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MIR-2007 04A, April 2007
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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April 2007 Non-Outpatient Prospective Payment System (Non-OPPS) Outpatient Code Editor (OCE) Specifications Version 22.2 (MM5523)
Provider Types Affected
Providers submitting claims to Medicare contractors (fiscal intermediaries (FI) and Part A/B Medicare Administrative Contractors (A/B MAC)) for outpatient services rendered to Medicare beneficiaries, where those services are not paid under the OPPS
Provider Action Needed
This article is based on Change Request (CR) 5523 which informs FIs that the April 2007 Non-Outpatient Prospective Payment System (Non-OPPS) Outpatient Code Editor (OCE) specifications have been updated to ensure correct billing and payment of claims. Be sure your billing staff is aware of the code changes in CR5523.
Background
The Non-OPPS OCE has been updated with numerous new additions, changes, and deletions to Healthcare Common Procedure Coding System/Current Procedural Terminology (HCPCS/CPT) codes. Rather than duplicate all the additions, deletions and changes in this article, the Centers for Medicare & Medicaid Services (CMS) directs you to CR5523, which contains the lengthy lists of these items. CR5523 is available at http://www.cms.hhs.gov/Transmittals/downloads/R1199CP.pdf  on the CMS Web site.
Providers may want to be aware that the new version of the Non-OPPS OCE with updated HCPCS/CPT codes listed in CR5523 is effective April 1, 2007 but they need to look at the specific HCPCS/CPT code changes that are, in some instances, effective earlier than April 1, 2007.
Additional Information
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.
Flu Shot Reminder
It’s Not Too Late to Give and Get the Flu Shot!
The peak of flu season typically occurs between late December and March; however, flu season can last until May. Protect yourself, your patients, and your family and friends by getting and giving the flu shot. Each office visit presents an opportunity for you to talk with your patients about the importance of getting an annual flu shot and a lifetime pneumococcal vaccination. Remember - influenza and pneumococcal vaccination and their administration are covered Part B benefits. Note that influenza and pneumococcal vaccines are NOT Part D covered drugs. 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 interpretive materials for a full and accurate statement of their contents.
MLN Matters Number: MM5523
Pub. 100-4, Transmittal# R1199CP, CR# 5523
Related CR Release Date: March 9, 2007
Effective Date: April 1, 2007
Implementation Date: April 2, 2007
PQRI Information Available
A new CMS Web page dedicated to providing information on the Physician Quality Reporting Initiative (PQRI) is now available.
On December 20, 2006, the President signed the Tax Relief and Health Care Act of 2006 (TRHCA). Section 101 under Title I authorizes the establishment of a physician quality reporting system by CMS. CMS has titled the statutory program the Physician Quality Reporting Initiative. For more information, visit http://www.cms.hhs.gov/pqri  on the CMS Web site.
| CPT five-digit codes, descriptions, and other data only are copyright 2006 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS clauses apply. |
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