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What's New The Centers for Medicare & Medicaid Services has reposted the recent scheduled release of modifications (Other codes effective July 1, 2009) to the Healthcare Common Procedure Coding System (HCPCS) code set to incorporate corrections. The revised update has been posted to the HCPCS website at http://www.cms.hhs.gov/HCPCSReleaseCodeSets/02_HCPCS_Quarterly_Update.asp We have now posted the slide presentations that were provided by AHRQ and by ECRI at CMS' July 9, 2009 HCPCS Public Meeting for NPWT devices. CMS' preliminary Healthcare Common Procedure Coding System (HCPCS) coding decision and preliminary Medicare Payment decision for negative pressure wound therapy (NPWT) devices is now published in the July 9, 2009 NPWT Public Meeting Agenda. This public meeting affords stakeholders an opportunity to provide input concerning the preliminary decision. The Medicare Improvements for Patients and Providers Act of 2008 required the Secretary to evaluate existing HCPCS codes for NPWT devices to ensure accurate reporting and billing for the items and services under such codes; use an existing process for the consideration of coding changes; and consider all relevant studies and information furnished through the process. CMS partnered with Agency of Healthcare Research and Quality (AHRQ) to commission a review of NPWT devices to ensure all relevant studies and information on NPWT were captured. ECRI Institute solicited information from stakeholders and searched literature in conducting this review. A draft report of their findings was published for comment in April 2009. After analysis of comments received, ECRI concluded that the available evidence does not support significant therapeutic distinction of a NPWT system or component of a system. The report informed CMS' HCPCS workgroup's decision. The final report will be publicly available no later than June 10, 2009 on AHRQ's homepage for the Technology Assessment Program at http://www.ahrq.gov/clinic/techix.htm (See Related Links Outside CMS below). -------------------------------------------------------------------- The Centers for Medicare & Medicaid Services have partnered with the Agency for Healthcare Research and Quality (AHRQ) to commission a review of Negative Pressure Wound Therapy (NPWT) devices. The purpose of this review is to provide information to the Centers for Medicare & Medicaid Services (CMS) for consideration in Healthcare Common Procedure Coding System (HCPCS) coding decisions. Section 154(c) (3) of the Medicare Improvements for Patient and Providers Act of 2008 (MIPPA) calls for the Secretary of Health and Human Services to perform an evaluation of the HCPCS codes for NPWT devices. The HCPCS Level II coding system is a comprehensive, standardized system that classifies similar products that are medical in nature into categories for the purpose of efficient claims processing. Products are classified based on similarities in function and whether the products exhibit significant therapeutic distinctions from other products. This review will facilitate CMS' evaluation of HCPCS coding for NPWT by providing CMS with relevant studies and information for use in consideration of coding changes, as required by the MIPPA legislation. CMS will use this review in its assessment of whether existing HCPCS codes adequately represent the technology and comparative benefits of NPWT devices. This review is one of several that are being conducted for the AHRQ Technology Assessment Program. It will include a review of all available literature on the topic and a solicitation from all interested stakeholders including health care professionals, scientific researchers, wound care organizations, biotech industry, and the patient wound care community for studies and other compelling clinical evidence regarding clinical outcomes associated with NPWT devices. We are particularly interested in those well-conducted clinical trials that describe the comparative benefits of these devices. The solicitation for studies and evidence was made available to industry stakeholders on December 30, 2008, and requested stakeholders provide this information to AHRQ by February 06, 2009. The Centers for Medicare & Medicaid Services is pleased to announce the scheduled release of modifications to the Healthcare Common Procedure Coding System (HCPCS) code set. These changes have been posted to the HCPCS website at http://www.cms.hhs.gov/HCPCSReleaseCodeSets/02_HCPCS_Quarterly_Update.asp . Changes are effective on the date indicated on the update. HCPCS Background Information Each year, in the United States, health care insurers process over 5 billion claims for payment. For Medicare and other health insurance programs to ensure that these claims are processed in an orderly and consistent manner, standardized coding systems are essential. The HCPCS Level II Code Set is one of the standard code sets used for this purpose. The HCPCS is divided into two principal subsystems, referred to as level I and level II of the HCPCS. Level I of the HCPCS is comprised of CPT (Current Procedural Terminology), a numeric coding system maintained by the American Medical Association (AMA). The CPT is a uniform coding system consisting of descriptive terms and identifying codes that are used primarily to identify medical services and procedures furnished by physicians and other health care professionals. These health care professionals use the CPT to identify services and procedures for which they bill public or private health insurance programs. Decisions regarding the addition, deletion, or revision of CPT codes are made by the AMA. The CPT codes are republished and updated annually by the AMA. Level I of the HCPCS, the CPT codes, does not include codes needed to separately report medical items or services that are regularly billed by suppliers other than physicians. Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office. Because Medicare and other insurers cover a variety of services, supplies, and equipment that are not identified by CPT codes, the level II HCPCS codes were established for submitting claims for these items. The development and use of level II of the HCPCS began in the 1980's. Level II codes are also referred to as alpha-numeric codes because they consist of a single alphabetical letter followed by 4 numeric digits, while CPT codes are identified using 5 numeric digits. In October of 2003, the Secretary of HHS delegated authority under the HIPAA legislation to CMS to maintain and distribute HCPCS Level II Codes. As stated in 42 CFR Sec. 414.40 (a) CMS establishes uniform national definitions of services, codes to represent services, and payment modifiers to the codes. Within CMS there is a CMS HCPCS Workgroup which is an internal workgroup comprised of representatives of the major components of CMS, as well as other consultants from pertinent Federal agencies. Prior to December 31, 2003, Level III HCPCS were developed and used by Medicaid State agencies, Medicare contractors, and private insurers in their specific programs or local areas of jurisdiction. For purposes of Medicare, level III codes were also referred to as local codes. Local codes were established when an insurer preferred that suppliers use a local code to identify a service, for which there is no level I or level II code, rather than use a "miscellaneous or not otherwise classified code." The Health Insurance Portability and Accountability Act of 1996 (HIPAA) required CMS to adopt standards for coding systems that are used for reporting health care transactions. We published, in the Federal Register on August 17, 2000 (65 FR 50312), regulations to implement this part of the HIPAA legislation. These regulations provided for the elimination of level III local codes by October 2002, at which time, the level I and level II code sets could be used. The elimination of local codes was postponed, as a result of section 532(a) of BIPA, which continued the use of local codes through December 31, 2003.
Page Last Modified: 08/06/2009 5:40:19 PM
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