Posts Tagged ‘HCPCS’

The annual update to the clotting factor furnishing fee is $0.170 per I.U. and is effective from Jan. 1, 2010 to Dec. 31, 2010. This fee is included in the published payment limit for HCPCS Level II clotting factor billing codes (J7189-J7195) and added to the payment for a clotting factor when no payment limit is published either on the Average Sales Price (ASP) Medicare Part B Drug Pricing File or the Not Otherwise Classified (NOC) Pricing File.

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The 2010 payment limits for splints and casts will be based on 2009 payment limits. Due to a -1.41 percent change in the consumer price index for all urban consumers (CPI-U) for the 12-month period ending June 2009, the inflation indexed charge (IIC) update factor for 2010 is 0 percent. Read more »

In 2007, Medicare reimbursement for power wheelchairs far exceeded durable medical equipment (DME) supplier acquisition costs, according to an Office of Inspector General (OIG) report.

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In the last EdgeBlast issue, we reported that HCPCS Level II codes for the H1N1 vaccine and Bevacizumab injection were recently added to the Medicare Physician Fee Schedule Database (MPFSDB), but you should also note other important changes this year’s October update holds in store. Read more »

Two new Level II HCPCS codes were added to the 2009 Medicare Physician Fee Schedule Database (MPFSDB) in the October update. Effective Sept. 1, report code G9142 Influenza A (H1N1) vaccine, any route of administration to describe the H1N1 vaccine itself, and G9141 Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family to describe the administration of the H1N1 vaccine.

Providers should report one unit of G9141 for each administration of the H1N1 vaccine. Read more »

Effective for claims with dates of service on and after March 3, 2009, Medicare will allow for coverage of certain sleep testing devices. The Centers for Medicare & Medicaid Services (CMS) posted, July 21, a National Coverage Determination (NCD) for sleep testing of obstructive sleep apnea (OSA) (240.4.1).

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Medicare Administrative Contractor (MAC) First Coast Service Options (FCSO) has posted on its Web site local coverage determination (LCD) revisions, most of which are effective for claims processed on or after July 6, for services rendered on or after July 1. Providers and staff serving Medicare patients in Florida, Puerto Rico, and the U.S. Virgin Islands (jurisdiction 9) should familiarize themselves with these changes.

Skin Substitute LCD (L28985 and L29279)

Codes added to the noncovered products section of this LCD include HCPCS Level II codes C9363, J3590, and Q4115.

C9363 - Skin substitute, Integra Meshed Bilayer Wound Matrix, per square centimeter (ASC only)
J3590 – Skin substitute, Integra Meshed Bilayer Wound Matrix, per square centimeter (Provider only)
Q4115 - Skin substitute, alloskin, per square centimeter

FCSO has also revised its list of noncovered Medicare services (LCD L29288 and L29398) to incude the following newly-added CPT® codes:

Local Noncoverage Decisions – Devices

CPT® code 0199T Physiologic recording of tremor using accelerometer(s) and gyroscope(s), (including frequency and amplitude) including interpretation and report

Local Noncoverage Decisions – Drugs and Biologicals

CPT® code 90670 Pneumococcal conjugate vaccine, 13 valent, for intramuscular use

Local Noncoverage Decisions – Procedures

CPT® code 0202T Posterior vertebral joint(s) arthroplasty (e.g. facet joint[s] replacement) including facetectomy, laminectomy, foraminotomy and vertebral column fixation, with or without injection of bone cement, including fluoroscopy, single level, lumbar spine

Local Coverage Decision

The non-surgical Renessa® treatment, represented by CPT® code 0193T Transurethral, radiofrequency micro-remodeling of the female bladder neck and proximal urethra for stress urinary incontinence and ICD-9-CM code 625.6 Stress urinary incontinence, female, is indicated for the transurethral treatment of female stress urinary incontinence (SUI) due to hypermobility in women who have failed conservative treatment and who are not candidates for surgical therapy.

FCSO has removed 0193T from its list of noncovered Medicare services and will consider reimbursement of this code on a case-by-case basis only.

To ensure payment, physicians submitting claims for Renessa® should follow federally approved guidelines and stay in accordance with the indications supported by peer-reviewed literature, which limits its use to moderate to severe SUI in women.

Providers submitting claims to FCSO should no longer use CPT® code 53899 Unlisted procedure, urinary system to report Renessa® treatments with dates of service on or after July 1.

LCDs are available through the CMS Medicare Coverage Database. Coding Guidelines for an LCD (when present) may be found by selecting “LCD Attachments” in the “Jump to Section,” drop-down menu at the top of the LCD page.

The Centers for Medicare & Medicaid Services (CMS) released the July 2009 Integrated Outpatient Code Editor (I/OCE) Specifications, version 10.2. This quarter’s update hosts a number of noteworthy changes that go into effect July 1. Read more »

The July 2009 update of the hospital Outpatient Prospective Payment System (OPPS) implements a number of changes to and billing instructions for various Medicare policies. The most affected areas of note are drugs and biologicals and Part B hospital outpatient services.

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Practioners and suppliers no longer need to differentiate between diagnostic and therapeutic clinical trial services on claims processed after July 10, according to the Centers for Medicare & Medicaid Services (CMS). For proper reimbursement, however, they need to follow recently changed Medicare Claims Processing Manual instructions to the letter.

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