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

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CodePayment LimitQ4011 $3.94Q4012 $8.88Q4013 $14.36Q4014 $24.21Q4015 $7.18Q4016 $12.10Q4017 $8.30Q4018 $13.23Q4019 $4.16Q4020 $6.62Q4021 $6.14Q4022 $11.08Q4023 $3.09Q4024 $5.54Q4025 $34.44Q4026 $107.54Q4027 $17.23Q4028 $53.78Q4029 $26.34Q4030 $69.33Q4031 $13.17Q4032 $34.66Q4004 $110.92Q4005 $11.81Q4006 $26.62Q4007 $5.92Q4008 $13.31Q4009 $7.89Q4010 $17.75Q4011 $3.94Q4012 $8.88Q4013 $14.36Q4014 $24.21Q4015 $7.18Q4016 $12.10Q4017 $8.30Q4018 $13.23Q4019 $4.16Q4020 $6.62Q4021 $6.14Q4022 $11.08Q4023 $3.09Q4024 $5.54Q4025 $34.44Q4026 $107.54CPT codes and descriptors are only copyright 2010 American Medical Association (or such other date publication of CPT)The Medicare Monthly Review 60 MMR 2011-01, January 2011
CodePayment LimitQ4027 $17.23Q4028 $53.78Q4029 $26.34Q4030 $69.33Q4031 $13.17Q4032 $34.66Additional InformationThe official instruction, CR 7225 issued to your carrier, FI, A/B MAC, and DME/MAC regarding thischange may be viewed at http://www.cms.gov/Transmittals/downloads/R2100CP.pdf on the CMS Website.If you have any questions, please contact your carrier, FI, A/B MAC, or DME MAC at their toll-freenumber, which may be found athttp://www.cms.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip on the CMS 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. CPT only copyright 2009 American Medical Association.New HCPCS Q-codes for 2010-2011 Seasonal Influenza VaccinesMLN Matters® Number: MM7234 Revised (3)Related Change Request (CR): 7234Related CR Release Date: November 19, 2010Effective Date: October 1, 2010 unless otherwise specifiedRelated CR Transmittal #: R815OTNImplementation Date: January 3, 2011Note: This article was revised on December 9, 2010, to correct the short descriptor for code Q2039 on page2. All other information is the same.Provider Types AffectedThis article is for physicians and providers submitting claims to Medicare contractors (carriers, fiscalintermediaries [FIs], and/or Part A/B Medicare administrative contractors [A/B MACs]) for influenzavaccines provided to Medicare beneficiaries.Provider Action NeededThe article is based on Change Request (CR) 7234 which establishes separate billing codes for each brandnameinfluenza vaccine product under common procedure terminology (CPT) code 90658 and describesthe process for updating the new specific Healthcare Common Procedure Coding System (HCPCS) codesand their payment allowances for Medicare during the 2010-2011 influenza season.BackgroundCMS has created specific HCPCS codes and payment allowances to replace CPT code 90658 for Medicarebilling purposes for the 2010-2011 influenza season.CPT codes and descriptors are only copyright 2010 American Medical Association (or such other date publication of CPT)The Medicare Monthly Review 61 MMR 2011-01, January 2011
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Centers for Medicare & Medicaid Ser
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National Government Services Articl
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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: last year, increased by 1.1 percent
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
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The Medicare Monthly Review, MMR-2011-01, January 2011 - CGS

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