MPFS Payment Files Updated for July
- By admin aapc
- In Billing
- June 18, 2012
- Comments Off on MPFS 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) Final Rule and the Middle Class Tax Relief and Job Creation Act of 2012. The latter legislation extended through Dec. 31, 2012 the zero percent update mandated in the Temporary Payroll Tax Cut Continuation Act of 2011, which curtailed a Medicare reimbursement rate reduction of 27.4 percent scheduled to take place Jan. 1, 2012.CMS transmittal 2481 instructs contractors to update their payment files to incorporate the following changes:
New HCPCS Level II codes effective April 1, 2012:
| HCPCS | Long Descriptor |
| G8907 | Patient documented not to have experienced any of the following events: a burn prior to discharge; a fall within the facility; wrong site/side/patient/procedure/implant event; or a hospital transfer or hospital admission upon discharge from the facility |
| G8908 | Patient documented to have received a burn prior to discharge |
| G8909 | Patient documented not to have received a burn prior to discharge |
| G8910 | Patient documented to have experienced a fall within ASC |
| G8911 | Patient documented not to have experienced a fall within ASC |
| G8912 | Patient documented to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event |
| G8913 | Patient documented not to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event |
| G8914 | Patient documented to have experienced a hospital transfer or hospital admission upon discharge from ASC |
| G8915 | Patient documented not to have experienced a hospital transfer or hospital admission upon discharge from ASC |
| G8916 | Patient with preoperative order for IV antibiotic surgical site infection (SSI) prophylaxis, antibiotic initiated on time |
| G8917 | Patient with preoperative order for IV antibiotic surgical site infection (SSI) prophylaxis, antibiotic not initiated on time |
| G8918 | Patient without preoperative order for IV antibiotic surgical site infection (SSI) prophylaxis |
Medicare contractors will only adjust claims processed before July 2 that are impacted with the addition of these ASC measurement G codes if such claims are brought to their attention.
Codes with revised MPFS payment indicators (PI):
| Code | Short Descriptor | Change Effective July 1 |
| J1680 | Human fibrinogen conc inj | Procedure status: I (Not valid for Medicare purposes) |
| J9001 | Doxorubicin hcl liposome inj | Procedure status: I |
| 15777 | Acellular derm matrix implt | Bilateral indicator: 1 |
| 38205 | Harvest allogeneic stem cells | Short descriptor correction – AMA errata |
| 57155 | Insert uteri tandem/ovoids | Short descriptor correction – AMA errata |
| 94729 | CO diffuse capacity | Short descriptor correction – AMA errata |
New HCPCS Level II codes to be added to the MPFSDB effective July 1:
| HCPCS | Long Descriptor |
| Q2034 | Influenza virus vaccine, split virus, for intramuscular use (Agriflu) |
| Q2045 | Injection, human fibrinogen concentrate, 1 mg |
| Q2046 | Injection, aflibercept, 1 mg |
| Q2048 | Injection, doxorubicin hydrochloride, liposomal, doxil, 10 mg |
| Q2049 | Injection, doxorubicin hydrochloride, liposomal, imported lipodox, 10 mg |
New Category III codes effective July 1:
| CPT® | Long Descriptor |
| 0302T | Insertion or removal and replacement of intracardiac ischemia monitoring system including imaging supervision and interpretation when performed and intra-operative interrogation and programming when performed; complete system (includes device and electrode) |
| 0303T | Insertion or removal and replacement of intracardiac ischemia monitoring system including imaging supervision and interpretation when performed and intra-operative interrogation and programming when performed; electrode only |
| 0304T | Insertion or removal and replacement of intracardiac ischemia monitoring system including imaging supervision and interpretation when performed and intra-operative interrogation and programming when performed; device only |
| 0307T | Removal of intracardiac ischemia |
| 0308T | Insertion of ocular telescope prosthesis including removal of crystalline lens |
MLN Matters article MM7844 is also available for you to reference.
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