Medicare Bulletin - March 2016 · MEDICARE BULLETIN GR 2016-03 MARCH 2016 2 Articles contained in this edition are current as of January 29, 2016. KENTUCKY & OHIO Administration The

Reaching Out to the Medicare

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BMedicare BulletinJurisdiction 15

MARCH 2016 • WWW.CGSMEDICARE.COM

© 2016 Copyright, CGS Administrators, LLC.

www.cgsmedicare.com

Medicare BulletinJurisdiction 15

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Bold, italicized material is excerpted from the American Medical Association Current Procedural Terminology CPT codes. Descriptions and other data only are copyrighted 2015 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.

MEDICARE BULLETIN • GR 2016-03 MARCH 2016 2

Articles contained in this edition are current as of January 29, 2016.

KENTUCKY & OHIO

Administration

The 277CA Edit Lookup Tool Now Available! 3

GOOD NEWS! Medical Review Decision Letters Available through myCGS! 3

myCGS General Inquiry – Part B 5

Update to the Interest Paid on Clean Non-PIP Claims Not Paid Timely 7

Coding

2016 Healthcare Common Procedure Coding System (HCPCS) Update 27

DMEPOS

MM9481: 2016 Durable Medical Equipment Prosthetics, Orthotics, and Supplies Healthcare Common Procedure Coding System (HCPCS) Code Jurisdiction List 21

Fee Schedules & Reimbursement

MM9476: Summary of Policies in the Calendar Year (CY) 2016 Medicare Physician Fee Schedule (MPFS) Final Rule and Telehealth Originating Site Facility Fee Payment Amount 10

MM9484: January 2016 Update of the Ambulatory Surgical Center (ASC) Payment System 13

Laboratory

MM9485: Clinical Laboratory Fee Schedule – Medicare Travel Allowance Fees for Collection of Specimens 22

MM9115 Revised: Clinical Laboratory Fee Schedule – Medicare Travel Allowance Fees for Collection of Specimens 24

MM9495: Clinical Laboratory Fee Schedule – Medicare Travel Allowance Fees for Collection of Specimens 27

Preventive Services

MM9271: Advance Care Planning (ACP) as an Optional Element of an Annual Wellness Visit (AWV) 7

MM9357 Revised: New Influenza Virus Vaccine Code 9

http://go.cms.gov/MLNGenInfo

http://go.cms.gov/MLNGenInfo

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This newsletter should be shared with all health care practitioners and managerial members of the provider/supplier staff. Newsletters issued after January 1997 are available at no cost from our website at http://www.cgsmedicare.com. © 2016 Copyright, CGS Administrators, LLC.

MEDICARE BULLETIN • GR 2016-03 MARCH 2016

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The Medicare Learning Network® (MLN), offered by the Centers for Medicare & Medicaid Services (CMS), includes a variety of educational resources for health care providers. Access Web-based training courses, national provider conference calls, materials from past conference calls, MLN articles, and much more. To stay informed about all of the CMS MLN products, refer to http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/MailingLists_FactSheet.pdf and subscribe to the CMS electronic mailing lists. Learn more about what the CMS MLN offers at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNGenInfo/index.html on the CMS website.

Kentucky & Ohio

The 277CA Edit Lookup Tool Now Available!

CGS is pleased to offer the 277CA Edit Lookup Tool, making it easier than ever to research error codes received on the 5010 277CA (Claim Acknowledgement) report. This tool provides easy-to-read descriptions of error codes received on the 5010 277CA report. With this tool, convenience is at your fingertips. No need to call the EDI help desk for assistance! From the comfort of your desk, at any time of day, access the 277CA Edit Lookup Tool at http://www.cgsmedicare.com/medicare_dynamic/edi/277CA_edit_lookup_tool/?part=b on the CGS website.

In addition, CGS has developed the “How to Use the 277CA Edit Tool” user guide, which is available at https://www.cgsmedicare.com/medicare_dynamic/edi/2.%20277CA%20EDI%20EDIT%20User%20Guide.pdf on the CGS website. This guide explains what data needs to be entered from the STC segment of the 277CA report. Simply click the “Submit” button, and a description of the error will display.

Kentucky & Ohio

GOOD NEWS! Medical Review Decision Letters Available through myCGS!

myCGS, our secure online Web portal, allows CGS J15 providers to perform a number of functions securely over the Web. It was recently enhanced to allow you immediate access to your Part A and Part B medical review decision letters!

Currently, decision letters are available for physical therapy services submitted by Part B providers credentialed as Family Practice (specialty 08); and Part A claims for major joint procedures. Additional specialties/services will be added over the coming months!

Once a decision is made on a claim for which documentation was requested and submitted, notification will be sent to your secure myCGS inbox located under the MESSAGES tab.

Medicare Learning Network®: A Valuable Educational Resource!

http://www.cgsmedicare.com

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/MailingLists_FactSheet.pdf




http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNGenInfo/index.html

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNGenInfo/index.html

http://www.cgsmedicare.com/medicare_dynamic/edi/277CA_edit_lookup_tool/?part=b

http://www.cgsmedicare.com/medicare_dynamic/edi/277CA_edit_lookup_tool/?part=b

https://www.cgsmedicare.com/medicare_dynamic/edi/2.%20277CA%20EDI%20EDIT%20User%20Guide.pdf

https://www.cgsmedicare.com/medicare_dynamic/edi/2.%20277CA%20EDI%20EDIT%20User%20Guide.pdf

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Select the message. A new window will display informing you a letter from our medical review department is available. Click the link in the message to view the actual decision letter.

The decision letter will identify the National Provider Identifier (NPI) and details of the claim including the patient’s Health Insurance Claim (HIC) number, name, and information on each line item of the claim.

NOTE: Decision letters are saved as a Portable Document Format (PDF) file. Once the decision letter is displayed, you may print the letter by selecting the “print” icon in the menu of your Acrobat Reader software. If you do not have Acrobat Reader software, a download (https://get.adobe.com/reader/?open) is available at no cost.

For information on other myCGS functions, including responding to additional documentation requests received from our medical review department, please refer to the myCGS User Manual (http://www.cgsmedicare.com/pdf/mycgs/chapter7_partb.pdf).


https://get.adobe.com/reader/?open

http://www.cgsmedicare.com/pdf/mycgs/chapter7_partb.pdf

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Kentucky & Ohio

myCGS General Inquiry – Part B

myCGS, our free Web portal, has been enhanced to allow providers to submit general inquiries directly to CGS.

The newly-created General Inquiry Form (located under the “Secure Forms” option) may be used to submit inquiries related to a number of topics including appeals, claims processing, finance, medical review, provider enrollment, and provider outreach.

Please Note: This enhancement is being offered as a convenient way for you to submit inquiries. The standard timeframe to respond to inquiries is 45 business days. Responses will be mailed to the correspondence address on file.

Also, this form should not be used in place of the other functions available to you through myCGS.

yy To submit a Redetermination (1st level appeal), please complete the Redetermination Request Form (http://www.cgsmedicare.com/pdf/partb_mycgs_redetermination_requests.pdf).

yy To submit an eOffset (offset authorization for a demanded overpayment), please complete the eOffset Request Form (http://www.cgsmedicare.com/articles/cope25833.html).

yy To submit a Part B claim, please refer to the Part B eClaims Job Aid (http://www.cgsmedicare.com/partb/mycgs/mycgs_eclaims_jobaid.pdf).

yy To respond to an additional documentation request (ADR) from our medical review department, please complete the MR ADR Response Form (http://www.cgsmedicare.com/partb/pubs/news/2015/0415/cope28413.html).

yy To request a Reopening (minor correction or omission) of a previously processed claim, please complete the Part B Reopening Request Form (http://www.cgsmedicare.com/partb/pubs/news/2014/0814/cope26668.html).

After logging on to the myCGS Web portal, select the FORMS tab. From the “Secure Forms” window at the “Select a Topic” drop-down box, select the Provider Contact Center option. At the “Select a Type” drop-down, you will find the General Inquiry Form. A link to the form is available directlly below it.

After clicking the form link and the page loads, you will find some fields are pre-populated based on your myCGS user ID. The required fields that must be completed to submit the General Inquiry Form are identified by a RED asterisk (*).

yy Requestor Name yy Requestor Phone Number yy Reason for Request yy Attachments


http://www.cgsmedicare.com/pdf/partb_mycgs_redetermination_requests.pdf

http://www.cgsmedicare.com/pdf/partb_mycgs_redetermination_requests.pdf

http://www.cgsmedicare.com/articles/cope25833.html

http://www.cgsmedicare.com/partb/mycgs/mycgs_eclaims_jobaid.pdf

http://www.cgsmedicare.com/partb/mycgs/mycgs_eclaims_jobaid.pdf

http://www.cgsmedicare.com/partb/pubs/news/2015/0415/cope28413.html




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Complete the top portion of the form. There is also an area to summarize the reason for the inquiry. In 2000 characters or less, summarize the issue.

Next, attach any documents you want to include that supports or further explains the inquiry. You may attach up to 10 documents http://www.cgsmedicare.com/partb/pubs/news/2015/0415/cope29055.html). Each attachment must be a PDF format and can be up to 40 MBs in size. The total size of all attachments cannot exceed 150 MBs.

NOTE: At least ONE attachment must be submitted.

Click the Browse button. A window will open allowing you to locate the PDF document stored on your system. Once you locate the document click “OPEN” to attach it to the form. A status bar (in BLUE) will appear indicating the document is uploading.

All files attached will appear under “Attached Files.” If a file is attached in error, simply click the RED ‘X’ to remove it.

After attaching the documentation, click SUBMIT to send the inquiry.

Once submitted, the eSignature box will display. Clicking OK is your confirmation that all information is correct and allows you to electronically sign the form.

After submitting the form, myCGS will default to the MESSAGES tab. You will receive a secure message confirming receipt of the form. A second message will be received confirming the form was accepted.




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The Confirmation message will include a submission ID. An e-mail notification will also be sent noting the submission ID. You may use the submission ID to track the status of your inquiry.

For more information on this and other myCGS functions, please refer to the myCGS User Manual (http://www.cgsmedicare.com/pdf/mycgs/chapter7_partb.pdf).

Kentucky & Ohio

Update to the Interest Paid on Clean Non-PIP Claims Not Paid Timely

According to the Medicare Claims Processing Manual, (Pub 100-04, Ch. 1., §80.2.2), interest is paid on clean claims, not paid under the periodic interim payment (PIP) method, if payment is not made within 30 days after the date of receipt. The interest rate is determined by the Treasury Department on a 6-mongh basis, effective every January and July 1. Effective, January 1, 2016, the interest amount is 2.500%.

For additional information about when interest is paid on a claim, and how to calculate the interest, refer to the Medicare Claims Processing Manual, (Pub 100-04, Ch. 1., §80.2.2) at http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c01.pdf on the Centers for Medicare & Medicaid Services (CMS) website. Current and past interest rate amounts can be viewed at http://fms.treas.gov/prompt/rates.html on the Treasury Department website.

