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

MMR-2007- 09A, September 2007

What’s New? Part A Updates for September 1, 2007

Note: All updates apply to Illinois, Indiana, Kentucky, and Ohio.

Intravenous Immune Globulin (IVIG) R17 (effective September 1, 2007): Source of revision – Internal. Correction of typographic error in the CPT/HCPCS section. The incorrect code Q0491 is deleted and replaced with code Q4091.

Outpatient Pulmonary Rehabilitation Services in Chronic Respiratory Disease R10 (effective 09/01/2007): Source of revision– Internal: Per clarification from CMS, CPT code 99211 is not to be used by non-physician practitioners billing on a CORF claim. HCPCS Code G0238 should be used instead. The CPT/HCPCS section of the LCD was modified to reflect this clarification. In March, 2007, the seven Contractor Medical Directors and MPU associates thoroughly reviewed each existing legacy LCD and applied agreed-upon criteria to determine the final roster of NGS policies. During the March 21 – 23 meeting, the CMDs decided which policies to retain/consolidate as all-NGS LCDs and which policies to retire. Data were pulled (including edit effectiveness data) and criteria were applied to each policy in making the retention determinations. The preparation and review of the policies in March constitutes the annual review for every legacy LCD and fulfills requirements in Chapter 13, Section 13.4(C) of the Medicare Program Integrity Manual. References to legacy AdminaStar Federal were updated to National Government Services. Minor formatting changes made to conform to National Government Services documentation standards. No notice period required and none given.

Posted August 8, 2007

Bone Mass Measurement R15 ║ (effective August 8, 2007): Source of revision – Internal: CMS Publication 100-04, Medicare Claims Processing Manual, Transmittal No.1236, Change Request #5521, dated May 11, 2007, implements changes to covered diagnosis for bone mass measurements. The “ICD-9-CM Codes That Support Medical Necessity” section of the policy is modified deleting codes 733.00, 733.0, 733.02, 733.03, 733.09 and 733.90. Clarification was added to the “limitations” section to correspond with the changes outlined in CR 5521. In March, 2007, the seven Contractor Medical Directors and MPU associates thoroughly reviewed each existing legacy LCD and applied agreed-upon criteria to determine the final roster of NGS policies. During the March 21 – 23 meeting, the CMDs decided which policies to retain/consolidate as all-NGS LCDs and which policies to retire. Data were pulled (including edit effectiveness data) and criteria were applied to each policy in making the retention determinations. The preparation and review of the policies in March constitutes the annual review for every legacy LCD and fulfills requirements in Chapter 13, Section 13.4(C) of the Medicare Program Integrity Manual. References to legacy AdminaStar Federal were updated to National Government Services. Minor formatting changes made to conform to National Government Services documentation standards. No notice period required and none given.

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The following article will be posted under the “ Usually Self-Administered Drug Exclusion List ” link of the “ Medical Policy Information ” page on the AdminaStar Federal (fiscal intermediary) Web site (www.adminastar.com) on September 1, 2007:

Medicare Payment for Drugs and Biologicals Furnished Incident to a Physician’s Service (R12) – Ohio Only

The following article will be posted under the “Archive” section of the “Medical Director's Corner and Other Articles (Current/Archive)” link of the “ Medical Policy Information ” page on the AdminaStar Federal (fiscal intermediary) Web site (www.adminastar.com) on September 1, 2007:

Medicare Payment for Drugs and Biologicals Furnished Incident to a Physician’s Service (R11) – Ohio Only