Highlights In This Issue ! Advance Beneficiary Notice 5 Carrier Jurisdiction for Medicare Payments When the Beneficiary Has an Out-of-State Address 6 Second Clarification Regarding Ambulance Fee Schedule Implementation 7 The Health Insurance Portability and Accountability ActAdministrative Simplification (HIPAAAS) 20 Provider HIPAA Readiness ChecklistGetting Started 22 HIPAA Resources 23 pdate HIPAA 101 For Health Care Providers Offices 24 Reader SurveyMedicare B Update! 32 New and Revised Connecticut Local Medical Review Policies 35 Connecticut Medicare Education and Outreach 2003 Medicare Made Easy Seminars 42 U New and Revised Florida Local Medical Review Policies 47 Florida Medicare Education and Outreach Medifest is Back! May 20-22, 2003 58 Features Connecticut and Florida To receive quick, automatic notification when new publications and A Physicians Focus 3 other items of interest are posted to our provider education Web sites, subscribe to our eNews mailing list Its very easy to do; go to Adminstrative 4 wwwconnecticutmedicarecom or wwwfloridamedicarecom, click on Claims 6 the yellow Join our Electronic Mailing List FCSO eNews bar and follow the prompts ENews notices are sent at least every other week, Coverage/Reimbursement 7 more frequently as required Electronic Media Claims 20 General Information 28 he Medicare B Update! Connecticut Only Tshould be shared with all Coverage/Reimbursement 33 healthcare practitioners and Local and Focused managerial members of the Medical Review Policies 35 provider/supplier staff Educational Resources 42 Publications issued begin- ning in 1997 are available at Florida Only no cost from our provider General Information 46 education Web sites: Local and Focused wwwconnecticutmedicarecom and wwwfloridamedicarecom Medical Review Policies 47 Educational Resources 57 Routing Suggestions: Index 62 q Physician/Provider q Office Manager q Billing/Vendor q Nursing Staff Other _________ A CMS Contracted Intermediary & Carrier q Medicare B A Newsletter for Connecticut and Florida Medicare Part B Providers Second Quarter 2003 Volume 1 Number 1 TABLE OF CONTENTS Connecticut and Florida Connecticut Local and Focused Medical Review Advance Notice Statement ............................................ 35 From the Medical Director – A Physician’s Focus ............. 3 Policy Changes Related to the 2003 HCPCS Update .... 35 Medicare B Administrative Provider Notification of Denials Based on Local Medical About the Connecticut and Florida Medicare B Update! .... 4 Review Policy ...................................................... 37 Update! Advance Beneficiary Notices (ABNs) ............................... 5 Preview Treatment Planning Software ........................ 37 Coverage and Billing for Pegfilgrastim (Neulasta™) ...... 37 Claims G0262: Wireless Capsule Endoscopy .......................... 38 Vol. 1, No. 1 Carrier Jurisdiction for Medicare Payments When the MAHD/ER: Metabolically Active Human Dermal/ Second Quarter 2003 Beneficiary Has an Out-of-State Address ................ 6 Epidermal Replacements ................................... 38 Correct Coding Initiative .................................................. 6 53850: Prostate Treatments ......................................... 38 Publications Pneumococcal Pneumonia, Hepatitis B, and Influenza 77280: Therapeutic Radiology Simulation-Aided Field Staff Virus Vaccines—Correction to Article ...................... 6 Setting ................................................................ 38 77300: Basic Radiation Dosimetry Calculation ............. 38 Bill Angel Coverage/Reimbursement 77302: Intensity Modulated Radiation Therapy (IMRT) .... 39 Shari Bailey Ambulance 77332: Treatment Devices, Design and Construction .... 39 Millie C. Pérez Second Clarification Regarding Ambulance Fee Schedule 77336: Radiation Physics Consult ................................ 39 Implementation ..................................................... 7 82232: Beta2 Microglobulin .......................................... 39 The Medicare B Update! Diagnostic Tests 90801: Psychiatric Diagnostic Interview Examination ..... 39 Diagnostic Services Ordered with Surrogate Unique 90804: Individual Psychotherapy ................................... 39 is published quarterly by Physician Identification Numbers (UPINs) ........... 10 90810: Interactive Individual Psychotherapy ................... 40 the Medicare Publications Ordering Diagnostic Tests ............................................ 11 90853: Group Psychotherapy ........................................ 40 Department of First Coast Crugs and Biologicals 90857: Interactive Group Psychotherapy ........................ 