tkermode
Networker
Hello all!
I am being asked to provide a reference to "prove" that 96416 is not correct for chemo pumps for Medicare patients. I am in CA, my MAC is Noridian, and they've retired all their old articles. I checked the Claims Processing Manual and several pages on the Noridian site, and (to my great surprise) came up empty. Any advice?
So far, I have looked in these places:
https://med.noridianmedicare.com/web/jeb/specialties/oncology-hematology - nothing here
https://med.noridianmedicare.com/web/jeb/topics/drugs-biologicals-injections - nadda
https://med.noridianmedicare.com/we...dling-and-unbundling-of-services-and-supplies - zilch
MCD Article A58532 https://localcoverage.cms.gov/mcd_archive/view/article.aspx?articleInfo=58532:49 - zero, and was retired 4/1/2023
CMS Claims Manual Ch. 12, Section 30.5 https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c12.pdf- zip
TR 3595, Change Request 9749 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3595CP.pdf - states code was added, but not that it "must" be used for pumps
MCD Article A52953 https://localcoverage.cms.gov/mcd_archive/view/article.aspx?articleInfo=52953:177&bc=0 - states G0498 must be used for pumps, but was retired 12/31/2020
I am being asked to provide a reference to "prove" that 96416 is not correct for chemo pumps for Medicare patients. I am in CA, my MAC is Noridian, and they've retired all their old articles. I checked the Claims Processing Manual and several pages on the Noridian site, and (to my great surprise) came up empty. Any advice?
So far, I have looked in these places:
https://med.noridianmedicare.com/web/jeb/specialties/oncology-hematology - nothing here
https://med.noridianmedicare.com/web/jeb/topics/drugs-biologicals-injections - nadda
https://med.noridianmedicare.com/we...dling-and-unbundling-of-services-and-supplies - zilch
MCD Article A58532 https://localcoverage.cms.gov/mcd_archive/view/article.aspx?articleInfo=58532:49 - zero, and was retired 4/1/2023
CMS Claims Manual Ch. 12, Section 30.5 https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c12.pdf- zip
TR 3595, Change Request 9749 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3595CP.pdf - states code was added, but not that it "must" be used for pumps
MCD Article A52953 https://localcoverage.cms.gov/mcd_archive/view/article.aspx?articleInfo=52953:177&bc=0 - states G0498 must be used for pumps, but was retired 12/31/2020