In This Issue... Promoting Colorectal Cancer Screening Important Information and Documentaion on Promoting the Prevention of Colorectal Cancer ....................................................................................................... 9 Intestinal and Multi-Visceral Transplantation Coverage Guidelines and Requirements for Approval of Transplantation Facilities12 Expanded Coverage of Positron Emission Tomography Scans New HCPCS Codes and Coverage Guidelines Effective July 1, 2001 ..................... 14 Skilled Nursing Facility Consolidated Billing Clarification on HCPCS Coding Update and Part B Fee Schedule Services .......... 22 Final Medical Review Policies 29540, 33282, 67221, 70450, 76090, 76092, 82947, 86353, 93922, C1300, C1305, J0207, and J9293 ......................................................................................... 31 Outpatient Prospective Payment System Bulletin Devices Eligible for Transitional Pass-Through Payments, New Categories and Crosswalk C-codes to Be Used in Coding Devices Eligible for Transitional Pass-Through Payments ............................................................................................ 68 Features From the Medical Director 3 he Medicare A Bulletin Administrative 4 Tshould be shared with all General Information 5 health care practitioners and managerial members of the General Coverage 12 provider/supplier staff. Hospital Services 17 Publications issued after End Stage Renal Disease 19 October 1, 1997, are available at no-cost from our provider Skilled Nursing Facility Services 22 Web site at Comprehensive Outpatient www.floridamedicare.com. Rehabilitation Facilities 25 Routing Suggestions: Critical Access Hospitals 26 ! Medicare Manager Fraud and Abuse 27 Provider Audit and Reimbursement 29 ! Reimbursement Director Electronic Data Interchange 30 ! Chief Financial Officer Local and Focused Medical Policies 31 ! Compliance Officer Outpatient Prospective Payment Services 68 ! DRG Coordinator ! ________________ FIRST COAST ! ________________ Medicare A Health Care Financing Administration SERVICE OPTIONS, INC. ! ________________ A Newsletter for Florida Medicare Part Providers A HCFA Contracted Carrier & Intermediary Third Quarter 2001 Volume 3, Number 3 TABLE OF CONTENTS Table of Contents Medicare A In This Issue ................................................. 1 Electronic Data Interchange Bulletin From the Intermediary Medical Director Elimination of HCFA Free Billing Software ........ 30 Vol. 3, No. 3 A Physician’s Focus Medical Policies Third Quarter Medicare Coverage of Drugs and Biologicals, Medical Policy Table of Contents ................. 31 2001 Payment Methodologies and Ethical Use of the American Medical Association’s Obligations of Health Care Professionals ... 3 (AMA’s) Current Procedural Terminology Publications Staff Administrative (CPT) Codes on Contractors’ Web Sites .. 31 Millie C. Pérez About The Medicare A Bulletin ....................... 4 Final Medical Policies Pauline Crutcher New Toll-Free Numbers Available .................. 4 29540: Strapping ........................................... 32 Shari Bailey Bill Angel General Information 33282: Insertable Loop Recorder .................... 34 67221: Ocular Photodynamic Therapy (OPT) Payment Revisions for Diagnostic and The Medicare A Bulletin is with Verteporfin ................................. 36 published bimonthly by the Screening Mammograms Performed 70450: Computerized Tomography Scans ....... 38 Medicare Publications with New Technologies ........................... 5 76090: Diagnostic Mammography ................ 42 Department, to provide Suspension of Requirements to Register for 76092: Screening Mammograms ................. 44 timely and useful Receiving Contractor’s Notification ............ 6 82947: Blood Glucose Testing ........................ 46 information to Medicare Elimination of Time Limit on Medicare Benefits Part A providers in Florida. 86353: Lymphocyte Transformation ............. 49 for Immunosuppressive Drugs ................. 6 93922: Noninvasive Physiologic Studies of Overpayment Interest Rate ............................ 6 Questions concerning this Upper or Lower Extremity Arteries ...... 51 Q & A Regarding Payment for the Services of publication or its contents C1300: Hyperbaric Oxygen Therapy ............ 54 may be directed in writing Therapy Students under Part A of Medicare 6 C1305: Apligraf® (Graftskin) ........................ 59 to: BIPA Changes to the Payment for DMEPOS .. 7 J0207: Amifostine (Ethyol®) ..........................62 Cervical Cancer Awareness and the Benefits Medicare Part A J9293: Mitoxantrone Hydrocloride ................ 64 of Pap Tests .......................................... 8 Publications Promoting Colorectal Cancer Screening ......... 