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Medicare Compliance & Reimbursement

CMS TRANSMITTALS:

Avoid Billing Medicare For 78609

Published on Sat Jul 07, 2007

Also: No NPI, no electronic funds.

Heads up: Medicare's Internet-Only Manual (IOM) incorrectly stated that Medicare will pay for brain PET scan code 78609. The IOM also wrongly said Medicare would cover unlisted radiopharmaceutical code A4641 as a "tracer" along with PET scan codes.

New transmittal 1301 (C.R. 5665) corrects the record and makes it clear Medicare won't pay for 78609 and won't cover A4641 with PET scans.

In other recent transmittals:

· The new interest rate for Medicare overpayments and underpayments will be 12.625 percent, according to transmittal 129 (C.R. 5300).

· You won't be allowed to enroll in Electronic Data Interchange (EDI) unless you can obtain at least at least one National Provider Identifier (NPI), says transmittal 1283 (C.R. 5637).

· Medicare will no longer accept claims with the QB or QU modifiers for Health Professional Shortage Area (HPSA) claims because these modifiers stopped being valid on Jan. 1, 2006, according to transmittal 1275 (C.R. 5629).
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