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Showing Patient Payments in CMS 1500 form


Most of the practices would collect copayments from the patient at the time service. Although it's not a violation for participating providers to accept payment prior to rendering services, there are specific guidelines to follow, especially when reporting these payments.

Additionally, some providers who accept assignment have a concern that Medicare issues partial checks to beneficiaries. Such checks are generally issued because of a patient paid amount in item 29 of the CMS-1500 (02/12) claim form.

Here are a few guidelines to follow;

Medicare Part B recommends not to collect copay amounts prior to a claim being submitted to Medicare since it is difficult to predict when deductible/coinsurance amounts will be applicable (and over-collection is considered program abuse). So, it is recommended that providers not to do so until Medicare Part B payment is received.

If you believe you can accurately predict the coinsurance amount and wish to collect it before Medicare Part B payment is received, note the amount collected for coinsurance on your claim form. It is recommended that providers do not collect the deductible prior to receiving payment from Medicare Part B because, as noted above, over-collection is considered program abuse. In addition, this practice can cause a portion of the provider's check to be issued to beneficiaries on assigned claims. 

Do not collect money from the patient for the preventive services for which copayment and coinsurance are waived. Please refer Preventive Services covered by Medicare.

Do not show any amounts collected from patients if the service is never covered by Medicare Part B or you believe, in a particular case, the service will be denied payment. Where patient paid amounts are shown for services that are denied payment, a portion of the provider's check may go to the beneficiary.

There is no need to show a patient paid amount in item 29 of form CMS-1500 (or electronic equivalent) when assignment is not accepted.

Reference: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c26.pdf

Medicare will hold HCPCS codes G0477 through G0483 till April 04, 2016


CMS discovered systems errors affecting claims with new drug testing laboratory codes (HCPCS codes G0477 through G0483) with dates of service on or after January 1, 2016. Your Medicare Administrative Contractor (MAC) will be holding these claims until April 4, 2016. No provider action is required. However, should you wish to avoid your claims from being held, you can remove codes G0477 through G0483 and submit the rest of the services on the claim. When the system is updated in April, you can submit an adjustment claim to add these HCPCS codes. Your MAC will correct any claims previously returned to you in error with these codes and reason code W7006 after the system is updated


2016 - New CPT codes for Arthrocentesis


20604 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); with ultrasound guidance, with permanent recording and reporting
(Do not report 20600, 20604 in conjunction with 76942) (If fluoroscopic, CT, or MRI guidance is performed, see 77002, 77012, 77021)

20606 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); with ultrasound guidance, with permanent recording and reporting

20611 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting (Do not report 20610, 20611 in conjunction with 27370, 76942) (If fluoroscopic, CT, or MRI guidance is performed, see 77002, 77012, 77021)

The above three new codes (20604, 20606 and 20611) describe ultrasound imaging guidance as an inclusive component of arthrocentesis, aspiration and/or injection of a joint or bursa. Fluoroscopicguided arthrocentesis will remain component coded. Revisions were made to 20605 and 20610 to denote the procedures are performed without ultrasound guidance.

2015 MU Attestation Deadline Approaching


If you are an eligible professional participating in the Medicare EHR Incentive Program, you have until 11:59 p.m. ET on February 29, 2016 to attest Meaningful Use for 2015 EHR reporting period. 

If you are participating in the Medicaid EHR Incentive Program, please refer to your state's website for attestation information.

If you are a Medicaid participant who is subject to Medicare penalties and you’re attesting for the first time in 2015, you can demonstrate Meaningful Use on the Medicare attestation portal by February 29th to avoid penalties in 2016 and 2017. You will still need to submit a Medicaid attestation with your state to earn incentives. If you are a returning Medicaid MU participant who is eligible for Medicare penalties but unable to meet the 30% patient volume threshold, then also you can demonstrate Meaningful Use on the Medicare attestation portal by February 29th to avoid 2017 penalties.

Medicare Attestation Portal: https://ehrincentives.cms.gov/hitech/login.action

Inpatient Hospital Payment Rate Impacted by the Consolidated Appropriations Act, 2016


CMS is currently revising the Inpatient Prospective Payment System (IPPS) FY 2016 Pricer to reflect the new payment calculation requirement.  The amount of the payment with respect to the operating costs of inpatient hospital services of a subsection (d) Puerto Rico hospital for inpatient hospital discharges on or after January 1, 2016, will be based on 0 percent of the applicable Puerto Rico percentage and 100 percent of the applicable Federal percentage. In addition, the IPPS FY 2016 Pricer will include conforming changes to certain FY 2016 IPPS operating rates and factors that result from the application of the new Puerto Rico hospital payment calculation requirement, which are applicable to all IPPS hospital discharges on or after January 1, 2016. We will also incorporate the revised IPPS rates into the Long-Term Care Hospital (LTCH) Pricer, as they are used for certain LTCH claims payments.

