2004 DMEPOS REGION C FEE SCHEDULE NOW AVAILABLE

The 2004 DMEPOS Region C Fee Schedule is back online.

2004 Drug Fee Update

2004 Drug Fee Prices are available.

2004 HCPCS Code Update: New, Deleted and Crosswalked HCPCS Codes

HCPCS code updates for 2004 are now available. Changes include added, deleted and crosswalked HCPCS codes, as well as changes to HCPCS code descriptions. These changes are effective for dates of service on or after January 1, 2004.

2004 Medicare Physician Fee Schedule Increase - A Letter from Tommy G. Thompson

Medicare Prescription Drug, Improvement, and Modernization Act not only provides an expansion of preventive and prescription drug benefits but also includes many important payment reforms for doctors and hospitals. As you make your decision to participate in Medicare next year, you will be pleased to learn that the new law provides for an average 1.5 percent increase in Medicare reimbursements to physicians over the 2003 payment rates. Because of these changes, the December 31, 2003 deadline by which you have to decide about participating in the program next year has been extended to February 17, 2004. (OH/WV)

2004 Medicare Physician Fee Schedule Increase & Extension of the Annual Participation Enrollment Period

You have until February 17, 2004, to consider the new fee schedule increase before making your 2004 participation decision. The new fee schedule incorporates increases passed by Congress and signed by the President into law on December 8, 2003. (OH/WV/SC)

2004 Region C DMEPOS Fee Schedule

The 2004 Region C DMEPOS Fee Schedule is now available online.

2004 South Carolina Medicare Physician Fee Schedule Database Update (Excel file)

Attention Providers: An Excel version of the 2004 Medicare Physician Fee Schedule is now available online.

Albuterol and Ipratropium – Revised Coding Guidelines

This article contains a major revision to coding guidelines provided in an article posted to the DMERC web site in December 2003 ("Albuterol and Ipratropium - New HCPCS Code").

Ambulance Inflation Factor (AIF) for 2004

Effective January 1, 2004, the Ambulance Inflation Factor (AIF) for calendar year 2004 is 2.1 percent. (OH/WV)

April 2004 Quarterly Update for DMEPOS Fee Schedule

Fee schedule amounts for the new HCPCS codes listed in this article will be provided in the upcoming April quarterly DMEPOS fee schedule update.

Change in Coding on Medicare Claims for Darbepoetin Alfa (trade name Aranesp) and Epoetin Alfa (trade name Epogen, EPO) for Treatment of Anemia in End Stage Renal Disease (ESRD) Patients on Dialysis

Transmittal 36, Change Request 3037 modifies Transmittal 18, (CR 2963) issued on October 31, 2003. This transmittal reactivates HCPCS code J0880 for Medicare purposes effective January 1, 2004. For more information about this transmittal, please click on the hyperlink text above.

Clarification of Proof of Delivery Requirements

The CMS Program Integrity Manual has been revised to clarify proof of delivery requirements for DMEPOS.

Colorectal Cancer Screening Tests Expanded - National Coverage Determination

Effective for services furnished on or after January 1, 2004, screening Fecal Occult Blood Tests, HCPCS code G0328, may be paid as an alternative to HCPCS code G0107 for beneficiaries who have attained age 50. (OH/WV)

Drug and Biological Fee Schedule

Attention Providers: The 2004 Drug and Biological Fee Schedule is now available online.

Emergency Correction to the Fee Schedule Update for 2004 for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)

Important Notice: The 2004 Region C DMEPOS Fee Schedule has been changed. Visit the Palmetto GBA web site to learn more.

Epoetin and Darbepoetin – New HCPCS Codes

Effective for dates of service on or after January 1, 2004, new HCPCS codes were established for epoetin alfa (brand names Epogen and Procrit) and darbepoetin alfa (brand name Aranesp).

January 2004 Claims to be Held – Update

This article is an update to the "January 2004 Claims to be Held" article that was previously published on the Web site. To view the revised article, select the hypelink text above.

January 2004 Medicare Part A Advisory (2004-01)

The Part A January 2004 Medicare Advisory is now available online. To view this issue online, click on the link above.

Medicare’s Right to Recovery

The Medicare Secondary Payer Department revised this article to explain and provide instructions for the Medicare’s right to recover process. To read this article in its entirety, select the hyperlink text above.

Medicare Occupational Mix Table

This survey provides for the collection of occupational mix data prospectively for a 4-week period beginning on or after January 4, 2004 and ending February 7, 2004, or retrospectively for a 12-month period, that is, calendar year 2003.

