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National Government Services, Inc.
 Medicare Monthly Review Part A and B
A Combined Part A and Part B Newsletter
MMR-2008 03AB, March 2008

MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)

Use of Healthcare Common Procedure Coding System (HCPCS) V2787 When Billing Approved Astigmatism-Correcting Intraocular Lens (A-C IOL) in Ambulatory Surgery Centers (ASC), Physician Offices, and Hospital Outpatient Departments (HOPD)

MLN Matters Number: MM5853
Related Change Request (CR) #: 5853
Related CR Release Date: February 1, 2008
Effective Date: January 1, 2008
Related CR Transmittal #: R1430CP
Implementation Date: March 3, 2008

Provider Types Affected
Physicians and providers submitting claims to Medicare contractors (carriers, (FI), and/or Part A/B Medicare Administrative Contractors (A/B MAC)) for IOL related services provided to Medicare beneficiaries

Provider Action Needed
Impact to You
This article is based on Change Request (CR) 5853 which provides instructions regarding the use of HCPCS code V2787 when billing for intraocular lens procedures and services involving recognized Astigmatism-Correcting Intraocular Lens (A-C IOL) and taking place in Ambulatory Surgery Centers (ASC), Physician Offices, or Hospital Outpatient Departments (HOPD).

What You Need to Know
Effective for dates of service January 1, 2008 and later, when providing services to a Medicare beneficiary that involve the insertion of recognized A-C IOLs, and the service/procedure takes place in an ASC, HOPD, or physician office, then HCPCS code V2787 should be billed to report the noncovered charges for the A-C IOL functionality of the inserted intraocular lens. V2788 should not be used to report noncovered charges of the A-C IOLs on or after January 1, 2008.

What You Need to Do
See the Background and Additional Information sections of this article for further details regarding these changes.

Background
The Centers for Medicare & Medicaid Services (CMS) previously announced in CR 5527 (Transmittal 1228, April 27, 2007) a new administrator ruling regarding the insertion of astigmatism-correcting intraocular lens (A-C IOL) following cataract surgery. In that CR, CMS provided payment policies and billing instructions for services related to Intraocular Lens (IOL) procedures preformed with approved conventional IOLs or Astigmatism-Correcting Intraocular Lens (A-C IOL) in Ambulatory Surgery Centers (ASC), Hospital Outpatient Departments (HOPD), or Physician offices. In addition, that CR instructed providers to:

You can review CR 5527 at http://www.cms.hhs.gov/transmittals/downloads/R1228CP.pdfExternal PDF on the CMS Web site and its corresponding MLN Matters article, MM 5527, at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5527.pdfExternal PDF on the CMS Web site. CR 5853 instructs that, effective for dates of service on or after January 1, 2008, services provided to Medicare beneficiaries involving the insertion of a recognized A-C IOL in an ASC, HOPD, or physician office, HCPCS code V2787 should be billed to report the noncovered charges for the A-C IOL functionality of the inserted intraocular lens.

Note that (effective for dates of service on or after January 1, 2008) HCPCS code V2788:

Physician offices should continue to bill HCPCS code V2632 for the payable conventional IOL functionality of the A-C IOL. The payment for the conventional lens portion of the A-C IOL lens continues to be bundled with the facility procedure payment for ASCs and HOPDs.

As of March 3, 2008, your Medicare contractor(s) will accept HCPCS code V2787 for dates of service on or after January 1, 2008 to report noncovered charges incurred for services provided to a Medicare beneficiary involving the insertion an A-C IOL in a physician's office, an ASC facility, or a hospital outpatient setting. The annual HCPCS update will include the definition of HCPCS code V2787 as follows:

HCPCS Code

Descriptor

V2787

Astigmatism correcting function of intraocular lens. Noncovered by Medicare statue.

When Medicare denies A-C IOLs billed with V2787, they will return remittance reason code 96 (Noncovered charges) and remark code N425 (Statutorily excluded service(s)) or they may use reason code 204 (This service/ equipment/drug is not covered under the patient’s current benefit plan). Note that your Medicare contractor will not search their files to reprocess claims for HCPCS code V2787 that may have been denied prior to the implementation date for this change. However, they will adjust such claims if you bring them to the contractor’s attention.

Additional Information

The official instruction, CR 5853, issued to your Medicare carrier, FI, and A/B MAC regarding this change may be viewed at http://www.cms.hhs.gov/Transmittals/downloads/R1432CP.pdfExternal PDF on the CMS Web site. If you have any 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.zipZip File 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.

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/External Link on the CMS Web site.