Transcatheter Mitral Valve Implantation/Replacement (TMVI) – 0483T & 0484T

Transcatheter Mitral Valve Implantation/Replacement (TMVI) – 0483T & 0484T

The procedures include vascular access, catheterization, balloon valvuloplasty, valve deployment and (as needed) repositioning, temporary pacemaker insertion for rapid pacing, and access site closure. 0483T CPT Code Transcatheter mitral valve implantation/replacement (TMVI) with prosthetic valve; percutaneous approach, including trans-septal puncture, when performed 0484T CPT Code Transthoracic exposure (eg, thoracotomy, transapical) How to Avoid Denials? 1….

TAVR Rules Changed by CMS

TAVR Rules Changed by CMS

Transcatheter aortic valve replacement (TAVR) national coverage policy rules have been streamlined by the Centers for Medicare & Medicaid Services (CMS) as the minimally invasive intravenous procedure becomes more commonplace. However, it is still consider a clinical trial because of its relatively recent development. CMS said it will continue to cover TAVR under coverage with…

New CPT Codes

New CPT Codes

0509T    Electroretinography (ERG) with interpretation and report, pattern (PERG) 0510T    Removal of sinus tarsi implant    0511T    Removal and reinsertion of sinus tarsi implant    0512T    Extracorporeal shock wave for integumentary wound healing, high energy, including topical application and dressing care; initial wound    0513T    Extracorporeal shock wave for integumentary wound healing, high energy, including topical application and…

TFL for Each Level of Appeal

TFL for Each Level of Appeal

The time limits for filing appeals vary according to the type of appeal: Redetermination – The time limit for filing a request for redetermination is 120 days from the date of receipt of the Medicare Summary Notice (MSN) or Remittance Advice (RA).  QIC Reconsideration – The time limit for filing a request for reconsideration is 180 days…

Expired Medicare Legislative Provisions and Therapy Claims with the KX Modifier Rolling Hold

Expired Medicare Legislative Provisions and Therapy Claims with the KX Modifier Rolling Hold

CMS is committed to implementing the Medicare program in accordance with all applicable laws and regulations, including timely claims processing.  Several Medicare legislative provisions affecting health care providers and beneficiaries recently expired, including exceptions to the outpatient therapy caps, the Medicare physician work geographic adjustment floor, add-on payments for ambulance services and home health rural…

Good cause for extension of the time limit for filing appeals

Good cause for extension of the time limit for filing appeals

The time limit for filing a request for redetermination may be extended in certain situations. Generally, providers, physicians, or other suppliers are expected to file appeal requests on a timely basis. A request from the provider, physician, or other supplier to extend the period for filing the request for redetermination would not be routinely granted….

President Trump to replace Obamacare

President Trump to replace Obamacare

President Trump called on Democrats and Republicans to repeal and replace Obamacare with reforms that expand choice, increase access, lower costs, and provider better healthcare. “Mandating every American to buy government-approved health insurance was never the right solution for our country,” Trump said. “The way to make health insurance available to everyone is to lower…

Inpatient Hospital Payment Rate Impacted by the Consolidated Appropriations Act,

Inpatient Hospital Payment Rate Impacted by the Consolidated Appropriations Act,

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…