MLN Matters. . .Information for Medicare Providers |
|
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.pdf 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:
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/R1430CP.pdf 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.zip 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. Change Request Number: News Flash - It’s Not Too Late to Give and Get the Flu Shot! In the U.S., the peak of flu season typically occurs anywhere from late December through March; however, flu season can last as late as May. Each office visit presents an opportunity for you to talk with your patients about the importance of getting an annual flu shot and a one time pneumococcal vaccination. Protect yourself, your patients, and your family and friends by getting and giving the flu shot. Don’t Get the Flu. Don’t Give the Flu. Get Vaccinated! Remember - Influenza and pneumococcal vaccinations and their administration are covered Part B benefits. Note that influenza and pneumococcal vaccines are NOT Part D covered drugs. You and your staff can learn more about Medicare’s coverage of adult immunizations and related provider education resources, by reviewing Special Edition MLN Matters Article SE0748 at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0748.pdf News Flash - Test Your Medicare Claims Now! After you have submitted claims containing both National Provider Identifiers (NPI) and legacy identifiers and those claims have been paid, Medicare urges you to send a small batch of claims now with only the NPI in the primary provider fields. If the results are positive, begin increasing the number of claims in the batch. (Reminder: For institutional claims, the primary provider fields are the Billing and Pay-to Provider fields. For professional claims, the primary provider fields are the Billing, Pay-to, and Rendering Provider fields. If the Pay-to Provider is the same as the Billing Provider, the Pay-to Provider does not need to be identified.) Posted: 02/21/2008 |
on the CMS Web site and its corresponding MLN Matters article, MM 5527, at 
on the CMS Web site. 