NOTE: Should you have landed here as a result of a search ...File/June_2019_Advisory_JMB.pdf ·...

71
NOTE: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material that is copyrighted by the American Medical Association. You are forbidden to download the files unless you read, agree to, and abide by the provisions of the copyright statement. Read the copyright statement now and you will be linked back to here.

Transcript of NOTE: Should you have landed here as a result of a search ...File/June_2019_Advisory_JMB.pdf ·...

  • NOTE: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material that is copyrighted by the American Medical Association. You are forbidden to download the files unless you read, agree to, and abide by the provisions of the copyright statement. Read the copyright statement now and you will be linked back to here.

    http://www.palmettogba.com/viewamalicensehttp://www.palmettogba.com/viewamalicense

  • JM PART B MEDICARE ADVISORYLatest Medicare News for JM Part B What’s Inside...

    Administration Help Us Improve/Enhance Our Website ................................................................................. 3 Get Your Medicare News Electronically

    Medicare Summary Notice (MSN) Changes to Assist Beneficiaries Enrolled in the

    ................................................................................ 4 CMS Quarterly Provider Update ............................................................................................ 6 Medicare Beneficiary Identifier (MBI) Look-up Tool ............................................................ 7

    Qualified Medicare Beneficiary (QMB) Program ............................................................... 9 New Patient Office or Other Outpatient Visits eCBR Now Available .................................. 11 Reporting the HCPCS Level II Modifiers of the Patient Relationship Categories

    and Codes ......................................................................................................................... 12 Proper Use of Modifier 59 .................................................................................................... 14 Additional Processing Instructions to Update the Standard Paper Remit (SPR) .................. 21 Claim Status Category and Claim Status Codes Update ...................................................... 23

    Drugs and Biologicals Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological

    Code Changes – July 2019 Update.................................................................................... 25

    Education Educational Events Where You Can Ask Questions ............................................................. 27

    Electronic Data Interchange (EDI) Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC),

    Medicare Remit Easy Print (MREP) and PC Print Update ............................................... 29

    Fee Schedules and Reimbursement Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) -

    July 2019 Update ............................................................................................................... 31 Medicare Physician Fee Schedule Database File Record Layout ......................................... 34

    Continued >>

    palmettogba.com/jmb

    The JM Part B Medicare Advisory contains coverage, billing and other information for Part B. This information is not intended to constitute legal advice. It is our official notice to those we serve concerning their responsibilities and obligations as mandated by Medicare regulations and guidelines. This information is readily available at no cost on the Palmetto GBA website. It is the responsibility of each facility to obtain this information and to follow the guidelines. The JM Part B Medicare Advisory includes information provided by the Centers for Medicare & Medicaid Services (CMS) and is current at the time of publication. The information is subject to change at any time. This bulletin should be shared with all health care practitioners and managerial members of the provider staff. Bulletins are available at no-cost from our website at https://www.PalmettoGBA.com/JMB.

    CPT only copyright 2018 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee sched-ules, relative value units, conversion factors and/or related components are not assigned by the AMA, and are not part of CPT®, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. The Code on Dental Procedures and Nomenclature is published in Current Dental Terminology (CDT), Copyright © 2018 American Dental Association (ADA). All rights reserved.

    June 2019 Volume 2019, Issue 6

    https://www.PalmettoGBA.com/JMB

  • MedicineDocumentation of Evaluation and Management Services of Teaching Physicians ......................................................35 International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National

    Coverage Determination (NCDs) ..............................................................................................................................36

    ChiropracticMedicare Coverage for Chiropractic Services – Medical Record Documentation Requirements for Initial and

    Subsequent Visits .....................................................................................................................................................38 Use of the AT modifier for Chiropractic Billing (New Information Along with Information in MM3449) ................45 Educational Resources to Assist Chiropractors with Medicare Billing .......................................................................49

    LaboratoryRe-implementation of the AMCC Lab Panel Claims Payment System Logic .............................................................54 Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge

    Payment .....................................................................................................................................................................56

    EtceteraMedical Director’s Desk ...............................................................................................................................................61 MLN Connects ..............................................................................................................................................................69

    CMS Provider Minute Videos

    The Medicare Learning Network has a series of CMS Provider Minute Videos (https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/MLN-Multimedia.html) on a variety of topics, such as psychiatry, preventive services, lumbar spinal fusion, and much more. The videos offer tips and guidelines to help you properly submit claims and maintain sufficient supporting documentation. Check the site often as CMS adds new videos periodically to further help you navigate the Medicare program.

    CPT codes, descriptors and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2018 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

    2 6/2019

    https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/MLN-Multimedia.html

  • Help Us Improve/Enhance Our Website We need your help to enhance the Palmetto GBA website. As a valued website visitor, only you know what information and tools are needed to assist you with your work.

    Your input is important to us. Please complete the short survey sponsored by CMS and conducted by ForeSee Results. It represents your voice and provides us with detailed information on the types of services you like, want, or are dissatisfied with on the website. Please be specific in your evaluation of the website. Your detailed answers help us get it right.

    Palmetto GBA strives to enhance your experience with our website providing accurate, detailed and current information. With the content changing daily, it’s best to access the website regularly to ensure you have the most current information. We have found that some visitors print old forms and articles that may have become obsolete, so it’s important to visit often.

    If you have taken the survey in the past, thank you. We have used those results to add many new features to help you diagnose and fix claim denials, stay in compliance with Medicare regulations, and ultimately, better serve your patients.

    We encourage you to complete this survey and appreciate your feedback. Each new idea, self-service tool, and article depends on you, and your participation in our Foresee survey.

    Please complete the survey today! (https://survey.foreseeresults.com/survey/display?cid=wtsU0tp0khBZxlUgcpcMxA==&sid=link-palmetto-jm)

    CPT codes, descriptors and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2018 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

    3 6/2019

    https://survey.foreseeresults.com/survey/display?cid=wtsU0tp0khBZxlUgcpcMxA==&sid=link-palmetto-jm

  • Get Your Medicare News Electronically The Palmetto GBAMedicare listserv is a wonderful communication tool that offers its members the opportunity to stay informed about: • Medicare incentive programs • Fee Schedule changes • New legislation concerning Medicare • And so much more!

    How to register to receive the Palmetto GBA Medicare Listserv: Go to http://tinyurl.com/PalmettoGBAListserv and select “Register Now.” Complete and submit the online form. Be sure to select the specialties that interest you so information can be sent.

    Note: Once the registration information is entered, you will receive a confirmation/welcome message informing you that you’ve been successfully added to our listserv. You must acknowledge this confirmation within three days of your registration.

    eServices Eligibility eServices, by Palmetto GBA, allows you to search for patient eligibility, which is a functionality of HETS. HETS requires you to enter beneficiary last name and Medicare ID Number, in addition to either the birth date or first name. See options below:

    • Medicare ID Number, Last Name, First Name, Birth Date • Medicare ID Number, Last Name, Birth Date • Medicare ID Number, Last Name, First Name

    For more information about eServices and the many services it offers, please visit our website at http://www.PalmettoGBA.com/eServices.

    CPT codes, descriptors and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2018 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

    4 6/2019

    http://tinyurl.com/PalmettoGBAListservhttp://www.PalmettoGBA.com/eServices

  • Medicare Learning Network® (MLN) Want to stay informed about the latest changes to the Medicare Program? Get connected with the Medicare Learning Network® (MLN) – the home for education, information, and resources for health care professionals.

