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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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Changes to the Laboratory National Coverage Determination (NCD) Edit Software for July 2006
Provider Types Affected
Physicians, providers, and suppliers submitting claims to Medicare carriers and fiscal interme-diaries (FIs) for clinical diagnostic laboratory services provided for Medicare beneficiaries
Impact on Providers
This article is based on Change Request (CR) 5108, which communicates requirements to Medicare contractors (carriers and FIs) notifying them of changes to the laboratory edit module and to update the laboratory edit module for changes in laboratory NCD code lists for July 2006.
Background
The National Coverage Determinations (NCDs) for clinical diagnostic laboratory services were developed by the laboratory negotiated rulemaking committee and published as a final rule on November 23, 2001. Subsequently, the Centers for Medicare & Medicaid Services (CMS) contracted for nationally uniform software to be developed and incorporated into its shared systems so that laboratory claims subject to one of the 23 NCDs can be processed uniformly throughout the nation effective January 1, 2003.
The laboratory edit module for the NCDs is updated quarterly (as necessary) to reflect coding updates and substantive changes to the NCDs developed through the NCD process. (See the Medicare Claims Processing Manual (Pub.100-4), Chapter 16, §120.2; http://www.cms.hhs.gov/manuals/downloads/clm104c16.pdf). These changes are a result of coding analysis decisions developed under the procedures for maintenance of codes in the negotiated NCDs, and several of the listed changes correct Current Procedural Terminology (CPT) codes to reflect the current CPT update.
CR5108 informs your Medicare carrier and FI about changes in the laboratory NCD code lists for July 2006 that require updating of the laboratory edit module. The key change being made to the NCD code lists for July 2006 is that CPT code 83704 (Quantitation of lipoprotein particle numbers and lipoprotein particles subclasses) is being added to the list of HCPCS/CPT codes covered by Medicare for the Lipids Testing NCD.
Implementation
The implementation date for the instruction is July 3, 2006.
Additional Information
For complete details, please see the official instruction (CR5108) issued to your carrier/intermediary regarding this change. That instruction may be viewed at http://www.cms.hhs.gov/Transmittals/downloads/R959CP.pdf  on the CMS Web site.
If you have any questions, please contact your carrier/intermediary at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.pdf 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: MM5108
Pub. 100-4, Transmittal# R959CP, CR# 5108
Related CR Release Date: May 26, 2006
Effective Date: July 1, 2006
Implementation Date: July 3, 2006
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