Kentucky & Ohio

MM9271: Advance Care Planning (ACP) as an Optional Element of an Annual Wellness Visit (AWV)

The Centers for Medicare & Medicaid Services (CMS) has issued the following Medicare Learning Network® (MLN) Matters article. This MLN Matters article and other CMS articles can be found on the CMS website at: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/2015-MLN-Matters-Articles.html

MLN Matters® Number: MM9271Related CR Release Date: December 22, 2015Related CR Transmittal #: R216BP and R3428CP

Related Change Request (CR) #: CR 9271Effective Date: January 1, 2016Implementation Date: January 4, 2016

Provider Types Affected

This MLN Matters® Article is intended for providers who submit claims to Medicare Administrative Contractors (MACs) for Advance Care Planning (ACP) services provided as an optional element of the Annual Wellness Visit (AWV) to Medicare beneficiaries.

Provider Action Needed

Change Request (CR) 9271 informs providers to waive the deductible and the coinsurance for ACP when furnished as an optional element of an AWV. Make sure your billing staffs are aware of these changes.


http://www.cgsmedicare.com/pdf/mycgs/chapter7_partb.pdf

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c01.pdf

http://fms.treas.gov/prompt/rates.html

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/2015-MLN-Matters-Articles.html


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Background

The Centers for Medicare & Medicaid Services (CMS) made the Current Procedural Terminology (CPT) codes for ACP separately payable for Medicare. The change in policy will be implemented through the annual Medicare Physician Fee Schedule Database (MPFSDB) update.

In addition, CMS is also including voluntary ACP as an optional element of the AWV. ACP services furnished on the same day and by the same provider as an AWV are considered a preventive service. Therefore, the deductible and coinsurance are not applied to the codes used to report ACP services when performed as part of an AWV.

Voluntary ACP means the face-to-face service between a physician (or other qualified health care professional) and the patient discussing advance directives, with or without completing relevant legal forms. An advance directive is a document appointing an agent and/or recording the wishes of a patient pertaining to his/her medical treatment at a future time should he/she lack decisional capacity at that time.

Voluntary ACP, upon agreement with the patient, would be an optional element of the AWV. Effective January 1, 2016, when ACP services are provided as a part of an AWV, practitioners would report CPT code 99497 (plus add-on code 99498 for each additional 30 minutes, if applicable) for the ACP services in addition to either of the AWV codes G0438 and G0439. CPT codes 99497 and 99498 used to describe ACP are separately payable under the Medicare Physician Fee Schedule (MPFS). When voluntary ACP services are furnished as a part of an AWV, the coinsurance and deductible would not be applied for ACP. Under that circumstance, both the ACP and AWV must also be billed together on the same claim. In order to have the deductible and coinsurance waived for ACP when performed with an AWV, the ACP code(s) must be billed with modifier 33 (Preventive services). Since payment for an AWV is limited to only once a year, the deductible and coinsurance for ACP billed with an AWV can only be waived once a year.

Critical Access Hospitals (CAHs) may also bill for these professional services provided on or after January 1, 2016, using type of bill 85X with revenue codes 96X, 97X, and 98X. The CAH Method II payment will be based on the lesser of the actual charge or the facility-specific MPFS.

However, the deductible and coinsurance does apply when ACP is not furnished as part of a covered AWV.

Additional Information

The official instruction, CR9271, was issued to your MAC regarding this change via two transmittals. The first updates the “Medicare Benefit Policy Manual” and it is available at http://www.cms.hhs.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R216BP.pdf on the CMS website. The second transmittal updates the “Medicare Claims Processing Manual” and it is available at http://www.cms.hhs.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3428CP.pdf on the CMS website.

If you have any questions, please contact your MAC at their toll-free number. That number is available at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/index.html under - How Does It Work.


http://www.cms.hhs.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R216BP.pdf

http://www.cms.hhs.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R216BP.pdf

http://www.cms.hhs.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3428CP.pdf


http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/index.html


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Kentucky & Ohio

MM9357 Revised: New Influenza Virus Vaccine Code

The Centers for Medicare & Medicaid Services (CMS) has revised the following Medicare Learning Network® (MLN) Matters article. This MLN Matters article and other CMS articles can be found on the CMS website at: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/2015-MLN-Matters-Articles.html

MLN Matters® Number: MM9357 RevisedRelated CR Release Date: December 22, 2015Related CR Transmittal #: R3429CP

Related Change Request (CR) #: CR 9357Effective Date: August 1, 2015Implementation Date: April 4, 2016

Note: This article was revised on December 24, 2015, to reflect the revised CR9357 issued on December 22. In the article, the CR release date, transmittal number, and the Web address for accessing the CR are revised. All other information remains the same.


This MLN Matters® Article is intended for physicians and other providers submitting claims to Medicare Administrative Contractors (MACs) for certain influenza vaccine services provided to Medicare beneficiaries.


Change Request (CR) 9357 provides instructions for Medicare systems to be updated to include influenza virus vaccine code 90630 (Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use) for claims with dates of service on or after August 1, 2015. Make sure your billing staffs are aware of this code change.

Background

CR9357 provides that (effective for claims with dates of service on or after August 1, 2015, processed on or after April 4, 2016) Medicare will pay for vaccine Current Procedural Terminology (CPT) code 90630 (Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use).

Your MAC will add influenza virus vaccine CPT code 90630 to existing influenza virus vaccine edits and accept it for claims with dates of service on or after August 1, 2015.

Effective for dates of service on and after August 1, 2015, MACs will:

yy Pay for vaccine code 90630 on institutional claims as follows:

y� Hospitals – Types of Bill (TOB) 12X and 13X, Skilled Nursing Facilities (SNFs) –TOB 22X and 23X, Home Health Agencies (HHAs) – TOB 34X, hospital-based Renal Dialysis Facilities (RDFs) – TOB 72X, and Critical Access Hospitals (CAHs) – TOB 85X, based on reasonable cost;

y� Indian Health Service (IHS) Hospitals – TOB 12X, and 13X and IHS CAHs – TOB 85X, based on the lower of the actual charge or 95 percent of the Average Wholesale Price (AWP); and

y� Comprehensive Outpatient Rehabilitation Facility (CORF) – TOB 75X, and independent RDFs – TOB 72X, based on the lower of actual charge or 95 percent of the AWP.

yy Pay for code 90630 on professional claims using the CMS Seasonal Influenza Vaccines Pricing webpage at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/VaccinesPricing.html to determine the payment rate for influenza virus vaccine code 90630.




https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/VaccinesPricing.html

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/VaccinesPricing.html

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Note: In all of the above instances, annual Part B deductible and coinsurance do not apply.

In addition, until Medicare systems changes are implemented, MACs will hold institutional claims containing influenza virus vaccine CPT codes 90630 (with dates of service on or after August 1, 2015) that they receive before April 4, 2016. Once the system changes described in CR9357 are implemented, these institutional claims will be processed and paid.


The official instruction, CR9357, issued to your MAC regarding this change is available at http://www.cms.hhs.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3429CP.pdf on the CMS website.


Kentucky & Ohio

MM9476: Summary of Policies in the Calendar Year (CY) 2016 Medicare Physician Fee Schedule (MPFS) Final Rule and Telehealth Originating Site Facility Fee Payment Amount


MLN Matters® Number: MM9476Related CR Release Date: December 18, 2015Related CR Transmittal #: R3423CP



This MLN Matters® Article is intended for physicians and other providers who submit claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.


This article is based on Change Request (CR) 9476 which provides a summary of the policies in the Calendar Year (CY) 2016 Medicare Physician Fee Schedule (MPFS) Final Rule and announces the Telehealth Originating Site Facility Fee payment amount. Make sure that your billing staff is aware of these updates for 2016.

Background

The Social Security Act (Section 1848(b)(1); see http://www.ssa.gov/OP_Home/ssact/title18/1848.htm) requires the Centers for Medicare & Medicaid Services (CMS) to establish by regulation a fee schedule of payment amounts for physicians’ services for the subsequent year. CMS issued a final rule with comment period on October 30, 2015, (see http://www.gpo.gov/fdsys/pkg/FR-2015-11-16/pdf/2015-28005.pdf), that updates payment policies and Medicare payment rates for services furnished by physicians and Non-Physician Practitioners (NPPs) that are paid under the MPFS in CY 2016.

The final rule also addresses public comments on Medicare payment policies proposed earlier this year. The proposed rule “Revisions to Payment Policies under the Physician Fee Schedule








http://www.ssa.gov/OP_Home/ssact/title18/1848.htm


http://www.gpo.gov/fdsys/pkg/FR-2015-11-16/pdf/2015-28005.pdf


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and Other Revisions to Part B for CY 2016” was published in the Federal Register on July 15, 2015 (see http://www.gpo.gov/fdsys/pkg/FR-2015-07-15/pdf/2015-16875.pdf).

The final rule also addresses interim final values established in the CY 2015 MPFS final rule with comment period. The final rule assigns interim final values for new, revised, and potentially misvalued codes for CY 2016 and requests comments on these values. CMS will accept comments on those items open to comment in the final rule with comment period until December 29, 2015.

CR9476 provides a summary of the payment polices under the Medicare Physician Fee Schedule (PFS) and makes other policy changes related to Medicare Part B payment. These changes are applicable to services furnished in CY 2016 and they are as follows:

Sustainable Growth Rate (SGR)

The Medicare Access and CHIP Reauthorization Act of 2015 (Pub. L. 114-10, enacted on April 16, 2015) (MACRA; see http://www.gpo.gov/fdsys/pkg/BILLS-114hr2enr/pdf/BILLS-114hr2enr.pdf) repealed the Medicare SGR update formula for payments under the MPFS.

Access to Telehealth Services

CMS is adding the following services to the list of services that can be furnished to Medicare beneficiaries under the telehealth benefit: Prolonged service inpatient CPT codes 99356 and 99357 and ESRD-related services 90963 through 90966. The prolonged service codes can only be billed in conjunction with subsequent hospital and subsequent nursing facility codes. Limits of one subsequent hospital visit every three days, and one subsequent nursing facility visit every 30 days, would continue to apply when the services are furnished as telehealth services.

For the ESRD-related services, the required clinical examination of the catheter access site must be furnished face-to-face “hands on” (without the use of an interactive telecommunications system) by a physician, Clinical Nurse Specialist (CNS), Nurse Practitioner (NP), or Physician Assistant (PA). For the complete list of telehealth services, visit http://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/index.html on the CMS website.

