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Medicare Coverage Of Percutaneous Image-Guided Lumbar Decompression

The Centers for Medicare & Medicaid Services (CMS) requests Medicare Administrative Contractors (MACs) acknowledge Medicare coverage of Percutaneous Image-guided Lumbar Decompression (PILD) under the Coverage with Evidence Development (CED) paradigm. Coverage applies for beneficiaries with Lumbar Spinal Stenosis (LSS) enrolled in a CMS-approved prospective longitudinal study. Transmittal: https:/​/​www.cms.gov/​Regulations-and-Guidance/​Guidance/​Transmittals/​2017Downloads/​R3787CP.pdf Subject: Percutaneous Image-guided Lumbar Decompression (PILD) for […]

Review Changes To Coordination of Benefits Agreement

The Centers for Medicare & Medicaid Services (CMS) requests Medicare Administrative Contractors (MACs) review changes to the Coordination of Benefits Agreement (COBA) claims crossover process effecting handling in the Common Working File. Full Transmittal: https:/​/​www.cms.gov/​Regulations-and-Guidance/​Guidance/​Transmittals/​2017Downloads/​R3765CP.pdf Subject: Modifications to the Common Working File (CWF) In Support of the Coordination of Benefits Agreement (COBA) Crossover Process Number: […]

Remove Third Party Software From the CCEM

The Centers for Medicare & Medicaid Services (CMS) requests Medicare Administrative Contractors (MACs) remove third party software from the Combined Common Edits/​Enhancements Module (CCEM) and otherwise work with the software and the CCEM to ensure proper integration. Full Transmittal: https:/​/​www.cms.gov/​Regulations-and-Guidance/​Guidance/​Transmittals/​2017Downloads/​R1842OTN.pdf Subject: Remove HSQLDB from the Combined Common Edits/​Enhancements Module (CCEM) Number: 1842 Title: 10088 Release […]

Processing Claims For Oxygen and Oxygen Equipment

The Centers for Medicare & Medicaid Services (CMS) requests Medicare Administrative Contractors (MACs) adjust processing claims for oxygen and oxygen equipment under the Medicare Part B benefit for durable medical equipment as per updates to section 130.6 of chapter 20 of the Medicare Claims Processing Manual (Pub.100-04). FullTransmittal: https:/​/​www.cms.gov/​Regulations-and-Guidance/​Guidance/​Transmittals/​2017Downloads/​R3730CP.pdf Subject: Payment for Oxygen Volume Adjustments […]

Recurring Update Notification For Hospital Outpatient Prospective System

The Centers for Medicare & Medicaid Services (CMS) requests Medicare Administrative Contractors (MACs) review and utilize a Recurring Update Notification which updates the Hospital Outpatient Prospective Payment System (OPPS) and may require changes to the Healthcare Common Procedure Coding System (HCPCS), Ambulatory Payment Classification (APC), HCPCS Modifier, and Revenue Code. Contractors shall manually add and […]

Review Routine Changes to April 2017 Fee Schedule

The Centers for Medicare & Medicaid Services (CMS) requests Medicare Administrative Contractors (MACs) review routine changes to the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule for April 2017. Contractors shall implement any changes in pricing and process claims according to the new guidance. Full Transmittal: https:/​/​www.cms.gov/​Regulations-and-Guidance/​Guidance/​Transmittals/​2017Downloads/​R3729CP.pdf Subject: April Quarterly Update for 2017 […]

Acknowledge Recurring Update Notification

The Centers for Medicare & Medicaid Services (CMS) requests Medicare Administrative Contractors (MACs) acknowledge a Recurring Update Notification for the Ambulatory Surgical Center (ASC) Payment System as well as updates to the Healthcare Common Procedure Coding System (HCPCS). Full Transmittal: https:/​/​www.cms.gov/​Regulations-and-Guidance/​Guidance/​Transmittals/​2017Downloads/​R3726CP.pdf Subject: April 2017 Update of the Ambulatory Surgical Center (ASC) Payment System Number: 3726 Title: […]

Revisions to Cost Reporting Periods

The Centers for Medicare & Medicaid Services (CMS) requests Medicare Administrative Contractors (MACs) review revisions for cost reporting periods ending on or after December31, 2016, according to the Medicare Provider Reimbursement Manual updates given. Full Transmittal: https:/​/​www.cms.gov/​Regulations-and-Guidance/​Guidance/​Transmittals/​2017Downloads/​R14P229.pdf Subject: NEW/​REVISED MATERIAL–EFFECTIVE: Cost reporting periods ending on or after December 31, 2016 Number: 14 Title: N/​A Release […]

Updates To Medicare Physician Fee Schedule Database

The Centers for Medicare & Medicaid Services (CMS) requests that Medicare Administrative Contractors (MACs) review changes to the Medicare Physician Fee Schedule Database (MPFSDB) for April 2017. MACs are instructed to update their systems and send a receipt notification by email to price_file_receipt@cms.hhs.gov, stating the name of the file received and the entity for which […]

Payment For Advanced Care Planning

The Centers for Medicare & Medicaid Services (CMS) requests Medicare Administrative Contractors (MACs) to make payment for Advance Care Planning according to system changes. CMS has made the CPT code 99497 for Advance Care Planning (ACP) separately payable for Medicare OPPS claims when the service meets the criteria for separate payment under OPPS. A Medicare […]