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

The PLB codes to report on the 835 and HIGLAS and HIPAA PLB Crosswalk may be found in theattachment in CR 7068Additional InformationFor complete details regarding this Change Request (CR) please see the official instruction (Transmittal812/CR 7068) issued to your Medicare contractor athttp://www.cms.gov/transmittals/downloads/R812OTN.pdf on the CMS Web site.You may also want to review the following MLN Matters articles:• Limitation on Recoupment (935) for Provider, Physicians and Suppliers Overpayments athttp://www.cms.gov/MLNMattersArticles/downloads/MM6183.pdf and• Reporting of Recoupment for Overpayment on the Remittance Advice (RA) athttp://www.cms.gov/MLNMattersArticles/downloads/MM6870.pdf on the CMS Web site.If you have questions, please contact your Medicare contractor at their toll-free number which may befound at http://www.cms.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip on the CMSWeb 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. Note HIGLAS stands for Healthcare Integrated General Ledger Accounting System (HIGLAS), which is CMS accounting systemAnnual Wellness Visit, Including Personalized Prevention Plan ServicesMLN Matters® Number: MM7079 RevisedRelated Change Request (CR) #: 7079Related CR Release Date: December 3, 2010Effective Date: January 1, 2011Related CR Transmittal #: R134BP and R2109CPImplementation Date: April 4, 2011Note: This article was revised on December 16, 2010, to make corrections to the method of payments toinstitutional providers shown on page 5. All other information is the same.Provider Types AffectedThis article is for physicians, nonphysician practitioners, and providers submitting claims to Medicarecontractors (carriers, Medicare administrative contractors [MACs], and/or fiscal intermediaries [FIs]) forservices provided to Medicare beneficiaries.Provider Action NeededThe Affordable Care Act provides for an annual wellness visit (AWV), including personalized preventionplan services (PPPS) for Medicare beneficiaries as of January 1, 2011. CR 7079 provides the requirementsfor the AWV, which are summarized in this article. Make sure billing staff are aware of these services andhow to bill for them.BackgroundPursuant to section 4103 of the Affordable Care Act of 2010 , the Centers for Medicare & MedicaidServices (CMS) amended sections 411.15(a)(1) and 411.15 (k)(15) of 42 CFR (list of examples of routinephysical examinations excluded from coverage) effective for services furnished on or after January 1,CPT codes and descriptors are only copyright 2010 American Medical Association (or such other date publication of CPT)The Medicare Monthly Review 44 MMR 2011-01, January 2011