Certified Registered Nurse Anesthetists (CRNAs) initially were omitted from the list of distant site practitioners for telehealth services in the regulation because CMS did not believe these practitioners would furnish any of the service on the list of Medicare telehealth services. However, CRNAs in some states are licensed to furnish certain services on the telehealth list, including evaluation and management services. Therefore, CMS revised the regulation at 42 CFR 410.78(b)(2) (http://www.ecfr.gov/cgi-bin/text-idx?SID=6e06827438f8f30fa7fbc12acf20732b&mc=true&node=pt42.2.410&rgn=div5%23se42.2.410_178) (Telehealth services) to include a CRNA, as described under 42 CFR 410.69 (http://www.ecfr.gov/cgi-bin/text-idx?SID=6e06827438f8f30fa7fbc12acf20732b&mc=true&node=pt42.2.410&rgn=div5%23se42.2.410_169), to the list of distant site practitioners who can furnish Medicare telehealth services.

Telehealth Origination Site Facility Fee Payment Amount Update

The Social Security Act (Section 1834(m)(2)(B); see https://www.ssa.gov/OP_Home/ssact/title18/1834.htm) establishes the payment amount for the Medicare telehealth originating site facility fee for telehealth services provided from October 1, 2001, through December 31, 2002, at $20. For telehealth services provided on or after January 1 of each subsequent calendar year, the telehealth originating site facility fee is increased by the percentage increase in the Medicare Economic Index (MEI) as defined in the Social Security Act (Section 1842(i)(3); see https://www.ssa.gov/OP_Home/ssact/title18/1842.htm).

The MEI increase for 2016 is 1.1 percent. Therefore, for CY 2016, the payment amount for HCPCS code Q3014 (Telehealth originating site facility fee) is 80 percent of the lesser of the actual charge, or $25.10. (The beneficiary is responsible for any unmet deductible amount and Medicare coinsurance.)



http://www.gpo.gov/fdsys/pkg/BILLS-114hr2enr/pdf/BILLS-114hr2enr.pdf


http://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/index.html

http://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/index.html

http://www.ecfr.gov/cgi-bin/text-idx?SID=6e06827438f8f30fa7fbc12acf20732b&mc=true&node=pt42.2.410&rgn=div5%23se42.2.410_178




https://www.ssa.gov/OP_Home/ssact/title18/1834.htm



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Incomplete Colonoscopies

The method for calculating the payment for incomplete colonoscopies has been revised for 2016. New payment rates will apply when modifier 53 (discontinued procedure) is appended to codes 44388, 45378, G0105, and G0121. (For more information, see the MLN Matters article (MM9317) corresponding to CR9317 at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9317.pdf on the CMS website.)

Advance Care Planning, and With an Annual Wellness Visit (AWV)

Advance Care Planning (ACP) services are separately payable under the MPFS in 2016 (deductible and coinsurance apply). When voluntary ACP services are furnished as part of an Annual Wellness Visit (AWV), the deductible and coinsurance would not be applied for ACP.

Portable X-ray Transportation Fee

The “Medicare Claims Processing Manual,” Chapter13, Section 90.3 was revised to remove the word “Medicare” before “patient” in Section 90.3. Also, guidance for the billing of the transportation fee of portable X-ray suppliers has been clarified. When more than one patient is X-rayed at the same location, the single transportation payment under the Physician Fee Schedule is to be prorated among all patients (Medicare Parts A and B, and non-Medicare) receiving portable X-ray services during that trip, regardless of their insurance status. For more information, see the MLN Matters article (MM9354) corresponding to CR9354 for more information at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9354.pdf on the CMS website.

“Incident to” Policy

CMS finalized the changes to 42 CFR 410.26(a)(1) (http://www.ecfr.gov/cgi-bin/text-idx?tpl=/ecfrbrowse/Title42/42cfr410_main_02.tpl) without modification, and the change to the regulation at 42 CFR 410.26(b)(5) with a clarifying modification. Specifically, CMS is amending the definition of the term, “auxiliary personnel” at § 410.26(a)(1) that are permitted to provide “incident to” services to exclude individuals who have been excluded from the Medicare program or have had their Medicare enrollment revoked. Additionally, CMS is amending § 410.26(b)(5) by revising the final sentence to make clear that the physician (or other practitioner) directly supervising the auxiliary personnel need not be the same physician (or other practitioner) that is treating the patient more broadly, and adding a sentence to specify that only the physician (or other practitioner) that supervises the auxiliary personnel that provide incident to services may bill Medicare Part B for those incident to services.

Establishing Values for New, Revised, and Misvalued Codes

The list of codes with changes for CY 2016 included under this definition of “adjustments to Relative Value Units (RVUs) for misvalued codes” is available under the “downloads” section at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices.html on the CMS website.

Target for Relative Value Adjustments for Misvalued Services

The Protecting Access to Medicare Act of 2014 (PAMA; Section 220(d); see http://www.gpo.gov/fdsys/pkg/BILLS-113hr4302enr/pdf/BILLS-113hr4302enr.pdf) added a new subparagraph tot the Social Security Act (Section 1848(c)(2)(O)) to establish an annual target for reductions in MPFS expenditures resulting from adjustments to relative values of misvalued codes. Under the Social Security Act (Section 1848(c)(2)(O)(ii)), if the estimated net reduction in expenditures for a year as a result of adjustments to the relative values for misvalued codes is equal to or greater than the target for that year, reduced expenditures attributable to such adjustments will be redistributed in a budget-neutral manner within the MPFS in accordance with the existing budget neutrality requirement under the Social Security Act (Section 1848(c)(2)(B)(ii)(II)). The provision also specifies that the amount by which such reduced expenditures exceeds the target for a given year will be treated as a net reduction in expenditures for the succeeding


https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9317.pdf




http://www.ecfr.gov/cgi-bin/text-idx?tpl=/ecfrbrowse/Title42/42cfr410_main_02.tpl

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http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices.html

http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices.html



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year, for purposes of determining whether the target has been met for that subsequent year. Section 1848(c)(2)(O)(iv)) defines a target recapture amount as the difference between the target for the year and the estimated net reduction in expenditures under the MPFS resulting from adjustments to RVUs for misvalued codes. Section 1848(c)(2)(O)(iii)) specifies that, if the estimated net reduction in MPFS expenditures for the year is less than the target for the year, an amount equal to the target recapture amount will not be taken into account when applying the budget neutrality requirements specified in the Social Security Act (Section 1848(c)(2)(B)(ii)(II)). The PAMA (Section 220(d)) applies to Calendar Years (CYs) 2017 through 2020 and sets the target under the Social Security Act (Section 1848(c)(2)(O)(v)) at 0.5 percent of the estimated amount of expenditures under the PFS for each of those 4 years.

The Achieving a Better Life Experience Act of 2014 (ABLE; Section 202) (Division B of Pub. L. 113-295, enacted December 19, 2014) amended the Social Security Act (Section 1848(c)(2)(O)) to accelerate the application of the MPFS expenditure reduction target to CYs 2016, 2017, and 2018, and to set a 1 percent target for CY 2016 and 0.5 percent for CYs 2017 and 2018. As a result of these provisions, if the estimated net reduction for a given year is less than the target for that year, payments under the MPFS will be reduced.

In the CY 2016 PFS proposed rule, CMS proposed a methodology to implement this statutory provision in a manner consistent with the broader statutory construct of the MPFS. CMS finalized the policy to calculate the net reduction using the simpler method as proposed. CMS estimates the CY 2016 net reduction in expenditures resulting from adjustments to relative values of misvalued codes to be 0.23 percent. Since this does not meet the 1 percent target established by the Achieving a Better Life Experience Act of 2014 (ABLE), payments under the MPFS must be reduced by the difference between the target for the year and the estimated net reduction in expenditures (the “Target Recapture Amount”). As a result, CMS estimates that the CY 2016 Target Recapture Amount will produce a reduction to the CF of -0.77 percent.


The official instruction, CR9476, issued to your MAC regarding this change is available at https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3423CP.pdf on the CMS website.


Kentucky & Ohio

MM9484: January 2016 Update of the Ambulatory Surgical Center (ASC) Payment System





This MLN Matters® Article is intended for Ambulatory Surgical Centers (ASCs) submitting claims to Medicare Administrative Contractors (MACs) for services to Medicare beneficiaries.


https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3423CP.pdf






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Change Request (CR) 9484 informs MACs about changes to and billing instructions for various payment policies implemented in the January 2016 ASC payment system update. As appropriate, this notification also includes updates to the Healthcare Common Procedure Coding System (HCPCS). Make sure that your billing staff are aware of these changes.

Background

Included in CR9484 are Calendar Year (CY) 2016 payment rates for separately payable drugs and biologicals, including descriptors for newly created Level II HCPCS codes for drugs and biologicals (ASC DRUG files), and the CY 2016 ASC payment rates for covered surgical and ancillary services (ASCFS file). There is also an update to Chapter 14 of the “Medicare Claims Processing Manual.”

Many ASC payment rates under the ASC payment system are established using payment rate information in the Medicare Physician Fee Schedule (MPFS). The payment files associated with this transmittal reflect the most recent changes to CY 2016 MPFS payment. Key updates are:

1. New Device Pass-Through Category and Device Offset for Payment

Additional payments may be made to the ASC for covered ancillary services, including certain implantable devices with pass-through status under the outpatient prospective payment system (OPPS). Section 1833(t)(6)(B) of the Social Security Act (the Act) requires that, under the OPPS, categories of devices be eligible for transitional pass-through payments for at least 2, but not more than 3 years. Section 1833(t)(6)(B)(ii)(IV) of the Act requires that we create additional categories for transitional pass-through payment of new medical devices not described by current or expired categories of devices. This policy was implemented in the 2008 revised ASC payment system.

The Centers for Medicare & Medicaid Services (CMS) is establishing one new HCPCS device pass-through category as of January 1, 2016, for the OPPS and the ASC payment systems. Table 1 provides a listing of new coding and payment information concerning the new device category for transitional pass-through payment. HCPCS code C1822 (Gen, neuro, HF, rechg bat) is assigned ASC PI=J7 (OPPS pass-through device paid separately when provided integral to a surgical procedure on ASC list; payment contractor-priced). Table 1 below shows more details.

Table 1 − New Device Pass-Through CodeHCPCS Code Effective Date Short Descriptor Long Descriptor ASC PIC1822 01-01-2015 Gen, neuro, HF,

rechg batGenerator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system

J7

2. Device Offset from Payment for New Device Category

Section 1833(t)(6)(D)(ii) of the Act requires that CMS deduct from pass-through payments for devices an amount that reflects the portion of the Ambulatory Payment Classification (APC) payment amount in the Outpatient Prospective Payment System (OPPS). This policy is also in effect in the ASC payment system. Basically, CMS has determined that a portion of the APC payment amount associated with the cost of HCPCS code C1822 is reflected in APC 5464. The HCPCS code C1822 device should always be billed with CPT Code 63685 (Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling) which is assigned to APC 5464 for CY 2016. The device portion included in the ASC procedure payment for 63685 is 84 percent, and is deducted from the procedure payment when performed with C1822.


