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Issue #100 - May 7, 2008 
AAPC

Newly Covered HCPCS Codes
Effective April 1, Centers for Medicare and Medicaid Services (CMS) issued their quarterly update for Level II HCPCS codes, in transmittal R1492. There are four Medicare codes no longer covered and eight newly covered codes under Medicare.

Medicare no longer pays for the following four HCPCS codes:

J7602  Albuterol, all formulations including separated isomers, inhalation solution, FDA-approved final product, non-compounded, administered through DME, concentrated form, per 1 mg (Albuterol) or per 0.5 mg (Levalbuterol)

J7603  Albuterol, all formulations including separated isomers, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose, per 1 mg (Albuterol) or per 0.5 mg (Levalbuterol)

J1751  Injection, iron dextran 165, 50 mg

J1752  Injection, iron dextran 267, 50 mg 

Medicare now pays for the following eight HCPCS codes:

J7611  Albuterol, inhalation solution, FDA-approved final product, non-compounded, administered through DME, concentrated form, 1mg

J7612  Levalbuterol, inhalation solution, FDA-approved final product, non-compounded, administered through DME, concentrated form, 0.5 mg

J7613  Albuterol, inhalation solution, FDA-approved final product, non-compounded, administeredthrough DME, unit dose, 1mg

J7614  Levalbuterol, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose, 0.5 mg

Q4096 Injection, Von Willebrand Factor Complex, human, ristocetin cofactor (not otherwise specified), per i.u. VWF:RCO

Q4097 Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg

Q4098 Injection, iron dextran, 50 mg

Q4099 Formoterol fumarate, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose form, 20 micrograms

View the CMS change request (CR) 5981

Expanded Ways to Participate in PQRI
On April 15 the CMS announced new options under the PQRI program to make it easier to participate.

New options in the PQRI law allows for CMS to offer:

  • Reporting approaches that give you more options to successfully participate.
  • Alternate reporting periods to allow you to begin reporting on July 1, and still receive an incentive payment (1.5 percent of allowable charges for services provided from July 1 through Dec. 31).
  • More options for submitting quality measures data to CMS through a qualified, established clinical data registry, in which you may already be participating. 
  • Removal of the limit (cap) on your incentive for the 2008 reporting period.
For more on new PQRI reporting options, go to: http://www.cms.hhs.gov/PQRI/

Get New ABN Forms
CMS posted a revised Advanced Beneficiary Notice of Non-coverage (ABN) for use when Medicare payment denial is expected. The revised ABN is for providers (including independent laboratories), physicians, practitioners, and suppliers. This ABN replaces the existing ABN-G (form CMS-R-131G), ABN-L (form CMS-R-131L), and NEMB (form CMS-20007).

CMS allows a six-month transition period from the date of implementation, March 3, to use the revised form and instructions. Providers and suppliers should use the revised ABN (CMS-R-131) no later than Sept. 1.

For downloadable ABN forms, instructions, and FAQs, go to: http://www.cms.hhs.gov/BNI/02_ABNGABNL.asp

Decision on DNA Stool Test
for Colorectal Cancer

On Aug. 1, 2007, CMS initiated the national coverage determination (NCD) process by opening a tracking sheet for Screening DNA Stool Test for Colorectal Cancer (CAG-00144N). CMS will not expand the colorectal cancer screening benefit to cover the only commercially available test, PreGen-Plus™, as the FDA requires premarket review of this test. When a commercially available stool DNA test has been cleared or approved by the FDA, CMS will consider a reconsideration request.

Colorectal cancer (CRC) screening with fecal occult blood tests (FOBTs) has been recommended by various professional organizations including the U.S. Preventive Services Task Force (USPSTF). To find out more, go to: http://www.ahrq.gov/clinic/uspstf/uspscolo.htm

View the Screening DNA Stool Test for Colorectal Cancer final decision memo.

Incident to Policy Update
CMS posted transmittal R87BP that provides clarity for services incident to a physician’s or non-physician practitioner’s service in the office setting. The policy goes into effect June 2.

The number of services provided as incident to physician’s or non-physician practitioner’s (NPPs) services has steadily grown. As a response to this growth, the original instructions are insufficient when the benefit is applied in various settings for different services. Change Request (CR) 5288 was published as a response to frequent requests of policy clarification for Part B services provided incident to the services of physicians.

There is no significant change in Medicare policy. The incident to policy update’s intent is to clarify current policy and local interpretations for consistency.

To see how it affects carriers and Medicare administrative contractors (MACs), go to the CMS website.

Test Yourself Online
The Test Yourself questions can be accessed online at www.aapc.com/testyourself/ . Once you go there and take the test, you can automatically grade your answers, correct any mistakes and have your CEUs automatically added to your CEU Tracker for submission.

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