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2004 Annual Update 2004 Third Quarterly Update: Due to policy changes, the following coding changes will be implemented: Effective for claims with dates of service on or after January 1, 2004, HCPCS codes L5673 and L5679 will be separately payable by the carrier. For further information, refer to Change Request 3295 (see link below), Transmittal 191, issued May 28, 2004. Effective for claims with dates of service on or after October 1, 2004, HCPCS codes G0329 will be added to the list of therapy codes that cannot be separately paid by the Medicare carriers and must be included in consolidated billing. Effective for claims with dates of service on or after October 1, 2004, HCPCS codes G0237, G0238, G0239, G0302, G0303, G0304, and G0305 will be added to the list of therapy codes that can be separately paid by the Medicare carriers and are not included in consolidated billing. 2004 Second Quarterly Update: There was no second quarterly update. 2004 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, 2004. HCPCS codes 92613, Endoscopy swallow tst (fees) and 92615, Eval laryngoscopy sense tst, will no longer be included as therapy services that have to be consolidated and will be removed from coding file 4. Per the Medicare Physician Fee Schedule, these services are not considered physician services and therefore may still not be separately paid outside of the Prospective Payment Rate provided to the SNF. HCPCS codes 92597, Oral speech device eval and 0020T, Extracorp shock wave tx, ft will be treated as therapy services and will be subject to consolidated billing. These codes will be removed from Coding File 1 and added to Coding File 4 2004 Annual Update: Coding Files 1 and 2 - Coding files 1 and 2 have been updated to reflect new codes that have been developed for 2004. In general, any codes representing physician's professional services have been added to the files as separately payable by the Medicare carrier. In addition, the following new codes have been added as payable for, anesthesia services, chemotherapy drugs, customized prosthetic devices, dialysis related supplies, EPO, Aranesp, and radioisotope services.
Anesthesia Services - 00529, Anesth, Chest Partition View - new code effective 1/01/2004
- 01173, Anesth, FX Repaid, Pelus - new code effective 1/01/2004
- 01958, Anesth, Antepartition Manipul - new code effective 1/01/2004
Chemotherapy Drugs - J9092, Cyclophosphamide 2.0 grm inj - Policy decision to make separately payable for dates of service on or after January 1, 2004
- J9178, Inj, epirubicin hcl, 2 mg - new code effective 1/01/2004
- J9263, Oxaliplatin - new code effective 1/01/2004
Customized Prosthetic Devices - L5681, Intl custm cong/latyp insert - new code effective 1/01/2004
- L5683, Initial custom socket insert - new code effective 1/1/2004
Dialysis Related Supplies - A4671, - Disposable cycler set - new code effective 1/01/2004
- A4672, - Drainage ext line, dialysis - new code effective 1/01/2004
- A4673, - Ext line w easy lock connect - new code effective 1/01/2004
- A4674, - Chem/antisept solution, 8oz - new code effective 1/01/2004
- A4728, - Dialysate solution, non-dex - new code effective 1/01/2004
EPO and Aranesp - Q4054, - Darbopoetin alfa, esrd use - new code effective 1/01/2004
- Q4055, - Epoetin alfa esrd use - new code effective 1/01/2004
Note: Codes Q9920 - Q9940 are discontinued as of December 31, 2003.
Radioisotope Services - A9530, - Th I131 so iodide sol millic - new code effective 1/01/2004
- G3001, - Admin + supply, tositumomab - new code effective 1/01/2004
- 78804, - Tumor imaging, whole body - new code effective 1/01/2004
- 79403, - Hematopoetic nuclear therapy - new code effective 1/01/2004
Coding File 3 - Coding File 3 has been updated with one new code for 2004. - A0800, Amb trans 7 pm - 7 am - new code effective 1/01/2004
Coding File 4 - This file has been updated to add new therapy services that must be consolidated and may not be paid separately by the carrier for beneficiaries in a non-covered Part B skilled nursing facility stay. These services are also not separately payable for beneficiaries in a Part A covered stay and will, therefore, not appear as payable services in files 1, 2 or 3. - G0237, Therapeutic procd strg endur - Policy decision to include as therapy for dates of service on or after January 1, 2004
- G0238, - Oth resp proc, indiv - Policy decision to include as therapy for dates of service on or after January 1, 2004
- G0239, Oth resp proc, group - Policy decision to include as therapy for dates of service on or after January 1, 2004
- G0302, Pre-op service LVRS complete - new code effective 1/01/2004
- G0303, Pre-op service LVRS 10-15dos - new code effective 1/01/2004
- G0304, Pre-op service LVRS 1-9 dos - new code effective 1/01/2004
- G0305, Post op service LVRS min 6 - new code effective 1/01/2004
- 97755, Assistive technology assess - new code effective 1/01/2004
Therapy Codes Separately Payable When Performed By Physicians The following codes will be considered therapy when performed by therapists and included in consolidated billing. They will be separately paid when performed by physicians. | 29065 | 29075 | 29085 | 29086 | 29105 | 29125 | 29126 | | 29130 | 29131 | 29200 | 29220 | 29240 | 29260 | 29280 | | 29345 | 29365 | 29405 | 29445 | 29505 | 29515 | 29520 | | 29540 | 29550 | 29580 | 29590 | 64550 | | |
2004 Carrier Update (Coding Files)
File 1 - Part A Stay - Physician Services (see file below)
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) The professional component of the services represented by these codes are not subject to skilled nursing facility (SNF) consolidated billing 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)
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. 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 (see file below)
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.
Page Last Modified: 01/04/2006 12:00:00 AM
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