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MIR-2006-7AB, July 2006
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Drug Administration Coding and Payment Policy – Update to Pub. 100-04 Medicare Claims Processing Manual
Provider Types Affected
Physicians and providers billing Medicare carriers for drug administration procedures
Providers Action Needed
This article and Change Request (CR) 5028 provide specific information regarding the interim G codes that were adopted in 2005 and opera-tional until 2006 when the new Current Procedural Terminology (CPT) codes become operational. In 2006, CPT codes replace the interim G codes. Beginning in 2006, physicians will follow CPT coding guidelines and select codes that best represent the underlying service. Imple-mentation of these revised coding guidelines will help Medicare make prompt and correct payments for drug administration services.
Under the Medicare Modernization Act (MMA), drug administration codes included three categories of services for which there were no work relative value units as of October 1, 2003:
- Hydration
- Therapeutic, prophylactic, and diagnostic injections and infusions
- Chemotherapy administration
The MMA established work relative value units for these codes and provided transitional payment adjustments in 2004 and 2005. Carriers have and may continue to pay for these services under the Medicare physician fee schedule.
Background
The purpose of this CR is to incorporate in the Medicare Claims Processing Manual the payment policy and claims processing instructions previously included in Transmittal 129, CR 3631 (2005 Drug Administration Coding Revisions), issued on December 10, 2004, and Transmittal 148, CR3818 (Revised Coding Guidelines for Drug Adminis-tration Codes), issued on April 15, 2005.
Implementation
The implementation date for this instruction is June 26, 2006.
Additional Information
The official instructions issued to your Medicare carrier regarding this change can be found at http://www.cms.hhs.gov/Transmittals/downloads/R968CP.pdf  on the CMS Web site.
The address for Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, Section 30.5. (Internet Only Manual), is http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf on the CMS Web site.
Transmittal 129, CR3631 (2005 Drug Adminis-tration Coding Revisions), issued on December 10, 2004, may be viewed at http://www.cms.hhs.gov/transmittals/Downloads/R129OTN.pdf on the CMS Web site.
The MLN article MM3631 may be viewed at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM3631.pdf on the CMS Web site.
Transmittal 148, CR 3818 (Revised Coding Guidelines for Drug Administration Codes), issued on April 15, 2005, may be viewed at http://www.cms.hhs.gov/Transmittals/downloads/R148OTN.pdf on the CMS Web site.
The MLN article MM3818 may be viewed at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM3818.pdf on the CMS Web site.
If you have questions, please contact your Medicare intermediary, carrier, or DMERC at their toll-free number, which may be found at http://www.cms.hhs.gov/apps/contacts/  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.
Medlearn Matters Number: MM5028
Pub. 100-4, Transmittal# R968CP, CR# 5028
Related CR Release Date: May 26, 2006
Effective Date: June 26, 2006
Implementation Date: June 26, 2006
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