Important Information ! for Readers of the Medicare B Update! his issue marks the final publication that will be printed for the Tremainder of the current fiscal year that ends September 30, 2000. There will not be a printed September/October 2000 issue. The September/October 2000 edition will be available on our website, www.floridamedicare.com. This will allow readers of the Update! to access date sensitive information more quickly than is possible via traditionally-published materials. Effective for fiscal year 2001, the Update! will be produced on a quarterly basis. The initial quarterly issue of the Update! will be for the pdate first quarter of calendar year 2000, and will be available in mid-November. It will provide information that will be effective January 1, 2001, including the 2001 HCPCS changes. The quarterly format Update! will be provided to readers approximately forty-five days prior to implementation of HCFAs quarterly system releases. Additionally, the website will be updated throughout the quarter between publications to ensure providers are furnished with the latest information in plenty of time to allow them to U make necessary changes. These in-between items will soon be found in a new Hot Topics! section within the Part B Publications area of the website. Information posted to the website in this manner will be provided in the subsequent quarterly issue of the Update! lease share the Medicare B Features PUpdate! with appropriate members of your organization. From the Medical Director 3 Routing Suggestions: Administrative 4 o Physician/Provider Claims 5 Coverage/Reimbursement 6 o Office Manager Local and Focused Medical Review 25 o Biller/Vendor Electronic Media Claims 67 General Information 68 o Nursing Staff Educational Resources 72 o Other __________ Index 79 __________ __________ __________ __________ __________ 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 July/August 2000 Volume 13, Number 4 TABLE OF CONTENTS Important Information for Readers of Local and Focused the Medicare B Update! .... Front Cover Medical Review Policies - continued J2792: Rho (D) Immune Globulin Medicare B From the Carrier Medical Director Intravenous ....................................... 36 A Physicians Focus Update! J3240: Thyrotropin Alfa (ThyrogenÒ) ....... 38 Whats New In Medicare? ................... 3 53850: Prostate Treatments ..................... 40 Vol. 13, No. 4 62310, 62311, 62318, 62319: Epidural/ Administrative July/August 2000 Subarachnoid Injections .................... 43 General Information About the 71010: Chest X-Ray ................................. 43 Publications Medicare B Update! .............................. 4 Staff 82108: Aluminum ...................................... 51 Advance Notice Requirement ..................... 4 Bill Angel 83735: Magnesium Correction ............. 53 Shari Bailey 87621: Human Papillomavirus DNA Assay, Claims Pauline Crutcher Amplified Probe Technique ................. 53 Millie C. Pérez Correct Coding Initiative Version 6.1 .......... 6 90804-90809, 90816-90822: Health Professional Shortage Area The Medicare B Individual Psychotherapy .................... 55 (HPSA) Designation .............................. 6 Update! is published 92135: Scanning Computerized by the Medicare UPIN Directory on CD-ROM ....................... 6 Ophthalmic Diagnostic Imaging ........... 56 Publications 93965: Non-Invasive Evaluation of Department, to Coverage/Reimbursement Extremity Veins ................................... 59 provide timely and Ambulatory Surgical Center 98940: Chiropractic Services .................... 61 useful information to ASC Approved Procedures ......................... 7 Medicare Part B providers in Florida. Durable Medical Equipment, Electronic Media Claims Prosthetics, and Orthotics Filing Medicare Claims Electronically ....... 67 Questions concerning Carrier Jurisdiction List for Durable Medical Electronic Funds Transfer ......................... 67 this publication or its contents may be Equipment, Prosthetic and Orthotic Electronic Remittance Notice .................... 67 directed in writing to: Devices (DMEPOS) ........................... 14 General Information Medicare Part B Hematology/Oncology Publications Pancreas Transplants- Fraud and Abuse P.O. Box 2078 Revision to Effective Date ................... 22 Caveat Emptor - Let the Buyer Beware .... 68 Jacksonville, FL General Information 32231-0048 Influenza/PPV Vaccines Do Not Forward Initiative ........................ 69 Pneumococcal Pneumonia Virus Vaccines ... 22 CPT five-digit codes, Overpayment Interest Rate ....................... 