    The Medicare Learning Network® is a registered trademark of the Centers for Medicare & Medicaid Services (CMS) and the brand name for official CMS education and information for health care professionals. It provides educational products on Medicare-related topics, such as provider enrollment, preventive services, claims

    processing, provider compliance, and Medicare payment policies. MLN products are offered in a variety of formats, including training guides, articles, educational tools, booklets, fact sheets, web-based training courses (many of which offer continuing education credits) – all available to you free of charge!

    The following items may be found on the CMS web page at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/index.html • MLN Catalog: is a free interactive downloadable document that lists all MLN products by media format. To

    access the catalog, scroll to the “Downloads” section and select “MLN Catalog.” Once you have opened the catalog, you may either click on the title of a product or you can click on the type of “Formats Available.” This will link you to an online version of the product or the Product Ordering Page.

    • MLN Product Ordering Page: allows you to order hard copy versions of various products. These products are available to you for free. To access the MLN Product Ordering Page, scroll to the “Related Links” and select “MLN Product Ordering Page.”

    • MLN Product of the Month: highlights a Medicare provider education product or set of products each month along with some teaching aids, such as crossword puzzles, to help you learn more while having fun!

    Other resources: • MLN Publications List: contains the electronic versions of the downloadable publications. These products

    are available to you for free. To access the MLN Publications go to: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/MLN-Publications.html. You will then be able to use the “Filter On” feature to search by topic or key word or you can sort by date, topic, title, or format.

    MLN Educational Products Electronic Mailing List To stay up-to-date on the latest news about new and revised MLN products and services, subscribe to the MLN Educational Products electronic mailing list! This service is free of charge. Once you subscribe, you will receive an e-mail when new and revised MLN products are released.

    To subscribe to the service: 1. Go to https://list.nih.gov/cgi-bin/wa.exe?A0=mln_education_products-l and select the ‘Subscribe or

    Unsubscribe’ link under the ‘Options’ tab on the right side of the page. 2. Follow the instructions to set up an account and start receiving updates immediately – it’s that easy!

    If you would like to contact the MLN, please email CMS at [email protected].

    CPT codes, descriptors and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2018 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

    5 6/2019

    https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/index.htmlhttps://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/MLN-Publications.htmlhttps://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/MLN-Publications.htmlhttps://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/MLN-Publications.htmlhttps://list.nih.gov/cgi-bin/wa.exe?A0=mln_education_products-lmailto:[email protected]

  • CMS Quarterly Provider Update The Quarterly Provider Update is a comprehensive resource published by the Centers for Medicare & Medicaid Services (CMS) on the first business day of each quarter. It is a listing of all non-regulatory changes to Medicare including program memoranda, manual changes and any other instructions that could affect providers. Regulations and instructions published in the previous quarter are also included in the update. The purpose of the Quarterly Provider Update is to: • Inform providers about new developments in the Medicare program • Assist providers in understanding CMS programs and complying with Medicare regulations and instructions • Ensure that providers have time to react and prepare for new requirements • Announce new or changing Medicare requirements on a predictable schedule • Communicate the specific days that CMS business will be published in the ‘Federal Register’

    To receive notification when regulations and program instructions are added throughout the quarter, sign up for the Quarterly Provider Update listserv (electronic mailing list) at https://public.govdelivery.com/accounts/USCMS/subscriber/new?pop=t&qsp=566.

    We encourage you to bookmark the Quarterly Provider Update Web site at www.cms.gov/Regulations-and-Guidance/Regulations-and-Policies/QuarterlyProviderUpdates/index. html and visit it often for this valuable information.

    CPT codes, descriptors and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2018 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

    6 6/2019

    https://public.govdelivery.com/accounts/USCMS/subscriber/new?pop=t&qsp=566http://www.cms.gov/Regulations-and-Guidance/Regulations-and-Policies/QuarterlyProviderUpdates/index

  • Medicare Beneficiary Identifier (MBI) Look-up Tool The Medicare Beneficiary Identifier (MBI) Look-up tool allows providers to use our secure eServices online portal to obtain the new MBI number when patients do not present their Medicare card. The MBI Look-up tool will only return an MBI if the new Medicare card has been mailed to avoid potential confusion if the MBI is used before the beneficiary receives their new Medicare card.

    As background, the New Medicare Card Project, was established in the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 which mandates the removal of the Social Security Number (SSN)-based Health Insurance Claim Number (HICN) from Medicare cards by April 2019. CMS began mailing new Medicare cards with the MBI on April 2, 2018. The Railroad Retirement Board mailed new Medicare cards with the MBI to all Railroad Medicare beneficiaries in June 2018.

    From April 1, 2018 to December 31, 2019, CMS will offer a transition period during which the system will accept both HICNs and MBIs on Medicare transactions (including eligibility requests and claims) for beneficiaries in the Medicare program prior to April 1, 2018 (i.e., those who received a HICN on their Medicare card). Note: Providers should not submit both numbers on the same transaction.

    Beginning in January 2020, physicians may only use MBIs, with limited exceptions.

    When the new Medicare card is mailed to people with Medicare, you will be able to use the eServices MBI Look-Up Tool to obtain a patient’s MBI. To submit an inquiry you must do the following: • Once logged into eServices, click on the MBI LOOKUP tab located in the header of the portal • Complete the required* fields:

    • Beneficiary’s Last Name • First Name • Date of birth and • Social security number. NOTE: The social security number must be in the XXX-XX-XXXX format

    • To meet our CAPTCHA requirements, you must select the I’M NOT A ROBOT checkbox • Click SUBMIT INQUIRY

    Continued >> CPT codes, descriptors and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2018 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

    7 6/2019

  • g p

    g p p

    g p p

    Figure 1: MBI Lookup Tab

    Look-Up Tool Status Results If the inquiry successfully returns an MBI, the screen will refresh with the data at the bottom.

    Figure 2: MBI Lookup Successful Response Screenshot

    In the event that your MBI lookup request does not result in a successful response, eServices will display error messages to assist you. If any required fields are left blank or are not in a proper format, a message will appear advising you which fields to correct.

    Figure 3: MBI Lookup Unsuccessful Response Screenshot

    Ch eck the CMS New Medicare Card Project Outreach & Education webpage at https://www.cms.gov/Medicare/ New-Medicare-Card/Outreach-and-Education/Outreach-and-education.html and the Medicare Beneficiary Identifier (MBI) Look-up Tool Clarification article at https://www.cms.gov/Outreach-and-Education/Outreach/ FFSProvPartProg/Downloads/2018-05-17-eNews.pdf for additional information.

    CPT codes, descriptors and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2018 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

    8 6/2019

    https://www.cms.gov/Medicare/New-Medicare-Card/Outreach-and-Education/Outreach-and-education.htmlhttps://www.cms.gov/Outreach-and-Education/Outreach/FFSProvPartProg/Downloads/2018-05-17-eNews.pdf

  • Medicare Summary Notice (MSN) Changes to Assist Beneficiaries Enrolled in the Qualified Medicare Beneficiary

    (QMB) Program MLN Matters Number: MM11230 Related CR Release Date: May 3, 2019 Related CR Transmittal Number: R4290CP Related Change Request (CR) Number: 11230 Effective Date: October 1, 2019 Implementation Date: October 7, 2019 for claims processed on or after this date

    Provider Type Affected This MLN Matters Article is for providers and suppliers who serve Qualified Medicare Beneficiaries (QMBs).

