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May Medicare Transmittals and Other Updates

Published on 

Wednesday, May 27, 2020

MEDICARE TRANSMITTALS – RECURRING UPDATES

International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs)—October 2020 Update

  • Article Release Date: May 1, 2020
  • What You Need to Know: Change Request (CR) 11749 provides information about updated ICD-10 conversions as well as coding updates specific to NCDs. In this update new ICD-10-CM codes have been added to NCD 90.2 Next Generation Sequencing.
  • MLN MM11749: https://www.cms.gov/files/document/mm11749.pdf

Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) – July 2020 Update

Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update

  • Article Release Date: May 22, 2020
  • What You Need to Know: CR 11708 is a code update notification indicating when updates to the CARC and RARC lists are made available at the official Accredited Standards Committee (ASC) X12 website.
  • MLN MM11708: https://www.cms.gov/files/document/mm11708.pdf

October 2020 Healthcare Common Procedure Coding System (HCPCS) Quarterly Update Reminder

  • Transmittal Release Date: May 22, 2020
  • What You Need to Know: The complete HCPCS file is updated and released quarterly to the Medicare contractors. The file contains existing, new, revised and discontinued HCPCS codes for the October 2020 quarter. Contractors must download the file via the CMS mainframe in September 2020. The recurring update notification applies to chapter 23, section 20 of the Medicare Claims Processing Manual.
  • Transmittal 10153: https://www.cms.gov/files/document/r10153cp.pdf

 

OTHER MEDICARE TRANSMITTALS

 Modify Edits in the Fee for Service (FFS) System when a Beneficiary has a Medicare Advantage (MA) Plan

  • Article Release Date: May 1, 2020
  • What You Need to Know:
  • Change Request (CR) 11580 modifies Medicare system edits on inpatient claims when a beneficiary’s MA plan becomes effective during the inpatient admission.
  • The CMS is streamlining the editing for MA plans’ claims when it is determined that certain services are being disallowed on MA plans that are considered significant cost. FFS Medicare will pay for services obtained by beneficiaries enrolled in MA plans in this circumstance.
  • MACs will allow Condition Code (CC) 78 on inpatient and outpatient claims for MA beneficiaries when it is determined that certain services are being disallowed on MA plans that are considered a significant cost. An update will occur to any current editing that does not allow this scenario.
  • Condition Code 78 = newly covered Medicare service for which a HMO does not pay.
  • MLN MM11580: https://www.cms.gov/files/document/mm11580.pdf

New Codes for Therapist Assistants Providing Maintenance Programs in the Home Health Setting

  • Article Release Date: May 1, 2020
  • What You Need to Know: CR 11721 details changes to Home Health (HH) billing and processing instructions, including new G-codes describing therapy assistant services. Also included is a correction to the processing of HH claims that receive episode sequence edits.
  • MLN MM11721: https://www.cms.gov/files/document/mm11721.pdf

Medicare Clarifies Recognition of Interstate License Compacts

  • Special Edition Article Release Date: May 5, 2020
  • What You Need to Know: This article clarifies the CMS recognition of interstate license compacts. CMS acknowledges that more compacts may be underway as new legislation is passed but at this time they have determined that interstate license compact for the following provider types will be treated as valid and full licenses for purposes of meeting federal license requirements:
  • Physicians,
  • Physical and Occupational Therapists,
  • Speech Language Therapists,
  • Nurse Practitioners, and
  • MLN Article SE20008: https://www.cms.gov/files/document/SE20008.pdf

Updates to Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) to Correct the Adjustment Process

  • Article Release Date: May 8, 2020
  • What You Need to Know: Change Request 11727 contains updates to Medicare’s claims processing systems to make corrections to processing of adjustments and other billing issues for SNF Patient Driven Payment Model (PDPM) claims. CMS advises you to make sure your billing staffs are aware of these updates.
  • MLN Article MM11727: https://www.cms.gov/2020-mln-matters-articles-0

