Posts Tagged ‘cancer’

Health care providers in Colorado, New Mexico, Oklahoma and Texas submitting claims to TrailBlazer Health Enterprises should be aware of revisions the jurisdiction 4 (J4) Part A and Part B Medicare Administrative Contractor (A/B MAC) made, Oct. 5, to two local coverage determinations (LCD).

The revisions were made in response to a recent addition to the list of HCPCS Level II codes payable by Medicare, as noted in the October 2009 quarterly update released Aug. 28 by the Centers for Medicare & Medicaid Services (CMS). Read more »

Recent changes to Pub. 100-03 of the Medicare National Coverage Determinations (NCD) Manual may soon affect the way your practice bills for f-18 flouro-D-glucose positron emission tomography (FDG PET) imaging services. Read more »

Despite the American Cancer Society, the U.S. Multi Society Task Force on Colorectal Cancer, and the American College of Radiology’s 2008 recommendation, the Centers for Medicare & Medicaid Services (CMS) is upholding a National Coverage Determination (NCD). Computed tomography colonography (CTC) as a colorectal cancer screening option for average risk individuals age 50 and older remains a noncovered Medicare benefit.

CTC, also referred to as virtual colonoscopy, uses computed tomography (CT) to acquire advanced 2-D or 3-D images for interpretation. For 2009, CTC screening is reported with Category III code 066T Computed tomographic (CT) colonography (ie, virtual colonoscopy); screening. There is a CPT® 2009 parenthetical note instructing coders and billers not to report 066T with computed tomographic codes 72192-72194, 74150-74170.

Colorectal cancer screening procedures for average risk individuals age 50 and older covered under Medicare Part B include:

1. Annual fecal occult blood tests (FOBTs)
2. Flexible sigmoidoscopy every four years
3. Screening colonoscopy every 10 years
4. Barium enema every four years as an alternative to flexible sigmoidoscopy or every two years as an alternative to colonoscopy for patients at high risk

CMS relayed this information on Aug. 7 in Transmittal 105, Change Request 6578. For additional information, please refer to the Colorectal Cancer Screening Tests NCD (210.3).

The Centers for Medicare & Medicaid Services (CMS) is revising Section 220.6 of the National Coverage Determinaton (NCD) Manual to reflect a new coverage framework for the use of F-18 flouro-D-glucose positron emission tomography (FDG PET) in determining initial and subsequent onocologic treatment strategies, as outlined in the NCD (CAG-00181R).

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Noridian Administrative Services has clarified its coverage policy for chemotherapeutic drugs that may cause chemotherapy-induced anemia.

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A rash of Office of Inspector General (OIG) reports has uncovered millions of dollars in Medicare overpayments to various acute care hospitals between the years 2004-2005. A failure to update systems with new Medicare guidance caused hospitals to incorrectly bill oxaliplatin service units, the OIG finds.

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The American Urological Association (AUA) updated, April 27, its prostate cancer screening guideline for men. Well-informed men aged 40 and older who have a life expectancy of at least 10 years should be offered the prostate specific antigen (PSA) test to establish a baseline reading; for men 50 and older, PSA testing should be individualized rather than a blanket annual test, the AUA recommends.

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The National Comprehensive Cancer Network (NCCN) has updated the NCCN Clinical Practice Guidelines in Oncology™ for Kidney Cancer to reflect March 30 Food and Drug Administration (FDA) approval of everolimas (Afinitor®, Novartis) for advanced renal cell carcinoma.

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A North Carolina fiscal intermediary incorrectly paid 89 of 91 Medicare claims for oxaliplatin services reviewed in an Office of Inspector General (OIG) audit. Prior to the April 23 report, implicated hospitals had already identified and refunded $1,762,070 in overpayments to Palmetto GBA. The OIG has requested Palmetto GBA recapture the remaining overpayments totaling $160,096.

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A National Coverage Determination (NCD) issued April 3 by the Centers for Medicare & Medicaid Services (CMS) expands coverage of positron emission tomography (PET) scans for the diagnosis and treatment of most solid tumor cancers in Medicare patients and removes the clinical study requirement in some cases.

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