12-State Medicare Home Health Coalition Meeting Questions and Answers - February 9, 2004

The February 9, 2004 12-State Medicare Home Health Coalition Meeting Questions and Answers are now available online. To view or print this document, select the hyperlink text above.

2004 Medicare Physician Fee Schedule Database (MPFSDB) ~ 1st Update

Effective April 5, 2004, for services performed on or after January 1, 2004, the Centers for Medicare & Medicaid Services (CMS) have made revisions to the 2004 Medicare Physician Fee Schedule Database (MPFSDB). (OH/WV)

2004 South Carolina Part A Ambulance Fee Schedule

The 2004 South Carolina Part A Ambulance Fee Schedule is now available online. To view or print a copy of this fee schedule, select the hyperlink text above.

2004 South Carolina Part A Clinical Laboratory Fee Schedule

The 2004 South Carolina Part A Clinical Laboratory Fee Schedule is now available online. To view or print this fee schedule, select the hyperlink text above.

2004 South Carolina Part A Comprehensive Outpatient Rehabilitation Facility (CORF) Fee Schedule

The 2004 South Carolina Part A CORF Fee Schedule in now available online. To view or print this fee schedule, select the hyperlink text above.

2004 South Carolina Part A Mammography Fee Schedule

The 2004 South Carolina Part A Mammography Fee Schedule is now available online. To view or access this fee schedule, select the hyperlink text above.

22 Modifier

Attention Providers: This is to remind you that the 22 modifier is used to identify an unusual procedural service. More information is available online at www.PalmettoGBA.com. Go to Part B Carrier/South Carolina/Learning and Education/Workshop Handouts or refer to page 13 of the Modifiers workshop handout from September 8, 2003.

April 2004 Changes to the Hospital Outpatient Prospective Payment System (OPPS): Payment for Drugs, Biologicals and Radiopharmaceuticals, Generic versus Brand Name - NC Part A

This article describes OPPS changes for payment of drugs, biologicals, and radiopharmaceuticals (brand name versus generic). To read this article in its entirety select the hyperlink text above. (NC Part A)

April 2004 Changes to the Hospital Outpatient Prospective Payment System (OPPS): Payment for Drugs, Biologicals and Radiopharmaceuticals, Generic versus Brand Name - SC Part A

This article describes OPPS changes for payment of drugs, biologicals, and radiopharmaceuticals (brand name versus generic). To read this article in its entirety select the hyperlink text above. (SC Part A)

CMS' Quarterly Provider Update

The Quarterly Provider Update is a comprehensive resource published by the Centers for Medicare & Medicaid Services (CMS) on the first business day of each quarter. It is a listing of all non-regulatory changes to Medicare including Program Memoranda, manual changes, and any other instructions that could affect providers. (OH/WV)

Comprehensive Error Rate Testing (CERT)

The Centers for Medicare & Medicaid Services (CMS) developed the Comprehensive Error Rate Testing (CERT) program in an effort to improve the processing and the medical decision making of Medicare claims. The purpose of the CERT program is to determine whether the contractor has processed Medicare claims accurately. (OH/WV)

Dental Services

This article is to help providers identify appropriate dental claims to submit to Medicare. (NC Part A)

Frequency Limitations for Darbepoetin Alfa (trade name Aranesp) for Treatment of Anemia in ESRD Patients on Dialysis, SC Part A

Medicare is instituting new frequency limitations for treatment of End Stage Renal Disease (ESRD) patients on dialysis with Darbepoetin Alfa (trade name Aranesp).

Frequency Limitations for Darbepoetin Alfa (trade name Aranesp) for Treatment of Anemia in ESRD Patients on Dialysis, SC Part B

Medicare is instituting new frequency limitations for treatment of End Stage Renal Disease (ESRD) patients on dialysis with Darbepoetin Alfa (trade name Aranesp).