69 descriptions, and Centralized Billing by Mass Immunizers other data only are for Influenza and PPV Vaccines ......... 22 Medicare Registration copyrighted by the Applications Available Via Webpage ........ 69 American Medical Injectable Drugs Portable X-Ray and IDTF Provider Numbers . 69 Association. All Cardiac Catheterization Facilities/Clinics ... 69 Rights Reserved. No Allowances for Injectable Drugs ............... 24 fee schedules, basic Revised Allowances for Portable X-Ray Medigap Crossover units, relative values Services ............................................. 25 Crossover Updates ................................... 70 or related listings are included in CPT. Nephrology AMA does not Live Kidney Donor (Modifier Q3) .............. 25 Educational Resources directly or indirectly Medicare Provider Education and Training practice medicine or Radiology Events for Year 2000 ......................... 72 dispense medical services. AMA Revised Allowances for Portable X-Ray Medical Specialty Seminar Schedule ....... 73 Services ............................................. 25 assumes no liability Lets Talk With Medicare - Part B Session ... 74 for data contained or Lets Talk With Medicare - Part A Session ... 75 not contained herein. Local and Focused Provider Education and Training Medical Review Policies ICD-9-CM codes Advisory Meeting ................................ 76 and their descriptions The List of Medicare Noncovered Services ... 25 www.floridamedicare.com - used in this Independent Diagnostic Testing Facility Florida Medicares Provider Website ... 77 publication are copyrightÓ 1998 (IDTF) ................................................ 26 Order Form - Part B Materials for 2000 .... 78 A0320: Ground Ambulance Services ........ 26 under the Uniform Index to Medicare B Update! .................... 79 Copyright J0001: Self-Administered Drugs ............... 30 Important Addresses, Phone Numbers, Convention. All J1745: Infliximab (RemicadeÔ) ................ 32 and Websites ....................... Back Cover rights reserved. J1950: Leuprolide Acetate ........................ 33 2 The Florida Medicare B Update! July/August 2000 FROM THE MEDICAL DIRECTOR A PHYSICIANS FOCUS Whats New In Medicare? edicare continues to adjust its benefits package to insure Mappropriate payments for medically necessary services. In an effort to explain coverage and allow Medicare beneficiaries access to the newest technology, President Clinton has directed Medicare to pay for the cost of covered services for Medicare patients enrolled in clinical trials of new drugs and services. Previously, our policy was to exclude from coverage all services that were related to non-covered services (Medicare Carriers Manual, section 2300). This new directive will make it easier for seniors to participate in trials of the newest technology available. In the past, Medicare patients have sometimes been excluded from such trials due to Medicares position of not paying for services related to noncovered services. This means that, in the future, Medicare may pay for the cost of doctors office visits and tests and other care that is needed by patients for their illness, even if they are participating in a clinical study. Medicare would normally cover these costs if the patient were not in a clinical trial. In all likelihood, patients will have to be enrolled in a formal clinical trial in order for Medicare to cover services under this provision. Information on available clinical trials may be obtained by visiting, www.clinicaltrials.gov. Remember that we have not received official notification from HCFA on this clarification. We will be providing official details, as they become available. Medicare has had a program for coverage of some devices under its Investigational Device Exemption (IDE) program for the past several years. Physicians conducting clinical trials for the Food and Drug Administration (FDA) approved category B devices may receive local carrier coverage by contacting us and providing the following information: A copy of their letter assigning them to the approved study. Two or three articles from peer reviewed journals indicating some patient benefit from the device (if available). A copy of the clinical trial protocol. A copy of the approved patient protocol. Any letters of endorsement from authorities in the field supporting the clinical benefit of the device. Identification of appropriate CPT/HCPCS codes and ICD-9 codes. Intended site of service. Expected charges. Any other pertinent information. Once we receive the information it usually takes 30-60 days to render a decision. Additional information on these and other Medicare topics can be found by visiting www.floridamedicare.com