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3. Revised Short and Long Descriptors for Packaged code HCPCS Code C1820

ASCs do not report packaged codes but with the establishment of HCPCS code C1822, CMS is modifying the short and long descriptors for existing HCPCS code C1820 to appropriately differentiate between HCPCS code C1822 and C1820.

The revised descriptors for C1820 are (short descriptor: Gen, neuro, non-HF rechg bat; long descriptor: Generator, neurostimulator (implantable), non high-frequency with rechargeable battery and charging system).

CMS notes that HCPCS code C1820 describes an implantable non high-frequency neurostimulator generator device with rechargeable battery and charging system, while HCPCS code C1822 describes an implantable high-frequency neurostimulator generator device with rechargeable battery and charging system. While ASCs do not report packaged codes, it is important to announce this distinction.

4. Removal of Device Portion from Procedures that are Assigned to a Device-Intensive APC and that are Discontinued Prior to the Administration of Anesthesia

In accordance with the regulations at 42 CFR 416.172(f) and Section 40.4 of Chapter 14 of the “Medicare Claims Processing Manual,” when a surgical procedure, for which anesthesia is planned, is terminated after the patient is prepared and taken to the room where the procedure is to be performed, but prior to the administration of anesthesia, ASCs are instructed to append modifier “73” to the procedure line item on the claim. Medicare processes these line items by removing one-half of the full program allowance.

In the CY 2016 OPPS/ASC (Outpatient Prospective Payment System/Ambulatory Surgical Center) final rule, that was published in the Federal Register on November 13, 2015, CMS revised its payment policy for surgical procedures, for which anesthesia is planned and that are discontinued prior to the administration of anesthesia, appended with modifier 73. Specifically, effective January 1, 2016, for such procedures that are assigned to device-intensive procedures, CMS will remove the full device portion of the device-intensive procedure payment prior to applying the additional payment adjustments that apply when the procedure is discontinued. This policy does not apply to procedures and services that are discontinued after the administration of anesthesia and include the 74 modifier. Additional information on this policy is included in CR9297, dated November 6, 2015. An MLN Matters® article related to CR9297 is available at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9297.pdf on the CMS website.

5. New Brachytherapy Source HCPCS

Section 1833(t)(2)(H) of the Act mandates the creation of additional groups of covered Outpatient Department (OPD) services that classify devices of brachytherapy consisting of a seed or seeds (or radioactive source) (“brachytherapy sources”) separately from other services or groups of services. The additional groups must reflect the number, isotope, and radioactive intensity of the brachytherapy sources furnished. CivaSheet is a new brachytherapy source.

This new brachytherapy source is payable in the ASC payment system. The HCPCS code assigned to this source and the payment rate under OPPS are listed in Table 2.

Table 2 – New Brachytherapy Source HCPCSHCPCS Code Effective Date Short Descriptor Long Descriptor ASC PIC2645 01-01-2016 Brachytx planar,

p-103Brachytherapy planar source, palladium - 103, per square millimeter

H2





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6. Billing Instructions for Corneal Tissue

As finalized in the CY 2016 OPPS/ASC final rule with comment period (80 FR 70472), procurement/acquisition of corneal tissue will be paid separately only when it is used in corneal transplant procedures. Specifically, corneal tissue will be separately paid when used in procedures performed in the OPD only when the corneal tissue is used in a corneal transplant procedure described by one of the following CPT codes:

- 65710 (Keratoplasty (corneal transplant); anterior lamellar);

- 65730 (Keratoplasty (corneal transplant); penetrating (except in aphakia or pseudophakia));

- 65750 (Keratoplasty (corneal transplant); penetrating (in aphakia));

- 65755 (Keratoplasty (corneal transplant); penetrating (in pseudophakia));

- 65756 (Keratoplasty (corneal transplant); endothelial and any successor code or new code describing a new type of corneal transplant procedure that uses eye banked corneal tissue.

HCPCS code V2785 (Processing, preserving, and transporting corneal tissue) should only be reported when corneal tissue is used in a corneal transplant procedure; V2785 should not be reported in any other circumstances.

7. Drugs, Biologicals, and Radiopharmaceuticals

New CY 2016 HCPCS Codes and Dosage Descriptors for Certain Drugs, Biologicals, and Radiopharmaceuticals

For CY 2016, several new HCPCS codes were created for reporting drugs and biologicals in the ASC setting. These new codes, their descriptors, and payment indicator (PI) are listed in Table 3.

Table 3 – New CY 2016 HCPCS Codes Effective for Certain Drugs, Biologicals, and RadiopharmaceuticalsHCPCS Code Effective Date Short Descriptor Long Descriptor ASC PIC9458 01-01-2016 Florbetaben f18 Florbetaben F18, diagnostic, per study

dose, up to 8.1 millicuriesK2

C9459 01-01-2016 Flutemetamol f18 Flutemetamol F18, diagnostic, per study dose, up to 5 millicuries

K2

C9460 01-01-2016 Injection, cangrelor Injection, cangrelor, 1 mg K2J0714 01-01-2016 ‘Injection, ceftazidime and avibactam,

0.5g/0.125gK2

J1575 01-01-2016 Hyqvia 100mg immuneglobulin

Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulin

K2

J7188 01-01-2016 Factor viii recomb obizur

Injection, factor viii (antihemophilic factor, recombinant), (obizur), per i.u.

K2

J7340 01-01-2016 Carbidopa levodopa enteral

Carbidopa 5 mg/levodopa 20 mg enteral suspension

K2

a. Other Changes to CY 2016 HCPCS and CPT Codes for Certain Drugs, Biologicals, and Radiopharmaceuticals

Many HCPCS and CPT codes for drugs, biologicals, and radiopharmaceuticals have undergone changes in their HCPCS and CPT code descriptors that will be effective in CY 2016. In addition, several temporary HCPCS C-codes have been deleted effective December 31, 2015, and replaced with permanent HCPCS codes in CY 2016. ASCs should pay close attention to accurate billing for units of service consistent with the dosages contained in the long descriptors of the CY 2016 HCPCS and CPT codes. Table 4 notes those drugs, biologicals, and


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radiopharmaceuticals that have undergone changes in their HCPCS/CPT code, their long descriptor, and/or short descriptor. Each product’s CY 2015 HCPCS/CPT code and long descriptor are noted in the two left hand columns and the CY 2016 HCPCS/CPT code and long descriptor are noted in the adjacent right hand columns. CY2016 HCPCS short descriptors that are unchanged from their crosswalked CY2015 short descriptor are annotated with an asterisk (*). CY2016 short descriptors are provided if changed from the CY2015 crosswalked short descriptor.

Table 4 – Other CY 2016 HCPCS and CPT Code Changes for Certain Drugs, Biologicals, and RadiopharmaceuticalsCY 2015 HCPCS/CPT code CY 2015 Long Descriptor

CY 2016 HCPCS/CPT Code CY 2016 Long Descriptor

CY 2016 Short Descriptors

C9025 Injection, ramucirumab, 5 mg J9308 Injection, ramucirumab, 5 mg *C9026 Injection, vedolizumab, 1 mg J3380 Injection, vedolizumab, 1 mg *C9027 Injection, pembrolizumab, 1 mg J9271 Injection, pembrolizumab, 1 mg *Q9975 Injection, Factor VIII, FC Fusion Protein

(Recombinant), per iuJ7205 Injection, factor viii fc fusion

(recombinant), per iu*

C9442 Injection, belinostat, 10 mg J9032 Injection, belinostat, 10 mg Injection, belinostat, 10 mg

C9443 Injection, dalbavancin, 10 mg J0875 Injection, dalbavancin, 5 mg *C9444 Injection, oritavancin, 10 mg J2407 Injection, oritavancin, 10 mg *C9445 Injection, c-1 esterase inhibitor

(recombinant), Ruconest, 10 unitsJ0596 Injection, c1 esterase inhibitor

(recombinant), ruconest, 10 units*

C9446 Injection, tedizolid phosphate, 1 mg J3090 Injection, tedizolid phosphate, 1 mg *Q9978 Netupitant 300 mg and Palonosetron

0.5 mg, oralJ8655 Netupitant 300 mg and

palonosetron 0.5 mg*

C9449 Injection, blinatumomab, 1 mcg J9039 Injection, blinatumomab, 1 microgram

*

C9450 Injection, fluocinolone acetonide intravitreal implant, 0.01 mg

J7313 Injection, fluocinolone acetonide, intravitreal implant, 0.01 mg

Fluocinol acet intravit imp

C9451 Injection, peramivir, 1 mg J2547 Injection, peramivir, 1 mg *C9452 Injection, ceftolozane 50 mg and

tazobactam 25 mgJ0695 Injection, ceftolozane 50 mg and

tazobactam 25 mg*

C9453 Injection, nivolumab, 1 mg J9299 Injection, nivolumab, 1 mg *C9454 Injection, pasireotide long acting, 1 mg J2502 Injection, pasireotide long acting,

1 mg*

C9455 Injection, siltuximab, 10 mg J2860 Injection, siltuximab, 10 mg *C9456 Injection, isavuconazonium sulfate, 1 mg J1833 Injection, isavuconazonium, 1 mg *C9457 Injection, sulfur hexafluoride lipid

microsphere, per mlQ9950 Injection, sulfur hexafluoride lipid

microspheres, per mlInj sulf hexa lipid microsph

J1446 Injection, tbo- filgrastim, 5 micrograms J1447 Injection, tbo-filgrastim, 1 microgram

Inj tbo filgrastim 1 microg

J7302 Levonorgestrel- releasing intrauterine contraceptive system, 52 mg

J7297 Levonorgestrel-releasing intrauterine contraceptive system, 52 mg, 3 year duration

*

J7302 Levonorgestrel- releasing intrauterine contraceptive system, 52 mg

J7298 Levonorgestrel-releasing intrauterine contraceptive system, 52 mg, 5 year duration

*

J7506 Prednisone, oral, per 5mg J7512 Prednisone, immediate release or delayed release, oral, 1 mg

*

J7508 Tacrolimus, extended release, oral, 0.1 mg

J7508 Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg

*

Q9979 Injection, alemtuzumab, 1 mg J0202 Injection, alemtuzumab, 1 mg *Q4153 Dermavest, per square centimeter Q4153 Dermavest and plurivest, per

square centimeter*


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Table 4 – Other CY 2016 HCPCS and CPT Code Changes for Certain Drugs, Biologicals, and RadiopharmaceuticalsCY 2015 HCPCS/CPT code CY 2015 Long Descriptor

