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2003 Annual Update Coding Files 1 and 2 - Coding files 1 and 2 have been updated to reflect new codes that have been developed for 2003. 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 chemotherapy, customized prosthetic devices, and dialysis related supplies.
Chemotherapy Drugs - J9010, Alemtuzumab, 10mg – new code effective January 1, 2003
Customized Prosthetic Devices - K0556, Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism – Code effective 10/01/2002
- K0557, Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism – Code effective 10/01/2002
- K0558, Addition to lower extremity, below knee/above knee, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code K0556 or K0557) – Code effective 10/01/2002
- K0559, Addition to lower extremity, below knee/above knee, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code K0556 or K0557) – Code effective 10/01/2002
- L5782, Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy duty – Code effective 1//01/2003
- L5848, Addition to endoskeletal, knee-shin system, hydraulic stance extension, dampening feature, adjustable - Code effective 1//01/2003
- L5995, Addition to lower extremity prosthesis, heavy duty feature (for patient weight > 300 lbs) - Code effective 1//01/2003
- L6638, Upper extremity addition to prosthesis, electric locking feature, only for use with manually powered elbow – Code effective 1/01/2003
- L6646, Upper extremity addition, shoulder joint, multipositional locking, flexion, adjustable abduction friction control, for use with body powered or external powered system – Code effective 1/01/2003
- L6647, Upper extremity addition, shoulder lock mechanism, body powered actuator – Code effective 1/01/2003
- L6648, Upper extremity addition, shoulder lock mechanism, external powered actuator – Code effective 1/01/2003
Dialysis Related Supplies - A4653, Peritoneal dialysis catheter anchoring device, belt, each - Code effective 1/01/2003
- A4930, Gloves, sterile, per pair - Code effective 1/01/2003
- A4931, Oral thermometer, reusable, any type, each - Code effective 1/01/2003
Therapy - G0279 – Extracorporeal shock wave therapy; involving elbow epicondylitis - Code effective 1/01/2003
- G0280 - Extracorporeal shock wave therapy; involving other than elbow epicondylitis or plantar fascitis - Code effective 1/01/2003
- 0029T – Treatments (s) for incontinence, pulsed magnetic neuromodulation, per day - Code effective 1/01/2003
- 92601 – Diagnostic analysis of cochlear implant, patient under 7 years of age; with programming - Code effective 1/01/2003
- 92602 - Diagnostic analysis of cochlear implant, patient under 7 years of age; subsequent reprogramming - Code effective 1/01/2003
- 92603 - Diagnostic analysis of cochlear implant, age 7 years or older; with programming - Code effective 1//01/2003
- 92604 - Diagnostic analysis of cochlear implant, age 7 years or older; subsequent reprogramming - Code effective 1/01/2003
- 92607 – Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; first hour - Code effective 1/01/2003
- 92608 - Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; each additional 30 minutes (list separately in addition to code for primary procedure) - Code effective 1/01/2003
- 92609 – Therapeutic services for the use of speech-generating device, including programming and modification – Code effective 1/01/2003
- 92610 – Evaluation of oral and pharyngeal swallowing function – Code effective 1/01/2003
- 92611 – Motion fluoroscopic evaluation of swallowing function by cine or video recording – Code effective 1/01/2003
- 92612 – Flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording – Code effective 1/01/2003
- 92614 - Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing by cine or video recording – Code effective 1/01/2003
- 92616 - Flexible fiberoptic endoscopic evaluation of swallowing and laryngeal sensory testing by cine or video recording – Code effective 1/01/2003
Chemotherapy Drugs Mistakenly Included as Separately Payable Effective January 1, 2003 for claims with dates of service on or after April 1, 2001, the following codes are no longer separately payable by the carrier. These codes were not specifically listed in the legislation and, therefore, should never have been allowed to pay separately by the carrier for skilled nursing facility consolidated billing purposes. - J9092, Cyclophospamide, 2.0 gram. J9160, Denileukin Diftitox, 300 mcg
- J9180, Epirubicin Hydrochloride, 50 mg
- J9355, Trastuzumab, 10 mg
- J9357, Valrubicin, Intrav3esical, 200 mg
Therapy Codes Separately Payable When Performed by Physicians Prior to this update, the therapy codes listed below were never separately payable, regardless of the type of provider rendering the service. On January 1, 2003, the files will be updated to reflect that these services may be separately payable when performed by a physician. Physicians that received denials for these services with dates of service on or after 4/1/01 through 12/31/02 should contact their Medicare carrier to have the claims reopened and correctly adjudicated. | 29065 | 29075 | 29085 | 29200 | 29345 | | 29365 | 29405 | 29445 | 29505 | 29515 |
Correction for Preventive Services to Coding Files 1 and 2
Prior to this update, the Medicare carriers would not pay separately for the professional components of a number of preventive services. Effective January 1, 2003, the professional component of the following services will pay separately by the carrier. Providers that received denials for these services with dates of service on or after 4/1/01 through 12/31/02 for beneficiaries in a Part A covered skilled nursing facility stay should contact their Medicare carrier to have the claims reopened and correctly adjudicated.
