The Centers for Medicare & Medicaid Services (CMS) has rendered outpatient intravenous insulin therapy (OIVIT) nationally non-covered by Medicare, effective Dec. 23, 2009.
CMS says it will create a new HCPCS Level II code for use of this non-covered service that will be effective Dec. 23, 2009 and implemented with the April 2010 Integrated Outpatient Code Editor (IOCE) and Medicare Physician Fee Schedule Database (MPFSDB).
August of last year, the Centers for Medicare & Medicaid Services (CMS) rendered a final National Coverage Determination (NCD) for warfarin responsiveness via pharmacogenomic testing. The news was not good. In short, CMS said there was insufficient evidence to support such testing improves health outcomes. The agency also said, however, that there was evidence to support pharmacogenomic testing for warfarin responsiveness under coverage with evidence development (CED). Medicare participating practitioners can, in fact, claim reimbursement for such services—providing they play by the rules.
The Centers for Medicare & Medicaid Services (CMS) is now encouraging physicians to provide annual voluntary human immunodeficiency virus (HIV) screening to at-risk individuals—including pregnant women—covered under Medicare Part A and Part B. Read more »
Monday, November 16th, 2009
The Centers for Medicare & Medicaid Services (CMS) has made a few important changes to the National Coverage Determination (NCD) edit software for clinical diagnostic laboratory services worth noting. In particular, a change to the effective date of coverage for three NCD ICD-9-CM diagnosis code lists will allow clinics to recoup any lost payments due to erroneous denials.
The effective date for three NCDs was “inadvertently” changed from Oct. 1, 2007 to July 1, 2009 with the July 1 quarterly release. The January 2010 quarterly release of the edit module for clinical diagnostic laboratory services corrects this mistake.
The affected ICD-9 code lists are those in the following NCDs:
The effective date for the ICD-9 codes listed in these NCDs will be revised from July 1, 2009 to Oct. 1, 2007, effective Jan. 1, 2010.
The January 2010 quarterly update also relocates ICD-9 codes 453-50 – 453.52 from the Serum Iron Studies NCD to the Gamma Glutamyl Transferase NCD, effective Jan. 1, 2010.
Medicare instructs contractors in Transmittal 1847, issued Nov. 6, not to search their files to retroactively pay claims but to adjust claims brought to their attention. A provider education article is available on the CMS Web site, and includes a list of affected ICD-9 codes.
Monday, November 16th, 2009
The Centers for Medicare & Medicaid Services (CMS) has initiated a national coverage analysis (NCA) for the use of allogeneic hematopoietic stem cell transplantation (HSCT) for Medicare patients with myelodysplastic syndrome (MDS).
MDS refers to a heterogeneous group of acquired bone marrow disorders characterized by dysplastic growth of hematopoietic progenitors and a hypercellular bone marrow with peripheral cytopenia. Medicare patients age 65 and older represent 80 percent of the total population receiving an MDS diagnosis. One potential therapy for MDS is allogeneic HSCT.
This analysis is in response to an NCA request letter industry stakeholders composed and sent to CMS.
Currently, allogeneic HSCT for MDS is neither a covered or non-covered indication under the national coverage determination (NCD) for Stem Cell Transplantation (110.8.1). As it is not in either of these two categories, it may be covered at local contractor discretion. National Government Services (NGS), jurisdiction 13 Part A/Part B Medicare Administrative Contractor (A/B MAC), recently developed a local coverage determination (LCD) for stem cell transplantation that includes MDS and myelofibrosis with myeloid metaplasia.
CMS is seeking public comment on this topic and says it is particularly interested in any additional recent clinical studies and other scientific information related to the outcomes of this treatment. “If the evidence is determined to be inadequate for coverage, we are especially interested in what types of studies are needed,” CMS states in the tracking sheet.
Public comment may be submitted until Dec. 10. The proposed decision memo is due out May 10, 2010 and the NCA is expected to be completed by Aug. 8, 2010.
The Centers for Medicare & Medicaid Services (CMS) has determined that its blanket of non-coverage for blood flow measurement using magnetic resonance imaging (MRI) technology contradicts its policies and magnetic resonance angiography (MRA). CMS has eliminated that from the national coverage determination (NCD), effective Sept. 28, and is allowing payers to choose to cover the services. This will impact four codes in January’s outpatient code editor (OCE).
Monday, October 5th, 2009
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 »
Monday, October 5th, 2009
Your practice may now be able to get paid for magnetic resonance imaging (MRI) when used for blood flow measurement. The Centers for Medicare & Medicaid Services (CMS) posted, Sept. 28, a decision memo stating that “the blanket noncoverage of MRI for blood flow determination at 220.2 is no longer supported by the available evidence.”
CMS says it will remove the phrase “blood flow measurement,” from the Nationally Noncovered Indications at 220.2(C)(2) of the National Coverage Determinations (NCD) Manual.
Coverage will be considered at the local level. Check with your local Medicare contractor for updated policy provisions.
For more details, go online to the CMS What’s New Report Results page and click on CAG-00399R.
Monday, August 17th, 2009
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:
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).
Monday, August 3rd, 2009
Centers for Medicare & Medicaid Services (CMS) Transmittal 1766, Change Request 6548, issued July 10, announces the changes that will be included in the October 2009 release of Medicare’s edit module for clinical diagnostic laboratory National Coverage Determinations (NCDs). Read more »
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