Revised NCD list

Revised NCD list

This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to NCDs effective from January 2020 These NCD codes changes are the results of newly available code sets and coding revisions to NCDs released separately. The revised NCD codes lists are, NCD110.18 Aprepitant: Contractors shall add J9036 as covered effective July…

Changes in Bypass Payment Edits (3-days and 1-day) For Donor Post-Kidney Transplant

Changes in Bypass Payment Edits (3-days and 1-day) For Donor Post-Kidney Transplant

The MACs to implement logic that ensures they bypass payment window edits (3-days and 1-day) when processing claims for donor post-kidney transplant complications services. MACs will hold certain claims, as noted below, until Medicare’s Common Working File (CWF) system edits these claims correctly. 3-Day Payment Window Edits: 7109: Outpatient Diagnostic Service against Inpatient in history…

CPT G0444 (2021)

CPT G0444 (2021)

Reimbursement Guidelines for Depression Screening – CPT G0444 Depression screening CPT G0444 can’t be coded with CPT G0402 & G0438 but you may report with CPT G0439. NCCI edits stated as “Code G0444 is a column 2 code for G0402. You may not override the edit”.Nationally Covered Indications: CMS will cover annual screening up to 15…

HCPCS Code Changes

HCPCS Code Changes

The HCPCS code set is updated on a quarterly basis. CR 11296 informs MACs and providers ofthe updated specific drug/biological HCPCS codes. The April 5, 2019, HCPCS file includes 10new HCPCS codes. Beginning on July 1, 2019, these HCPCS codes will be established andmay be used in submitting claims under Medicare effective for claims with…

Per Mile Travel Allowance P9603

Per Mile Travel Allowance P9603

In addition to a specimen collection fee Medicare, under Part B, covers a  travel allowance for a laboratory technician to draw a specimen from either a nursing home patient or homebound patient. The travel allowance is intended to cover the estimated travel costs of collecting a specimen and to reflect the technician’s salary and travel costs….

Holding of 2016 date-of-service claims for services paid under the Medicare physician fee schedule

Holding of 2016 date-of-service claims for services paid under the Medicare physician fee schedule

On October 30, 2015, the calendar year (CY) 2016 Medicare physician fee schedule (MPFS) final rule was published in the Federal Register. In order to implement corrections to technical errors discovered after publication of the MPFS rule and process claims correctly, Medicare administrative contractors will hold claims containing 2016 services paid under the MPFS for…

Medicare deductible, coinsurance, and premium rates

Medicare deductible, coinsurance, and premium rates

The Centers for Medicare & Medicaid Services (CMS) issued the 2016 deductibles, coinsurance, and premium rates for beneficiaries covered through the Medicare fee for service program. The 2016 deductible, coinsurance and base premium rates are: 2016 PART A – HOSPITAL INSURANCE (HI Deductible:$1,288.00 Coinsurance: $322.00 a day for 61st-90th day $644.00 a day for 91st-150th…