To allow sufficient time to develop and test, CMS will implement the IPPS and LTCH Pricers on April 4, 2016. Medicare Administrative Contractors (MACs) will reprocess IPPS inpatient claims from Puerto Rico and all other IPPS hospitals with a discharge date on or after January 1, 2016. The MACs will also reprocess LTCH claims with a discharge date on or after January 1, 2016, due to the impact of this change.  Puerto Rico hospitals (as well as all other IPPS and LTCH hospitals) do not need to take any action. We expect to reprocess claims no later than June 30, 2016.

Clinical laboratory fee schedule on travel allowances and specimen collection fees


The Centers for Medicare & Medicaid Services (CMS) updated payment rates for travel allowances and specimen collection fees when billed on a per mileage basis using Health Care Common Procedure Coding System (HCPCS) code P9603 and when billed on a flat rate basis using HCPCS code P9604 for 2016.

Payment of the travel allowance is made only if a specimen collection fee is also payable. The travel allowance is intended to cover the estimated travel costs of collecting a specimen including the laboratory technician’s salary and travel expenses. The per mile travel allowance is to be used in situations where the average trip to the patients’ homes is longer than 20 miles round trip.

The per flat-rate trip basis travel allowance is $9.90

Reference: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9485.pdf

2016 Deleted CPT codes


0099T   Implantation of intrastromal corneal ring segments

0103T   Holotranscobalamin, quantitative

0123T   Fistulization of sclera for glaucoma, through ciliary body

0182T   High dose rate electronic brachytherapy, per fraction

0223T   Acoustic cardiography, including automated analysis of combined acoustic and electrical intervals; single, with interpretation and report

0224T   Acoustic cardiography, including automated analysis of combined acoustic and electrical intervals; multiple, including serial trended analysis and limited reprogramming of device parameter, AV or VV delays only, with interpretation and report

0225T   Acoustic cardiography, including automated analysis of combined acoustic and electrical intervals; multiple, including serial trended analysis and limited reprogramming of device parameter, AV and VV delays, with interpretation and report

0233T   Skin advanced glycation endproducts (AGE) measurement by multi-wavelength fluorescent spectroscopy

0240T   Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report; with high resolution esophageal pressure topography

0241T   Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report; with stimulation or perfusion during high resolution esophageal pressure topography study (eg, stimulant, acid or alkali perfusion) (List separately in addition to code for primary procedure)

0243T   Intermittent measurement of wheeze rate for bronchodilator or bronchial-challenge diagnostic evaluation(s), with interpretation and report

0244T   Continuous measurement of wheeze rate during treatment assessment or during sleep for documentation of nocturnal wheeze and cough for diagnostic evaluation 3 to 24 hours, with interpretation and report

0262T   Implantation of catheter-delivered prosthetic pulmonary valve, endovascular approach

0311T   Non-invasive calculation and analysis of central arterial pressure waveforms with interpretation and report

21805   Open treatment of rib fracture without fixation, each

31620   Endobronchial ultrasound (EBUS) during bronchoscopic diagnostic or therapeutic intervention(s) (List separately in addition to code for primary procedure[s])

37202   Transcatheter therapy, infusion other than for thrombolysis, any type (eg, spasmolytic, vasoconstrictive)

37250   Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure)

37251   Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; each additional vessel (List separately in addition to code for primary procedure)

39400   Mediastinoscopy, includes biopsy(ies), when performed

47136   Liver allotransplantation; heterotopic, partial or whole, from cadaver or living donor, any age

47500   Injection procedure for percutaneous transhepatic cholangiography

47505   Injection procedure for cholangiography through an existing catheter (eg, percutaneous transhepatic or T-tube)

47510   Introduction of percutaneous transhepatic catheter for biliary drainage

47511   Introduction of percutaneous transhepatic stent for internal and external biliary drainage

47525   Change of percutaneous biliary drainage catheter

47530   Revision and/or reinsertion of transhepatic tube

47560   Laparoscopy, surgical; with guided transhepatic cholangiography, without biopsy

47561   Laparoscopy, surgical; with guided transhepatic cholangiography with biopsy

47630   Biliary duct stone extraction, percutaneous via T-tube tract, basket, or snare (eg, Burhenne technique)

50392   Introduction of intracatheter or catheter into renal pelvis for drainage and/or injection, percutaneous

50393   Introduction of ureteral catheter or stent into ureter through renal pelvis for drainage and/or injection, percutaneous

50394   Injection procedure for pyelography (as nephrostogram, pyelostogram, antegrade pyeloureterograms) through nephrostomy or pyelostomy tube, or indwelling ureteral catheter

50398   Change of nephrostomy or pyelostomy tube

64412   Injection, anesthetic agent; spinal accessory nerve

67112   Repair of retinal detachment; by scleral buckling or vitrectomy, on patient having previous ipsilateral retinal detachment repair(s) using scleral buckling or vitrectomy techniques

70373   Laryngography, contrast, radiological supervision and interpretation

72010   Radiologic examination, spine, entire, survey study, anteroposterior and lateral

72069   Radiologic examination, spine, thoracolumbar, standing (scoliosis)

72090   Radiologic examination, spine; scoliosis study, including supine and erect studies

73500   Radiologic examination, hip, unilateral; 1 view

73510   Radiologic examination, hip, unilateral; complete, minimum of 2 views

73520   Radiologic examination, hips, bilateral, minimum of 2 views of each hip, including anteroposterior view of pelvis