Frequency Limitations for Darbepoetin Alfa (trade name Aranesp) for Treatment of Anemia in ESRD Patients on Dialysis, RHHI

Medicare is instituting new frequency limitations for treatment of End Stage Renal Disease (ESRD) patients on dialysis with Darbepoetin Alfa (trade name Aranesp).

Frequency Limitations for Darbepoetin Alfa (trade name Aranesp) for Treatment of Anemia in ESRD Patients on Dialysis, NC Part A

Medicare is instituting new frequency limitations for treatment of End Stage Renal Disease (ESRD) patients on dialysis with Darbepoetin Alfa (trade name Aranesp).

Frequency Limitations for Darbepoetin Alfa (trade name Aranesp) for Treatment of Anemia in ESRD Patients on Dialysis, DMERC

Medicare is instituting new frequency limitations for treatment of End Stage Renal Disease (ESRD) patients on dialysis with Darbepoetin Alfa (trade name Aranesp).

Frequency Limitations for Darbepoetin Alfa (trade name Aranesp) for Treatment of Anemia in End Stage Renal Disease (ESRD) Patients on Dialysis

Medicare is instituting new frequency limitations for treatment of ESRD patients on dialysis with Darbepoetin Alfa (trade name Aranesp). (OH/WV)

HIPAA Vendor Listing for Ohio/West Virginia

An updated HIPAA Vendor Listing for Ohio and West Virginia Medicare Part B is now available online. (OH/WV)

Home Health and Hospice Provider Onsite Request Form

Attention Home Health and Hospice provider: The Home Health and Hospice Onsite Request are now available. Please click on the hyperlink text above for instructions to complete the request.

Medical Review "Frequently Asked Questions ...Answered for you!" (March 2004)

We are publishing medical review driven questions and answers that will educate you and your staff on issues that have been brought to our attention by physicians and providers like you. (OH/WV)

MMA - New 2005 Part B Annual Deductible

For calendar years 1991 through 2004, the Medicare Part B annual deductible has been $100. Beginning in 2005, the Medicare Part B deductible will be $110 (based on Section 629 of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA)). (OH/WV)

MMA Drug Pricing Update—Drug Exceptions

Attention providers: The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), (Section 303(b)(2)), created a process for increasing the 2004 payment limits for some Medicare Part B drugs and biologicals provided from April 1, 2004 through December 31, 2004. A complete article identifying those drugs and biologicals granted increases under this process and their new payment amounts is now available online.

MMA Drug Pricing Update - Drug Exceptions (2004 Drug & Biological Fee Schedule Update)

Physicians and suppliers should note that the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), (Section 303(b)(2)), created a process for increasing the 2004 payment limits for some Medicare Part B drugs and biologicals provided from April 1, 2004 through December 31, 2004. (OH/WV)

New Provider Call Center Office Hours!

Effective April 5, 2004, the Provider Call Center will be changing their office hours. (OH/WV)

Open Draft Local Coverage Determination Meeting Scheduled for South Carolina Palmetto GBA’s Fiscal Intermediary - April 27, 2004

Information and registration instructions for the April 27, 2004 Open Draft LCD Meeting is now available. To access this information and register for this meeting, click on the hyperlink text above.

Order Influenza Vaccine Now (NC Part A)

Attention Providers: In order to ensure the availability of influenza vaccine for administration early in the Fall of 2004, you should begin to order supplies of influenza vaccine immediately. More information is available online at www.PalmettoGBA.com. (NC Part A)

Order Influenza Vaccine Now (RHHI)

Attention Providers: In order to ensure the availability of influenza vaccine for administration early in the Fall of 2004, you should begin to order supplies of influenza vaccine immediately. More information is available online at www.PalmettoGBA.com. (RHHI)

Order Influenza Vaccine Now (SC Part A)

Attention Providers: In order to ensure the availability of influenza vaccine for administration early in the Fall of 2004, you should begin to order supplies of influenza vaccine immediately. More information is available online at www.PalmettoGBA.com. (SC Part A)

Order Influenza Vaccine Now (SC Part B)

