March-April 2000 Medicare B Update
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! In This Issue... Clarification to Medicares Critical Care Policies CPT 2000 Definition Changes Prompt Policy Changes ............................................. 7 End of the Grace Period for the 2000 HCPCS Update Effective April 1, 2000, Medicare Will No Longer Accept Procedure Codes and Modifiers Discontinued January 1, 2000 ........................................................... 11 Clarification of Medicares Ambulance Service Policies Complete Physician and Ambulance Instructions Regarding the 48-Hour Rule ................................................................................ 12 pdate Clinical Diagnostic Laboratory Organ and Disease Panels New Lab Panel Codes are Effective April 1, 2000.................................................... 17 Medicare 101 Seminars Full Day Sessions Offered for New Providers and Office Staff ................................ 59 U New Computer Based Training Courses Available HCFA Offers Courses on Womens Health and Adult Immunizations ..................... 66 Features lease share the Medicare B PUpdate! with appropriate From the Medical Director 3 members of your organization. Administrative 4 Routing Suggestions: Claims 6 o Physician/Provider Coverage/Reimbursement 12 Local and Focused Medical Review 19 o Office Manager Electronic Media Claims 50 o Biller/Vendor General Information 51 o Nursing Staff Educational Resources 54 Index 71 o Other __________ __________ __________ __________ __________ FIRST COAST __________ __________ Health Care Financing Administration SERVICE OPTIONS, INC. Medicare B A Newsletter for Florida Medicare Part B Providers B Part Medicare Florida for Newsletter A A HCFA Contracted Carrier & Intermediary March/April 2000 Volume 13, Number 2 TABLE OF CONTENTS From the Carrier Medical Director 64470, 64472, 64475, 64476: Paravertebral Facet A Physicians Focus: Joint Nerve Injection ............................................ 36 Announcing the Appointment of Our New 78472, 78473, 78481, 78483, 78494, 78496: Medicare B Intermediary Medical Director ........................... 3 Coverage for Cardiac Blood Pool Imaging ....... 38 82607, 82608: Vitamin B-12 Update! Administrative (Cyanocobalamin) Assay .................................. 39 Vol. 13, No. 2 Advance Notice Requirement ............................... 4 84436, 84437, 84439, 84443, 84479, 84480, March/April 2000 General Information About the Medicare B Update! .. 4 84481, 84482: Thyroid Function TestsRevision . 40 Publications Medicare Contractors Applying Deductible, 90801: Psychiatric Diagnostic Interview Staff Co-Insurance and Payment Updates Examination ...................................................... 41 Beginning January 10, 2000 ............................... 5 92548: Computerized Dynamic Posturography Bill Angel Use of GA Modifier: Waiver of Liability ................ 6 Noncoverage Continued ................................... 42 Shari Bailey 93000, 93005, 93010: Electrocardiography Pauline Crutcher Claims Revisions to Policy ............................................. 43 Carol McCrossin Additional Development Request: 93012, 93014, 93268, 93270, 93271, 93272, Millie C. Pérez Procedure-to-Place of Service Inconsistent ..... 7 G0004, G0005, G0006, G0007, G0015, G0016: Critical Care PoliciesClarification ...................... 7 Patient Demand Single or Multiple Event Recorder 43 The Medicare B Use of Modifier 58 .............................................. 10 93303, 93304, 93307, 93308, 93320-93321, Update! is published CPT 2000: Add-on Codes ................................ 10 93325: Transthoracic and Doppler Echocardio- bimonthly by the ICD-9-CM Millennium Edition ............................. 11 graphy and Doppler Flow Velocity Mapping Medicare Publications 2000 HCPCS UpdateEnd of Grace Period ..... 11 Correction to Policy .......................................... 46 Department, to 93501, 93510, 93511, 93514, 93524, 93526, provide timely and Coverage/Reimbursement 93527, 93528, 93529, 93530, 93531, 93532, useful information to Ambulance 93533: Cardiac Catheterization ........................ 46 Medicare Part B Clarification of Medicare Policies Concerning 94760, 94761, 94762: Noninvasive Ear or Pulse providers in Florida. Ambulance Services ................................... 12 Oximetry for Oxygen Saturation ....................... 48 Ambulance Questions and Answers .................. 13 98940-98942: ChiropractorCorrection ............ 49 Questions concerning General Surgery this publication or its Apligraf ..................................................... 14 Electronic Media Claims contents may be Hematology/Oncology Why Send Medicare Claims Electronically? directed in writing to: Weigh The Benefits! ........................................ 