Medicare B Newsline January 2007

Medicare B Newsline

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January 2007

Ambulatory Surgical Center (ASC)

2007 Update of HCPCS Codes and Payments for Ambulatory Surgical Centers (ASCs)

Drug Pricing

Competitive Acquisition Program (CAP) – Claim Processing for Not Otherwise Classified (”NOC“) Drugs
Medicare Part B Drug Competitive Acquisition Program (CAP): Do Not Bill a Prescription Order Number More Than Once

Clinical Laboratories

2007 Clinical Laboratory Fee Schedule - Annual Update
Clinical Laboratory Improvement Amendment Act (CLIA) – Tests Granted Waived Status under CLIA
Laboratory Competitive Bidding Demonstration

Durable Medical Equipment

Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)
Reasonable Charge Update for 2007 for Splints, Casts, Dialysis Supplies, Dialysis Equipment, and Certain Intraocular Lenses

Education From Electronic Data Interchange (EDI)

Alabama - Top Five Reasons for Claim Rejections for November 2006
Georgia - Top Five Reasons for Claim Rejections for November 2006
Mississippi - Top Five Reasons for Claim Rejections for November 2006

Education From Medical Review

Bevacizumab (AVASTIN™)
Dacogen™(Decitabine)

Education From Provider Enrollment

Claims Submitted With Only a National Provider Identifier (NPI) During the Stage 2 NPI Transition Period
2007 Healthcare Common Procedure Coding System (HCPCS) Update
NPI Billing Alert
NPI Countdown

Education From Provider Outreach and Education

Advanced Beneficiary Notices (ABNs)
Announcement of Medicare Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Payment Rate Increases
Cahaba Government Benefit Administrators (GBA) E-mail Notification Service-Subscribe NOW
Cavernous Nerves Electrical Stimulation with Penile Plethysmograph
Correct Coding Initiative (CCI) Edits; Version 130
Education from Medical Review
Medicare Part B Provider Call Center Hours and Telephone Numbers
New 2007 Current Procedural Terminology (CPT) Mammography Codes
Once In A Lifetime Procedures
Processing All Diagnosis Codes Reported on Claims Submitted to Carriers
Schedule of Upcoming Events
Ultrasound Screening for Abdominal Aortic Aneurysms (AAA)

General Medicare Questions for Patients/Beneficiaries

Holiday Schedule

Local Coverage Determinations (LCD) Updates

Amifostine (Ethyol®)
Cahaba GBA Self-Administered Drug List
Cetuximab (ERBITUX®)
Consolidation of Local Coverage Determination (LCD) Identification (ID) Numbers
Coronary CT Angiography and Electron Beam Computed Tomography of the Coronary Vessels
FDA Drug HCPCS Updates
Local Coverage Determinations (LCD) Updates
Luteinizing Hormone-Releasing Hormone Analogs in the Treatment of Prostate Cancer
Optical Coherence Tomography (OCT)
Oxaliplatin for Injection (Eloxatin™)
Paravertebral Facet Joint Denervation

Medicare B Newsline Quality Survey

Nephrology

Implementation of Changes in End Stage Renal Disease (ESRD) Payment for Calendar Year (CY) 2007

Radiology

Duplicate Claim Edit for the Technical Component (TC) of Radiology and Pathology Laboratory Services

Therapy

Outpatient Therapy Cap Exceptions Clarifications

Update to Local Coverage Determination for Oxaliplatin for Injection (Eloxatin™)

Alabama – L13000
Georgia – L11272
Mississippi – L20096

Effective January 1, 2007:

Notification of the Local Coverage Determination for Oxaliplatin for Injection (Eloxatin™) was published in the November 2005 issue of the Medicare Focus.

Effective for claims with dates of service January 1, 2007 and after, the LCD is updated to include coverage for the following USP DI off label indication:

Advanced/metastatic gastric carcinoma. Oxaliplatin in combination with irinotecan or fluorouracil with leucovorin or folinic acid has demonstrated activity in the treatment of advanced/metastatic gastric carcinoma.

ICD-9 codes 151.0-151.9 have been added for this indication.

A copy of the updated Local Coverage Determination can be found https://www.cahabagba.com. Click on your state for the information you need.

CPT five digit codes, nomenclature and other data only are copyright 2005 American Medical Association. All rights reserved. No fee schedules, basic units, relative values or related listings are included in CPT. AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for the data contained or not contained herein.