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New Condition Codes 49 and 50
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MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Provider Types Affected
Providers who bill fiscal intermediaries (FIs) or regional home health intermediaries (RHHIs)
Provider Action Needed
Impact to You
These new condition codes are to be used to describe an item that is provided without cost because it is under warranty, replaced, recalled, or was defective.
What You Need to Know
The Centers for Medicare & Medicaid Services (CMS) intends to use these codes for tracking purposes initially, as they need to be able to track replacements given to Medicare beneficiaries.
What You Need to Do
Use the new codes in Form Locator 24-30 field on claims as follows:
Code 49: Product Replacement within Product Lifecycle —Replacement of product earlier than the anticipated lifecycle due to an indication that the product is not functioning properly—warranty.
Code 50: Product Replacement for Known Recall of a Product —Manufacturer or Food and Drug Administration (FDA) has identified the product for recall and therefore replacement.
Background
CMS requested and received new condition codes from the National Uniform Billing Committee to describe situations when a provider receives a product without cost. This could happen because the item was recalled for any of the reasons mentioned above, and it is important for CMS to track recall/ replacement items.
Implementation
The implementation date for this instruction is April 3, 2006.
Additional Information
The official instructions issued to the intermediary/RHHI regarding this change can be found at http://www.cms.hhs.gov/Transmittals/  o n the CMS Web site. On the above page, scroll down while referring to the CR NUM column on the right to find the links for CR4058. Click on the links to open and view the files for those CRs.
If you have any questions, please contact your FI or RHHI at their toll-free number, which may be found at http://www.cms.hhs.gov/MedlearnProducts/downloads/CallCenterTollNumDirectory.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.
For more information, visit the Medlearn Matters Web page at: http://www.cms.hhs.gov/MedlearnMattersArticles/.
Pub. 100-4, Transmittal #: 741 , CR# 4058
Medlearn Matters Number: MM 4058
Related CR Release Date: November 4, 2005
Effective Date: April 1, 2006
Implementation Date: April 3, 2006
Posted: 11/21/2005
CPT codes, descriptions, and other data only are copyright 2005 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Apply.
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