CY 2016 HCPCS/CPT Code CY 2016 Long Descriptor

CY 2016 Short Descriptors

Q9976 Injection, ferric pyrophosphate citrate solution, 0.1 mg of iron

J1443 Injection, ferric pyrophosphate citrate solution, 0.1 mg of iron

Injection, ferric pyrophosphate citrate solution, 0.1 mg of iron

Q9977 Compounded Drug, Not Otherwise Classified

J7999 Compounded Drug, Not Otherwise Classified

*

S5011 5 % dextrose in lactated ringers, 1000 ml

J7121 5 % dextrose in lactated ringers infusion, up to 1000 cc

*

* CY2016 HCPCS short descriptors that are unchanged from their crosswalked CY2015 short descriptor.

b. Drugs and Biologicals with Payments Based on Average Sales Price (ASP) Effective January 1, 2016

For CY 2016, payment for nonpass-through drugs, biologicals, and therapeutic radiopharmaceuticals is made at a single rate of ASP + 6 percent, which provides payment for both the acquisition cost and pharmacy overhead costs associated with the drug, biological, or therapeutic radiopharmaceutical. In CY 2016, a single payment of ASP + 6 percent for pass-through drugs, biologicals, and radiopharmaceuticals is made to provide payment for both the acquisition cost and pharmacy overhead costs of these pass-through items. Payments for drugs and biologicals based on ASPs will be updated on a quarterly basis as later quarter ASP submissions become available. Updated payment rates effective January 1, 2016, are available in the January 2016 ASC Addendum BB at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/11_Addenda_Updates.html on the CMS website.

c. Drugs and Biologicals Based on ASP Methodology with Restated Payment Rates

Some drugs and biologicals based on ASP methodology may have payment rates that are corrected retroactively. These retroactive corrections typically occur on a quarterly basis. The list of drugs and biologicals with corrected payments rates are accessible on the first date of the quarter at http://cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/index.html on the CMS website. Suppliers who think they may have received an incorrect payment for drugs and biologicals impacted by these corrections may request their MAC to adjust the previously processed claims.

d. Biosimilar Payment Policy

Effective January 1, 2016, the payment rate for biosimilars approved for payment in the ASC payment system will be the same as the payment rate in the OPPS and physician office setting, calculated as the ASP of the biosimilar(s) described by the HCPCS code + 6 percent of the ASP of the reference product. Payment will be made at the single ASP + 6 percent rate.

e. Updated Guidance: Billing and Payment for New Drugs, Biologicals, or Radiopharmaceuticals Approved by the FDA but Before Assignment of a Product-Specific HCPCS Code

As in the OPPS, ASCs are allowed to bill for new drugs, biologicals, and therapeutic radiopharmaceuticals that are approved by the FDA on or after January 1, 2004, for which OPPS pass-through status has not been approved and a C-code and APC


http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/11_Addenda_Updates.html



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payment have not been assigned using the “unclassified” drug/biological HCPCS code C9399 (Unclassified drugs or biological). Drugs, biologicals, and therapeutic radiopharmaceuticals that are assigned to HCPCS code C9399 are MAC priced.

Diagnostic radiopharmaceuticals and contrast agents are policy packaged under both the OPPS and ASC payment system unless they have been granted pass-through status. Therefore, new diagnostic radiopharmaceuticals and contrast agents are an exception to the above policy and should not be billed with C9399 prior to the approval of pass-through status. Instead, they are packaged in the ASC setting with payment already included in the surgical procedure performed, and are not billed.

f. Skin Substitute Procedure Edits

The payment for skin substitute products that do not qualify for OPPS pass-through status are packaged into the OPPS payment for the associated skin substitute application procedure. This policy is also implemented in the ASC payment system. The skin substitute products are divided into two groups: 1) high cost skin substitute products and 2) low cost skin substitute products for packaging purposes. Table 5 lists the skin substitute products and their assignment as either a high cost or a low cost skin substitute product, when applicable. ASCs should not separately bill for packaged skin substitutes (ASC PI=N1).

High cost skin substitute products should only be utilized in combination with the performance of one of the skin application procedures described by CPT codes 15271-15278. Low cost skin substitute products should only be utilized in combination with the performance of one of the skin application procedures described by HCPCS code C5271-C5278. All OPPS pass-through skin substitute products (ASC PI=K2) should be billed in combination with one of the skin application procedures described by CPT code 15271-15278.

Table 5 – Skin Substitute Product Assignment to High Cost/Low Cost Status for CY 2016CY 2016 HCPCS Code CY 2016 Short Descriptor

ASC PI

Low/High Cost Skin Substitute

C9349 PuraPly, PuraPly antimic K2 HighC9363 Integra Meshed Bil Wound Mat N1 HighQ4101 Apligraf N1 HighQ4102 Oasis Wound Matrix N1 LowQ4103 Oasis Burn Matrix N1 HighQ4104 Integra BMWD N1 HighQ4105 Integra DRT N1 HighQ4106 Dermagraft N1 HighQ4107 GraftJacket N1 HighQ4108 Integra Matrix N1 HighQ4110 Primatrix N1 HighQ4111 Gammagraft N1 LowQ4115 Alloskin N1 LowQ4116 Alloderm N1 HighQ4117 Hyalomatrix N1 LowQ4119 Matristem Wound Matrix N1 LowQ4120 Matristem Burn Matrix N1 HighQ4121 Theraskin K2 HighQ4122 Dermacell N1 HighQ4123 Alloskin N1 HighQ4124 Oasis Tri-layer Wound Matrix N1 LowQ4126 Memoderm/derma/tranz/integup N1 High


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Table 5 – Skin Substitute Product Assignment to High Cost/Low Cost Status for CY 2016CY 2016 HCPCS Code CY 2016 Short Descriptor

ASC PI

Low/High Cost Skin Substitute

Q4127 Talymed N1 HighQ4128 Flexhd/Allopatchhd/Matrixhd N1 HighQ4129 Unite Biomatrix N1 LowQ4131 Epifix N1 HighQ4132 Grafix Core N1 HighQ4133 Grafix Prime N1 HighQ4134 hMatrix N1 LowQ4135 Mediskin N1 LowQ4136 Ezderm N1 LowQ4137 Amnioexcel or Biodexcel, 1cm N1 HighQ4138 Biodfence DryFlex, 1cm N1 HighQ4140 Biodfence 1cm N1 HighQ4141 Alloskin ac, 1cm N1 HighQ4143 Repriza, 1cm N1 LowQ4146 Tensix, 1CM N1 LowQ4147 Architect ecm, 1cm N1 HighQ4148 Neox 1k, 1cm N1 HighQ4150 Allowrap DS or Dry 1 sq cm N1 HighQ4151* AmnioBand, Guardian 1 sq cm N1 HighQ4152* Dermapure 1 square cm N1 HighQ4153 Dermavest 1 square cm N1 HighQ4154* Biovance 1 square cm N1 HighQ4156* Neox 100 1 square cm N1 HighQ4157 Revitalon 1 square cm N1 LowQ4158 MariGen 1 square cm N1 LowQ4159 Affinity 1 square cm N1 HighQ4160 NuShield 1 square cm N1 HighQ4161 Bio-Connekt per square cm N1 LowQ4162 Amnio bio and woundex flow N1 LowQ4163 Amnion bio and woundex sq cm N1 LowQ4164 Helicoll, per square cm N1 LowQ4165 Keramatrix, per square cm N1 Low

* HCPCS codes Q4151, Q4152, Q4154, and Q4156 were assigned to the low cost group in the CY 2016 OPPS/ASC final rule with comment period. Upon submission of updated pricing information, Q4151, Q4152, Q4154, and Q4156 are assigned to the high cost group for CY 2016.

8. CY 2016 ASC Wage Index

In the CY 2016 OPPS/ASC final rule, CMS-1633-FC, and CMS-1607-F2 (80 FR 70298), CMS reminded readers that in the CY 2015 OPPS/ASC final rule with comment period (79 FR 66937), CMS finalized a 1-year transition or “blended” policy that it applied in CY 2015 for all ASCs that experienced any decrease in their actual wage index exclusively due to the implementation of the new OMB delineations. When the CY 2015 wage index blended value did not correspond to an existing Core Based Statistical Area (CBSA) number, CMS implemented this transition by creating alternate or pseudo CBSA numbers (50000 series) to accommodate those wage index values. This transition became operational via CR9021, dated January 9, 2015. This transition does not apply in CY 2016. For CY 2016, the final CY 2016 ASC wage indexes fully reflect the new OMB labor market area delineations and the pseudo-CBSAs are being end dated.


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The complete set of pseudo-CBSAs and their crosswalk to their final CY2016 ASC wage indices are included in Attachment B of CR9484. Attachment B is an Excel® spreadsheet that is sorted in this manner: columns A-C show State/county and state/county code, columns D-E are provided as a historical reference, and columns F-H show the CY2015 pseudo-CBSA related data that will be crosswalked to the final CY2016 CBSA information contained in columns I-K.

9. Continued Use of C1841 in ASCs

Effective October 1, 2013, and expiring December 31, 2015, one device (C1841 - Retinal prosthesis, includes all internal and external components) was eligible for pass-through payment in the OPPS and ASC payment systems. After pass-through status expires for a medical device, the payment for the device is packaged into the payment for the associated procedure. Effective January 1, 2016, in the OPPS and ASC payment systems, C1841 is now packaged into CPT code 0100T, which is assigned to New Technology APC 1599 with a final payment of $95,000 for CY 2016.

Due to current ASC systems limitations, CMS cannot implement the identical policy in ASCs. As an administrative workaround until CMS can correct this system limitation, both C1841 and 0100T must be reported when a retinal prosthesis is implanted in the ASC.

10. Coverage Determinations

The fact that a drug, device, procedure, or service is assigned a HCPCS code and a payment rate under the ASC payment system does not imply coverage by the Medicare program, but indicates only how the product, procedure, or service may be paid if covered by the program. Medicare Administrative Contractors (MACs) determine whether a drug, device, procedure, or other service meets all program requirements for coverage. For example, MACs determine that it is reasonable and necessary to treat the beneficiary’s condition and whether it is excluded from payment.


The official instruction, CR9484, issued to your MAC regarding this change, is available at https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3430CP.pdf on the CMS website.

If you have questions, please contact your MAC at their toll-free number. The number is available at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/index.html under - How Does It Work?

Kentucky & Ohio

MM9481: 2016 Durable Medical Equipment Prosthetics, Orthotics, and Supplies Healthcare Common Procedure Coding System (HCPCS) Code Jurisdiction List



Related Change Request (CR) #: CR 9481Effective Date: January 1, 2016Implementation Date: February 1, 2016








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This MLN Matters® Article is intended for providers and suppliers submitting claims to Medicare Administrative Contractors (MACs), including Durable Medical Equipment MACs for DMEPOS services provided to Medicare beneficiaries.


Change Request (CR) 9481 notifies suppliers that the spreadsheet containing an updated jurisdiction list of Healthcare Common Procedure Coding System (HCPCS) codes is updated annually to reflect codes that have been added or discontinued (deleted) each year. Changes in Chapter 23, Section 20.3 of the “Medicare Claims Processing Manual” are reflected in the recurring update notification. The spreadsheet for the 2016 DMEPOS Jurisdiction List is an Excel® spreadsheet and is available under the Coding Category at http://www.cms.gov/Center/Provider-Type/Durable-Medical-Equipment-DME-Center.html and is also attached to CR9481.