50 Extension of Medicare Benefits for Medicare Part B Immunosuppresive Drugs ................................. 15 General Information Publications 2000 Medicare Allowances for P.O. Box 2078 Radionuclide Materials ..................................... 15 Fraud and Abuse Jacksonville, FL Injectable Drugs Fraud and Abuse in the Medicare Program ....... 51 32231-0048 Injectable Drug PricingCorrection ................... 17 Financial Laboratory/Pathology Overpayment Interest Rate ................................ 52 CPT five-digit codes, Clinical Diagnostic Laboratory Organ Medicare Registration descriptions, and or Disease Panels ............................................ 17 Assignment of Group Provider Numbers ........... 52 other data only are Physical/Occupational Therapy Changing Specialties .......................................... 53 copyrighted by the Two-Year Moratorium on the Financial Limitation Provider Change of Address .............................. 53 American Medical for Outpatient Rehabilitation Services ................ 17 Incomplete Applications ...................................... 53 Association. All Rights Reserved. No Local and Focused Educational Resources fee schedules, basic Medical Review Policies Medicare and the MillenniumA New Dawning ... 54 units, relative values or related listings are A9270: The List of Medicare Noncovered Services .. 19 Medifest Course Descriptions ............................ 57 included in CPT. G0108, G0109: Diabetes Outpatient MEDICARE 101 ............................................... 59 AMA does not Self-Management Training ............................... 23 Part A Providers Medicare 101 Course Survey ..... 60 directly or indirectly G0166 (93799): External Counterpulsation Part B Providers Medicare 101 Course Survey .... 61 practice medicine or Clarification ................................................. 26 Lets Talk With Medicare Part A ...................... 62 dispense medical J1561, J1562: Intravenous Immune Globulin Lets Talk With Medicare Part B ...................... 63 services. AMA Revision ...................................................... 26 Medicare Part A and Part B Provider Education assumes no liability J2430: Pamidronate (Aredia®, APD) ................. 28 and Training Advisory Meeting ......................... 64 for data contained or J9999: Antineoplastic DrugsAdditions to Policy .. 28 New Computer Based Training not contained herein. Florida Medicare Program Safeguards Courses Available ............................................. 66 Focused Medical Review.................................. 29 Medicare Provider Website to Replace BBS ...... 67 ICD-9-CM codes 20974: Osteogenic Stimulator for Fracture Healing .. 30 Important Website Links ..................................... 67 and their descriptions 22899: Coverage for Percutaneous Vertebroplasty .. 31 Order FormPart B Materials for 2000 ............. 69 used in this 27599, 29870, 29874: Autologous Cultured Order FormYear 2000 Medifest, General publication are copyrightÓ 1998 Chondrocyte Implantation .......................... 32 Program Module, and Specialty Seminar Books ... 69 under the Uniform 62310, 62311, 62318, 62319: Index to Medicare B Update! .............................. 71 Copyright Epidural/Subarachnoid Injections .................... 33 Important Addresses Convention. All 64555: Sacral Neuromodulation ......................... 35 and Phone Numbers .......................... Back Cover rights reserved. 2 The Florida Medicare B Update! March/April 2000 FROM THE MEDICAL DIRECTOR A PHYSICIANS FOCUS Announcing the Appointment of Our New Intermediary Medical Director In this issues A Physicians Focus, I am pleased to announce the appointment of our new Intermediary Medical Director, James J. Corcoran, Jr., M.D., M.P.H. im Corcoran started with First Coast Service Options, Inc. on JDecember 1, 1999, as Intermediary Medical Director (Medicare Part A of Florida). Dr. Corcoran will concentrate on the Intermediary Medical Director responsibilities, while I will continue to concentrate on the Carrier Medical Director (Medicare Part B of Florida) responsibilities. In this column, I would like to provide you with the highlights of Dr. Corcorans credentials and professional accomplishments. Dr. Corcoran was born in Ithaca, New York, and raised in Pennsylvania. He received his undergraduate degree from Harvard College and his medical degree from Pennsylvania State University. After an internship in the Boston area, Dr. Corcoran headed south to pursue his residency training in Internal Medicine in Augusta, Georgia. Dr. Corcoran settled in South Carolina and enjoyed private practice in Greenville for seven years. His practice included working with hospital systems as a provider of patient care and an