    What You Need To Know CR 11230 alerts providers of further modifications to Medicare’s claims processing systems to ensure that the Medicare Summary Notice (MSN) appropriately differentiates between QMB claims that are paid and denied and to show accurate patient payment liability amounts for beneficiaries enrolled in QMB. Please make sure your billing staffs are aware of these modifications.

    Background Through CRs 9911 and 10433, the Centers for Medicare & Medicaid Services (CMS) modified its claims processing systems to identify the QMB status of beneficiaries and exemption from Medicare Parts A and B cost-sharing charges. Articles related to CRs 9911 and 10433 are available at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/ Downloads/MM9911.pdf and https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10433.pdf, respectively.

    The QMB program is a State Medicaid benefit that assists low-income Medicare beneficiaries with Medicare premiums and cost sharing, including deductibles, coinsurance, and copays. In 2016, there were 7.5 million individuals (more than one out of eight beneficiaries) enrolled in the QMB program. Some QMBs (22 percent) get state Medicaid assistance with Medicare premiums and cost sharing alone, but most (78 percent) simultaneously have full Medicaid coverage, which may cover care for services that Medicare does not cover.

    Federal law bars Medicare providers and suppliers from billing an individual enrolled in the QMB program for Medicare Part A and Part B cost sharing for covered items and services. (See Sections 1902(n)(3)(B), 1902(n) (3)(C), 1905(p)(3), 1866(a)(1)(A), and 1848(g)(3)(A) of the Social Security Act [the Act]). The QMB system updates are part of CMS’ongoing efforts to help providers comply with QMB billing prohibitions. The updates also educate QMBs that they cannot be billed for Medicare deductibles and coinsurance.

    As implemented through CRs 9911 and 10433, the Common Working File (CWF) identifies that a beneficiary has active QMB status, which results in Remittance Advice (RA) and Medicare Summary Notice (MSN) messages for QMB claims.

    Continued >> CPT codes, descriptors and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2018 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

    9 6/2019

    https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9911.pdfhttps://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10433.pdf

  • The RA includes two (2) Alert Remittance Advice Remark Codes (RARCs) that identify an individual currently enrolled in QMB and tells providers they may not collect deductible and coinsurance amounts from these beneficiaries. The RAs contain the QMB RARCs only in conjunction with paid claims generating Claim Adjustment Group Code Patient Responsibility (PR) and Claim Adjustment Reason Codes (CARC) 1, 2, and 66, and report Medicare deductible and coinsurance amounts so that coordination of benefits activities may result using copies of RAs if necessary.

    The MSN generated for all QMB individuals includes information regarding their QMB status and lack of liability for Medicare cost-sharing amounts for covered Parts A and B items and services However, CMS has recently learned that the claims processing systems do not differentiate between paid and fully denied claims or denied service lines, and initiate the changes whenever an individual is enrolled in QMB. .

    CR 11230 includes the following modifications to the claims processing systems to ensure that the MSNs appropriately differentiate between QMB claims that are paid and denied:

    MSNs with QMB claims that are paid • If an MSN includes at least one detail line for a QMB that contains an allowed amount greater than zero,

    page one (the summary page), will use MSN Message 62.0 to briefly explain the QMB billing protections (in the “Be Informed!” section).

    • Also, on page one, the patient’s total liability amount (in the “Total You May Be billed” field) will omit the deductible and coinsurance amounts for details lines that are for a QMB and include an allowed amount greater than zero.

    • Further, in the claims detail section of the MSN, if the detail line is for a QMB and includes an allowed amount greater than zero, such detail line will reflect $0 (in the “Maximum You May Be Billed” field) and include message 62.1 that informs the beneficiary of her/his QMB status and billing protections.

    MSNs with QMB claims that are denied (and also rejected for Fiscal Intermediary Standard System (FISS)) • In the claim detail pages of the MSN, if a detail line is for a QMB and contains an allowed amount of zero,

    the MSN: • Will reflect the beneficiary’s total liability amount in the “Maximum You May Be Billed” field and • Include new MSN 11.21 message to inform the beneficiary that even though Medicare has denied the

    claim, Medicaid may pay for the care. • Since most QMBs also have full Medicaid coverage, it’s important to convey that their full Medicaid

    coverage may cover care that Medicare has denied.

    Note: For supplier claims processed by VIPS Medicare System (VMS), if a detail line is flagged as QMB and contains an allowed amount of zero, and the beneficiary has not signed an Advance Beneficiary Notice or is subject to Waiver of Liability which has not been attached, the Medicare Administrative Contractor (MAC) will not print MSN message 11.21.

    Continued >> CPT codes, descriptors and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2018 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

    10 6/2019

  • Additional Information The official instruction, CR11230, issued to your MAC regarding this change is available at https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019Downloads/R4290CP.pdf.

    If you have questions, your MACs may have more information. Find their website at http://go.cms.gov/MAC-website-list.

    For more information, refer to the Qualified Medicare Beneficiary (QMB) Program at: https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/QMB.html

    Document History Date of Change Description May 7, 2019 Initial article released.

    New Patient Office or Other Outpatient Visits eCBR Now Available

    Comparative Billing Reports (CBRs) are an educational tool you can use to examine your billing patterns and utilization of services in comparison to your peers. eCBRs (electronic CBRs) are located in our free provider portal, eServices, and can be viewed and downloaded online. Our newest eCBR focuses

    on providers who have submitted claims for New Patient Office or other Outpatient Visit Evaluation and Management (E/M) Services (CPT codes 99201-99205). If you bill these codes, then this eCBR is for you!

    Get your personalized eCBR results on New Patient Visit (E/M) Services (CPT codes 99201-99205) by logging into eServices today at www.PalmettoGBA.com/eServices. An eCBR is available for providers who have at least 10 calims in history for this CPT code family during the time period selected.

    CPT codes, descriptors and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2018 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

    11 6/2019

    https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019Downloads/R4290CP.pdfhttp://go.cms.gov/MAC-website-listhttps://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-O%EF%AC%83ce/QMB.htmlhttp://www.PalmettoGBA.com/eServices

  • Reporting the HCPCS Level II Modifiers of the Patient Relationship Categories and Codes

    MLN Matters Number: MM11259 Related CR Release Date: May 10, 2019 Related CR Transmittal Number: R2300OTN Related Change Request (CR) Number: 11259 Effective Date: January 1, 2018 Implementation Date: August 12, 2019

    Provider Types Affected This MLN Matters Article is for physicians, providers and suppliers billing Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.

    Provider Action Needed CR 11259 advises and provides educational information regarding reporting of the HCPCS Level II code modifiers for the Patient Relationship Categories and Codes (PRC). CR 11259 contains advice and educational information for MACs and clinicians reporting the PRC. Make sure your billing staffs are aware of this information.

    Background Section 1848(r)(3) of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires the development of PRC codes to help the attribution of patients and episodes to one or more physicians or applicable practitioners (clinicians) for purposes of cost measurement. Section 1848(r)(4) of the Act requires clinicians, as determined appropriate by the Secretary, to include the applicable PRC codes on claims for items and services furnished on or after January 1, 2018.

    During this initial period of implementation, reporting of the PRC on claims is voluntary. In the future, it will be mandatory and tied to cost measures preceded by rulemaking. As of January 1, 2018, Medicare Part B Merit-Based Incentive Payment System (MIPS)-eligible clinicians may now report their patient relationships on Medicare claims using the PRC codes.

    Below is the description of the PRC Code Modifiers X1, X2, X3, X4 and X5: • X1 - Continuous/Broad services = For reporting services by clinicians who provide the principal care for

    a patient, with no planned endpoint of the relationship • X2- Continuous/Focused services = For reporting services by clinicians whose expertise is needed for the

    ongoing management of a chronic disease or a condition that needs to be managed and followed for a long time.