The official instruction, CR9481, issued to your MAC regarding this change is available at https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3432CP.pdf on the CMS website.


Kentucky & Ohio

MM9485: Clinical Laboratory Fee Schedule – Medicare Travel Allowance Fees for Collection of Specimens



Related Change Request (CR) #: CR 9485Effective Date: January 1, 2016Implementation Date: February 1, 2016


This MLN Matters® Article is intended for clinical diagnostic laboratories submitting claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.


Change Request (CR) 9485 revises the payment of travel allowances when billed on a per mileage basis using Healthcare Common Procedure Coding System (HCPCS) code P9603 and when billed on a flat-rate basis using HCPCS code P9604 for CY 2016.

Background

Medicare Part B allows payment for a specimen collection fee and travel allowance, when medically necessary, for a laboratory technician to draw a specimen from either a nursing home patient or homebound patient under Section 1833(h)(3) of the Social Security Act. Payment for these services is made based on the clinical laboratory fee schedule.


http://www.cms.gov/Center/Provider-Type/Durable-Medical-Equipment-DME-Center.html

http://www.cms.gov/Center/Provider-Type/Durable-Medical-Equipment-DME-Center.html







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The travel codes allow for payment either on a per mileage basis (P9603) or on a flat-rate per trip basis (P9604). Payment of the travel allowance is made only if a specimen collection fee is also payable. The travel allowance is intended to cover the estimated travel costs of collecting a specimen, including the laboratory technician’s salary and travel expenses.

Your MAC has the discretion to choose either a mileage basis or a flat rate, and how to set each type of allowance. Many MACs established local policy to pay based on a flat-rate basis only.

Under either method, when one trip is made for multiple specimen collections (for example, at a nursing home), the travel payment component is prorated based on the number of specimens collected on that trip, for both Medicare and non-Medicare patients, either at the time the claim is submitted by the laboratory or when the flat-rate is set by the MAC.

Per Mile Travel Allowance (P9603): The minimum “per mile travel allowance” is $0.99, which is to be used in situations where the average trip to the patients’ homes is longer than 20 miles round trip, and is to be prorated in situations where specimens are drawn from non-Medicare patients in the same trip. This allowance per mile was computed using the Federal mileage rate of $0.54 per mile plus an additional $0.45 per mile to cover the technician’s time and travel costs. MACs have the option of establishing a higher per mile rate in excess of the minimum $0.99 per mile if local conditions warrant it. The minimum mileage rate will be reviewed and updated throughout the year, as well as in conjunction with the Clinical Laboratory Fee Schedule (CLFS), as needed. At no time will the laboratory be allowed to bill for more miles than are reasonable, or for miles that are not actually traveled by the laboratory technician. The Internal Revenue Service (IRS) determines the standard mileage rate for businesses based on periodic studies of the fixed and variable costs of operating and automobile.

Per Flat-rate Trip Basis Travel Allowance (P9604): The per flat-rate trip basis travel allowance is $9.90.

Note: MACs will not search their files to either retract payment for claims already paid or to retroactively pay claims. However, MACs will adjust claims brought to their attention.


The official instruction, CR9485 issued to your MAC regarding this change is available at https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3433CP.pdf on the CMS website.







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Kentucky & Ohio

MM9115 Revised: Clinical Laboratory Fee Schedule – Medicare Travel Allowance Fees for Collection of Specimens

The Centers for Medicare & Medicaid Services (CMS) has revised the following Medicare Learning Network® (MLN) Matters article. This MLN Matters article and other CMS articles can be found on the CMS website at: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/2015-MLN-Matters-Articles.html

MLN Matters® Number: MM9115 RevisedRelated CR Release Date: December 30, 2015Related CR Transmittal #: R188NCD and R3319CPRelated Change Request (CR) #: CR 9115

Effective Date: October 9, 2014Implementation Date: September 8, 2015 for non-shared MAC edits; January 4, 2016 for shared systems changes

Note: This article was revised on January 5, 2016, to reflect the revised CR9115 issued on December 30, 2015. The CR was revised to show that HCPCS code G0464 expired on December 31, 2015, and is replaced in the 2016 Clinical Laboratory Fee Schedule with CPT code 81528. The article is revised to reflect this change. Also, the CR release date, transmittal number, and the Web address for accessing the CR are changed. All other information remains the same.


This MLN Matters® Article is intended for physicians, providers, and suppliers who submit claims to Medicare Administrative Contractors (MACs) for colorectal screening tests provided to Medicare beneficiaries.


STOP – Impact to YouThis article is based on Change Request (CR) 9115 which announces effective October 9, 2014, the Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is sufficient to cover Cologuard™ - a multitarget stool DNA test – as a colorectal cancer screening test for asymptomatic, average risk beneficiaries, aged 50 to 85 years.

CAUTION – What You Need to KnowCR9115 instructs the MACs that effective for claims with dates of service on or after October 9, 2014, Medicare will recognize new Healthcare Common Procedure Coding System (HCPCS) code G0464, (Colorectal cancer screening; stool-based DNA and fecal occult hemoglobin (for example, KRAS, NDRG4 and BMP3)) as a covered service. Only laboratories authorized by the manufacturer to perform the Cologuard™ test may bill for this service.

GO – What You Need to DoMake sure that your billing staff are aware of these changes.

Background

The Social Security Act (the Act) (Sections 1861(s)(2)(R) and 1861(pp) - see http://www.ssa.gov/OP_Home/ssact/title18/1861.htm) and regulations at 42 CFR 410.37 (see http://www.gpo.gov/fdsys/pkg/CFR-2011-title42-vol2/pdf/CFR-2011-title42-vol2-sec410-37.pdf) authorize coverage for screening colorectal cancer (CRC) tests under Medicare Part B. The statute and regulations authorize the Secretary to add other tests and procedures (and modifications to such tests and procedures for colorectal cancer screening) as the Secretary determines appropriate in consultation with appropriate experts and organizations.

As part of the CMS – Food and Drug Administration (FDA) Parallel Review Pilot Program, CMS finalized a NCD for Screening for CRC Using Cologuard™ - A Multitarget Stool DNA Test.






http://www.gpo.gov/fdsys/pkg/CFR-2011-title42-vol2/pdf/CFR-2011-title42-vol2-sec410-37.pdf

http://www.gpo.gov/fdsys/pkg/CFR-2011-title42-vol2/pdf/CFR-2011-title42-vol2-sec410-37.pdf

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After considering public comments and consulting with appropriate organizations, effective October 9, 2014, CMS has determined that the evidence is sufficient to cover Cologuard™ - a multitarget stool DNA test – as a colorectal cancer screening test for asymptomatic, average risk beneficiaries, who are ages 50 to 85 years.

Effective for claims with dates of service on or after October 9, 2014, MACs will recognize the new HCPCS code G0464 as a covered service. Be aware that claims for HCPCS code G0464 must also include ICD-9 diagnosis codes V76.41 and V76.51. Once ICD-10 is implemented, the claim must reflect ICD-10 diagnosis codes Z12.12 and Z12.11.

MACs will only pay for HCPCS code G0464 when it is submitted on Types of Bill (TOB) 13X hospital outpatient departments), 14X (hospital non-patient laboratories), or 85X (critical access hospitals. Payments will be made on TOB 13X and 14X based on the clinical laboratory fee schedule (CLFS). Payment for TOB 85X will be based on reasonable cost.

Note: HCPCS code G0464 is in the January 1, 2015 CLFS and Integrated Outpatient Code Editor (IOCE) updates with an effective date of October 9, 2014. Therefore, MACs shall apply contractor pricing to claims containing HCPCS G0464 with dates of service October 9, 2014, through December 31, 2014. However, in the 2016 CLFS, G0464 expires effective December 31, 2015, and effective January 1, 2016, CPT code 81528 replaces G0464.

You can refer to the revised Pub. 100-03, Medicare NCD Manual, Chapter 1, Section 210.3, Colorectal Cancer Screening Tests, for coverage policy. For claims processing instructions, refer to revised Pub. 100-04, Medicare Claims Processing Manual, Chapter 18, Section 60, Colorectal Cancer Screening. Both of these revised manuals are included as attachments to CR9115.

Effective for dates of service on or after October 9, 2014, Medicare Part B will cover the CologuardTM test once every 3 years for Medicare beneficiaries that meet all of the following criteria:

yy Age 50 to 85 years;

yy Asymptomatic (no signs or symptoms of colorectal disease including but not limited to lower gastrointestinal pain, blood in stool, positive guaiac fecal occult blood test or fecal immunochemical test); and

yy At average risk of developing colorectal cancer (no personal history of adenomatous polyps, colorectal cancer, or inflammatory bowel disease, including Crohn’s Disease and ulcerative colitis; no family history of colorectal cancers or adenomatous polyps, familial adenomatous polyposis, or hereditary nonpolyposis colorectal cancer).

There is no coinsurance or deductible for tests paid under the CLFS. Therefore, there is no coinsurance or deductible for HCPCS code G0464.

Medicare will pay for this service for eligible beneficiaries only once every 3 years. Next eligible dates will be displayed on all Common Working File (CWF) provider query screens. Subsequent claim lines for HCPCS code G0464 received in the same 3-year period will be denied using the following:

yy Claim Adjustment Reason Code (CARC) 119 - “Benefit maximum for this time period has been reached;”

yy Remittance Advice Remarks Code (RARC) N386 - “This decision was based on a National Coverage Determination (NCD). An NCD provides a coverage determination as to whether a particular item or service is covered. A copy of this policy is available at http://www.cms.gov/mcd/search.asp. If you do not have Web access, you may contact the contractor to request a copy of the NCD;” and

yy Group Code CO assigning financial liability to the provider, if a claim is received with a GZ modifier indicating no signed Advance Beneficiary Notice (ABN) is on file.


http://www.cms.gov/mcd/search.asp


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To be eligible for this service, beneficiaries must be aged 50-85 or the claim line item will be denied with the following messages:

yy CARC 6 - “The procedure/revenue code is inconsistent with the patient’s age. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.”

yy RARC N129 - “Not eligible due to the patient’s age.”

yy Group Code CO assigning financial liability to the provider, if a claim is received with a GZ modifier indicating no signed ABN is on file.

Failure to include the required ICD-9 or ICD-10 codes on the claim line will result in denial of the claim line with the following messages:

yy CARC 167 – “This (these) diagnosis(es) is (are) not covered. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.”

yy RARC N386 - “This decision was based on a National Coverage Determination (NCD). An NCD provides a coverage determination as to whether a particular item or service is covered. A copy of this policy is available at http://www.cms.gov/mcd/search.asp on the CMS website. If you do not have Web access, you may contact the contractor to request a copy of the NCD.”


