Additional $50 Payment for New Technology Intraocular Lenses (NTIOLs) Furnished in Ambulatory Surgical Centers (ASCs) Provider Types Affected Provider Action Needed Impact to You What You Need to Know What You Need to Do Background CR4361, from which this article is taken, announces the approval of NTIOL Category 3 (as defined in Federal Register Notice, 71 FR 4586, dated January 27, 2006), which applies to Advanced Medical Optics (AMO), Tecnis® IOL model numbers Z9000, Z9001, and ZA9003 (characteristic: improved contrast sensitivity). This category and the associated $50 NTIOL Medicare payment adjustment will expire on February 26, 2011. The payment adjustment is allowed when Medicare-approved ASCs (place of service 24) insert this IOL and submit HCPCS code Q1003 (created for this purpose) on the same claim as the surgical insertion procedure (HCPCS codes 66982, 66983, 66984, 66985, or 66986). HCPCS code Q1003 is already established and listed in the HCPCS file, and the Medicare Claims Processing Manual, Chapter 14, Sections 10.2 & 40.3, has been updated to reflect this change. Please be aware that carriers will deny payment for Q1003 when submitted by ASCs not approved by Medicare. If denied, the carrier will use appropriate messages such as MSN# 16.2 (This service cannot be paid when provided in this location/facility) and Claims Adjustment Reason Code #58 (Payment adjusted because treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service). Carriers will return as unprocessable claims for NTIOLs with Q1003 alone or with a code other than 66982, 66983, 66984, 66985, or 66986. When such claims are returned, claim adjustment reason code 16 (Claim/service lacks information needed for adjudication. Additional information is supplied using remittance advice codes whenever appropriate) will be used. The remittance advice remark code of M67 (Missing/Incomplete/Invalid other procedure codes) and remark code MA130 (Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information) will be used as appropriate. Further, payment will be denied if submitted for services rendered after the discontinued date (February 26, 2011). If denied, they will use messages such as: MSN # 21.11 (This service was not covered by Medicare at the time you received it) and Claims Adjustment Reason Code # 27 (Expenses incurred after coverage terminated). Additional Information If you have any questions, please contact your carrier at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.pdf Disclaimer MLN Matters Number: MM4361 |
on the CMS Web site. The revised Medicare Claims Processing Manual, Chapter 14 (Ambulatory Surgical Centers), Sections 10.2 (10.2 - Ambulatory Surgical Center Services on ASC List) and 40.3 – (Payment for Intraocular Lens (IOL)) are attached to CR4361.