    • X3 -Episodic/Broad services = For reporting services by clinicians who have broad responsibility for the comprehensive needs of the patients, that is limited to a defined period and circumstance, such as a hospitalization.

    • X4 - Episodic/Focused services = For reporting services by specialty focused clinicians who provide time-limited care. The patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention.

    Continued >> CPT codes, descriptors and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2018 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

    12 6/2019

  • • X5 - Only as Ordered by Another Clinician = For reporting services by a clinician who furnishes care tothe patient only as ordered by another clinician. This patient relationship category is reported for patientrelationships that may not be adequately captured in the four categories described above.

    These categories encompass different scenarios. Information materials on requirements, scenarios and reporting of these code modifiers is available at https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/value-based-programs/ macra-mips-and-apms/macra-feedback.html.

    The Centers for Medicare & Medicaid Services (CMS) has several goals for the voluntary reporting period: • For clinicians to gain familiarity with the categories and experience submitting the codes• To collect data on the use and submission of the codes for analyses to inform the potential future use of

    these codes in cost measure attribution methodology in the Quality Payment Program

    The codes are currently in a voluntary reporting period. Whether and how the codes are reported on claims will not affect Medicare reimbursement. For now, the modifiers have no impact on beneficiaries.

    Reporting of these modifiers will be mandatory in the near future and CMS advises clinicians to participate during the voluntary reporting period to ease transition.

    Additional Information The official instruction, CR 11259, issued to your MAC regarding this change is available at https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019Downloads/R2300OTN.pdf.

    If you have questions, your MACs may have more information. Find their website at http://go.cms.gov/MAC-website-list.

    Document History Date of Change Description May 16, 2019 Initial article released.

    CPT codes, descriptors and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2018 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

    13 6/2019

    https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/value-based-programs/macra-mips-and-apms/macra-feedback.htmlhttps://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019Downloads/R2300OTN.pdfhttp://go.cms.gov/MAC-website-list

  • Proper Use of Modifier 59 MLN Matters® Number: SE1418 Revised Related Change Request (CR) #: N/A Article Release Date: May 17, 2019 Effective Date: N/A Related CR Transmittal #: N/A Implementation Date: N/A

    Note: We revised this article on May 17, 2019, to reflect that CPT Code 11100 was deleted on January 1, 2019. In Example 1, CPT Code 11100 is replaced with CPT Code 11102. All other information is unchanged.

    Provider Types Affected This MLN Matters® Special Edition Article is intended for physicians and providers submitting claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.

    Provider Action Needed This special edition article is being provided by the Centers for Medicare & Medicaid Services (CMS) to clarify the proper use of Modifier 59. The article only clarifies existing policy. Make sure that your billing staffs are aware of the proper use of Modifier 59.

    Background The Medicare National Correct Coding Initiative (NCCI) includes Procedure-to-Procedure (PTP) edits that define when HCPCS)/ Current Procedural Terminology (CPT) codes should not be reported together either in all situations or in most situations.

    For PTP edits that have a Correct Coding Modifier Indicator (CCMI) of “0,” the codes should never be reported together by the same provider for the same beneficiary on the same date of service. If they are reported on the same date of service, the column one code is eligible for payment and the column two code is denied.

    For PTP edits that have a CCMI of “1,” the codes may be reported together only in defined circumstances which are identified on the claim by the use of specific NCCI-associated modifiers. (Refer to the National Correct Coding Initiative Policy Manual for Medicare Services, Chapter 1, for general information about the NCCI program, PTP edits, CCMIs, and NCCI-associated modifiers. This manual is available in the download section at http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html)

    One function of NCCI PTP edits is to prevent payment for codes that report overlapping services except in those instances where the services are “separate and distinct.” Modifier 59 is an important NCCI-associated modifier that is often used incorrectly.

    The CPT Manual defines modifier 59 as follows: “Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day. Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are

    Continued >> CPT codes, descriptors and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2018 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

    14 6/2019

    http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html

  • appropriate under the circumstances. Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. However, when another already established modifier is appropriate, it should be used rather than modifier 59. Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. Note: Modifier 59 should not be appended to an E/M service. To report a separate and distinct E/M service with a non-E/M service performed on the same date, see modifier 25.”

    Modifier 59 and other NCCI-associated modifiers should NOT be used to bypass a PTP edit unless the proper criteria for use of the modifier are met. Documentation in the medical record must satisfy the criteria required by any NCCI-associated modifier that is used. 1. Modifier 59 is used appropriately for different anatomic sites during the same encounter only

    when procedures which are not ordinarily performed or encountered on the same day are per-formed on different organs, or different anatomic regions, or in limited situations on different, non-contiguous lesions in different anatomic regions of the same organ. One of the common uses of modifier 59 is for surgical procedures, non-surgical therapeutic procedures, or diagnostic procedures that are performed at different anatomic sites, are not ordinarily performed or encountered on the same day, and that cannot be described by one of the more specific anatomic NCCI-associated modifiers –that is, RT, LT, E1-E4, FA, F1-F9, TA, T1-T9, LC, LD, RC, LM, or RI. (See examples 1, 2, and 3.) From an NCCI perspective, the definition of different anatomic sites includes different organs or, in certain instances, different lesions in the same organ. However, NCCI edits are typically created to prevent the inappropriate billing of lesions and sites that should not be considered to be separate and distinct. Modifier 59 should only be used to identify clearly independent services that represent significant departures from the usual situations described by the NCCI edit. The treatment of contiguous structures in the same organ or anatomic region does not constitute treatment of different anatomic sites. For example: • Treatment of the nail, nail bed, and adjacent soft tissue distal to and including the skin overlying the

    distal interphalangeal joint on the same toe or finger constitutes treatment of a single anatomic site. (See example 4.)

    • Treatment of posterior segment structures in the eye constitutes treatment of a single anatomic site. (See example 5.)

    • Arthroscopic treatment of structures in adjoining areas of the same shoulder constitutes treatment of a single anatomic site. (See example 6.)

    2. Modifier 59 is used appropriately when the procedures are performed in different encounters on the same day. Another common use of modifier 59 is for surgical procedures, non-surgical therapeutic procedures, or diagnostic procedures that are performed during different patient encounters on the same day and that cannot be described by one of the more specific NCCI-associated modifiers – i.e., 24, 25, 27, 57, 58, 78, 79, or 91. (See example 7) As noted in the CPT definition, modifier 59 should only be used if no other modifier more appropriately describes the relationship of the two procedure codes.

    3. Modifier 59 is used inappropriately if the basis for its use is that the narrative description of the two codes is different. One of the common misuses of modifier 59 is related to the portion of the definition of modifier 59

    Continued >> CPT codes, descriptors and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2018 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

    15 6/2019

  • allowing its use to describe a “different procedure or surgery.” The code descriptors of the two codes of a code pair edit usually represent different procedures, even though they may be overlapping. The edit indicates that the two procedures should not be reported together if performed at the same anatomic site and same patient encounter as those procedures would not be considered to be “separate and distinct.” The provider should not use modifier 59 for such an edit based on the two codes being “different procedures.” (See example 8.) However, if the two procedures are performed at separate anatomic sites or at separate patient encounters on the same date of service, modifier 59 may be appended to indicate that they are different procedures on that date of service. Additionally, there may be limited circumstances sometimes identified in the National Correct Coding Initiative Policy Manual for Medicare Services (available in the downloads section at https://www.cms.gov/Medicare/Coding/ NationalCorrectCodInitEd/index.html) when the two codes of an edit pair may be reported together with modifier 59 when performed at the same patient encounter or at the same anatomic site.

