Centers for <strong>Medicare</strong> & Medicaid Services – Articles for Part A and Part B Providers Page A BMetastasis of Cancer in the Context of a Clinical Trial (MM7125)Quarterly Update to Correct Coding Initiative Edits, Version 17.0, effective <strong>January</strong> 1, 53 A P<strong>2<strong>01</strong>1</strong> (MM7210)Ventricular Assist Devices as Destination <strong>The</strong>rapy (MM7220 Revised) 54 A PUpdate to <strong>Medicare</strong> Deductible, Coinsurance and Premium Rates for <strong>2<strong>01</strong>1</strong> (MM7224) 56 A A,PReasonable Charge Update for <strong>2<strong>01</strong>1</strong> for Splints, Casts, and Certain Intraocular Lenses 58 A P(MM7225)New HCPCS Q-codes for 2<strong>01</strong>0-<strong>2<strong>01</strong>1</strong> Seasonal Influenza Vaccines (MM7234 Revised) 61 A A,PClinical Laboratory Fee Schedule – <strong>Medicare</strong> Travel Allowance Fees for Collection of 64 A LSpecimens (MM7239)2<strong>01</strong>0–<strong>2<strong>01</strong>1</strong> Seasonal Influenza Resources for Health Care Professionals (SE1031Revised)66 A N,PCenters for <strong>Medicare</strong> & Medicaid Services – Articles for Part A Providers Page A BIncentive Payment Program for Primary Care Services, Section 55<strong>01</strong>(a) of the Patient 70 AProtection and Affordable Care Act, Payment to a Critical Access Hospital Paid Underthe Optional Method (MM7115)Systems Changes Necessary to Implement “Technical Correction Related to Critical 73 AAccess Hospital Services,” Section 3128 of the Affordable Care Act, Pub. L. 111-148(MM7219)Implementation of Changes in End-Stage Renal Disease Payment for Calendar Year 75 A<strong>2<strong>01</strong>1</strong> (MM7237)Home Health Face-to-Face Encounter - A New Home Health Certification Requirement(SE1038)77 MAnnouncement of <strong>Medicare</strong> Rural Health Clinics (RHCs) and Federally QualifiedHealth Centers (FQHCs) Payment Rate Increases (MM71<strong>01</strong>)79 A, F,RCenters for <strong>Medicare</strong> & Medicaid Services – Articles for Part B Providers Page A BEnd-Stage Renal Disease Home Dialysis <strong>Monthly</strong> Capitation Payment (MM7003) 81 A,PEdit to Deny Payment to Physicians and Other Suppliers for the Technical Component 83 A,P(TC) of Pathology Services Furnished on Same Date as Inpatient and OutpatientServices and Implements New Messages (MM7061)Section 55<strong>01</strong>(b) Incentive Payment Program for Major Surgical Procedures Furnished in 84 AHealth Professional Shortage Areas Under the Affordable Care Act (MM7063)New Physician Specialty Codes for Cardiac Electrophysiology and Sports Medicine 87 N,P(MM7209)Edits on the Ordering/Referring Providers in <strong>Medicare</strong> Part B Claims (Change Requests 88 N,P6417, 6421, and 6696) (SE1<strong>01</strong>1 Revised)Physicians and Nonphysician Practitioners Excluded from Deactivation in <strong>Medicare</strong> 94 N,PDue to Inactivity with <strong>Medicare</strong> (SE1034)Recovery Audit Contractor Demonstration High-Risk Vulnerabilities for Physicians(SE1036)95 PCPT codes and descriptors are only copyright 2<strong>01</strong>0 American Medical Association (or such other date publication of CPT)<strong>The</strong> <strong>Medicare</strong> <strong>Monthly</strong> <strong>Review</strong> 2 <strong>MMR</strong> <strong>2<strong>01</strong>1</strong>-<strong>01</strong>, <strong>January</strong> <strong>2<strong>01</strong>1</strong>
This key is provided as a convenience to alert providers/suppliers to articles with topics that may pertain to their particular field.This key is not a guarantee that information in other articles will not also apply. It is each provider’s/supplier’s responsibility tobecome familiar with the contents of each newsletter:Part A Key: A-All Providers, C-Community Mental Health Centers (CMHC), E-Renal Dialysis (ESRD) Providers, F-Federally Qualified Health Centers (FQHC), H-Hospitals, M-Home Health Providers, O-Comprehensive OutpatientRehabilitation Facilities (CORF) and Outpatient Physical <strong>The</strong>rapy Providers, P-Hospice Providers, R-Rural Health Center(RHC), S-Skilled Nursing Facilities (SNF), NA-Not ApplicablePart B Key: A-All Providers, B-Ambulance, C-Cardiovascular, D-DMEPOS, E-Drugs & Biologicals, F-ASC, G-Anesthesia,H-Physical & Occupational <strong>The</strong>rapy, I-Beneficiaries, J-Insurers, K-Home Health Care, L-Laboratory, M-Medicine, N-Non-Physician Practitioner, O-Nuclear Medicine, P-Physicians, Q-Mental Health R-Radiology, S-Surgery, T-Nephrology, U-Urology, V-Chiropractor, W-Ophthalmology & Optometry, X-Podiatry, Y-Radiation Z-Oncology, NA-Not ApplicableContact Information can be found on our Web site at: http://www.NGS<strong>Medicare</strong>.com.<strong>Medicare</strong> policies can be accessed from the Medical Policy Center section of our Web site. Providers without access to theInternet can request hard copies from National Government Services.CPT codes and descriptors are only copyright 2<strong>01</strong>0 American Medical Association (or such other date publication of CPT)<strong>The</strong> <strong>Medicare</strong> <strong>Monthly</strong> <strong>Review</strong> 3 <strong>MMR</strong> <strong>2<strong>01</strong>1</strong>-<strong>01</strong>, <strong>January</strong> <strong>2<strong>01</strong>1</strong>
- 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 and 14: For dates of service prior to 01/01
- Page 15 and 16: Article for Magnetic Resonance Imag
- 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
- Page 65 and 66:
Provider Action NeededImpact to You
- Page 67 and 68:
IntroductionAnnual outbreaks of sea
- Page 69 and 70:
• CMS Frequently Asked Questions
- Page 71 and 72:
Primary Care ServicesThe Affordable
- Page 73 and 74:
The Affordable Care Act authorizes
- Page 75 and 76:
Implementation of Changes in End-St
- Page 77 and 78:
Home Health Face-to-Face Encounter
- Page 79 and 80:
collaborate with and inform the com
- Page 81 and 82:
News Flash - A revised Medicare Lea
- Page 83 and 84:
DisclaimerThis article was prepared
- Page 85 and 86:
Provider Types AffectedThis program
- Page 87 and 88:
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
- Page 95 and 96:
• Doctor of podiatric medicine;
- Page 97:
ased on the CPT code descriptor, re