October Update to 2010 MPFSDB

Physicians and non-physician practitioners (NPPs) submitting claims for services provided to Medicare beneficiaries should be aware that the Centers for Medicare & Medicaid Services (CMS) issued, Sept. 17, changes to payment files in the 2010 Medicare Physician Fee Schedule Database (MPFSDB). Medicare contractors will process Part B claims using these updated payment files, but are not instructed to automatically adjust claims.

Magnetic Resonance Angiography

The procedure status for CPT® codes 72159 Magnetic resonance angiography, spinal canal and contents, with or without contrast material(s) and 73225 Magnetic resonance angiography, upper extremity, with or without contrast material(s) has changed from noncovered to restricted. This change is effective for service dates on or after June 3. Check your contractor’s local coverage determination (LCD) for policy guidelines.

Indicator Changes

The following indicator changes to Category III codes introduced this summer are effective for service dates on and after July 1:

0223T–0233T Assistant to Surgery Indicator = 9 Concept does not apply

The following indicator changes to CPT® and HCPCS Level II codes are effective Jan. 1:

Multiple Procedure Indicator: 2 Standard multiple surgery criteria applies (Jan. 1, 1996, and after)
Urinary System codes 51725-TC – 51729-TC, 51736-TC, 51741-TC, 51784-TC, 51785-TC, 51792-TC

Multiple Procedure Indicator: 0 Criteria does not apply
Male Genital System codes 54240, 54240-26, 54250, 54250-26
Maternity Care/Delivery codes 59020, 59020-26, 59025, 59025-26

Physician Supervision Diagnostic Indicator: 01 Procedure must be performed under the general supervision of a physician
Radiology codes 76813-TC, 76814-TC

Procedure Status: I Code is not valid for Medicare purposes. Medicare uses another code for the reporting of and payment for these services. (Code NOT subject to a 90 day grace period.)
HCPCS Level II Procedures/Professional Services (Temporary) codes G8443, G8445, G8446

Code Descriptions Changes

The long descriptors for the following codes have been changed:

G0432 Infectious agent antibody detection by enzyme immunoassay (EIA) technique, HIV-1 and/or HIV-2, screening

G0433 Infectious agent antibody detection by enzyme-linked immunosorbent assay (ELISA) technique, HIV-1 and/or HIV-2, screening

G0435 Infectious agent antibody detection by rapid antibody test, HIV-1 and/or HIV-2, screening

Q2025 Fludarabine phosphate, oral, 1 mg

The short descriptor for code G0435 also has been changed to read Rapid immunoassay HIV-1,2.

Source: MLN Matters article MM7112, issued Sept. 17

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2 Responses to “October Update to 2010 MPFSDB”

  1. Linda says:

    My clinic provides service to patient who are hospice patient and a majority who see the the patients are non-physician practitioners. I am having a very hard time getting claims paid and I am not sure what I am doing wrong I do use the GV & GW plus the Q5 modifier. Does any one have idea what is the best way to bill hospice patient when a NPP or MSN or APN see a patient for the doc.

  2. JC says:

    Linda, are you billing under the physicians NPI or does the APRN or PA have their own? If you are seeing the aptient or a non hospice visit then use the GW modifier. In the past when I have billed for PA’s and APRN’s it had to be billed under the Physicians NPI (upin). We recently saw a patient who was hopsice but was seeing us for a non hospice problem. We have a one physician practice, but the visit was billed with the GWm mod and was paid.
    Call your local carrier and find out how they want you to bill it. It may not be denying for the problem of non hospice or practioner. Hope this helps you.

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