    4. Other specific appropriate uses of modifier 59There are three other limited situations in which two services may be reported as separate and distinctbecause they are separated in time and describe non-overlapping services even though they may occurduring the same encounter, i.e.:

    A. Modifier 59 is used appropriately for two services described by timed codes provided during thesame encounter only when they are performed sequentially. There is an appropriate use for modifier59 that is applicable only to codes for which the unit of service is a measure of time (e.g., per 15 min-utes, per hour). If two timed services are provided in time periods that are separate and distinct and notinterspersed with each other (i.e., one service is completed before the subsequent service begins), modi-fier 59 may be used to identify the services. (See example 9.)

    B. Modifier 59 is used appropriately for a diagnostic procedure which precedes a therapeutic proce-dure only when the diagnostic procedure is the basis for performing the therapeutic procedure.When a diagnostic procedure precedes a surgical procedure or non-surgical therapeutic procedure andis the basis on which the decision to perform the surgical procedure is made, that diagnostic test may beconsidered to be a separate and distinct procedure as long as (a) it occurs before the therapeutic proce-dure and is not interspersed with services that are required for the therapeutic intervention; (b) it clearlyprovides the information needed to decide whether to proceed with the therapeutic procedure; and (c) itdoes not constitute a service that would have otherwise been required during the therapeutic interven-tion. (See example 10.) If the diagnostic procedure is an inherent component of the surgical procedure, itshould not be reported separately.

    C. Modifier 59 is used appropriately for a diagnostic procedure which occurs subsequent to a com-pleted therapeutic procedure only when the diagnostic procedure is not a common, expected, ornecessary follow-up to the therapeutic procedure. When a diagnostic procedure follows the surgicalprocedure or non-surgical therapeutic procedure, that diagnostic procedure maybe considered to be aseparate and distinct procedure as long as (a) it occurs after the completion of the therapeutic procedureand is not interspersed with or otherwise commingled with services that are only required for the ther-apeutic intervention, and (b) it does not constitute a service that would have otherwise been requiredduring the therapeutic intervention. If the post-procedure diagnostic procedure is an inherent componentor otherwise included (or not separately payable) post-procedure service of the surgical procedure ornon-surgical therapeutic procedure, it should not be reported separately.

    Continued >> CPT codes, descriptors and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2018 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

    16 6/2019

    https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html

  • Use of Modifier 59 does not require a different diagnosis for each HCPCS/CPT coded procedure. Conversely, different diagnoses are not adequate criteria for use of modifier 59. The HCPCS/CPT codes remain bundled unless the procedures are performed at different anatomic sites or separate patient encounters or meet one of the other three scenarios described above.

    Modifiers XE, XS, XP, and XU are effective January 1, 2015. These modifiers were developed to provide greater reporting specificity in situations where modifier 59 was previously reported and may be utilized in lieu of modifier 59 whenever possible. (Modifier 59 should only be utilized if no other more specific modifier is appropriate.)

    Although NCCI will eventually require use of these modifiers rather than modifier 59 with certain edits, providers may begin using them for claims with dates of service on or after January 1, 2015. The modifiers are defined as follows: • XE – “Separate encounter, A service that is distinct because it occurred during a separate encounter”

    This modifier should only be used to describe separate encounters on the same date of service. • XS – “Separate Structure, A service that is distinct because it was performed on a separate organ/

    structure” • XP – “Separate Practitioner, Aservice that is distinct because it was performed by a different practitioner” • XU – “Unusual Non-Overlapping Service, The use of a service that is distinct because it does not

    overlap usual components of the main service”

    Examples of Modifier 59 Usage Following are some examples developed to help guide physicians and providers on the proper use of Modifier 59 (Please remember that Medicare policy is that Modifier 59 is used appropriately for different anatomic sites during the same encounter only when procedures which are not ordinarily performed or encountered on the same day are performed on different organs, or different anatomic regions, or in limited situations on different, non-contiguous lesions in different anatomic regions of the same organ.):

    Example 1: Column 1 Code / Column 2 Code - 17000/11102 • CPT Code 17000 – Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical

    curettement), premalignant lesions (eg, actinic keratoses); first lesion • CPT Code - 11102 Tangential biopsy of skin (e.g., shave, scoop, saucerize, curette); single lesion

    Modifier 59 may be reported with code 11102 if the procedures are performed at different anatomic sites on the same side of the body and a specific anatomic modifier is not applicable. If the procedures are performed on different sides of the body, modifiers RT and LT or another pair of anatomic modifiers should be used, not modifier 59.

    Modifier 59 is used appropriately for different anatomic sites during the same encounter only when procedures which are not ordinarily performed or encountered on the same day are performed on different organs, or different anatomic regions, or in limited situations on different, non-contiguous lesions in different anatomic regions of the same organ.

    Example 2: Column 1 Code/Column 2 Code 47370/76942 • CPT Code 47370 – Laparoscopy, surgical, ablation of one or more liver tumor(s); radiofrequency

    Continued >> CPT codes, descriptors and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2018 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

    17 6/2019

  • • CPT Code 76942 – Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation

    CPT code 76942 should not be reported and Modifier 59 should not be used if the ultrasonic guidance is for needle placement for the laparoscopic liver tumor ablation procedure. Code 76942 may be reported with modifier 59 if the ultrasonic guidance for needle placement is unrelated to the laparoscopic liver tumor ablation procedure.

    Example 3: Column 1 Code/Column 2 Code 93453/76000 • CPT Code 93453 – Combined right and left heart catheterization including intraprocedural injections(s)

    for left ventriculography, imaging supervision and interpretation, when performed • CPT Code 76000 – Fluoroscopy (separate procedure), up to one hour physician time, other than 71023 or

    71034 (eg, cardiac fluoroscopy)

    CPT code 76000 should not be reported and Modifier 59 should not be used for fluoroscopy that is used in conjunction with a cardiac catheterization procedure. Modifier 59 may be reported with code 76000 if the fluoroscopy is performed for a procedure unrelated to the cardiac catheterization procedure.

    Example 4: Column 1 Code / Column 2 Code - 11055/11720 • CPT Code 11055 - Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion • CPT Code 11720 – Debridement of nail(s) by any method(s); one to five

    CPT codes 11720 and 11055 should not be reported together for services performed on skin distal to and including the skin overlying the distal interphalangeal joint of the same toe. Modifier 59 should not be used if a nail is debrided on the same toe on which a hyperkeratotic lesion of the skin on or distal to the distal interphalangeal joint is pared. Modifier 59 may be reported with code 11720 if one to five nails are debrided and a hyperkeratotic lesion is pared on a toe other than one with a debrided toenail or the hyperkeratotic lesion is proximal to the skin overlying the distal interphalangeal joint of a toe on which a nail is debrided.

    Example 5: Column 1 Code / Column 2 code - 67210/67220 • CPT Code 67210 – Destruction of localized lesion of retina (eg, macular edema, tumors), 1 or more sessions;

    photocoagulation • CPT Code 67220 – Destruction of localized lesion of choroid (eg, choroidal neovascularization);

    photocoagulation (eg, laser), 1 or more sessions

    CPT code 67220 should not be reported and Modifier 59 should not be used if both procedures are performed during the same operative session because the retina and choroid are contiguous structures of the same organ.