Attention Providers: In order to ensure the availability of influenza vaccine for administration early in the Fall of 2004, you should begin to order supplies of influenza vaccine immediately. More information is available online at www.PalmettoGBA.com. (SC Part B)

Order the Influenza Vaccine Now (OH/WV)

In order to ensure the availability of influenza vaccine for administration early in the Fall of 2004, physicians and providers should begin to order supplies of influenza vaccine immediately. (OH/WV)

Payment Rate for Fulvestrant (Faslodex) Under the Hospital OPPS (NC Part A)

This article provides the correct payment rate and copayment for Fulvestrant (Faslodex), effective for services furnished on or after January 1, 2004, which were incorrectly stated in Change Request 3145, Transmittal 113 (Pub. 100-04). (NC Part A)

Payment Rate for Fulvestrant (Faslodex) Under the Hospital OPPS (SC Part A)

This article provides the correct payment rate and copayment for Fulvestrant (Faslodex), effective for services furnished on or after January 1, 2004, which were incorrectly stated in Change Request 3145, Transmittal 113 (Pub. 100-04). (SC Part A)

Reason Codes U5606 and U5607 set to Return to Provider (RTP)

Effective March 22, 2004, claims that would previously reject with reason code U5606 and U5607 will now RTP. For instructions on how to correct this billing issue, please click on the hyperlink text above.

South Carolina Part A Provider Onsite Request Form

South Carolina Part A Providers: The South Carolina Part A Onsite Request is now available. Please click on the hyperlink text above for instructions to complete the request.

Temporarily Suspended Reason Codes Now to RTP

Effective April 1, 2004, temporarily suspended reason codes will now be returned to the provider. [NC Part A]

04-0002-L-OMALIZUMAB (XOLAIR)

The 45-day notice period for this South Carolina Medicare Part B LCD, OMALIZUMAB (XOLAIR), will start 04/01/2004. The LCD will become effective on 06/15/2004.

2002-29LR10-Cancer Chemotherapy & Chemotherapeutic Agents

This Medicare LMRP for Ohio & West Virginia was updated to reflect coverage of Pemetrexed dating back to the FDA approval date of 02/05/2004. (OH/WV)

2003-08LR3 -Vitamin B12 Injections

This Medicare Part B LMRP for Ohio & West Virginia was updated to include pemetrexed given in combination with cisplatindue. FDA approval on 02/05/2004. (OH/WV)

96A-0014-L-Syphilis Test

This South Carolina Medicare Part A "Draft" LCD is being presented for comment beginning 03/30/2004. The comment period will end 05/13/2004. Be sure to submit your comments online at www.PalmettoGBA.com.

96A-0014-L-Syphilis Test

This South Carolina Medicare Part A LCD, 96A-0014-L, Syphilis Test, has been revised. Under AMA/CPT and ADA/CDT Copyright Statement section of the policy added the American Dental Association copyright statement. Under CMS National Coverage Policy section of the policy deleted previously cited sections 10.2, 30.1, 30.2, 30.4, 40.1, 40.7, 50.1, 60, 80.4, and 110 located in CMS Manual System, Pub 100-4, Medicare Claims Processing, Chapter 16. Under Coverage Topic section of the policy deleted diagnostic tests and X-rays. Under ICD-9 Codes That Support Medical Necessity section of the policy, deleted V22.1 and added V23.2, V23.41, V23.49, V23.5, V23.7. These changes become effective 03/26/2004.

96-09-L006-Syphilis Test

This North Carolina Part A LCD, 96-09-L006, Syphilis Test, has been revised. Added TOB 18X, 71X, and 72X to the Type of Bill section. Added CPT codes 86593 and 86781 to the CPT/HCPCS section. Added ICD-9 codes 290.0-290.3, 782.1, V23.2, V23.41, V23.49, V23.5, and V23.7 to the ICD-9 diagnoses that support medical necessity section. This revision is effective 04/09/2004


Visit our Privacy Policy if you have any questions.

Copyright © 2004 Palmetto GBA. All Rights Reserved.