New Physician Specialty Code for Micrographic Dermatologic Surgery (MDS) and Adult Congenital Heart Disease (ACHD) and a New Supplier Specialty Code for Home Infusion Therapy Services

  • Article Release Date: May 11, 2020
  • What You Need to Know: This article highlights new physician specialty codes for MDS (D7) and ACHD (D8), and a new supplier specialty code for Home Infusion Therapy Services (D6).
  • MLN MM11750: https://www.cms.gov/files/document/MM11750.pdf

Therapy Codes Update

  • Article Release Date: May 15, 2020
  • What You Need to Know: This article includes updates to the list of codes that sometimes or always describe therapy services. Additions to the list reflect changes made in Calendar Year (CY) 2020 for the COVID-19 Public Health Emergency (PHE).
  • MLN MM11791: https://www.cms.gov/files/document/MM11791.pdf

Manual Update Pub. 100.-04, Chapter 38, to Remove Identification of Items or Services Related to the 2010 Oil Spill in the Gulf of Mexico Section

  • Article Release Date: May 15, 2020
  • What You Need to Know: Medicare is removing section 20 (and all of its subsections) of chapter 38 of the Medicare Claims Processing Manual (Identification of Items or Services Related to the 2010 Oil Spill in the Gulf of Mexico). The key impact of this notification is that modifier CS will no longer be used to denote services related to the 2010 oil spill. The effective and implementation date for this change is June 16, 2020.
  • MLN Matters MM11778: https://www.cms.gov/files/document/MM11778.pdf

 

REVISED MEDICARE TRANSMITTALS

Updates to Ensure the Original 1-Day and 3-Day Payment Window Edits are Consistent with Current Policy

  • Date Article Revised: April 30, 2020
  • What You Need to Know: This article was revised to reflect revised Change Request 11559. The CR informs MACs about changes to Medicare Common Working File (CWF) edits to ensure the original 1-Day and 3-Day Payment Window edits’ set and bypass conditions are consistent with current policy. There are no policy changes. Current policy is in the Medicare Claims Processing Manual, Chapter 4, Section 10.12 and Section 40.3.
  • MLN Article MM1159: https://www.cms.gov/files/document/mm11559.pdf

Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) – April 2020 Update

  • Date Article Revised: May 4, 2020
  • What You Need to Know: This article was revised to reflect revisions in CR 11661 issued on May 1, 2020. The following changes were made:
  • The relative value units for codes 99441-99442, and 99443 were revised,
  • Information for codes G2025 and G0071 was added, and
  • The statement at the end of page was updated.
  • MLN MM11661: https://www.cms.gov/files/document/mm11661.pdf

Medicare Continues to Modernize Payment Software

  • Article Release Date: May 19, 2020
  • What You Need to Know: This articles provides information about the CMS efforts to modernize payment grouping and code edit software. Specifically, this article is meant to inform providers that in October 2020, CMS will expand this effort to include the following additional software products:
  • The IRF Case-Mix Group (CMG) Grouper, and
  • The IRF Pricer and PC Pricer.
  • MLN SE20019: https://www.cms.gov/files/document/SE20019.pdf

Claim Status Category Codes and Claim Status Codes Updates

  • Article Release Date: May 22, 2020
  • What You Need to Know: CR 11699 updates the Claim Status and Claim Status Category Codes used for the Accredited Standards Committee (ASC) X12 276/277 Health Care Claim Status Request and Response and ASC X12 277 Health Care Claim Acknowledgment transactions.
  • MLN MM11699: https://www.cms.gov/files/document/mm11699.pdf

 

MEDICARE COVERAGE UPDATES

 

National Coverage Determination (NCD 30.3.3): Acupuncture for Chronic Low Back Pain (cLBP)

