Department of Health & CMS Manual System Human Services (DHHS) Pub 100-04 Medicare Claims Processing Centers for Medicare & Medicaid Services (CMS) Transmittal 3329 Date: August 14, 2015 Change Request 8628 SUBJECT: Update to Pub. 100-04, Chapter 18 to Provide Language-Only Changes for Updating ICD-10, the 02/12 version of the Form CMS-1500, and ASC X12 I. SUMMARY OF CHANGES: This CR contains language-only changes for updating ICD-10, the 02/12 version of the Form CMS-1500, and ASC X12 language in Pub 100-04, Chapter 18. Also, references to MACs replace the references to old contractor types in the sections that are included in this CR. There are no new coverage policies, payment policies, or codes introduced in this transmittal. Specific policy changes and related business requirements have been announced previously in various communications. EFFECTIVE DATE: Upon implementation of ICD-10; ASC X12: January 1, 2012 *Unless otherwise specified, the effective date is the date of service. IMPLEMENTATION DATE: ASC X12: September 14, 2015; Upon implementation of ICD-10 Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. Any other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents. II. CHANGES IN MANUAL INSTRUCTIONS: (N/A if manual is not updated) R=REVISED, N=NEW, D=DELETED R/N/D CHAPTER / SECTION / SUBSECTION / TITLE R 18/Table of Contents R 18/10.2.1/Healthcare Common Procedure Coding System (HCPCS) and Diagnosis Codes R 18/10.3.1/Roster Claims Submitted to A/B MACs (B) for Mass Immunization R 18/10.3.1.1/Centralized Billing for Influenza Virus and Pneumococcal Vaccines to Medicare A/B MACs (B) R 18/10.3.2/Claims Submitted to A/B MACs (A) for Mass Immunizations of Influenza Virus and Pneumococcal Vaccinations R 18/20.2/HCPCS and Diagnosis Codes for Mammography Services R 18/20.5 Billing Requirements – A/B MAC (B) Claims R 18/20.8.2/Remittance Advice Messages R 18/30.2/Pap Smears On and After July 1, 2001 R 18/30.5/HCPCS Codes for Billing R/N/D CHAPTER / SECTION / SUBSECTION / TITLE R 18/30.6/Diagnoses Codes R 18/30.9/Remittance Advice Codes R 18/40.2/Screening Pelvic Examinations on and After July 1, 2001 R 18/40.4/Diagnoses Codes R 18/40.6/Revenue Code and HCPCS Codes for Billing R 18/40.8/Remittance Advice Codes R 18/50.5/Diagnosis Coding R 18/50.8/Remittance Advice Notices R 18/60.1/Payment R 18/60.3/Determining High Risk for Developing Colorectal Cancer R 18/60.6/Billing Requirements for Claims Submitted to A/B MACs (A) R 18/60.8/Remittance Advice Notices R 18/70.1/Claims Submission Requirements and Applicable HCPCS Codes R 18/70.1.1/HCPCS and Diagnosis Coding R 18/70.4/Remittance Advice Notices R 18/80.2/A/B Medicare Administrative Contractor (MAC) (B) and Contractor Billing Requirements R 18/90.2/A/B MAC (B) Billing Requirements R 18/90.2.1/Modifier Requirements for Pre-diabetes R 18/90.3/A/B MAC (A) Billing Requirements R 18//90.3.1/Modifier Requirements for Pre-diabetes R 18//90.4/Diagnosis Code Reporting R 18/90.5/Medicare Summary Notices R 18/100.2/A/B MAC (B) Billing Requirements R 18/100.3/A/B MAC (A) Billing Requirements R 18/100.4/Diagnosis Code Reporting R 18/100.5/Medicare Summary Notice R 18/130.2/Billing Requirements R 18/130.5/Diagnosis Code Reporting R 18/130.6/Medicare Summary Notice (MSN) and Claim Adjustment Reason Codes (CARCs) R 18/140.7/Medicare Summary Notices (MSNs), Remittance Advice Remark Codes (RARCs), Claims Adjustment Reason Codes (CARCs), and Advance Beneficiary Notices (ABNs) R 18/150.1/Healthcare Common Procedure Coding System (HCPCS) and Diagnosis Coding R/N/D CHAPTER / SECTION / SUBSECTION / TITLE R 18/150.3/Medicare Summary Notices (MSNs), Remittance Advice Remark Codes (RARCs), Claims Adjustment Reason Codes (CARCs), and Group Codes R 18/170.2/Diagnosis Code Reporting R 19/170.3/Billing Requirements R 18/200.1/Policy R 18/200.3/Professional Billing Requirements R 18/200.4/Claim Adjustment Reason Codes (CARCs), Remittance Advice Remark Codes (RARCs), Group Codes, and Medicare Summary Notice (MSN) Messages R 18/200.5/Common Working File (CWF) Edits III. FUNDING: For Medicare Administrative Contractors (MACs): The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined in your contract. CMS does not construe this as a change to the MAC Statement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the