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MIR-2006-12AB, December 2006
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services) |
Clarification on Billing for Cryosurgery of the Prostate Gland
Note: This article was revised on November 16, 2006 to add a sub-heading to specify that CAHs must do the stated process annually. All other information remains the same. |
Provider Types Affected
Hospitals submitting claims to Medicare Fiscal Intermediaries (FIs) or Part A/B Medicare Administrative Contractors (A/B MACs) for services related to cryosurgery of the prostate gland.
Provider Action Needed
This article is based on Change Request (CR) 5376, which revises sections of the Medicare Claims Processing Manual related to cryosurgery of the prostate, expands revenue codes permissible for billing for this service, and corrects the payment method for Indian Health Service (IHS) facilities. Be sure your billing staff is aware of the revenue code information.
Background
Cryosurgery of the prostate, also known as cryoablation of the prostate (CAP), destroys prostate gland tissue by applying extremely cold temperatures; this reduces the size of the prostate gland.
This article is based on Change Request (CR) 5376 which:
- Relocates the section on cryosurgery of the prostate from Chapter 18, Screening and Preventive Services, in the Medicare Claims Processing Manual (Publication 100-04) to Chapter 32, Billing Requirements for Special Services, in the same manual, and
- Expands the revenue codes permissible for billing this service to include 0360 and 0369, as well as 0361.
CR5376 also changes the manual to clarify the payment method for cryosurgery in Indian Health Service (IHS) facilities. These revised sections of the manual are included as attachments to CR 5376.
Additional Information
CAHs That Elect Method II Must Do So Annually
In addition, CR5376 revises the Medicare Claims Processing Manual by clarifying that Critical Access Hospitals (CAHs) wishing to be paid using the optional method (Method II) for professional outpatient services must make the election to do so annually.
Note: There are no policy changes related to these clarifications.
For complete details, please see the official instruction, CR5376, issued to your FI or A/B MAC regarding this change. That instruction may be viewed at http://www.cms.hhs.gov/Transmittals/downloads/R1111CP.pdf  on the CMS Web site.
If you have any questions, please contact your FI or A/B MAC at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip  on the CMS Web site.
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.
MLN Matters Number: MM5376 Revised
Related Change Request (CR) #: 5376
Related CR Release Date: November 9, 2006
Effective Date: April 1, 2007
Related CR Transmittal #: R1111CP
Implementation Date: April 2, 2007
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