40 Service Options, Inc., to Deletion of Q Codes and Reactivation of CPT Codes for 92002: Evaluation and Management Services in provide timely and useful Hepatitis B Vaccine .............................................. 11 Ophthalmology and Optometry ............................ 40 information to Medicare End-Stage Renal Disease 93922: Non-Invasive Physiologic Studies of the Upper Levocarnitine for use in Treatment of Carnitine Deficiency or Lower Extremity Arteries ................................... 40 Part B providers in in End-Stage Renal Disease (ESRD) Patients ...... 11 93965: Non-Invasive Evaluation of Extremity Veins ......... 41 Connecticut and Florida. Laboratory/Pathology Recent FDA Approvals .................................................. 41 Coverage and Billing for Home Prothrombin Time Questions concerning this International Normalized Ratio (INR) Monitoring for Connecticut Educational Resources publication or its contents Anticoagulation Management—Correction ........... 12 First Coast Service Options, Inc. Connecticut Medicare may be directed in writing New CLIA Waived Tests ................................................ 12 Education and Outreach 2003 Medicare Made Easy to: Mental Health Seminars On-site Training .................................. 42 Noncoverage of Multiple Electroconvulsive Therapy Medicare Part B Provider Communications Advisory Medicare Part B (MECT) ................................................................ 14 Group ................................................................. 43 Nonphysician Practitioners Medicare Made Easy Seminars Five Part Series for Part B Publications Clarification Regarding Nonphysician Practitioners Billing Providers ............................................................ 44 P.O. Box 45270 on Behalf of a Diabetes Outpatient Self-Management Medicare Education & Outreach Event Registration Form44 Jacksonville, FL Training Services (DSMT) Program and Common www.connecticutmedicare.com - Connecticut Medicare’s 32232-5270 Working File Edits for DSMT & Medical Nutrition Provider Education Web Site ............................... 45 Therapy (MNT) .................................................... 14 CPT codes, descriptors, Physical Therapy/Occupational Therapy Florida Only and other data only are Coverage and Billing Requirements for Electrical General Information copyright 2002 American Stimulation for the Treatment of Wounds .............. 15 Provide Complete Cover Information on Faxes .............. 46 Medical Association (or Coverage and Billing for Neuromuscular Electrical Stimulation .......................................................... 16 Florida Local and Focused Medical Review such other date of Podiatry Advance Notice Statement ............................................ 47 publication of CPT). All Requirements for Payment of Medicare Claims for Foot Policy Changes Related to the 2003 HCPCS Update .... 47 Rights Reserved. and Nail Care Services ........................................ 17 Provider Notification of Denials Based on Local Medical Applicable FARS/DFARS Radiology Review Policy ...................................................... 51 apply. No fee schedules, Weekly Radiation Therapy Management ....................... 19 Preview Treatment Planning Software ........................ 52 basic units, relative Surgery Coverage and Billing for Pegfilgrastim (Neulasta™) ...... 52 Coverage and Billing for Percutaneous Image-Guided G0108: Diabetes Outpatient Self-Management Training 52 values, or related listings Breast Biopsy—Clarification ................................ 19 G0245: Peripheral Neuropathy with Loss of Protective are included in CPT. AMA Telehealth Services Sensation (LOPS) ............................................... 53 does not directly or Medicare Telehealth Update ......................................... 19 G0262: Wireless Capsule Endoscopy .......................... 53 indirectly practice J2430: Pamidronate (Aredia®, APD) ............................. 53 Electronic Media Claims medicine or dispense Recent FDA Approvals .................................................. 53 medical services. AMA The Health Insurance Portability and Accountability Act— J7340: Apligraf® (Graftskin)—Policy Retired .................. 53 Administrative Simplification (HIPAA–AS) ............. 20 J9999: Antineoplastic Drugs ......................................... 53 assumes no liability for Provider HIPAA Readiness Checklist—Getting Started ... 22 MAHD/ER: Metabolically Active Human Dermal/ data contained or not HIPAA Resources ......................................................... 23 Epidermal Replacements ................................... 54 contained herein. HIPAA 101 For Health Care Providers’ Offices ................ 24 NCSVCS: The List of Medicare Noncovered Services