2005 Annual Update

2005 Third Quarterly Update

Due to policy changes, the following coding changes were implemented effective for claims with dates of service on or after January 28, 2005.

Effective October 3, 2005, codes:

will automatically be separately payable when submitted with the modifier 26. When brought to their attention, Carriers shall reopen and reprocess claims incorrectly denied that were submitted prior to October 3, 2005.

2005 Second Quarterly Update

Due to policy changes, the following coding changes will be implemented effective for claims with dates of service on or after April 1, 2005.

Coding Files 1 — Prior to January 1, 2005, CMS mistakenly did not include code L5781 as a service to be excluded from SNF. Effective for claims with dates of service on or after January 1, 2003 to December 31, 2004, when brought to their attention DMERCs and FIs shall reopen and reprocess claims with the code L5781 and override timely filing when necessary allowing claims for those services to be paid for prior dates of service. Providers and suppliers cannot collect money from both a SNF and Medicare Part B for the same service, equipment, or device for the same date of service. Suppliers that now receive payment from Medicare Part B are expected in all cases to refund any money they received from the SNF for the same item

In addition, CMS mistakenly left the code L5673 off of the website. However, it is in the payment files and has been paying correctly.

2005 First Quarterly Update

Due to policy changes, the following coding changes will be implemented effective for claims with dates of service on or after April 1, 2005.

The following codes will no longer be considered therapy:

92601	92602	92603	92604	92605	92606	97014
97545	97546

However, the following codes will be separately payable by the carrier:

92601

92602

92603

92604

The following codes shall be considered therapy and shall be subject to consolidated billing:

96110

96111

96115

2005 Annual Update

Note: Coding file 1 was revised on 12/09/2004. The following codes were inadvertently included on this file as separately payable, and, have since been removed.

Anesthesia Services

This code will be added to the excluded anesthesia services for claims with dates of service on or after 1/01/2005.

• 00561, new code effective 1/01/2005

Chemotherapy Drugs

These codes will be added to the excluded chemotherapy drugs for claims with dates of service on or after 1/01/2005.

• J9041, new code effective 1/01/2005
• J9055, new code effective 1/01/2005
• J9305, new code effective 1/01/2005
• J9395, policy decision to add to excluded chemotherapy drugs effective for claims with dates of service on or after 1/01/2005

Chemotherapy Administration

The following codes will be added to the excluded chemotherapy administration codes effective for claims with dates of service on or after 1/01/2005:

*   = Revised on 12/09/2004 to include these codes

Customized Prosthetic Devices

The following are new codes for 2005. They will be added to the excluded list of customized prosthetic devices effective for claims with dates of service on or after 1/01/2005:

Coding File 3 - There are no changes to this file for 2005

Coding File 4

Effective for claims with dates of service on or after 1/01/2005, the following codes will no longer be included as therapy services subject to consolidated billing. They must be billed separately to the Medicare carrier.

Therapy Codes Separately Payable When Performed by Physicians

For claims with dates of service prior to 1/01/2005, the following codes are considered therapy when performed by therapists and are included in consolidated billing. They are separately paid when performed by physicians. Effective for claims with dates of service on or after 1/01/2005, 64550 is the only code considered therapy when performed by therapists and included in consolidated billing, but is separately payable when performed by physicians.

File 1 - Part A Stay - Physician Services Revised: June 2005 (see file below)

Note: Services represented by these codes are not subject to skilled nursing facility (SNF) consolidated billing for Medicare beneficiaries in a SNF Part A covered stay. They should be submitted to the Part B Medicare carrier or Durable Medical Equipment Regional Carrier, as appropriate, for payment consideration.

File 2 - Part A Stay - Professional Components of Services to be Submitted with a 26 Modifier (see file below)

Note: The professional component of the services represented by these codes are not subject to skilled nursing facility (SNF) consolidated bilg and will be considered for payment by the Part B Medicare carrier for Medicare beneficiaries in a SNF Part A stay. These codes must be submitted with a modifier of 26 to indicate "professional component".

File 3 - Part A Stay - Ambulance (see file below)

Note: These are ambulance codes that will always be denied by the Part B Medicare carrier for Medicare beneficiaries in a skilled nursing facility Part A covered stay when submitted with an NN modifier. Effective 10/4/04, per Transmittal 163, these ambulance codes will also be denied when submitted with modifiers ND or DN.

In addition, when not subject to SNF CB, certain codes for drugs and EKG testing provided during an ambulance transport to or from a SNF may be separately payable during the transition to the Ambulance Fee Schedule. (This policy applies only to Method 3 and 4 ambulance suppliers, and only in those areas where suppliers are eligible to bill separately for these services.) Contact your local carrier for additional information.

File 4 - Part B Stay Only - Therapy Services Revised: June 2005 (see file below)

Note: Services represented by these codes are the only services subject to skilled nursing facility (SNF) consolidated billing for Medicare beneficiaries in a SNF Part B stay. The file includes codes for physical, occupational and speech therapy. The Part B Medicare carrier will always deny these codes for Medicare beneficiaries in a SNF Part B stay. Therapy services must be provided and billed under arrangement with the SNF.

Downloads
2005 Carrier Update (coding files) File 1 — Part A Stay — Physician Services (PDF, 161KB)   File 2 — Part A Stay — Professional Components of Services to be Submitted with a 26 Modifier (PDF, 45KB) File 3 — Part A Stay — Ambulance (PDF, 12KB) File 4 — Part B Stay Only — Therapy Services (PDF, 11KB)  Search Instructions (PDF, 315KB)
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