Both Depth and Area Matter when Reporting Debridement
Correct coding of surgical debridement (11042-11047) requires documentation of both the measurement of the wound surface area after debridement and the depth of tissue that is removed. The Centers for...
View ArticleExtracorporeal Photopheresis for BOS Now Covered
The Centers for Medicare & Medicaid Services (CMS) recently revised the National Coverage Determination (NCD) for Extracorporeal Photopheresis (110.4) to add coverage for the treatment of...
View ArticleO2 for Cluster Headaches Paid After Oct. 1
Home oxygen for cluster headaches (CH) will be reimbursed for up to 36 months beginning Oct. 1, the Centers for Medicare & Medicaid Services (CMS) recently announced. The move follows a Jan. 14...
View ArticleLook for New Codes, New Status Indicators in July ASC PS Update
The July update of the Ambulatory Surgical Center Payment System (ASC PS) implements several changes to Medicare billing instructions of which ASC coding and billing staff should be aware. The update...
View ArticleTrailBlazer Implements New Lab Edit
Effective May 14, TrailBlazer Health Enterprises has instituted an edit for the following laboratory CPT® codes: 80074 Acute hepatitis panel 80076 Hepatic function panel These lab services have been...
View ArticleMPFS Payment Files Updated for July
The Centers for Medicare & Medicaid Services (CMS) recently released payment files to contractors that reflect up-to-date payment policy in line with the 2012 Medicare Physician Fee Schedule (MPFS)...
View ArticleJ1 MAC: Prostate Molecular Markers Not Covered
Billing and coding guidelines for prostate molecular marker claims submitted to Palmetto GBA have changed. The Part B Medicare administrative contractor (MAC) for jurisdiction 1 (American Samoa,...
View ArticleContractor Warns of Incorrect Use of AQ Modifier
Confusion regarding which services qualify for the Health Professional Shortage Area (HPSA) 10 percent bonus is mounting, Palmetto GBA says. “Submitting HPSA modifiers on claims that do not qualify for...
View ArticleAMA Releases Midterm CPT Code Changes
The American Medical Association (AMA) released a host of mid-term CPT® code updates July 1. Among the new releases are vaccine codes for 2013 and 2014, and a number of Category II and III codes. In...
View ArticleUnitedHealthcare Updates Policies for Fourth Quarter
If UnitedHealthcare is among your list of payers, you’ll want to take note of several policy updates the insurer says it will implement on or before the fourth quarter of 2012. From prior authorization...
View ArticleMore Than 16 Million Seen for Preventive Service in 2012
Just six months into 2012 and already over 16 million people with original Medicare have received at least one preventive service at no cost to them, U.S. Department of Health & Human Services...
View ArticleCMS Reopens NCD for PET Coverage
A request from the Medical Imaging & Technology Alliance (MITA) and other stakeholders has the Centers for Medicare & Medicaid Services (CMS) reconsidering coverage of certain uses of positron...
View ArticleCMS’ MPFS Proposed Rule Solves Longstanding Problems
The changes to policies and rates under the Center for Medicare & Medicaid Services’ (CMS) proposed rule for the Medicare Physician Fee Schedule (MPFS) include sweeping fixes, and it allows for...
View ArticleCMS Provider Call: Let’s Talk MPFS Payment Modifier
The Centers for Medicare & Medicaid Services (CMS) will hold a National Provider Call Aug. 1 from 2:30 p.m. to 4 p.m. ET to provide physicians, physician groups, practice managers, medical and...
View ArticleJ1 MAC: Percutaneous Endovascular Cardiac Assist Covered
It isn’t every day a Medicare administrative contractor (MAC) says it will cover a procedure that has neither a specific CPT® code describing it nor any concrete proof that the medical intervention is...
View ArticleNew Waived Tests Have Retroactive Effective Dates
The Centers for Medicare & Medicaid Services (CMS) recently notified contractors of 11 new tests approved by the U.S. Food and Drug Administration (FDA) as waived tests under Clinical Laboratory...
View ArticleCMS Opens NCA for OPT NCD
The Centers for Medicare & Medicaid Services (CMS) has opened a National Coverage Analysis (NCA) for the Ocular Photodynamic Therapy (OPT) National Coverage Determination (NCD 80.3.1) after...
View ArticleMACs Will Decide Liver Transplant Coverage for CA
Medicare administrative contractors (MAC) are in a better position to determine coverage of adult liver transplants for patients with three additional malignancies, according to the Centers for...
View ArticleCMS Posts Final Decision for Autologous PRP Coverage
In a final decision memo, the Centers for Medicare & Medicare Services (CMS) says there is insufficient evidence that autologous platelet-rich plasma (PRP) improves health outcomes in individuals...
View ArticleOPPS Update Includes Added Coverage, New Codes, and Corrected Pay Rates
The October 2012 update to the Outpatient Prospective Payment System (OPPS) includes added coverage, two new drug/biological codes, and three corrected payment rates. Providers and suppliers paid under...
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