Moratorium on Outpatient Rehabilitation Therapy Caps Renewed

Beginning December 8, 2003, and continuing through December 31, 2005, there are no payment caps on claims received for the physical therapy, speech-language pathology, and occupational therapy services. The payment caps for these services remain in effect for claims received on September 1, 2003 through December 7, 2003, for services rendered during that timeframe. (OH/WV/SC)

NC Medicare Part A HCPCS File

Providers, please see this article for information concerning the NC FISS system rejection of some claims with an error message indicating the HCPCS code that was entered on the claim was not found on the HCPCS file.

New Basis for Medicare Drug Payment Amounts for Durable Medical Equipment Regional Carriers (DMERCs)

A new basis for the upper payment limit for drugs and biologicals not paid on a cost or prospective payment basis has been established. To learn more visit the Palmetto GBA web site.

Ohio 2004 Medicare Physician Fee Schedule and Participation Enrollment - Revised

The revised Ohio 2004 Medicare Physician Fee Schedule is now available on our Web site. (OH)

Pending Settlement Letter E-Mail Pilot

A pilot project has been initiated for providers serviced out of our Columbia, South Carolina office. This project will allow the provider to be notified of a pending settlement by e-mail and respond through the same medium. This currently does not apply to correspondence issued by any of our other offices.

Physician/Supplier Guide to Medicare (Ohio/West Virginia)

The Physician/Supplier Guide to Medicare (Ohio/West Virginia) provides basic Medicare information. The Guide will help you understand the basics of Medicare and also provide detailed billing instructions.

Prefabricated Orthoses, Revised Coding Clarification: Winter 2003 Advisory Article Rescinded

The article titled “Orthoses – Coding Clarification” that was published in the Winter 2003 Region C DMERC Medicare Advisory is being rescinded.

Region C DMEPOS Supplier Manual (updated through Winter 2003)

The Region C DMERC DMEPOS Supplier Manual has been updated for Winter 2003. Included in this revision are updates to the following LMRPs: Wheelchair Options/Accessories, CPAP, RAD, and refractive lenses.

West Virginia 2004 Medicare Physician Fee Schedule and Participation Enrollment - Revised

The revised West Virginia 2004 Medicare Physician Fee Schedule is now available on our Web site. (WV)

00-0003-L-HEMODIALYSIS ACCESS INTERVENTIONS

This South Carolina Medicare Part B LMRP has been revised. New 2004 CPT code 36838 has been added. The revised effective date is 01/01/2004.

01-0001-L-BRONCHOSCOPY

This South Carolina Medicare Part B LMRP 01-0001-L, Bronchoscopy, has been revised to add 2004 CPT codes 31632 and 31633. The revision effective date is 01/01/2004.

02-0003-L-WIRELESS CAPSULE ENDOSCOPY

This South Carolina Medicare Part B LMRP has been revised by the addition of new 2004 CPT code 91110. The revised effective date is 01/01/2004.

02-0009-L-WHITE CELL COLONY STIMULATING FACTORS

This South Carolina Medicare LMRP has been revised by adding J2505 per 2004 HCPCS update. The revised effective date is 01/01/2004.

03-0001-L-OCTREOTIDE ACETATE FOR INJECTION (SANDOSTATIN

This South Carolina Medicare Part B LMRP, 03-0001-L, Octreotide Acetate for Injection, was revised. J codes J2353 and J2354 were assigned per 2004 HCPCS codes effective 01/05/2004.

03-0013-L-WOUND CARE SKIN GRAFT

This South Carolina Medicare Part B LMRP, Wound Care Skin Graft, is now in the notice period which began 01/05/2004. The policy will become effective on 02/15/2004.

03-0014-L-ALEFACEPT THERAPY

The notice period for this South Carolina Medicare Part B LMRP, Alefacept Therapy, will begin on 12/01/2003. The policy will become effective on 1/15/2004.

03-0016-L-BRAIN NATRIURETIC PEPTIDE (BNP)

This South Carolina Medicare Part B LMRP, Brain Natriuretic Peptide (BNP), is in the notice period starting 01/01/2004. The LMRP will become effective on 02/15/2004.

03-0017-L-EXTRACORPOREAL SHOCK WAVE THERAPY (ESWT)

This South Carolina Medicare Part B LMRP, Extracorporeal Shock Wave Therapy (ESWT), is in the notice period beginning 01/01/2004. The LMRP effective date is 02/15/2004.

