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MIR-2007-5AB, May 2007
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Update to Medicare Claims Processing Manual, Publication 100-04, Chapter 18, Section 60.1 Regarding Colorectal Screening Services
Provider Types Affected
Physicians, suppliers, and providers who submit claims for screening and diagnostic colorectal services to Medicare contractors (Fiscal intermediaries (FI), carriers, Part A/B Medicare Administrative Contractors (A/B MAC))
Background
The Centers for Medicare & Medicaid Services (CMS) is aware that Chapter 60, Section 60.1 of the Medicare Claims Processing Manual (Publication 100-04) needed clarification regarding application of the annual Part B deductible for diagnostic colorectal services. Section 5113 of the Deficit Reduction Act (DRA) of 2005 waived the requirement for the annual Part B deductible for screening colorectal services, NOT diagnostic colorectal services. CR5541 clarifies that portion of the manual.
Key Points
The following are the key points of the revised portion of Chapter 18, Section 60.1 of the Medicare Claims Processing Manual, which is attached to CR5541 (the Web address for CR5541 is provided in the Additional Information section of this article).
- Prior to January 1, 2007 , deductible and coinsurance apply to HCPCS codes G0104, G0105, G0106, G0120, and G0121. On or after January 1, 2007, the annual Part B deductible is waived for the listed HCPCS coded screening services. Coinsurance still applies.
- Coinsurance and deductible applies to the diagnostic colorectal service codes 45330, 45378, and 74280.
Additional Information
You may see the official instruction (CR5541) issued to your Medicare carrier, FI, or A/B MAC by going to http://www.cms.hhs.gov/Transmittals/downloads/R1217CP.pdf  on the CMS Web site.
If you have questions, please contact your Medicare carrier, 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.
MLN Matters Number: MM5541
Pub. 100-4, Transmittal# R1217CP, CR# 5541
Related CR Release Date: March 30, 2007
Effective Date: July 1, 2007
Implementation Date: July 2, 2007
he Inpatient Rehabilitation Facility Prospective Payment System Fact Sheet, which provides information about Inpatient Rehabilitation Facility Prospective Payment System rates and classification criterion, is now available in downloadable format on the Centers for Medicare & Medicaid Services Medicare Learning Network Publications Page located at http://www.cms.hhs.gov/MLNProducts/downloads/IRFPPSFactSheet0307.pdf .
| 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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