January 15, 2008
1st Quarter 2008 Part B Customer Service Frequently Asked Questions
I am somewhat confused about the COBA Medigap 5 digit codes. Are the new codes the same as the Payer ID numbers? If so, have they always been the same?
Effective October 1, 2007, the Centers for Medicare & Medicaid Services transferred the mandatory Medicare supplemental (Medigap) insurance claim-based crossover process from the Medicare contractors to the national Coordination of Benefits Contractor (COBC). During this transition, the COBC assigned new 5-digit Coordination of Benefits Agreement (COBA) numbers to the Medigap insurer. Providers are to make certain that claims are now submitted with the appropriate COBA claim-based Medigap 5-digit identifier.
Articles from the Centers for Medicare & Medicaid Services (CMS) were posted on our web site concerning the mandatory Medigap (claim-based) crossover process. Please refer to the following links for more information and guidelines concerning this transition:
- http://www.cignagovernmentservices.com/partb/pubs/news/2007/0707/cope5999.html
- http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5601.pdf
- http://www.cms.hhs.gov/COBAgreement/
- http://www.cms.hhs.gov/COBAgreement/Downloads/Medigap%20Claim-based%20COBA%20IDs%20for%20Billing%20Purpose.pdf
If we are filing an office visit on the same day the patient receives a flu vaccine, is it necessary to add modifier 25 to the E/M service?
If the patient's visit is only to receive a flu immunization, the doctor cannot charge for an office visit. If, however the physician renders other services that can be accurately described by an evaluation and management code, these services can be billed separately. Office visits billed with administration codes G0008, G0009 and G0010 do not require the 25 modifier.
What is the fee schedules amounts for the influenza and pneumonia vaccines and when are they effective?
Effective September 1, 2007, the payment allowances for the influenza and pneumonia vaccines are as followed:
Influenza Vaccine Payments
- CPT 90655 is $16.109;
- CPT 90656 is $17.366;
- CPT 90657 is $6.609;
- CPT 90658 is $13.218; and
- CPT 90660 (FluMist, a nasal influenza vaccine) is $21.176. Providers should note that CPT 90660 may be covered in those cases where the local Medicare contractor determines that its use is medically reasonable and necessary for the beneficiary.
Pneumococcal Vaccine Payments
- CPT 90732 is $29.730; and
- CPT 90669 is $78.803.
Reference: MLN Matter Article 5744 (http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5744.pdf)
I am trying to find the HMO directory that tells which company is associated with the code given on the automated system. Can you tell me where to find this information?
There are web sites available that will give information on the Medicare Advantage Plans, based on the plan's identification number given on the Interactive Voice Response (IVR), including the address and type of plan. These listings are currently updated and maintained by the Centers for Medicare & Medicaid Services (CMS). Please refer to the CMS links below for this current listing of Medicare Advantage Plans:
- http://www.cms.hhs.gov/HealthPlansGenInfo/
- http://www.cms.hhs.gov/healthplansgeninfo/downloads/claims_processing_20060120.pdf.
I was told that our claims were being denied because our NPI number is not enrolled. How do I enroll our NPI number with Medicare?
Certain information entered into the National Plan and Provider Enumeration System (NPPES) in order to obtain and maintain your National Provider Identifier (NPI) is used by Medicare in processing claims. If the information you entered in NPPES is not correct, your claims may reject. It is important to verify that information is entered correctly. Once the NPI application information has been submitted and the NPI assigned, NPPES will send the health care provider a notification that includes their NPI. (Providers can contact Customer Service to verify that their NPI was cross-walked correctly from NPPES.)
Medicare Learning Network (MLN) Matters article, SE0725 addresses information regarding the NPPES errors and using the NPI on Medicare claims. This article may be viewed and/or downloaded on the Centers for Medicare & Medicaid Services (CMS) web site at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0725.pdf.
Is there anywhere on your web site physicians can go to check a patient's Medicare coverage. If not, what is the best way for us to verify if a patient has Medicare insurance?
In adherence with privacy guidelines, providers cannot check the patient's Medicare eligibility on a Medicare contractor's web site. However, the patient's eligibility can be checked on the Interactive Voice Response (IVR) system. Providers are required to use the IVR system for transactions such as patient eligibility and claim status. Complete guidelines and instructions for using the IVR system can be found on our web site at http://www.cignagovernmentservices.com/partb/claims/ivr.html.
What is the deductible for 2008?
The 2008 Medicare Part B deductible is $135.00. The 2008 Part A deductible is $1,024.00
Where can I get a copy of the Part B 2008 fee schedule?
The 2008 Physician Fee Schedule can be viewed and/or downloaded from our web site at http://www.cignagovernmentservices.com/partb/coverage/fees/index.html.
Where can I find a list of modifiers paid by Medicare?
We do not publish a comprehensive list of modifiers payable by Medicare. However, the modifiers are listed in the Current Procedural Terminology (CPT) coding handbook and in the HealthCare Procedure Coding System (HCPCS) book. The American Medical Association's CPT handbook includes a list of most modifiers and provides a detailed description of Level I (1) modifiers (composed of two numbers). The HCPCS handbook provides a comprehensive list of Level II (2) modifiers (composed of either two alphas or an alpha and a number). Also, the Centers for Medicare & Medicaid Services (CMS) online Medicare Claims Processing Manual and the Medicare Benefit Policy Manual gives instructions for the using the appropriate modifier with specific services. Please refer to the CMS web site at http://www.cms.hhs.gov/Manuals/IOM/list.asp, for more information.
We are trying to change our physician office address. Can we do this over the phone or on your website?
An address change requires submitting the appropriate CMS-855 Medicare enrollment application. The instructions included with each form provide the best guidance on what is needed to complete an address change. At this time this process is not available on-line..
Providers will need to have a National Provider Identifier (NPI) and may need to complete an Electronic Funds Transfer Authorization Agreement (CMS-588) with the address change. Please understand that to change a practice location, special payment address, or a "pay to" address the Provider Enrollment Department must validate all information.
You may obtain the current versions of the CMS 855 forms through the Centers for Medicare & Medicaid Services website at http://www.cms.hhs.gov/CMSForms/CMSForms/list.asp. From this page, under "Select from the Following Options,"
- Select "Show only (select one or more options):"
- Select "Show only items containing the following word"
- Type "855" in the box
- Click the "Show Items" button
- Select the proper CMS-855 form
Providers receive a courtesy letter within fifteen days, acknowledging receipt of the application. If the application is complete and accurate, it is processed timely. However, if additional information is required to process an application, Provider Enrollment will send another detailing the additional items required.
You may contact our Provider Enrollment Department at 1.866.520.4007 for assistance with the forms and further instructions.