  • Article Release Date: May 13, 2020
  • What Your Need to Know: This article informs you that CMS will cover acupuncture for cLBP effective for claims with dates of service on or after January 21, 2020. The article reminds you that acupuncture for fibromyalgia or osteoarthritis is still non-covered by Medicare.
  • MLN MM11755: https://www.cms.gov/files/document/MM11755.pdf

National Coverage Determinations (NCD) 20.19 Ambulatory Blood Pressure Monitoring (ABPM)

  • Date Article Released: May 12, 2020
  • What You Need to Know: For dates of service on and after July 2, 2019, the CMS will cover ABPM for the diagnosis of hypertension in Medicare under updated criteria detailed in this article. The Effective Date was July 2, 2019. The Implementation Date for Local MAC edits is June 16, 2020.
  • MLN MM11650: https://www.cms.gov/files/document/MM11650.pdf

National Coverage Determination (NCD) 160.18 Vagus Nerve Stimulation (VNS)

  • Date Transmittal Released: May 22, 2020
  • What You Need to Know: NCD 160.18, Vagus Nerve Stimulation was initially issued in 1999 to provide coverage for VNS for patients with medically refractory partial onset seizures, for whom surgery is not recommended or for whom surgery had failed. New to this NCD, for claims with a date of service on or after February 15, 2019, the CMS covers FDA-approved VNS devices for treatment-resistant depression through Coverage with Evidence Development (CED) when all reasonable and necessary criteria are met.
  • Transmittal 10145: https://www.cms.gov/files/document/r10145ncd.pdf

 

OTHER MEDICARE UPDATES

MLN Booklet (ICN MLN901623) April 2020: Advanced Practice Registered Nurses, Anesthesiologist Assistants, and Physician Assistants

This MLN Booklet outlines the required healthcare practitioner qualifications and coverage, billing, and payment criteria for Medicare services furnished by:

  • Advanced Practice Registered Nurses (APRNs), including:
  • Certified Registered Nurse Anesthetists (CRNAs)
  • Nurse Practitioners (NPs)
  • Certified Nurse-Midwives (CNMs)
  • Clinical Nurse Specialists (CNSs)
  • Anesthesiology Assistants (AAs), and
  • Physician Assistants (PAs)

Fiscal Year 2021 IPPS and LTCH PPS Proposed Rule

CMS released the FY 2021 IPPS and LTCH PPR Proposed Rule. In a related Fact Sheet CMS indicates the agency’s singular objective is “transforming the healthcare delivery system through competition and innovation to provide patients with better value and results.” CMS is accepting comments on the Proposed Rule through 5 pm EDT on July 10, 2020.

May 7, 2020: Original Medicare (Fee-for-Service) Appeals: Enhanced Opportunity for Submission of 2nd Level of Appeals, Reconsiderations

CMS posted the following announcement on their Original Medicare (Fee-for-Service) Appeals webpage on May 7th: Qualified Independent Contractors (QICs) that process 2nd level Medicare Fee-For-Service (FFS) claim appeals, reconsiderations, on behalf of the Centers for Medicare & Medicaid Services (CMS) have established alternative communication mediums for CMS stakeholders to submit reconsideration requests and related documentation to the QIC. The websites for the respective QIC jurisdictions contain instructions to stakeholders for electronic (e.g., fax or portal) submission of reconsideration requests or documentation.” A table on this page provides guidance regarding the options for submitting reconsiderations and related documentation by QIC jurisdiction.

May 8, 2020: Hospital Outpatient Therapeutic Services That Have Been Evaluated for a Change in Supervision Level

On May 8th, CMS added this document to the available downloads on the CMS Hospital Outpatient PPS 

Webpage. Included in the download is a table providing the level of supervision required for hospital outpatient therapeutic services. Information prior to the table highlights changes made in an interim final rule addressing supervision requirements for non-surgical extended duration services (NSEDTS) and pulmonary rehabilitation services, cardiac rehabilitation services, and intensive cardiac rehabilitation services during the COVID-19 Public Health Emergency (PHE).

Article Author:

This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.