    Example 6: Column 1 Code / Column 2 Code - 29827/29820 • CPT Code 29827 – Arthroscopy, shoulder, surgical; with rotator cuff repair • CPT Code 29820 – Arthroscopy, shoulder, surgical; synovectomy, partial

    CPT code 29820 should not be reported and Modifier 59 should not be used if both procedures are performed on the same shoulder during the same operative session because the shoulder joint is a single anatomic structure. If the procedures are performed on different shoulders, modifiers RT and LT should be used, not Modifier 59.

    Continued >> CPT codes, descriptors and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2018 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

    18 6/2019

  • Example 7: Column 1 Code / Column 2 Code - 93015/93040 • CPT Code 93015 – Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise,

    continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report

    • CPT Code 93040 – Rhythm ECG, one to three leads; with interpretation and report

    Modifier 59 may be reported if the rhythm ECG is performed at a different encounter than the cardiovascular stress test. If a rhythm ECG is performed during the cardiovascular stress test encounter, CPT code 93040 should not be reported and Modifier 59 should not be used. Modifier 59 is used appropriately when the procedures are performed in different encounters on the same day.

    Example 8: Column 1 Code/Column 2 code - 34833/34820 • CPT code 34833 - Open iliac artery exposure with creation of conduit for delivery of endovascular prosthesis

    or for establishment of cardiopulmonary bypass, by abdominal or retroperitoneal incision, unilateral (List separately in addition to code for primary procedure)

    • CPT code 34820 - Open iliac artery exposure for delivery of endovascular prosthesis or iliac occlusion during endovascular therapy, by abdominal or retroperitoneal incision, unilateral (List separately in addition to code for primary procedure)

    CPT code 34833 is followed by a CPT Manual instruction that states: “(Do not report 34833 in conjunction with 33364, 33953, 33954, 33959, 33962, 33969, 33984, 34820 when performed on the same side).” Although the CPT code descriptors for 34833 and 34820 describe different procedures, they should not be reported together for the same side. Modifier 59 should not be appended to either code to report the two procedures for the same side of the body. If the two procedures were performed on different sides of the body, they may be reported with modifiers LT and RT as appropriate. However, modifier 59 is used inappropriately if the basis for its use is that the narrative description of the two codes is different.

    Example 9: Column 1 Code / Column 2 Code - 97140/97530 • CPT Code 97140 – Manual therapy techniques (eg, mobilization/manipulation, manual lymphatic drainage,

    manual traction), one or more regions, each 15 minutes • CPT Code 97530 – Therapeutic activities, direct (one-on-one) patient contact by the provider (use of

    dynamic activities to improve functional performance), each 15 minutes

    Modifier 59 may be reported if the two procedures are performed in distinctly different 15 minute time blocks. For example, one service may be performed during the initial 15 minutes of therapy and the other service performed during the second 15 minutes of therapy. Alternatively, the therapy time blocks may be split. For example, manual therapy might be performed for 10 minutes, followed by 15 minutes of therapeutic activities, followed by another 5 minutes of manual therapy. CPT code 97530 should not be reported and modifier 59 should not be used if the two procedures are performed during the same time block. Modifier 59 is used appropriately when two timed procedures are performed in different blocks of time on the same day.

    Example 10: Column 1 Code / Column 2 Code - 37220/75710 • CPT Code 37220 – Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial

    vessel; with transluminal angioplasty • CPT Code 75710 – Angiography, extremity, unilateral, radiological supervision and interpretation.

    Continued >> CPT codes, descriptors and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2018 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

    19 6/2019

  • Modifier 59 may be reported with CPT code 75710 if a diagnostic angiography has not been previously performed and the decision to perform the revascularization is based on the result of the diagnostic angiography. The CPT Manual defines additional circumstances under which diagnostic angiography may be reported with an interventional vascular procedure on the same artery. Modifier 59 is used appropriately for a diagnostic procedure which precedes a therapeutic procedure only when the diagnostic procedure is the basis for performing the therapeutic procedure.

    Additional Information The CMS webpage on the National Correct Coding Initiative Edits is available at http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html on the CMS website.

    There is a modifier 59 article on this website also. The CPT Manual includes the definition of Modifier 59, as well as CPT codes used with Modifier 59. The manual is available at http://www.ama-assn.org/ama on the American Medical Association (AMA) website.

    You may want to review MLN Matters® article MM8863 (https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/ downloads/MM8863.pdf) that alerts providers that CMS is establishing four new HCPCS Modifiers to define subsets of Modifier 59, Distinct Procedural Services.

    Document History Date of Change Description May 17, 2019 We revised this article to reflect that CPT Code 11100 was deleted on January 1,

    2019. In Example 1, CPT Code 11100 is replaced with CPT Code 11102. January 3, 2018 We updated the article to conform with latest Modifier 59 article on the NCCI

    website with the latest Modifier 59 article. The key update was the addition of information regarding the XE, XS, XP, and XU modifiers.

    May 27, 2015 This article was revised to provide a reference to MLN Matters Article SE1503 that advises physicians, providers and suppliers submitting bills to Medicare that additional guidance and education on the appropriate use of the new X modifiers will be introduced in a gradual, controlled fashion by CMS and that providers may continue to use Modifier -59 after January 1, 2015, in any instance in which it was correctly used before January 1, 2015. All other information is unchanged.

    June 2, 2014 Initial article released.

    CPT codes, descriptors and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2018 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

    20 6/2019

    http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.htmlhttp://www.ama-assn.org/amahttps://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM8863.pdfhttps://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM8863.pdf

  • Additional Processing Instructions to Update the Standard Paper Remit (SPR)

    MLN Matters Number: MM11289 Related CR Release Date: May 21, 2019 Related CR Transmittal Number: R2307OTN Related Change Request (CR) Number: 11289 Effective Date: October 1, 2019 Implementation Date: October 7, 2019

    Provider Type Affected This MLN Matters Article is for physicians, providers and suppliers billing Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.

    Provider Action Needed CR 11289 is to provide additional instructions to the MACs to update the SPR to ensure that no SPR is mailed out after the implementation of this CR with a Health Insurance Claim Number (HICN) or Social Security Number per the Social Security Number (SSN) Fraud Prevention Act of 2017. Make sure your billing staff s are aware of these changes.

    Background The Social Security Number Fraud Prevention Act of 2017 restricts the inclusion of Social Security Numbers (SSNs) on documents sent by mail no later than September 15, 2022. Effective October 1, 2019, MACs will mask the Patient Control Number field (also named the Patient CNTRL Number) or the Patient Account Number (ACNT) field on any print file used to create an SPR for mailing if it contains a HICN or SSN.

    Notes: The Patient Control Number field is a “free format” field and the HICN or SSN could be present anywhere in the field. This direction does not affect SPRs used for the portal process.

    MACs will check the Patient Control Number field or the ACNT field to see if there is a HICN or SSN anywhere within the field and, if so, the MACs will replace the first five digits of the HICN or SSN with capital Xs on any print file used to create an SPR for mailing. MACs shall follow the RRB HICN masking criteria defined in CR11112 to mask the Patient Control Number field or the ACNT field. Examples for reference are below.

    HICN Examples • XXXXX7777A • XXXXX7777C1

    RRB HICN Examples • AXXXXX1370 • WCAXXXXX2388 • CAXXXXX1

    Continued >> CPT codes, descriptors and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2018 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

    21 6/2019

  • Note 1: This masking requirement does not apply to RRB numbers issued before March 1964, which included an alpha prefix and 6 digits; for example, A000000.

