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

Additional InformationThe official instruction, CR 7042, issued to your carrier, FI, and/or A/B MAC regarding this change maybe viewed at http://www.cms.gov/Transmittals/downloads/R2104CP.pdf on the CMS Web site.If you have any questions, please contact your carrier, FI, or A/B MAC at their toll-free number, whichmay be found at http://www.cms.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip on theCMS Web site.DisclaimerThis article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links tostatutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of eitherthe written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statementof their contents.Expansion of Medicare Telehealth Services for Calendar Year 2011MLN Matters® Number: MM7049Related Change Request (CR) #: 7049Related CR Release Date: August 20, 2010Effective Date: January 1, 2011Related CR Transmittal #: R2032CP and R131BPImplementation Date: January 3, 2011Provider Types AffectedThis article is for physicians, nonphysician practitioners (NPP), hospitals, and skilled nursing facilities(SNFs) submitting claims to Medicare contractors (carriers, fiscal intermediaries [FIs], and/or Part A/BMedicare administrative contractors [A/B MACs]) for telehealth services provided to Medicarebeneficiaries.Provider Action NeededThe Centers for Medicare & Medicaid Services (CMS) issued Change Request (CR) 7049 to alert providersthat 14 Healthcare Common Procedure Coding System (HCPCS) codes were added to the list of Medicaretelehealth services for:• Individual and group kidney disease education (KDE) services;• Individual and group diabetes self-management training (DSMT) services;• Group medical nutrition therapy (MNT) services;• Group health and behavior assessment and intervention (HBAI) services; and• Subsequent hospital care and nursing facility care services.• Make sure your billing staffs are aware of these changes.BackgroundAs noted in the 2011 Medicare Physician Fee Schedule Final Rule published on November 29, 2010, CMSis adding14 codes to the list of Medicare distant site telehealth services for individual and group KDEservices, individual and group DSMT services, group MNT services, group HBAI services, andsubsequent hospital care and nursing facility care services. Payment for these services will be made at theapplicable physician fee schedule (PFS) payment amount for the service of the physician or practitioner.CR 7049 adds the relevant policy instructions to the CMS Internet-Only Manual (IOM) Publication 100-04,Medicare Claims Processing Manual and Publication 100-02, Medicare Benefit Policy Manual and thosechanges may be reviewed by consulting CR 7049 athttp://www.cms.gov/Transmittals/downloads/R2032CP.pdf andhttp://www.cms.gov/Transmittals/downloads/R131BP.pdf, respectively, on the CMS Web site.CPT codes and descriptors are only copyright 2010 American Medical Association (or such other date publication of CPT)The Medicare Monthly Review 36 MMR 2011-01, January 2011