The Medicare Monthly Review, MMR-2011-01, January 2011 - CGS

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LCD for Endoscopy by Capsule (L25468)R6 (effective 01/01/2011): Annual LCD review per CMS Program Integrity Manual, Chapter 13, Section13.4[C]. The references in the “CMS National Coverage Policy” section and the coding requirements inthe LCD were reviewed. Minor template changes were made to reflect current template language. Nocomment and notice periods required and none given.Article for Endoscopy by Capsule – Supplemental Instructions Article (A48399)Article published January 2011: Annual LCD review per CMS Program Integrity Manual, Chapter 13,Section 13.4[C]. The coding requirements in the SIA were reviewed. Minor template changes were madeto reflect current template language.LCD for Extracorporeal Shock Wave Therapy (ESWT) For Musculoskeletal Indications (L28470)R2 (effective 01/01/2011): Annual LCD review per CMS Program Integrity Manual, Chapter 13, Section13.4[C]. The references in the “CMS National Coverage Policy” section and the coding requirements inthe LCD were reviewed. Minor template changes were made to reflect current template language. Nocomment and notice periods required and none given.Article for Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Indications -Supplemental Instructions Article (A48009)Article published January 2011: Annual LCD review per CMS Program Integrity Manual, Chapter 13,Section 13.4[C]. The coding requirements in the SIA were reviewed. Minor template changes were madeto reflect current template language.LCD for High Sensitivity C-Reactive Protein (hsCRP) Testing (L26445)R4 (effective 01/01/2011): Annual LCD review per CMS Program Integrity Manual, Chapter 13, Section13.4[C]. Content reviewed, and LCD updated for current National Government Services and CMStemplate changes. CPT code 86141 descriptor revised with 2011 CPT annual code update. No commentand notice periods required and none given.High Sensitivity C-Reactive Protein (hsCRP) Testing –- Supplemental Instructions Article (A45939)Article published January 2011: Annual review per CMS Program Integrity Manual, Chapter 13, Section13.4[C]. Content reviewed and article updated for current NATIONAL GOVERNMENT SERVICES andCMS template changes. CPT code 86141 descriptor revised with 2011 CPT annual code update.LCD for Hyperbaric Oxygen Therapy (HBO) (L25204)R6 (effective date 01/01/2011): The Limitations section was updated with the following statement:“Training and/or certification for providers currently providing HBO will not be required until 12 months(11/1/2011) after the effective date of this LCD.” No notice given and none required.Article for Intravenous Immune Globulin (IVIG) - Related to LCD L25820 (A47381)Article published January 2011: the article has been revised to indicate that effective for dates of serviceon or after 01/01/2011, HCPCS code C9270 should be used to report injection, immune globulin(Gammaplex), intravenous, non-lyophilized (e.g. liquid), 500 mg for claims submitted to the FI or Part AMAC. Based on the annual HCPCS update HCPCS code J1599 injection, immune globulin, intravenous,non-lyophilized (e.g., liquid), not othererwise specified, 500 mg has been added effective for dates ofservice on or after 01/01/2011.Article for Local Coverage Determination (LCD) Reconsideration Process - Medical Policy Article(A47355)Article published January 2011: The fax number for reconsideration requests was changed.CPT codes and descriptors are only copyright 2010 American Medical Association (or such other date publication of CPT)The Medicare Monthly Review 14 MMR 2011-01, January 2011
Article for Magnetic Resonance Imaging – Supplemental Instructions Article (A48016)Article published January 2011: An assisted living facility (13), ambulatory surgical center (24), nursingfacility (32- for Medicare patient not in a Part A stay), custodial care facility (33), community mentalhealth center (53) and state or local public health clinics (71) were removed from the coding guidelines forthe payable places of service under Part B for the professional component (modifier 26).LCD for Nonvascular Extremity Ultrasound (L28178)R4 (effective 01/01/2011): Due to the annual HCPCS update for 2011, CPT code 76880 was removed andCPT codes 76881 and 76882 were added to the following statement in the “Limitations” section:Extremity ultrasound (CPT codes 76881 or 76882) is limited to studies of the arms and legs.CPT code 76880 was deleted 12/31/2010 and removed from the listing in the “CPT/HCPCS Codes” sectionof the LCD. An explanatory note regarding the code deletion was added to this section. CPT codes 76881and 76882 were added as the replacement codes.Minor template changes were made to reflect current template language. No comment and notice periodsrequired and none given.Article for