National Government Services, Inc. Medicare Monthly Review Part A and B
A Combined Part A and Part B Newsletter

MMR-2007 11A, November 2007

Correction to CR 5645 -July 2007 Quarterly Update to the Healthcare Common Procedure Coding System (HCPCS) Codes for Albuterol, Levalbuterol, and Reclast®

Provider Types Affected
Physicians, providers, and suppliers who bill Medicare fiscal intermediaries (FI) and Medicare Administrative Contractors (A/B MAC) for providing Albuterol, Levalbuterol, Reclast®, and Zometa® to Medicare beneficiaries.  

Provider Action Needed
Review the tables in this article that detail the appropriate HCPCS codes for Albuterol, Levalbuterol, and Reclast®, effective for claims with on or after July 1, 2007. Make certain that your billing staffs are aware of these HCPCS code changes.  

Key Points
Effective July 1, 2007, the HCPCS codes in table 1 will no longer be payable for Medicare.  

Table 1
HCPCS Codes Not Payable for Dates of Service on or after July 1, 2007

In place of the Table 1 codes, the HCPCS codes displayed in Table 2 will be payable, effective July 1, 2007.  

 Table 2
HCPCS Codes Payable for Services on or After July 1, 2007

Also, effective July 1, 2007, a new code applies for Reclast® as follows:

Table 3
HCPCS Q4095 Payable for Services on or after July 1, 2007, for Reclast®:

Also, please note the following:

• Currently, Reclast® 5 mg/100 ml bottle (NDC 0078-0435-61) is the only product that should be billed using HCPCS code Q4095. If other products under the FDA’s approval for Reclast® become available, code Q4095 would be used to bill for such products.
• HCPCS code J3487 (short description: Zoledronic acid; long description: Injection, zoledronic acid, 1 mg) is used to bill for products under the Food and Drug Administration’s (FDA’s) approval for Zometa® or such therapeutically equivalent products that may become available as identified in the FDA’s Orange Book.
• Your FI or A/B MAC will not search their files to adjust claims processed prior to the implementation of this change. However, if claims were not processed correctly, the FI or A/B MAC will adjust them if you bring the claims to their attention.

Additional Information
You may see the official instruction (CR5735) issued to your Medicare FI or A/B MAC by going to http://www.cms.hhs.gov/Transmittals/downloads/R1351CP.pdf on the CMS Web site.

If you have questions, please contact your Medicare 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.

* Additional Information Provided by National Government Services
This Change Request (CR) does not apply to National Government Services Part A Providers. The OPPS IOCE will not process HCPCS Codes Q4093 or Q4094 at this time.