73530   Radiologic examination, hip, during operative procedure

73540   Radiologic examination, pelvis and hips, infant or child, minimum of 2 views

73550   Radiologic examination, femur, 2 views

74305   Cholangiography and/or pancreatography; through existing catheter, radiological supervision and interpretation

74320   Cholangiography, percutaneous, transhepatic, radiological supervision and interpretation

74327   Postoperative biliary duct calculus removal, percutaneous via T-tube tract, basket, or snare (eg, Burhenne technique), radiological supervision and interpretation

74475   Introduction of intracatheter or catheter into renal pelvis for drainage and/or injection, percutaneous, radiological supervision and interpretation

74480   Introduction of ureteral catheter or stent into ureter through renal pelvis for drainage and/or injection, percutaneous, radiological supervision and interpretation

75896   Transcatheter therapy, infusion, other than for thrombolysis, radiological supervision and interpretation

75945   Intravascular ultrasound (non-coronary vessel), radiological supervision and interpretation; initial vessel

75946   Intravascular ultrasound (non-coronary vessel), radiological supervision and interpretation; each additional non-coronary vessel (List separately in addition to code for primary procedure)

75980   Percutaneous transhepatic biliary drainage with contrast monitoring, radiological supervision and interpretation

75982   Percutaneous placement of drainage catheter for combined internal and external biliary drainage or of a drainage stent for internal biliary drainage in patients with an inoperable mechanical biliary obstruction, radiological supervision and interpretation

77776   Interstitial radiation source application; simple

77777   Interstitial radiation source application; intermediate

77785   Remote afterloading high dose rate radionuclide brachytherapy; 1 channel

77786   Remote afterloading high dose rate radionuclide brachytherapy; 2-12 channels

77787   Remote afterloading high dose rate radionuclide brachytherapy; over 12 channels

82486   Chromatography, qualitative; column (eg, gas liquid or HPLC), analyte not elsewhere specified

82487   Chromatography, qualitative; paper, 1-dimensional, analyte not elsewhere specified

82488   Chromatography, qualitative; paper, 2-dimensional, analyte not elsewhere specified

82489   Chromatography, qualitative; thin layer, analyte not elsewhere specified

82491   Chromatography, quantitative, column (eg, gas liquid or HPLC); single analyte not elsewhere specified, single stationary and mobile phase

82492   Chromatography, quantitative, column (eg, gas liquid or HPLC); multiple analytes, single stationary and mobile phase

82541   Column chromatography/mass spectrometry (eg, GC/MS, or HPLC/MS), non-drug analyte not elsewhere specified; qualitative, single stationary and mobile phase

82543   Column chromatography/mass spectrometry (eg, GC/MS, or HPLC/MS), non-drug analyte not elsewhere specified; stable isotope dilution, single analyte, quantitative, single stationary and mobile phase

82544   Column chromatography/mass spectrometry (eg, GC/MS, or HPLC/MS), non-drug analyte not elsewhere specified; stable isotope dilution, multiple analytes, quantitative, single stationary and mobile phase

83788   Mass spectrometry and tandem mass spectrometry (MS, MS/MS), analyte not elsewhere specified; qualitative, each specimen

88347   Immunofluorescent study, each antibody; indirect method

90645   Hemophilus influenza b vaccine (Hib), HbOC conjugate (4 dose schedule), for intramuscular use

90646   Hemophilus influenza b vaccine (Hib), PRP-D conjugate, for booster use only, intramuscular use

90669   Pneumococcal conjugate vaccine, 7 valent (PCV7), for intramuscular use

90692   Typhoid vaccine, heat- and phenol-inactivated (H-P), for subcutaneous or intradermal use

90693   Typhoid vaccine, acetone-killed, dried (AKD), for subcutaneous use (U.S. military)

90703   Tetanus toxoid adsorbed, for intramuscular use

90704   Mumps virus vaccine, live, for subcutaneous use

90705   Measles virus vaccine, live, for subcutaneous use

90706   Rubella virus vaccine, live, for subcutaneous use

90708   Measles and rubella virus vaccine, live, for subcutaneous use

90712   Poliovirus vaccine, (any type[s]) (OPV), live, for oral use

90719   Diphtheria toxoid, for intramuscular use

90720   Diphtheria, tetanus toxoids, and whole cell pertussis vaccine and Haemophilus influenzae b vaccine (DTwP-Hib), for intramuscular use

90721   Diphtheria, tetanus toxoids, and acellular pertussis vaccine and Haemophilus influenzae b vaccine (DTaP/Hib), for intramuscular use

90725   Cholera vaccine for injectable use

90727   Plague vaccine, for intramuscular use

90735   Japanese encephalitis virus vaccine, for subcutaneous use

92543   Caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes 4 tests), with recording

95973   Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex spinal cord, or peripheral (ie, peripheral nerve, sacral nerve, neuromuscular) (except cranial nerve) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)


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