9 Additions and Revisions to Previously P.O. Box 2078 Colorectal Cancer Screening Campaign Print Published Medical Policy Jacksonville, FL Materials ............................................. 10 70544: Magnetic Resonance Angiography ... 66 32231-0048 Some Important Facts You Should Know 82435: Chloride .......................................... 66 CPT five-digit codes, about Colorectal Cancer ........................ 11 82728: Serum Ferritin .................................... 66 descriptions, and other data 94010: Spirometry ....................................... 66 only are copyright 1999 by General Coverage J1561: Intravenous Immune Globulin ........... 66 American Medical New CLIA Waived Tests .............................. 12 J9999: Doxorubicin HCL—Antineoplastic Association (or such other date of publication of CPT). Intestinal and Multi-Visceral Transplantation .. 12 Drug Policy ....................................... 66 Expanded Coverage of PET Scans and All Rights Reserved. LMRP Development Changes ..................... 67 Related Claims Processing Changes .... 14 Applicable FARS/DFARS Verteporfin .................................................... 16 Outpatient Prospective Payment System apply. No fee schedules, basic units, relative values or Hospital Services Devices Eligible for Transitional Pass-Through related listings are included Payment ............................................. 68 Postacute Care Transfer Policy .................... 17 in CPT. AMA does not Independent Laboratory Billing for the TC of Categories for Use in Coding Devices Eligible directly or indirectly Physician Pathology Services to Hospital for Transitional Pass-Through Payment .. 80 practice medicine or Patients ............................................... 18 General Coding, Billing Instructions and dispense medical services. Explanations for Categories Used in AMA assumes no liability for End of Stage Renal Disease Coding Devices Eligible for Transitional data contained or not End of Stage Renal Disease Drug Pricing Pass-Through Payment ....................... 82 contained herein. Update ................................................. 19 C-Codes for Categories Used in Coding ICD-9-CM codes and their Devices Eligible for Transitional Pass- descriptions used in this Skilled Nursing Facility Services Through Payment ................................ 84 publication are copyright Clarification and HCPCS Coding Update: Part Crosswalk to New Category C-codes Used in 1998 under the Uniform B Fee Schedule and Consolidated Billing . 22 Coding Devices Eligible for Transitional Copyright Convention. All Delay in Edit Implementation Consolidated Pass-Through Payments ........................ 85 rights reserved. Billing for SNF Residents ...................... 24 Further Guidance Regarding Billing under the Third-party websites. This Comprehensive Outpatient OPPS ................................................. 106 document contains Rehabilitation Facility Services Procedures Subject to Home Health references to sites operated Consolidated Billing .............................. 108 by third parties. Such Expansion of Moratorium on the Application references are provided for of the $1,500.00 Financial Limitation for Educational Resources your convenience only. Outpatient Rehabilitation services ........... 25 HCFA Announces Revised Fee Policy in Fiscal BCBSF and/or FCSO do not control such sites and are not Critical Access Hospitals Year 2001 for Provider Education and Training Activities ................................. 109 responsible for their content. Clinical Diagnostic Laboratory Tests Furnished The inclusion of these by Critical Access Hospitals .................... 26 www.floridamedicare.com—Florida Medicare’s references within this Salary Equivalency Guidelines Update Factors 26 Provider Web Site ................................ 109 document does not suggest Order Form - Part A Materials .................... 110 any endorsement of the Fraud and Abuse material on such sites or any Fraud and Abuse in the Medicare Program ...... 27 Other Information association with their Addresses, Medicare Web sites, operators. Provider Audit and Reimbursement and Phone Numbers ........................... 111 Hospital Payments and Disproportionate Share Hospital Thresholds ................................ 29 2 The Florida Medicare A Bulletin Third Quarter 2001 FROM THE INTERMEDIARY MEDICAL DIRECTOR A PHYSICIAN’S FOCUS Medicare Coverage of Drugs and Biologicals, Payment Methodologies, and Ethical Obligations of Health Care Professionals hough the Medicare Program insures nearly one in seven TAmericans, its current benefit package is not as comprehensive as most private insurance plans. Drug coverage, especially