    SSN Examples: • XXXXX1234 • XXX-XX-1234

    MACs will not mask the Medicare Beneficiary Identifier (MBI).

    Additional Information The official instruction, CR11289, issued to your MAC regarding this change is available at https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019Downloads/R2307OTN.pdf.

    If you have questions, your MACs may have more information. Find their website at http://go.cms.gov/MAC-website-list.

    Document History Date of Change Description May 21, 2019 Initial article released.

    CPT codes, descriptors and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2018 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

    22 6/2019

    https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019Downloads/R2307OTN.pdfhttp://go.cms.gov/MAC-website-list

  • Claim Status Category and Claim Status Codes Update MLN Matters Number: MM11292 Related CR Release Date: May 17, 2019 Related CR Transmittal Number: R4304CP Related Change Request (CR) Number: 11292 Effective Date: October 1, 2019 Implementation October 7, 2019

    Provider Type Affected This MLN Matters Article is for physicians, providers, and suppliers submitting claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.

    Provider Action Needed CR11292 updates, as needed, the Claim Status and Claim Status Category Codes used for the Accredited Standards Committee (ASC) X12 276/277, Health Care Claim Status Request and Response and ASC X12 277 Health Care Claim Acknowledgment transactions. Make sure your billing staffs are aware of these updates.

    Background The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires all covered entities to use only Claim Status Category Codes and Claim Status Codes approved by the National Code Maintenance Committee in the ASC X12 276/277 Health Care Claim Status Request and Response transa ction standards adopted under HIPAA for electronically submitting health care claims status requests and responses. These codes explain the status of submitted claim(s). Do not use proprietary codes in the ASC X12 276/277 transactions to report claim status. The National Code Maintenance Committee meets at the beginning of each ASC X12 trimester meeting (January/February, June, and September/October) and makes decisions about additions, modifications, and retirement of existing codes. The Committee allows the industry 6 months for implementation of newly added or changed codes.

    The codes sets are available at http://www.wpc-edi.com/reference/codelists/healthcare/claim-status-category-codes/ and http://www.wpc-edi.com/reference/codelists/healthcare/claim-status-codes/.

    Included in the code lists are specific details, including the date when a code was added, changed, or deleted. All code changes approved during the June 2019 committee meeting are available on these sites on or about July 1, 2019.

    The Centers for Medicare & Medicaid Services (CMS) will issue future updates to these codes as needed. MACs must update their claims systems to ensure they use the current version of these codes in their claim status responses.

    MACs use these code changes in editing all ASC X12 276 transactions the MACs process on or after the implementation date and are in the ASC X12 277 transactions issued on and after the implementation date of CR11292.

    Continued >> CPT codes, descriptors and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2018 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

    23 6/2019

    http://www.wpc-edi.com/reference/codelists/healthcare/claim-status-category-codes/http://www.wpc-edi.com/reference/codelists/healthcare/claim-status-codes/

  • MACs must comply with the requirements in the current standards adopted under HIPAA for electronically submitting certain health care transactions, among them the ASC X12 276/277 Health Care Claim Status Request and Response. The MACs must use valid Claim Status Category Codes and Claim Status Codes when sending ASC X12 277 Health Care Claim Status Responses. They must also use valid Claim Status Category Codes and Claim Status Codes when sending ASC X12 277 Healthcare Claim Acknowledgments. References in CR11292 to “277 responses” and “claim status responses” encompass both the ASC X12 277 Health Care Claim Status Response and the ASC X12 277 Healthcare Claim Acknowledgment transactions.

    Additional Information The official instruction, CR11292, issued to your MAC regarding this change is available at https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019Downloads/R4304CP.pdf.

    If you have questions, your MACs may have more information. Find their website at http://go.cms.gov/MAC-website-list.

    Document History Date of Change Description May 17, 2019 Initial article released.

    CPT codes, descriptors and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2018 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

    24 6/2019

    https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019Downloads/R4304CP.pdfhttp://go.cms.gov/MAC-website-list

  • Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes – July 2019 Update

    MLN Matters Number: MM11296 Related CR Release Date: May 17, 2019 Related CR Transmittal Number: R4306CP Related Change Request (CR) Number: 11296 Effective Date: July 1, 2019 Implementation Date: July 1, 2019

    Provider Types Affected This MLN Matters Article is for physicians, providers and suppliers billing Medicare Administrative Contractors (MACs) for drug and biological services.

    Provider Action Needed CR 11296 updates the HCPCS code set for codes related to drugs and biologicals. Please make sure your billing staffs are aware of these updates.

    Background The HCPCS code set is updated on a quarterly basis. CR 11296 informs MACs and providers of the updated specific drug/biological HCPCS codes. The April 5, 2019, HCPCS file includes 10 new HCPCS codes.

    These HCPCS codes will be payable for Medicare, effective for claims with dates of service on or after July 1, 2019:

    1) J1444 a. Short Descriptor: Fe pyro cit pow 0.1 mg iron b. Long Descriptor: Injection, ferric pyrophosphate citrate powder, 0.1 mg of iron c. Type of Service (TOS): 1, L

    2) J7208 a. Short Descriptor: Inj. jivi 1 iu b. Long Descriptor: Injection, factor viii, (antihemophilic factor, recombinant), pegylated-aucl, (jivi), 1

    i.u. c. TOS: 1

    3) J7677 a. Short Descriptor: Revefenacin inh non-com 1mcg b. Long Descriptor: Revefenacin inhalation solution, fda-approved final product, non-compounded, ad-

    ministered through DME, 1 microgram c. TOS: 1, P

    4) J9030 a. Short Descriptor: Bcg live intravesical 1mg b. Long Descriptor: BCG live intravesical instillation, 1 mg c. TOS: 1, P

    Continued >> CPT codes, descriptors and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2018 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

    25 6/2019

  • 5) J9036 a. Short Descriptor: Inj., belrapzo/bendamustine b. Long Descriptor: Injection, bendamustine hydrochloride, (Belrapzo/bendamustine), 1 mg c. TOS: 1

    6) J9356 a. Short Descriptor: Inj. herceptin hylecta, 10mg b. Long Descriptor: Injection, trastuzumab, 10 mg and Hyaluronidase-oysk c. TOS: 1

    7) Q5112 a. Short Descriptor: Inj ontruzant 10 mg b. Long Descriptor: Injection, trastuzumab-dttb, biosimilar, (Ontruzant), 10 mg c. TOS: 1, P

    8) Q5113 a. Short Descriptor: Inj herzuma 10 mg b. Long Descriptor: Injection, trastuzumab-pkrb, biosimilar, (Herzuma), 10 mg c. TOS: 1, P

    9) Q5114 a. Short Descriptor: Inj ogivri 10 mg b. Long Descriptor: Injection, Trastuzumab-dkst, biosimilar, (Ogivri), 10 mg c. TOS: 1, P

    10) Q5115 a. Short Descriptor: Inj rituximab-abbs bio 10 mg b. Long Descriptor: Injection, rituximab-abbs, biosimilar, 10 mg c. TOS: 1, P

    Medicare will not pay for HCPCS code J9031 (Bcg (intravesical) per instillation), effective for claims with dates of service on or after July 1, 2019.

    The long and short descriptors for HCPCS code J9355 will be modified, effective for claims with dates of service on or after July 1, 2019, The TOS and all other indicators will remain the same. • J9355 Short Descriptor: Inj trastuzumab excl biosimi • J9355 Long Descriptor: Injection, trastuzumab, excludes biosimilar, 10 mg

    Additional Information The official instruction, CR 11296, issued to your MAC regarding this change is available at https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019Downloads/R4306CP.pdf.

