1. Effective with date of service July 1, 2011, the ONLY immunization administration codes covered for Medicaid recipients in the Health Check age range, 0 through 20 years of age, are CPT 90471 through CPT 90474. 2. Claims billed with CPT immunization administration codes CPT 90460 and CPT 90461 (effective for dates of service on and after…
CMS distributes a prospectively determined amount of uncompensated care payments to “Medicare disproportionate share hospitals” based on their relative share of uncompensated care nationally. As required under law, this amount is equal to an estimate of 75 percent of what otherwise would have been paid as Medicare disproportionate share hospital payments, adjusted for the change…
CMS Releases Additional Medicaid & CHIP COVID-19 FAQs for State Medicaid and CHIP Agencies CMS released additional frequently asked questions (FAQs) to aid state Medicaid and Children’s Health Insurance Program (CHIP) agencies in their response to the coronavirus disease 2019 (COVID-19) pandemic. The new FAQs cover a variety of Medicaid and CHIP topics, including emergency…
Updated May 9, 2020, with information from the 4/30/20 rule CMS will pay for phone calls using codes CPT 99441—99443. The 4/30/20 rule adds these to the telehealth list and increased payment for these services CMS continues did not add CPT 98966–98968 to the telehealth list These codes previously had a non-covered status Physicians, nurse…
The March 30 Interim Final Rule with Comment Period added coverage during the Public Health Emergency for audio-only telephone evaluation and management visits (CPT MAC codes 99441, 99442, and 99443) retroactive to March 1. On April 30, a new Physician Fee Schedule was implemented increasing the payment rate for these codes. Medicare Administrative Contractors (MACs) will…
As a part of President Trump’s Opening Up America Again effort, the Centers for Medicare & Medicaid Services (CMS) announced a new independent Commission that will conduct a comprehensive assessment of the nursing home response to the 2019 Novel Coronavirus (COVID-19) pandemic. The Commission will provide independent recommendations to the contractor to review and report…
New Patient: (CPT 99201 has been deleted. To report, use CPT 99202) CPT 99202 Office or other outpatient visit for the evaluation and management of a new patient,which requires a medically appropriate history and/or examination and straightforwardmedical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date…
LCD ID number: L36342 (Florida/Puerto Rico/U.S. Virgin Islands) After review of the local coverage determination (LCD) for screening and diagnostic mammography, it was determined to retire the LCD based on national coverage determination (NCD) 220.4. Therefore, the related coding guideline article is also being retired. Effective date: The retirement of this LCD and related coding…
This would help your organization join the fight against Hepatitis B (HBV) infection by understanding what conditions are necessary for coverage of HBV screening and how to properly code the Hepatitis B surface antigen (HBsAg) serologic test. Conditions for Coverage of HBsAg Serologic Testing: The patient’s primary care physician or practitioner, an eligible Medicare provider,…
Chronic care management (CCM) is a critical component of primary care that contributes to better outcomes and higher satisfaction for patients. CHRONIC CARE MANAGEMENT (CCM): Medicare initially provided payment for CPT code 99490 beginning January 1, 2015 to separately identify and value clinical staff time and other resources used in providing CCM. CMS adopted 3…