MIR-2007-2AB, February 2007

Medicare Payment for Preadministration-Related Services Associated with IVIG Administration — Payment Extended through CY 2007

Provider Types Affected
Physicians and hospitals that bill Medicare carriers, fiscal intermediaries (FI), or Part A/B Medicare Administrative Contractors (A/B MAC) for Intravenous Immune Globulin (IVIG) administration

Provider Action Needed

Impact to You
You may bill for preadministration-related services associated with Intravenous Immune Globulin (IVIG) administration (HCPCS code G0332) during calendar year 2007. The preadministration-related service must be billed on the same claim and have the same date of service, as the claim for the IVIG itself (codes J1566 and/or J1567) and the drug administration service.

What You Need to Know
CR 5428, from which this article was taken, extends payment of the preadministration-related service for IVIG through CY 2007 but only when submitted on the same claim as the IVIG and its administration.

What You Need to Do
Make sure that your billing staff is aware that they must include your charges for the IVIG preadministration-related services on the same claim (and with the same date of service) as the IVIG and its administration.

Background
Under Section 1861(s)(1) and 1861(s)(2), Medicare Part B covers intravenous immune globulin (IVIG) administered by physicians in physician offices and by hospital outpatient departments. More specifically, when you administer IVIG to a Medicare beneficiary in the physician office or hospital outpatient department, Medicare makes separate payments to the physician or hospital for both the IVIG product itself and for its administration via intravenous infusion.

In addition, for 2006, the Centers for Medicare & Medicaid Services (CMS) established a temporary preadministration-related service payment, for physicians and hospital outpatient departments that administer IVIG to Medicare beneficiaries, to cover the effort required to locate and acquire adequate IVIG product and to prepare for an infusion of IVIG during this current period where there may be potential market issues. CR 5428, from which this article was taken, announces the extension of this temporary payment for the IVIG preadministration-related service through CY 2007.

As a reminder, here are some important details that you should know:

• The policy and billing requirements concerning the IVIG preadministration-related services payment are the same in 2007 as they were in 2006.
• This IVIG preadministration service payment is in addition to Medicare’s payments to the physician or hospital for the IVIG product itself and for its administration by intravenous infusion.
• Medicare carriers, FIs, or A/B MACs will pay for these services, that are provided in a physician office, under the physician fee schedule; and FIs or A/B MACs will pay for them under the outpatient prospective payment system (OPPS), for hospitals subject to OPPS (bill types: 12X, 13X) or under current payment methodologies for all non-OPPS hospitals (bill types: 12X, 13X, 85X).
• You need to use HCPCS code G0332 - Preadministration-Related Services for Intravenous Infusion of Immunoglobulin, (this service is to be billed in conjunction with administration of immunoglobulin) to bill for this service.
• You can bill for this only one IVIG preadministration per patient per day of IVIG administration.
• The service must be billed on the same claim form as the IVIG product (HCPCS codes J1566 (Injection, immune globulin, intravenous, lyophilized (E.G. powder), 500 mg) and/or J1567 (Injection, immune globulin, intravenous, non-lyophilized (E.G. liquid), 500 mg), and have the same date of service as the IVIG product and a drug administration service.
• Your claims for preadministration-related services will be returned/rejected by your FI, carrier, or A/B MAC if more than 1 unit of service of G0332 is indicated on the same claim for the same date of service. They will use the appropriate reason/remark code such as:
• M80-“Not covered when performed during the same session/date as a previously processed service for the patient;”
• B5-“Payment adjusted because coverage/program guidelines were not met or were exceeded;”
• M67-“Missing other procedure codes;” and/or
• 16-“Claim/service lacks information which is needed for adjudication.”

Additional Information
You can find the official instruction, CR 5428, issued to your FI, carrier, or A/B MAC by visiting http://www.cms.hhs.gov/Transmittals/downloads/R1140CP.pdf on the CMS Web site

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.zip on the CMS Web site.

Flu Shot Reminder
As a respected source of health care information, patients trust their doctors’ recommendations. If you have Medicare patients who haven’t yet received their flu shot, help protect them by recommending an annual influenza and a one time pneumococcal vaccination. Medicare provides coverage for flu and pneumococcal vaccines and their administration. And don’t forget to immunize yourself and your staff. Protect yourself, your patients, and your family and friends. Get Your Flu Shot. Remember - Influenza vaccination is a covered Part B benefit. Note that influenza vaccine is NOT a Part D covered drug. For more information about Medicare’s coverage of adult immunizations and educational resources, go to CMS’s Web site: http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0667.pdf.

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

MLN Matters Number: MM5428
Pub. 100-4, Transmittal# R1140CP, CR# 5428
Related CR Release Date: December 22, 2006
Effective Date: January 1, 2007
Implementation Date: January 2, 2007

Do you have your NPI?
National Provider Identifiers (NPIs) will be required on claims sent on or after May 23, 2007. Every health care provider needs to get an NPI. Learn more about the NPI and how to apply for an NPI by visiting http://www.cms.hhs.gov/NationalProvIdentStand/ on the CMS Web site.