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

Medicare Payment for Preadministration-Related Services Associated with IVIG Administration-Payment Extended through CY 2007 (MM5428-R)

Note : This article was changed on July 9, 2007, to reference MM5635. MM5635 implemented HCPCS coding changes for Immune Globulin. On and after July 1, 2007, HCPCS code J1567 (injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), 500 mg) will no longer be payable by Medicare. To view the new HCPCS codes, please go to http://www.cms.hhs.gov/MLNMattersArticles/downloads/mm5635.pdf on the CMS Web site.

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

What You Need to Do
Make sure that your billing staff is aware that they must include your claim 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, 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 IVIG product and a drug administration service. (See note above regarding J1567.)
• Your claims for preadministration-related services will be returned/rejected by your FI, carrier, or A/B MAC if more than one 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.

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

National Provider Identifier (NPI) News – Medicare is now asking that submitters send a small number of claims using only the NPI. If no claims are rejected, the submitter can gradually increase the volume. Additional information can be found at the CMS NPI Web site at http://www.cms.hhs.gov/NationalProvIdentStand/   .