Claim line items submitted on TOBs other than 13X, 14X, or 85X will be denied with the following messages:

yy CARC 170: “Payment is denied when performed/billed by this type of provider. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.”

yy RARC N95 – “This provider type/provider specialty may not bill this service.”


All other indications for colorectal cancer screening not otherwise specified in the Act and regulations, or otherwise specified in Section 210.3 of the NCD Manual, remain nationally non-covered.


The official instruction, CR9115, was issued to your MAC regarding this change via two transmittals. The first updates the “Medicare National Coverage Determinations Manual” and it is available at http://www.cms.hhs.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R188NCD.pdf on the CMS website. The second transmittal updates the “Medicare Claims Processing Manual” and it is available at http://www.cms.hhs.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3319CP.pdf on the CMS website.

If you have any questions, please contact your MAC at their toll-free number. That number is available at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/index.html under “How Does It Work.”



http://www.cms.hhs.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R188NCD.pdf

http://www.cms.hhs.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R188NCD.pdf





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Kentucky & Ohio

MM9495: Clinical Laboratory Fee Schedule – Medicare Travel Allowance Fees for Collection of Specimens


MLN Matters® Number: MM9495Related CR Release Date: January 8, 2016Related CR Transmittal #: R3438CP

Related Change Request (CR) #: CR 9495 Effective Date: January 1, 2016Implementation Date: January 4, 2016


This MLN Matters® Article is intended for physicians, providers, and suppliers submitting claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.

What You Need to Know

Change Request (CR) 9495 amends payment files that were issued to contractors based on the CY 2016 Medicare Physician Fee Schedule (MPFS) Final Rule. The Centers for Medicare & Medicaid Services (CMS) amended these payment files in order to correct technical errors to the MPFS update files, and to include corrections described in the CY 2016 MPFS Final Rule Correction Notice. Your MAC will disclose the revised MPFS fees on their website as soon as possible, if they have not done so already.

Background

Some Relative Value Units published in the CY 2016 MPFS Final Rule have been revised to align their values with the CY 2016 MPFS Final Rule policies. These changes are discussed in the CY 2016 MPFS Final Rule Correction Notice. In addition, there were corrections made to invalid or missing payment indicators for several procedure codes. The amended 2016 MPFS payment files reflect all these changes for services furnished on or after January 1, 2016.


The official instruction, CR9495 issued to your MAC regarding this change is available at http://www.cms.hhs.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3438CP.pdf on the CMS website.


Kentucky & Ohio

2016 Healthcare Common Procedure Coding System (HCPCS) Update

The annual update of CPT/HCPCS codes will be effective for services rendered on and after January 1, 2016. Services provided on or after January 1, 2016, should be filed using the 2016 codes. Services rendered in 2015 should be filed using 2015 codes.








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HCPCS is a five-digit coding system using numbers and letters. There are two divisions of codes assigned and maintained by different organizations:

Level 1: The first division is the CPT codes established by the American Medical Association. These codes range from 00100-99999 and represent physician services such as examinations, radiology, pathology, and surgery.

Level 2: The second division of codes are assigned and maintained by CMS. These codes are a combination of one letter and four numbers that range from A0000-V9999. These codes are common to all carriers.

CPTS/HCPCS Codes/Modifiers DateG0299 01/01/2016G0300 01/01/2016G0475 04/13/2015G0476 07/09/2015G0477 01/01/2016G0478 01/01/2016G0479 01/01/2016G0480 01/01/2016G0481 01/01/2016G0482 01/01/2016G0483 01/01/2016G9473 01/01/2016G9474 01/01/2016G9475 01/01/2016G9476 01/01/2016G9477 01/01/2016G9478 01/01/2016G9479 01/01/2016G9480 01/01/2016G9496 01/01/2016G9497 01/01/2016G9498 01/01/2016G9499 01/01/2016G9500 01/01/2016G9501 01/01/2016G9502 01/01/2016G9503 01/01/2016G9504 01/01/2016G9505 01/01/2016G9506 01/01/2016G9507 01/01/2016G9508 01/01/2016G9509 01/01/2016G9510 01/01/2016G9511 01/01/2016G9512 01/01/2016G9513 01/01/2016G9514 01/01/2016G9515 01/01/2016

CPTS/HCPCS Codes/Modifiers DateG9516 01/01/2016G9517 01/01/2016G9518 01/01/2016G9519 01/01/2016G9520 01/01/2016G9521 01/01/2016G9522 01/01/2016G9523 01/01/2016G9524 01/01/2016G9525 01/01/2016G9526 01/01/2016G9529 01/01/2016G9530 01/01/2016G9531 01/01/2016G9532 01/01/2016G9533 01/01/2016G9534 01/01/2016G9535 01/01/2016G9536 01/01/2016G9537 01/01/2016G9538 01/01/2016G9539 01/01/2016G9540 01/01/2016G9541 01/01/2016G9542 01/01/2016G9543 01/01/2016G9544 01/01/2016G9547 01/01/2016G9548 01/01/2016G9549 01/01/2016G9550 01/01/2016G9551 01/01/2016G9552 01/01/2016G9553 01/01/2016G9554 01/01/2016G9555 01/01/2016G9556 01/01/2016G9557 01/01/2016G9558 01/01/2016

Medicare Part B 2016 HCPCS/CPT Code Adds

CPTS/HCPCS Codes/Modifiers DateCP 01/01/2016CT 01/01/2016EX 04/01/2015ZA 01/01/2016A4337 01/01/2016C1822 01/01/2016C2613 01/01/2016C2623 01/01/2016C2645 01/01/2016C9458 01/01/2016C9459 01/01/2016C9460 01/01/2016C9743 01/01/2016D0251 01/01/2016D0422 01/01/2016D0423 01/01/2016D1354 01/01/2016D4283 01/01/2016D4285 01/01/2016D5221 01/01/2016D5222 01/01/2016D5223 01/01/2016D5224 01/01/2016D7881 01/01/2016D8681 01/01/2016D9223 01/01/2016D9243 01/01/2016D9932 01/01/2016D9933 01/01/2016D9934 01/01/2016D9935 01/01/2016D9943 01/01/2016E0465 01/01/2016E0466 01/01/2016E1012 01/01/2016G0296 02/05/2015G0297 02/05/2015


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CPTS/HCPCS Codes/Modifiers DateG9559 01/01/2016G9560 01/01/2016G9561 01/01/2016G9562 01/01/2016G9563 01/01/2016G9572 01/01/2016G9573 01/01/2016G9574 01/01/2016G9577 01/01/2016G9578 01/01/2016G9579 01/01/2016G9580 01/01/2016G9581 01/01/2016G9582 01/01/2016G9583 01/01/2016G9584 01/01/2016G9585 01/01/2016G9593 01/01/2016G9594 01/01/2016G9595 01/01/2016G9596 01/01/2016G9597 01/01/2016G9598 01/01/2016G9599 01/01/2016G9600 01/01/2016G9601 01/01/2016G9602 01/01/2016G9603 01/01/2016G9604 01/01/2016G9605 01/01/2016G9606 01/01/2016G9607 01/01/2016G9608 01/01/2016G9609 01/01/2016G9610 01/01/2016G9611 01/01/2016G9612 01/01/2016G9613 01/01/2016G9614 01/01/2016G9615 01/01/2016G9616 01/01/2016G9617 01/01/2016G9618 01/01/2016G9619 01/01/2016G9620 01/01/2016G9621 01/01/2016G9622 01/01/2016G9623 01/01/2016

CPTS/HCPCS Codes/Modifiers DateG9624 01/01/2016G9625 01/01/2016G9626 01/01/2016G9627 01/01/2016G9628 01/01/2016G9629 01/01/2016G9630 01/01/2016G9631 01/01/2016G9632 01/01/2016G9633 01/01/2016G9634 01/01/2016G9635 01/01/2016G9636 01/01/2016G9637 01/01/2016G9638 01/01/2016G9639 01/01/2016G9640 01/01/2016G9641 01/01/2016G9642 01/01/2016G9643 01/01/2016G9644 01/01/2016G9645 01/01/2016G9646 01/01/2016G9647 01/01/2016G9648 01/01/2016G9649 01/01/2016G9650 01/01/2016G9651 01/01/2016G9652 01/01/2016G9653 01/01/2016G9654 01/01/2016G9655 01/01/2016G9656 01/01/2016G9657 01/01/2016G9658 01/01/2016G9659 01/01/2016G9660 01/01/2016G9661 01/01/2016G9662 01/01/2016G9663 01/01/2016G9664 01/01/2016G9665 01/01/2016G9666 01/01/2016G9667 01/01/2016G9669 01/01/2016G9670 01/01/2016G9671 01/01/2016G9672 01/01/2016

CPTS/HCPCS Codes/Modifiers DateG9673 01/01/2016G9674 01/01/2016G9675 01/01/2016G9676 01/01/2016G9677 01/01/2016J0202 01/01/2016J0596 01/01/2016J0695 01/01/2016J0714 01/01/2016J0875 01/01/2016J1443 01/01/2016J1447 01/01/2016J1575 01/01/2016J1833 01/01/2016J2407 01/01/2016J2502 01/01/2016J2547 01/01/2016J2860 01/01/2016J3090 01/01/2016J3380 01/01/2016J7121 01/01/2016J7188 01/01/2016J7205 01/01/2016J7297 01/01/2016J7298 01/01/2016J7313 01/01/2016J7328 01/01/2016J7340 01/01/2016J7503 01/01/2016J7512 01/01/2016J7999 01/01/2016J8655 01/01/2016J9032 01/01/2016J9039 01/01/2016J9271 01/01/2016J9299 01/01/2016J9308 01/01/2016L8607 01/01/2016P9070 01/01/2016P9071 01/01/2016P9072 01/01/2016Q4161 01/01/2016Q4162 01/01/2016Q4163 01/01/2016Q4164 01/01/2016Q4165 01/01/2016Q5101 07/01/2015Q9950 01/01/2016


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CPTS/HCPCS Codes/Modifiers DateQ9980 01/01/20160009M 07/01/20150010M 07/01/201510035 01/01/201610036 01/01/201631652 01/01/201631653 01/01/201631654 01/01/201633477 01/01/201637252 01/01/201637253 01/01/201639401 01/01/201639402 01/01/201643210 01/01/201647531 01/01/201647532 01/01/201647533 01/01/201647534 01/01/201647535 01/01/201647536 01/01/201647537 01/01/201647538 01/01/201647539 01/01/201647540 01/01/201647541 01/01/201647542 01/01/201647543 01/01/201647544 01/01/201649185 01/01/201650430 01/01/201650431 01/01/201650432 01/01/201650433 01/01/201650434 01/01/201650435 01/01/201650606 01/01/201650693 01/01/201650694 01/01/201650695 01/01/201650705 01/01/201650706 01/01/201654437 01/01/201654438 01/01/201661645 01/01/201661650 01/01/201661651 01/01/201664461 01/01/201664462 01/01/2016