    If you have questions, your MACs may have more information. Find their website at http://go.cms.gov/MAC-website-list.

    Document History Date of Change Description May 20, 2019 Initial article released.

    CPT codes, descriptors and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2018 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

    26 6/2019

    https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019Downloads/R4306CP.pdfhttp://go.cms.gov/MAC-website-list

  • Educational Events Where You Can Ask Questions and Get Answers from Palmetto GBA

    Don’t Miss this Wonderful Opportunity! If you are in search of an opportunity to interact with and get answers to your Medicare billing,

    coverage and documentation questions from Palmetto GBA’s Provider Outreach and Education (POE) department, please see these educational offerings which have a question and answer session:

    Event Title Date/ Time

    Address, phone number (or link if Webinar)

    JJ/JM Part A and B Medical Review (MR) Hot Topic Targeted Probe and Educate (TPE) Teleconference

    June 3, 2019 2 p.m. ET

    Teleconference Number: (877) 789-3907 Confirmation ID Number: 1291838

    Check out these resources Quarterly Ask ACTs are intended to open the communication channels between providers the Contractor and Palmetto GBA, which allows for timely identification of problems Teleconferences (ACTs) and information-sharing in an informal and interactive atmosphere. These

    teleconferences will be held at least quarterly via teleconference. http://tinyurl.com/jkb4458

    Proceding the presentation, providers are given an opportunity to ask questions both on the topics discussed as well as any other question they may have. While we encourage providers to submit questions prior to the call, this is not required. Just fill out the Ask the Contractor Teleconference (ACT): Submit A Question form (http://tinyurl.com/hjq84dg). Once the form is completed, please fax it to (803) 935-0140, Attention: Ask-the-Contractor Teleconference

    Quarterly Updates Webcasts

    http://tinyurl.com/gsrb8gt

    The Quarterly Update Webcasts are intended to provide ongoing, scheduled opportunities for providers to stay up to date on Medicare requirements.

    Providers are able to type a question and have it responded to by the POE department throughout the webcast. At the end of the presentation the moderator will also read and respond to questions submitted by attendees in order to share the responses with the group at large.

    Event Registration Portal Visit our Event Registration Portal to find information on upcoming educational events and seminars.

    http://tinyurl.com/gsrb8gt This is a complete listing of both our face-to-face outreach opportunities as well as our teleconference and webcast listings. Providers are able to dialogue with POE and get answers to their questions at all of these educational events.

    If you have a question that you need an answer to today or a claims specific question which requires the disclosure of PII or PHI for response, please contact the Provider Contact Center (PCC) at 1-855-696-0705 for Jurisdiction M or 877-567-7271 for Jurisdiction J. CPT codes, descriptors and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2018 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

    27 6/2019

    http://tinyurl.com/jkb4458http://tinyurl.com/hjq84dghttp://tinyurl.com/gsrb8gthttp://tinyurl.com/gsrb8gt

  • Be sure to save the date to attend the 2019 MACtoberfest, held on October 8-9, 2019, at the Crowne Plaza Asheville, North Carolina.

    CPT codes, descriptors and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2018 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

    28 6/2019

  • Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP)

    and PC Print Update MLN Matters Number: MM11252 Related CR Release Date: May 17, 2019 Related CR Transmittal Number: R4303CP Related Change Request (CR) Number: 11252 Effective Date: October 1, 2019 Implementation Date: October 7, 2019

    Provider Types Affected This MLN Matters Article is for physicians, providers and suppliers billing Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.

    Provider Action Needed CR 11252 updates the Remittance Advice Remark Code (RARC) and Claims Adjustment Reason Code (CARC) lists and instructs the maintainers of the ViPS Medicare System (VMS) and Fiscal Intermediary Shared System (FISS) to update the Medicare Remit Easy Print (MREP) and PC Print software. Make sure your billing staff s are aware of these changes and obtain the new MREP or PC Print software if they use that software.

    Background The Health Insurance Portability and Accountability Act of 1996 (HIPAA) instructs health plans to conduct standard electronic transactions adopted under HIPAA using valid standard codes. CARCs and RARCs, as appropriate, provide either supplemental explanation for monetary adjustment or policy information that generally applies to the monetary adjustment. Medicare policy requires use of CARCs and RARCs, as appropriate, in remittance advice and coordination of benefits transactions.

    The Centers for Medicare & Medicaid Services (CMS) instructs MACs to conduct updates based on the code update schedule three times per year – around March 1, July 1, and November 1.

    CR 11252 is a code update notification indicating when updates to CARC and RARC lists are available on the Washington Publishing Company (WPC) website. Shared System Maintainers (SSMs) are responsible for implementing code deactivation, making sure they do not use any deactivated codes in original business messages, and allowing the deactivated code in derivative messages. SSMs must make sure that Medicare does not report any deactivated code on or after the effective date for deactivation as posted on the WPC website. If any new or modified code has an effective date later than the implementation date in CR11252, MACs must implement on the date specified at http://wpc-edi.com/Reference/.

    A discrepancy between the dates may arise as the WPC only updates the website three times per year and the dates may not match the CMS release schedule. For CR 11252, MACs and SSMs must get the complete list for both CARC and RARC from the WPC website to obtain the comprehensive lists for both code sets and determine the changes that are on the code list since the last code update (CR 11204;

    Continued >> CPT codes, descriptors and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2018 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

    29 6/2019

    http://wpc-edi.com/Reference/

  • https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/ Downloads/MM11204.pdf).

    Additional Information The official instruction, CR 11252, issued to your MAC regarding this change is available at https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019Downloads/R4303CP.pdf.

    If you have questions, your MACs may have more information. Find their website at http://go.cms.gov/MAC-website-list.

    Document History Date of Change Description May 17, 2019 Initial article released.

    CPT codes, descriptors and other data only are copyright 2018 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2018 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

    30 6/2019

    https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM11204.pdfhttps://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019Downloads/R4303CP.pdfhttp://go.cms.gov/MAC-website-list

  • Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - July 2019 Update

    MLN Matters Number: MM11293 Related CR Release Date: May 3, 2019 Related CR Transmittal Number: R4292CP Related Change Request (CR) Number: 11293 Effective Date: January 1, 2019 Implementation Date: July 1, 2019

    Provider Types Affected This MLN Matters Article is for physicians, providers and suppliers billing Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.

    Provider Action Needed CR 11293 informs providers that the Centers for Medicare & Medicaid Services (CMS) has issued payment files to the MACs based upon the 2019 Medicare Physician Fee Schedule (MPFS) Final Rule. CR 11293 amends those payment files, to be effective for services furnished between January 1, 2019, and December 31, 2019. Be sure your billing staffs are aware of these updates.

    Background Below is a summary of the changes for the July update to the 2019 MPFSDB. Unless otherwise stated, these changes are effective for dates of service on and after January 1, 2019.

    HCPCS Codes and Actions CODE ACTION 27369 Multiple Procedure indicator = 2, Bilateral Surgery = 1, Assistant Surgery = 1 28740 Bilateral Surgery indicator = 1

    Revised MP RVU and HCPCS The malpractice relative value unit (MP RVU) has been revised for numerous HCPCS codes. These MP RVU changes have minimal impact on payment. The complete list of the revised MP RVUs is a part of the CR, which is available at https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019Downloads/R4292CP.pdf.

    J and Q Code Changes The MPFSDB file will reflect the changes below effective for dates of service J