Contracting Officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions regarding continued performance requirements. IV. ATTACHMENTS: Business Requirements Manual Instruction Attachment - Business Requirements Pub. 100-04 Transmittal: 3329 Date: August 14, 2015 Change Request: 8628 SUBJECT: Update to Pub. 100-04, Chapter 18 to Provide Language-Only Changes for Updating ICD-10, the 02/12 version of the Form CMS-1500, and ASC X12 EFFECTIVE DATE: Upon implementation of ICD-10; ASC X12: January 1, 2012 *Unless otherwise specified, the effective date is the date of service. IMPLEMENTATION DATE: ASC X12: September 14, 2015; Upon implementation of ICD-10 I. GENERAL INFORMATION A. Background: This Change Request (CR) contains language-only changes for updating ICD-10, the 02/12 version of the Form CMS-1500, and ASC X12 language in Pub 100-04, Chapter 18. Also, references to MACs replace the references to old contractor types in the sections that are included in this CR. There are no new coverage policies, payment policies, or codes introduced in this transmittal. Specific policy changes and related business requirements have been announced previously in various communications. B. Policy: This Change Request (CR) contains language-only changes for updating ICD-10, the 02/12 version of the Form CMS-1500, and ASC X12 language in Pub. 100-04, Chapter 18. Also, references to MACs replace the references to old contractor types in the sections that are included in this CR. There are no new coverage policies, payment policies, or codes introduced in this transmittal. Specific policy changes and related business requirements have been announced previously in various communications. II. BUSINESS REQUIREMENTS TABLE "Shall" denotes a mandatory requirement, and "should" denotes an optional requirement. Number Requirement Responsibility A/B D Shared- Other MAC M System E Maintainers A B H F M V C H M I C M W H A S S S F C S 8628.1 A/B MACs and the SMAC shall be aware of the X X X RRB-SMAC updated language for ICD-10, the 02/12 version of the Form CMS-1500, and for ASC X12 in Pub. 100 - 04, Chapter 18. III. PROVIDER EDUCATION TABLE Number Requirement Responsibility A/B D C MAC M E E D A B H I H M H A C None IV. SUPPORTING INFORMATION Section A: Recommendations and supporting information associated with listed requirements: N/A "Should" denotes a recommendation. X-Ref Recommendations or other supporting information: Requirement Number Section B: All other recommendations and supporting information: N/A V. CONTACTS Pre-Implementation Contact(s): Not Applicable Post-Implementation Contact(s): Contact your Contracting Officer's Representative (COR). VI. FUNDING Section A: For Medicare Administrative Contractors (MACs): The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined in your contract. CMS does not construe this as a change to the MAC Statement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the Contracting Officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions regarding continued performance requirements. ATTACHMENTS: 0 Medicare Claims Processing Manual Chapter 18 - Preventive and Screening Services Table of Contents (Rev. 3329, Issued: 08-14-15) 10.3.1 - Roster Claims Submitted to A/B MACs (B) for Mass Immunization 10.3.1.1 - Centralized Billing for Influenza Virus and Pneumococcal Vaccines to A/B MACs (B) 10.3.2 - Claims Submitted to A/B MACs (A) for Mass Immunizations of Influenza Virus and Pneumococcal Vaccinations 20.5 - Billing Requirements-A/B MAC (B) Claims 60.6 - Billing Requirements for Claims Submitted to A/B MACs (A) 80.2 - A/B Medicare Administrative Contractor (MAC) (B) Billing Requirements 90.2 - A/B MAC (B) Billing Requirements 90.3 - A/B MAC (A) Billing Requirements 100.2 - A/B MAC (B) Billing Requirements 100.3 - A/B MAC (A) Billing Requirements 10.2.1 - Healthcare Common Procedure Coding System (HCPCS) and Diagnosis Codes (Rev. 3329, Issued: 08-14-15, Effective: 01-01-12, Implementation: 09-14-15) Vaccines and their administration are reported using separate codes. The following codes are for reporting the vaccines only. HCPCS Definition 90653 Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use 90654 Influenza virus vaccine, split virus, preservative-free, for intradermal use, for adults ages 18