- Colorectal Screening - G0104, G0105, G0106, G0120, G0121
- Prostate – G0102
- Pap Smear – G0101, Q0091
- Bone Mass – G0130, 76076, 76078, 78350
- Glaucoma Screening – G0117, G0118
April Quarterly Update No changes were made for this quarterly update. July Quarterly Update No changes were made for this quarterly update. October Quarterly Update Effective March 1, 2003, the payment status on the Medicare Physician Fee Schedule for procedure code 92597, Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech, changed from "Not valid for Medicare purposes" to "Active." Effective October 1, 2003, the SNF consolidated billing code files will be updated to reflect that procedure code 92597 is considered part of the therapy services that cannot be separately paid by the Medicare carrier. Payment for this service is included in the payment made to the SNF. 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. There are additional situations in which ambulance services are consolidated. Coding File 3 - There were no changes for 2003 to File 3 for ambulance services. 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. 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.) Diagnostic Services Separately Payable for Beneficiaries Receiving Treatment for End Stage Renal Disease On December 13, 2002, CMS published PM AB-02-175, "Revisions to Common Working File Edits for Skilled Nursing Facility (SNF) Consolidated Billing (CB) to Permit Payment for Certain Diagnostic Services Furnished to Beneficiaries Receiving Treatment for End Stage Renal Disease at an Independent or Provider-Based Dialysis Facility." This PM implements changes to the editing of claims to permit separate payment for claims for dialysis-related diagnostic furnished to an End Stage Renal Disease beneficiary not withstanding that such beneficiary is in a SNF Part A stay. CMS will bypass the SNF CB edits for claims received on or after April 1, 2003, with line items that contain the "CB" modifier for dates of services April 1, 2001 and later. Please see PM AB-02-175 (see PM below) for more details and specifics on the payment policy and processing requirements for claims. New Requirements for Claims for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) On November 8, 2002, CMS published PM B-02-87, "Skilled Nursing Facility (SNF) Consolidated Billing - New Requirements for Claims for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies". This PM clarifies CMS' position on claims for DMEPOS claims with dates of service that coincide with an inpatient Part A SNF stay. For purposes of SNF consolidated billing crossover edits, CWF and Durable Medical Equipment Regional Carriers (DMERCs) will deny DMEPOS claims received on or after April 1, 2003 only in those situations where the date of service on the claim falls within the beneficiary's Part A SNF stay (not including the date the beneficiary is discharged from the Part A SNF stay). For span-dated items (e.g., capped rental claims), the supplier can re-bill on the date the beneficiary is discharged from the SNF Part A stay. The date the supplier re-bills (i.e., the date of discharge from the SNF Part A stay) will become the date of service ("from" date on a claim form) for all subsequent claims. Please see PM B-02-087 (see PM below) for more details and examples.
Page Last Modified: 01/04/2006 12:00:00 AM
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