Nonvascular Extremity Ultrasound – Supplemental Instructions Article (A48353)Article published January 2011: Due to the annual HCPCS update for 2011, CPT code 76880 was removedand CPT codes 76881 and 76882 were added to the following coding guidelines in the “Article Text”section and a paragraph in the “Other Comments” section:Use CPT code 76942 when billing for ultrasonic guidance for needle biopsy. It would be inappropriate touse CPT codes 76881 or 76882 in this situation.Claims for ultrasound of the extremity, CPT codes 76881 or 76882, must be reported with the appropriatesite modifier (LT or RT or both).CPT codes 76881 and 76882 are nonvascular by definition. For vascular studies of the extremities, refer toCPT codes 93922-93931 for arteries and 93965-93971 for veins.CPT code 76880 was deleted 12/31/2010 and removed from the listing in the “CPT/HCPCS Codes” sectionof the LCD. An explanatory note regarding the code deletion was added to this section. CPT codes 76881and 76882 were added as the replacement codes.Minor template changes were made to reflect current template language.LCD for Ophthalmic Biometry for Intraocular Lens Power Calculation (L26441)R4 (effective 01/01/2011): Annual LCD review per CMS Program Integrity Manual, Chapter 13, Section13.4[C]. Content reviewed, and LCD updated for current National Government Services and CMStemplate changes. No comment and notice periods required and none given.Article for Ophthalmic Biometry for Intraocular Lens Power Calculation – Supplemental InstructionsArticle (A45936)Article published January 2011: Annual review per CMS Program Integrity Manual, Chapter 13, Section13.4[C]. Content reviewed and article updated for current National Government Services and CMStemplate changes.CPT codes and descriptors are only copyright 2010 American Medical Association (or such other date publication of CPT)The Medicare Monthly Review 15 MMR 2011-01, January 2011
Page 2 and 3: Centers for Medicare & Medicaid Ser
Page 4: National Government Services Articl
Page 7: R4 (effective 12/16/2010): Due to a
Page 10 and 11: Article for Cardiovascular Nuclear
Page 13: For dates of service prior to 01/01
Page 17 and 18: LCD for Scanning Computerized Ophth
Page 19 and 20: Article for Determination of Cardia
Page 21 and 22: • CMS Internet-Only Manual (IOM),
Page 23 and 24: to the third party but no notificat
Page 25 and 26: Provider Types AffectedThis article
Page 27 and 28: • HCPCS codes Q2026, Q2027, and G
Page 29 and 30: Calendar Year 2011 Annual Update fo
Page 31 and 32: Mapping Information• New code 829
Page 33 and 34: Waiver of Coinsurance and Deductibl
Page 35 and 36: Ambulance Inflation Factor for CY 2
Page 37 and 38: Key Points of CR 7049CMS is adding
Page 39 and 40: Medicare-covered preventive service
Page 41 and 42: staff, please visit http://www.cms.
Page 43 and 44: CMS has decided to follow the same
Page 45 and 46: 2011. This amendment’s expanded c
Page 47 and 48: • Rural Health Clinics (TOB 71X)
Page 49 and 50: Note: CMS requests provider, physic
Page 51 and 52: If you have any questions, please c
Page 53 and 54: Quarterly Update to Correct Coding
Page 55 and 56: • Peak oxygen consumption.Note: V
Page 57 and 58: more than 12 months after a person
Page 59 and 60: last year, increased by 1.1 percent
Page 61 and 62: CodePayment LimitQ4027 $17.23Q4028
Page 63 and 64: BillingIn general, it is inappropri
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Provider Action NeededImpact to You
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IntroductionAnnual outbreaks of sea
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• CMS Frequently Asked Questions
Page 71 and 72:
Primary Care ServicesThe Affordable
Page 73 and 74:
The Affordable Care Act authorizes
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Implementation of Changes in End-St
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Home Health Face-to-Face Encounter
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collaborate with and inform the com
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News Flash - A revised Medicare Lea
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DisclaimerThis article was prepared
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Provider Types AffectedThis program
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News Flash - Each Office Visit is a
Page 89 and 90:
Provider Types AffectedPhysicians,
Page 91 and 92:
On January 28, 2010, CMS made avail
Page 93 and 94:
spelling the Ordering/Referring Pro
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• Doctor of podiatric medicine;
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ased on the CPT code descriptor, re
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The Medicare Monthly Review, MMR-2011-01, January 2011 - CGS

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