98-0018-L-FECAL OCCULT BLOOD TESTS

This Medicare Part B LRMP Fecal Occult Blood Tests 98-0018-L has been updated to reflect additional code G0328 per Change Request 2996, effective 01/06/2004.

98-0031-L-IMPLANTED CATHETERS/PUMPS FOR INTRATHECAL OPIOID INFUSIONS

This South Carolina Medicare Part B LMRP, 98-0031-L, Implanted Catheters/Pumps for Intrathecal Opioid Infusions, has been revised. CPT codes 95990 and 95991 have been added per 2004 HCPCS update. The revision effective date is 01/01/2004.

99-0002-L-INDEPENDENT DIAGNOSTIC TESTING FACILITY (IDTF)

This South Carolina Medicare Part B LMRP, 99-0002-L, Independent Diagnostic Testing Facility (IDTF), has been revised. New 2004 CPT codes have been added. The revision effective date is 01/01/2004.

01A-0018-L-Colorectal Cancer Screening

TThis South Carolina Medicare Part A LMRP, 01A-0018-L, Colorectal Cancer Screening, has been revised. Under CMS National Coverage Policy section of the policy manual citations added to reflect Change Request 2996 dated December 19, 2003.Under CPT/HCPCS Codes section of the policy HCPCS code G0328 was added. Under the Coding Guidelines section of the policy #1 was expanded to address screening fecal occult blood tests performed on or after January 1, 2004. These changes become effective 01/12/2004.

99A-0005-L-Observation Room Services

This South Carolina Medicare Part A LMRP, 99A-0005-L, Outpatient Observation Room Services, has been revised. Under CPT/HCPCS Codes section of this policy, HCPCS code Q0081 has been added. Under Type of Bill Code section of the policy added bill type 85X. Under Revenue Codes section of the policy added 0760 revenue code. Under CMS National Coverage Policy section of the policy added a manual citation to reflect the Internet Only Manual. Under Limitations and Indications of Coverage and/or Medical Necessity section of the policy changed wakening to awakening. Under Coding Guidelines added verbiage related to HCPCS code Q0081, verbiage related to revenue code 0760 and verbiage related to reimbursement for outpatient Critical Access Hospital services. These changes become effective 01/16/2004.

00-09-U002-Noninvasive Vascular Studies

The North Carolina Part A intermediary revised the noninvasive vascular studies LMRP 00-09-U002 by adding ICD-9 code V71.7 observation for suspected cardiovascular disease to the diagnosis codes that support medical necessity in the section cerebrovascular arterial studies (93875-93882). This revision is effective 01/23/2004.

01-01-Levocarnitine (CarnitorTM, L-CarnitineTM) I-22

The North Carolina Part A intermediary revised the Levocarnitine LMRP 01-01 by deleting HCPCS code Q0081 from the CPT/HCPCS codes section of the policy. This revision is effective 01/23/2004.

01-05-Radiation Oncology - Radiation Verification, Delivery, and Management

The North Carolina Part A intermediary revised the Radiation Oncology-Radiation Verification, Delivery, and Management LMRP 01-05 by adding HCPCS codes G0339 Image-guided robotic linear accelerator-based stereotactic radiosurgery, complete course of therapy in one session, or first session of fractionated treatment and G0340 Image-guided robotic linear accelerator-based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per treatment to the CPT/HCPCS section of the policy. This revision is effective for services on or after January 1, 2004.

02-08-Pamidronate

The North Carolina Part A intermediary revised the Pamidronate local medical review policy (LMRP 02-08) by deleting HCPCS code Q0081 from the CPT/HCPCS codes section of the policy and adding clarifying language regarding Q0081 to the coding guidelines section of the policy. This revision is effective 01/23/2004.

03-02-Upper Gastrointestinal Endoscopy and Visualization

The North Carolina Part A intermediary revised the LMRP Upper Gastrointestinal Endoscopy and Visualization 03-02 by adding HCPCS code C9704 injection or insertion of inert substance for submucosal/intramuscular injection(s) into the upper gastrointestional tract, under fluoroscopic guidance and CPT code 43201 [esophagoscopy] with directed submucosal injection(s), any substance to the CPT/HCPCS codes section of the policy. This revision is effective for services on or after January 1, 2004.

98-07-S014-Colorectal Cancer Screening

The North Carolina Part A intermediary revised the colorectal cancer screening LMRP 98-07-S014 by expanding the ICD-9 code ranges 564.00-564.09 functional digestive disorders, not elsewhere classified and 564.81-564.89 other specified functional disorders of intestine in the diagnosis codes that support medical necessity. This revision is effective 01/23/2004.


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