotiated Rulemaking 9/27/02 AB-02-134 Q & A on Implementation of NCDs for Clinical Laboratory Services 9/27/02 Final Rule Establishing National Coverage and Administrative Policies for Clinical Diagnostic Laboratory Services (Effective 11/25/2002) 11/21/2001 National Coverage Determinations (NCD)- Clinical Lab Testing (Part 1 of 3) National Coverage Determinations (NCD)- Clinical Lab Testing (Part 2 of 3) National Coverage Determinations (NCD)- Clinical Lab Testing (Part 3 of 3) Medical Necessity of Laboratory Test CMS (formerly HCFA) ABN Quick Reference Guide 9/03/01 A-02-046 Clarification of Part B Medicare Payment for 18 HCPCS Codes to Skilled Nursing Facilities (SNF) 5/23/02 AB-02-027 Corrections to Program Memorandum (PM) A-01-135 -- Codes Billable by SNFs and Suppliers for SNF Residents 2/21/02 A-00-43: Advance Beneficiary Notices (ABNs) for Services for Which Institutional Part B Claims Will be Processed by Fiscal Intermediaries 7/27/01 AB-01-162 2002 Clinical Laboratory Fee Schedule and Laboratory Costs Subject to Reasonable Charge Payment Methodology 11/05/01 AB-01-47 Independent Laboratory Billing for the Technical Component (TC) of Physician Pathology Services to Hospital Patients 3/22/01 Screening Pap Smear and Screening Pelvic Examinations Update 03/19/01 Colorectal Screening Update 03/19/01 Medicare Hospital Manual Transmittal 769 Changes in Colorectal Billing Effective 7/1/01 2/13/00 Payment for Blood Clotting Factor Administered to Hemophilia Inpatients - Correction 2/5/01 AB-00-134 Cervical or Vaginal Smear Tests (Pap Smears) in Calendar Year (CY) 2001 Clinical Diagnostic Laboratory Fee Schedule 12/29/00 Medicare Special Bulletin AB2000-05: 2001 CPT Code Changes 12/01/00 AB-00-108 Glucose Monitoring 12/01/00 Proposed rule requiring hospitals that transfuse blood and blood products to prepare and follow written procedures for appropriate action when it is determined that blood and blood products the hospitals received and transfused are at increased risk for transmitting hepatitis C virus (HCV)) 11/16/00 Medicare Hospital Manual Transmittal # 758 Prostrate Cancer Screening Tests and Procedures 7/28/00 Proposed Rules: Clinical diagnostic laboratory services; coverage and administrative policies; negotiated rulemaking 3/10/00 OIG Advisory Opinion No. 99-13 - re: Pathology Account Billing12/08/99 College of American Pathologist (CAP) LAP Checklist_6/99 Prostate Cancer Screening Tests6/99 Coverage of Testing for Hepatitis C in Patients Exposed to Infected Blood_6/99 Requirements for Principal Diagnosis on Outpatient Billing Reminder - Part A5/99 BBA97 Section Requiring Physicians to Provide Diagnosis Information OIG Clinical Laboratory Model Compliance Plan (8/98 version) OIG Clinical Laboratory Model Compliance Plan (3/97 version) Medicare Travel Allowance Fees for Collection of Specimens FDA Final Rule to Classify/Reclassify Analyte Specific Reagents (ASR) College of American Pathologist (CAP) Facts on ASRs FDA Final Rule to Classify/Reclassify Immunohistochemistry (IHC) Reagents Retention of Health Information

LABORATORY COMPLIANCE ISSUES

American Red Cross Blood Reimbursement Overview 06/28/05

Blood and Blood Component Hospital Billing Codes HM 2-20 (Effective 1/1/2003) 11/13/02

Medicare Hospital Outpatient Payment Update HM 2-8 (Effective 4/1/2002) 8/8/02

Revenue Code Changes Affecting Blood and Blood Products Announced (HM 2-14) 8/8/02

ARC and Reimbursement: Blood and Blood Product Coding for CY 2002 (HM 2-1) (Effective 1/1/2002) 8/8/02

National Coverage Determinations/Clinical Trials (non-Laboratory)
Medicare Coverage Policy Website Updated for new CMS web site 12/20/05 Medicare Coverage Policy - What's New Updated for new CMS web site 12/20/05 Medicare Coverage of Clinical Trials: Medicare Learning Network: Coverage of Clinical Trial Services Q/A 4/26/01 Medicare Coverage Policy ~ Clinical Trials 11/27/00 FDA Clinical Trials Website 11/27/00 R81NCD (Transmittal 81) Percutaneous Transluminal Angioplasty (PTA) Iss Dt 04/04/08 Eff Dt: 02/14/08 Impl Dt: 05/05/08 R3100TN (Transmittal 3100) Requirements for Including an 8-Digit Clinical Trial Number on Claims (See also MM5790) Iss Dt 01/18/08 Eff Dt: 01/01/08 Impl Dt: 04/07/08 R1418CP (Transmittal 1418) New HCPCS Modifiers when Billing for Patient Care in Clinical Research Studies (See also MM5805) Iss Dt 01/18/08 Eff Dt: 01/01/08 Impl Dt: 04/07/08 R80NCD (Transmittal 80) Erythropoiesis Stimulating Agents (ESAs) in Cancer and Related Neoplastic Conditions (See also R1413CP) (See also MM5818) Iss Dt 01/14/08 ff Dt: 07/30/07 Impl Dt: 04/07/08 R79NCD (Transmittal 79) Nebulized Beta Adrenergic Agonist Therapy for Lung Diseases (See also MM5820) Iss Dt 12/21/07 Eff Dt 09/10/07 Impl Dt 01/22/08 R78NCD (Transmittal 78) Pulmonary Rehabilitation Services (See also MM5834) Iss Dt 12/05/07 Eff Dt 09/25/07 Impl Dt: 01/07/08 R77NCD (Transmittal 77) Percutaneous Transluminal Angioplasty (PTA) Iss Dt 09/12/07 Eff Dt 04/30/07 Impl Dt 7/30/07 R76NCD (Transmittal 76) Ultrasound Diagnostic Procedures (See also MM5608) Iss Dt 09/12/07 Eff Dt 05/22/07 Impl Dt 9/28/07 R75NCD (Transmittal 75) Lumbar Artificial Disc Replacement (LADR) (See also MM5727) (See also R1340CP) Iss Dt 09/21/07 Eff Dt 08/14/07 Impl Dt 10/01/07 R74NCD (Transmittal 74) Medicare Clinical Trial Policy (CTP) (See also MM5719) Iss Dt 09/07/07 Eff Dt 07/09/07 Impl Dt 10/09/07 R72NCD (Transmittal 72) Ultrasound Diagnostic Procedures 08/28/07 Eff. Dt. 05/17/07 Impl. Dt 9/28/07 R68NCD (Transmittal 68) Ventricular Assist Devices (VADs) (See also MM5516) 04/13/07 Impl. Dt 5/14/07 R67NCD (Transmittal 67) Blood Brain Barrier Osmotic Disruption for Treatment of Brain Tumors (See also MM5530) 04/06/07 Impl. Dt 5/7/07 R66NCD (Transmittal 66) Extracorporeal Photopheresis (See also R1266CP) (See also MM5464) 03/09/07 R64NCD (Transmittal 64) Intracranial Percutaneous Transluminal Angioplasty (PTA) With Stenting (See also R

National Coverage Determinations/Clinical Trials (non-Laboratory)