CPTS/HCPCS Codes/Modifiers Date64463 01/01/201665785 01/01/201669209 01/01/201672081 01/01/201672082 01/01/201672083 01/01/201672084 01/01/201673501 01/01/201673502 01/01/201673503 01/01/201673521 01/01/201673522 01/01/201673523 01/01/201673551 01/01/201673552 01/01/201674712 01/01/201674713 01/01/201677767 01/01/201677768 01/01/201677770 01/01/201677771 01/01/201677772 01/01/201678265 01/01/201678266 01/01/201680081 01/01/201681162 01/01/201681170 01/01/201681218 01/01/201681219 01/01/201681272 01/01/201681273 01/01/201681276 01/01/201681311 01/01/201681314 01/01/201681412 01/01/201681432 01/01/201681433 01/01/201681434 01/01/201681437 01/01/201681438 01/01/201681442 01/01/201681490 01/01/201681493 01/01/201681525 01/01/201681528 01/01/201681535 01/01/201681536 01/01/201681538 01/01/2016

CPTS/HCPCS Codes/Modifiers Date81540 01/01/201681545 01/01/201681595 01/01/201688350 01/01/201690625 01/01/201692537 01/01/201692538 01/01/201693050 01/01/201696931 01/01/201696932 01/01/201696933 01/01/201696934 01/01/201696935 01/01/201696936 01/01/201699177 01/01/201699415 01/01/201699416 01/01/20160392T 07/01/20150393T 07/01/20150394T 01/01/20160395T 01/01/20160396T 01/01/20160397T 01/01/20160398T 01/01/20160399T 01/01/20160400T 01/01/20160401T 01/01/20160402T 01/01/20160403T 01/01/20160404T 01/01/20160405T 01/01/20160406T 01/01/20160407T 01/01/20160408T 01/01/20160409T 01/01/20160410T 01/01/20160411T 01/01/20160412T 01/01/20160413T 01/01/20160414T 01/01/20160415T 01/01/20160416T 01/01/20160417T 01/01/20160418T 01/01/20160419T 01/01/20160420T 01/01/20160421T 01/01/20160422T 01/01/2016


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CPTS/HCPCS Codes/Modifiers Date0423T 01/01/20160424T 01/01/20160425T 01/01/20160426T 01/01/20160427T 01/01/20160428T 01/01/20160429T 01/01/20160430T 01/01/20160431T 01/01/20160432T 01/01/20160433T 01/01/20160434T 01/01/20160435T 01/01/20160436T 01/01/2016JF 12/31/2015A7011 12/31/2015© All Current Procedural Terminology (CPT) codes and descriptors are copyrighted 2015 by the American Medical Association.

Medicare Part B 2016 HCPCS/CPT Discontinued Codes

C9025 12/31/2015C9026 12/31/2015C9027 12/31/2015C9136 12/31/2015C9442 12/31/2015C9443 12/31/2015C9444 12/31/2015C9445 12/31/2015C9446 12/31/2015C9448 12/31/2015C9449 12/31/2015C9450 12/31/2015C9451 12/31/2015C9452 12/31/2015C9453 12/31/2015C9454 12/31/2015C9455 12/31/2015C9456 12/31/2015C9457 12/31/2015C9724 12/31/2015C9737 12/31/2015D0260 12/31/2015D0421 12/31/2015D2970 12/31/2015

D9220 12/31/2015D9221 12/31/2015D9241 12/31/2015D9242 12/31/2015D9931 12/31/2015E0450 12/31/2015E0460 12/31/2015E0461 12/31/2015E0463 12/31/2015E0464 12/31/2015G0154 12/31/2015G0431 12/31/2015G0434 12/31/2015G6018 12/31/2015G6019 12/31/2015G6020 12/31/2015G6021 12/31/2015G6022 12/31/2015G6023 12/31/2015G6024 12/31/2015G6025 12/31/2015G6027 12/31/2015G6028 12/31/2015G6030 12/31/2015G6031 12/31/2015G6032 12/31/2015G6034 12/31/2015G6035 12/31/2015G6036 12/31/2015G6037 12/31/2015G6038 12/31/2015G6039 12/31/2015G6040 12/31/2015G6041 12/31/2015G6042 12/31/2015G6043 12/31/2015G6044 12/31/2015G6045 12/31/2015G6046 12/31/2015G6047 12/31/2015G6048 12/31/2015G6049 12/31/2015G6050 12/31/2015G6051 12/31/2015G6052 12/31/2015G6053 12/31/2015G6054 12/31/2015G6055 12/31/2015G6056 12/31/2015G6057 12/31/2015

G6058 12/31/2015G8530 12/31/2015G8531 12/31/2015G8532 12/31/2015G8713 12/31/2015G8714 12/31/2015G8717 12/31/2015G8718 12/31/2015G8720 12/31/2015G8870 12/31/2015G8871 12/31/2015G8951 12/31/2015G9320 12/31/2015G9323 12/31/2015G9325 12/31/2015G9328 12/31/2015G9343 12/31/2015G9346 12/31/2015G9362 12/31/2015G9363 12/31/2015G9369 12/31/2015G9370 12/31/2015G9376 12/31/2015G9377 12/31/2015G9378 12/31/2015G9379 12/31/2015G9391 12/31/2015G9392 12/31/2015G9433 12/31/2015J0886 12/31/2015J1446 12/31/2015J7302 12/31/2015J7506 12/31/2015J9010 12/31/2015Q9975 12/31/2015Q9976 12/31/2015Q9977 12/31/2015Q9978 12/31/2015Q9979 12/31/2015S0195 12/31/2015S2360 12/31/2015S2361 12/31/2015S3721 12/31/2015S3854 12/31/2015S3890 12/31/2015S5011 12/31/2015S8262 12/31/2015S9015 12/31/201521805 12/31/201531620 12/31/2015


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37202 12/31/201537250 12/31/201537251 12/31/201539400 12/31/201547136 12/31/201547500 12/31/201547505 12/31/201547510 12/31/201547511 12/31/201547525 12/31/201547530 12/31/201547560 12/31/201547561 12/31/201547630 12/31/201550392 12/31/201550393 12/31/201550394 12/31/201550398 12/31/201564412 12/31/201567112 12/31/201570373 12/31/201572010 12/31/201572069 12/31/201572090 12/31/201573500 12/31/201573510 12/31/201573520 12/31/201573530 12/31/201573540 12/31/201573550 12/31/201574305 12/31/201574320 12/31/201574327 12/31/201574475 12/31/201574480 12/31/201575896 12/31/201575945 12/31/201575946 12/31/201575980 12/31/201575982 12/31/201577776 12/31/201577777 12/31/201577785 12/31/201577786 12/31/201577787 12/31/201582486 12/31/201582487 12/31/201582488 12/31/201582489 12/31/201582491 12/31/2015

82492 12/31/201582541 12/31/201582543 12/31/201582544 12/31/201583788 12/31/201588347 12/31/201590645 12/31/201590646 12/31/201590669 12/31/201590692 12/31/201590693 12/31/201590703 12/31/201590704 12/31/201590705 12/31/201590706 12/31/201590708 12/31/201590712 12/31/201590719 12/31/201590720 12/31/201590721 12/31/201590725 12/31/201590727 12/31/201590735 12/31/201592543 12/31/201595973 12/31/20150099T 12/31/20150103T 12/31/20150123T 12/31/20150182T 12/31/20150223T 12/31/20150224T 12/31/20150225T 12/31/20150233T 12/31/20150240T 12/31/20150241T 12/31/20150243T 12/31/20150244T 12/31/20150262T 12/31/20150311T 12/31/2015© All Current Procedural Terminology (CPT) codes and descriptors are copyrighted 2015 by the American Medical Association.

Medicare Part B 2015 HCPCS/CPT Description Changes

B5000 01/01/2016B5100 01/01/2016

B5200 01/01/2016C1820 01/01/2016C9349 01/01/2016D0250 01/01/2016D0340 01/01/2016D4273 01/01/2016D4275 01/01/2016D4277 01/01/2016D4278 01/01/2016D5630 01/01/2016D5660 01/01/2016D5993 01/01/2016D6103 01/01/2016D6600 01/01/2016D6601 01/01/2016D6602 01/01/2016D6603 01/01/2016D6604 01/01/2016D6605 01/01/2016D6606 01/01/2016D6607 01/01/2016D6608 01/01/2016D6609 01/01/2016D6610 01/01/2016D6611 01/01/2016D6612 01/01/2016D6613 01/01/2016D6614 01/01/2016D6615 01/01/2016D6624 01/01/2016D6634 01/01/2016D6710 01/01/2016D6720 01/01/2016D6721 01/01/2016D6722 01/01/2016D6740 01/01/2016D6750 01/01/2016D6751 01/01/2016D6752 01/01/2016D6780 01/01/2016D6781 01/01/2016D6782 01/01/2016D6783 01/01/2016D6790 01/01/2016D6791 01/01/2016D6792 01/01/2016D6794 01/01/2016D9248 01/01/2016G8399 01/01/2016G8400 01/01/2016


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G8401 01/01/2016G8458 01/01/2016G8465 01/01/2016G8784 01/01/2016G8924 01/01/2016G8925 01/01/2016G8928 01/01/2016G8929 01/01/2016G8955 01/01/2016G9196 01/01/2016G9226 01/01/2016G9277 01/01/2016G9286 01/01/2016G9287 01/01/2016G9298 01/01/2016G9354 01/01/2016G9384 01/01/2016G9385 01/01/2016G9389 01/01/2016G9390 01/01/2016G9419 01/01/2016G9429 01/01/2016G9460 01/01/2016G9467 01/01/2016J0571 01/01/2016J0572 01/01/2016J0573 01/01/2016J0574 01/01/2016J0575 01/01/2016J1442 01/01/2016J7508 01/01/2016K0017 01/01/2016K0018 01/01/2016L1902 01/01/2016L1904 01/01/2016L8621 01/01/2016Q4153 01/01/201649407 01/01/201658542 01/01/201658958 01/01/201659510 01/01/201659620 01/01/201678351 01/01/201682105 01/01/201686687 01/01/201686688 01/01/201686689 01/01/201688381 01/01/201689055 01/01/201689342 01/01/2016

94060 01/01/201695076 01/01/201699235 01/01/201699500 01/01/20160295T 01/01/2016© All Current Procedural Terminology (CPT) codes and descriptors are copyrighted 2015 by the American Medical Association.


Documents

Medicare Bulletin - March 2016 · MEDICARE BULLETIN GR 2016-03 MARCH 2016 2 Articles contained in this edition are current as of January 29, 2016. KENTUCKY & OHIO Administration The