Medicare Billing, Claim Submission Updates
Colorectal screening services may be covered for inpatients under Part B, even though the patient has Part A coverage for the hospital stay, if applicable conditions of coverage are met and the patient has not exceeded frequency limitations. CMS Transmittal 1953 (CR 6760) requires providers to submit claims for colorectal screening services provided to hospital inpatients on a 12X Type of Bill (TOB), in place of 13X TOB effective for dates of service October 1, 2010 and later. Providers should use the discharge date of the hospital stay for the 12X TOB. This applies to the following services when provided to hospital inpatients under Part B, or when Part A benefits have been exhausted: Fecal Occult Blood Test (CPT 82270), Flexible Sigmoidoscopy (G0104), Colonoscopy (G0105 or G0121), Barium Enema as an alternative to other screening tests (G0106, G0120, G0122, or G0328). Continue to use appropriate TOBs for colorectal screening services provided to patients in settings other than hospital inpatient (13X, 14X, 22X, 23X, 83X, and 85X). See the transmittal at the link above or MLN Matters Article MM6760 for more information.
Effective October 1, 2010, providers are no longer required to submit value codes to report the total number of therapy visits when billing for therapy services. CMS Transmittal 1951 (CR 6899) removes the requirement to report the total number of therapy visits using value codes 50 – physical therapy, 51 – occupational therapy, 52 – speech therapy, and 53 – cardiac rehab. See the transmittal at the link above or MLN Matters Article MM6899 for more information.
HCPCS code L8509 describes a trachea-esophageal voice prosthesis inserted in a physician’s office or other outpatient setting by a licensed health care provider. CMS Transmittal 686 (CR 6743) states that effective for dates of service on or after October 1, 2010, claims for HCPCS code L8509 must be submitted to the A/B MAC or Part B carrier, instead of the DME MAC. The A/B MACs and Part B carriers will cover claims for HCPCS code L8509 as a prosthetic device; payment amount will be the lower of the actual charge or the fee schedule amount. Claims for these types of prostheses changed by the patient/caregiver in the home setting (HCPCS code L8507) will continue to be submitted to the DME MACs. See the transmittal at the link above or MLN Matters Article MM6743 for more information.