Provider Types Affected
Physicians, therapists, and providers of therapy services billing Medicare carriers, fiscal intermediaries (FI), including Regional Home Health Intermediaries (RHHI), or Part A/B Medicare Administrative Contractors (A/B MAC) for rehabilitation services

Provider Action Needed
Impact to You - One new code will added to the therapy code list for CY 2008. Code 96125 will be used for standard cognitive performance testing per hour of a qualified health care professional’s time, both face-to-face with the patient and time interpreting test results and preparing the report.

What You Need to Know - Code 96125 is considered “always therapy” regardless of who performs the service and will always require a therapy modifier (GN, GO, GP).

What You Need to Do - Make certain your office staffs are aware of the new code.

Background
Section 1834(k)(5) of the Social Security Act requires that all claims for outpatient rehabilitation therapy services and all comprehensive outpatient rehabilitation facility services be reported using a uniform coding system. The Healthcare Common Procedure Coding System/Current Procedural Terminology, 2008 Edition (HCPCS/CPT-4) is the coding system used for the reporting of these services.

Therapy services, including “always therapy” services, must follow all the policies for therapy services detailed in the Medicare Claims Processing Manual, Publication 100-4, Chapter 5 and the Medicare Benefit Policy Manual, Publication 100-2, Chapters 12 and 15. That manual is available at http://www.cms.hhs.gov/Manuals/IOM/list.asp#TopOfPage on the Centers for Medicare & Medicaid Services (CMS) Web site.

Additional Information
If you have questions, please contact your Medicare Carrier, FI, RHHI, or A/B MAC at their toll-free number, which can be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip on the CMS Web site.

For complete details regarding CR5810, please see the official instruction issued to your Medicare FI, RHHI, carrier, or A/B MAC. That instruction may be viewed by going to http://www.cms.hhs.gov/transmittals/downloads/R1377CP.pdf 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. CPT only copyright 2006 American Medical Association.

News Flash - The Centers for Medicare & Medicaid Services (CMS) reminds health care professionals that Medicare provides coverage of diabetes screening tests for beneficiaries at risk for diabetes or those diagnosed with pre-diabetes, as well as other covered services for people with diabetes. CMS has published a new provider brochure entitled Diabetes-Related Services. This tri-fold brochure provides health care professionals with an overview of Medicare’s coverage of diabetes screening tests, diabetes self-management training, medical nutrition therapy, and supplies and other services for Medicare beneficiaries with diabetes. You may download, view and print this new brochure by visiting the Medicare Learning Network (MLN) at http://www.cms.hhs.gov/MLNProducts/downloads/DiabetesSvcs.pdf on the CMS Web site. Printed copies of the brochure may be ordered, free of charge, from the MLN Product Ordering Page by visiting http://cms.meridianksi.com/kc/main/kc_frame.asp?kc_ident=kc0001&loc=5 on the CMS Web site.

Posted: 11/27/2007