Several new codes with retroactive effective dates highlight the April update to the 2012 Medicare Physician Fee Schedule Database (MPFSDB). The quarterly adjustment, mandated by the Centers for Medicare & Medicaid Services (CMS), means that you may want to re-examine claims using some of the retroactively effective codes and contact your Medicare administrative contractor (MAC) for any possible payment adjustments.
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April 12th, 2012
A new list of “other” HCPCS Level II codes and modifiers to be added or removed for the second quarter of 2012 is now posted on the Centers for Medicare & Medicaid Services (CMS) website.
CMS is deleting two modifiers added just two years ago, adding five temporary (non-Medicare) “S” codes that describe a mixed bag of services, and deleting 20 “S” codes that describe mainly genetic testing.
Modifiers to remove as of March 31:
V8 Infection present
V9 No infection present
Codes to add as of April 1:
| S0353 |
Treatment planning and care coordination management for cancer initial treatment |
| S0354 |
Treatment planning and care coordination management for cancer established patient with a change of regimen |
| S0596 |
Phakic intraocular lens for correction of refractive error |
| S3721 |
Prostate cancer antigen 3 (pca3) testing |
| S8930 |
Electrical stimulation of auricular acupuncture points; each 15 minutes of personal one-on-one contact with the patient |
Codes to remove as of March 31:
| S3711 |
Circulating tumor cell test |
| S3713 |
Kras mutation analysis testing |
| S3818 |
Complete gene sequence analysis; brca1 gene |
| S3819 |
Complete gene sequence analysis; brca2 gene |
| S3820 |
Complete BRCA1 and BRCA2 gene sequence analysis for susceptibility to breast and ovarian cancer |
| S3822 |
Single mutation analysis (in individual with a known brca1 or BRCA2 mutation in the family) for susceptibility to breast and ovarian cancer |
| S3823 |
Three-mutation brca1 and BRCA2 analysis for susceptibility to breast and ovarian cancer in ashkenazi individuals |
| S3828 |
Complete gene sequence analysis; MLH1 gene |
| S3829 |
Complete gene sequence analysis; MLH2 gene |
| S3830 |
Complete mlh1 and MSH2 gene sequence analysis for hereditary nonpolyposis colorectal cancer (HNPCC) genetic testing |
| S3831 |
Single-mutation analysis (in individual with a known mlh1 and msh2 mutation in the family) for hereditary nonpolyposis colorectal cancer (HNPCC) genetic testing |
| S3835 |
Complete gene sequence analysis for cystic fibrosis genetic testing |
| S3837 |
Complete gene sequence analysis for hemochromatosis genetic testing |
| S3843 |
DNA analysis of the f5 gene for susceptibility to factor v leiden thrombophilia |
| S3847 |
Genetic testing for Tay-Sachs disease |
| S3848 |
Genetic testing for Gaucher disease |
| S3851 |
Genetic testing for Canavan disease |
| S3860 |
Genetic testing, comprehensive cardiac ion channel analysis, for variants in 5 major cardiac ion channel genes for individuals with high index of suspicion for familial long qt syndrome (LQTS) or related syndromes |
January 27th, 2012