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Region C Issues
Page Content
Name |
Visits to Patients in Nursing Facilities CMS Issue Number: C002372011 |
Description |
If evaluation and management services are being rendered to patients in a skilled nursing facility, then the appropriate E&M codes are to be used. |
Type of Review |
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States |
Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, Virgin Islands, Virginia, West Virginia |
Provider type |
Physician |
Date of service |
10/01/2007 – Open |
References |
Additional information can be found in the following manuals/publications: https://www.cms.gov/manuals/downloads/clm104c12.pdf |
Name |
Ambulance/transport during a SNF stay to or from a diagnostic or therapeutic site CMS Issue Number: C001472011 |
Description |
Ambulance/transport services provided during a SNF stay are not separately paid under the Part B benefit. The cost for these services are considered part of the Part A Prospective Payment made to the SNF Provider. Ambulance transports to or from a diagnostic or therapeutic site other than a hospital or renal dialysis facility (e.g., an independent diagnostic testing facility (IDTF), cancer treatment center, radiation therapy center, wound care center, etc.). The ambulance transport is included in the SNF PPS rate if the first or second character (origin or destination) of any HCPCS code ambulance modifier is “D” (diagnostic or therapeutic site other than “P” or “H”), and the other modifier (origin or destination) is “N” (SNF). The first SNF is responsible for billing the services to the FI. |
Type of Review |
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States |
Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, Virgin Islands, Virginia, West Virginia
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Provider type |
Ambulance |
Date of service |
10/01/2007 – Open |
References |
Additional information can be found in the following manuals/publications:
1. http://www.cms.gov/manuals/downloads/clm104c15.pdf
2. http://www.cms.gov/manuals/downloads/clm104c06.pdf
3. http://oig.hhs.gov/oas/reports/region1/10800505.pdf
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Name |
Incorrect billing of Vaccine Administration Services |
Description |
Vaccine administration (90471-90472) are required to be billed with revenue code 0771 for all providers except RHC & FQHC. Providers billed cpt(s) 90471 - 90472 in revenue codes other than 0771 resulting in billing errors. |
Type of Review |
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States |
Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, Virgin Islands, Virginia, West Virginia |
Provider type |
Outpatient Hospital - Unspecified |
Date of service |
10/01/2007 – Open |
References |
http://www.cms.gov/manuals/downloads/clm104c18.pdf 2. http://www.cms.gov/medicare-coverage-database/details/lcd-
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Name |
Payments for Ambulatory Surgical Center Services Provided to Beneficiaries in Skilled Nursing Facility Stays Covered Under Medicare Part A |
Description |
Payment for the majority of Skilled Nursing Facility (SNF) services provided to beneficiaries in a Medicare covered Part A SNF stay are included in a bundled prospective payment made through the fiscal intermediary (FI)/A/B Medicare Administrative Contractor (MAC) to the SNF. These bundled services are to be billed by the SNF to the FI/A/B MAC in a consolidated bill. |
Type of Review |
Automated Review |
States |
AL, AR, CO, FL, GA, LA, MS, NM, NC, OK, SC,TN, TX, VA, WV, Puerto Rico, and Virgin Islands |
Provider type |
Ambulatory Surgery Center |
Date of service |
October 1, 2007-Present |
References |
http://oig.hhs.gov/oas/reports/region1/10900521.pdf http://www.ssa.gov/OP_Home/ssact/title18/1888.htm http://www.cms.gov/manuals/downloads/clm104c06.pdf http://www.cms.gov/SNFConsolidatedBilling/Downloads/08MajorCatExpl.pdf |
Name |
Untimed Codes |
Description |
Description Untimed Codes – CPT codes (excluding modifiers KX, and 59) where the procedure is not defined by a specific timeframe (untimed codes), the provider should enter a one (1) in the units billed column per date of service. |
Type of Review |
Automated Review |
States |
AL, AR, CO, FL, GA, LA, MS, NM, NC, OK, SC,TN, TX, VA, WV, Puerto Rico, and Virgin Islands |
Provider type |
Physician / Outpatient Hospital |
Date of service |
October 1, 2007-Present |
References |
CMS Pub 100-04, Transmittal 1019, dated 8.3.06, pages 7-11.
CMS Pub 100-04, Ch. 5, § 20.2.
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Name |
Ambulance SNF to SNF Transfer |
Description |
Ambulance claims for SNF to SNF transfers (modifier NN) are not separately payable under Part B. The SNF discharging the beneficiary to another SNF is financially responsible for the transportation fees. Ambulance providers should seek payment from the transferring SNF. |
Type of Review |
Automated Review |
States |
AL, AR, CO, FL, GA, LA, MS, NM, NC, OK, SC,TN, TX, VA, WV, Puerto Rico, and Virgin Islands |
Provider type |
Part B |
Date of service |
Claims paid on or After October 1, 2007 |
References |
CMS Pub 100-04, Chapter 15 § 30.2.2; and Change Request 3212
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