June 2003 Part B Medicare Bulletin
Table of Contents
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- April Quarterly Update for 2003 DMEPOS Fee Schedule
- CMS Ambulatory Surgical Center Approved Codes & Groupings
- Diagnosis Code for Screening Pap Smear and Pelvic Examination Services
- EDI and HIPAA – A Winning Combination!
- HIPAA – October 16, 2003 Deadline is Approaching Quickly
- Magnetic Resonance Angiography
- Mammography Computer Aided Detection (CAD) Equipment
- Managed Care Reasonable Charge Data Disclosure Requirements
for
Ambulance Services - Managing Medicare Appeals
- New Health Care Claims Status Category Codes for Use
with the Health Care
Claim Status Request and Response ASC X12N 276/277 - Overpayment Refunds
- Program Integrity Manual Update
- Second Update to the 2003 MPFSDB
- Single Drug Pricer (SDP) Updates
- Stem Cell Transplantation
- Ten Steps to HIPAA Compliance
- Updated Information on the Implementation of the Financial
Limitation for
Outpatient Rehabilitation Services - What 's New with Medicare Part B Provider Enrollment?
- " You want me to order WHAT?" – Marketing Schemes
EDI and HIPAA – A Winning Combination!
CIGNA Government Services offers a variety of EDI services for your office! Not only can you send your Medicare claims electronically, you can also check the status of your assigned claims, determine whether a patient is eligible for the Medicare program - even receive your Medicare payments electronically! Plus - you can even receive your Remittance Notice, receipt listings and error reports electronically! Does this sound good to you?
Health care providers who use EDI see improvements in office operations including reduced administrative costs, streamlined cash flow and fewer claim-related errors.
And - EDI makes it easy to submit corrected or rejected claims…electronically. Imagine! No more paper claims!
Combine the power of EDI with the new HIPAA (Health Insurance Portability and Accountability Act) standards and you have a WIN-WIN combination! Why settle for manual preparation and longer payment periods when you can streamline the process and improve your cash flow? Log on to our Web site for details on EDI services, www.cignamedicare.com/edi/Index.html.
While you're online, don't forget to register for one of our Medicare workshops. We'll show you even more benefits of EDI and HIPAA!
HIPAA – October 16, 2003 Deadline is Approaching Quickly
The April 14, 2003, HIPAA privacy deadline and the April 16, 2003, testing deadline have passed, and the October 16, 2003, deadline for compliance with the HIPAA electronic transactions and code set standards is approaching quickly. Many providers are only now starting to think about what they need to do to become HIPAA compliant. To avoid being a HIPAA covered entity, some consultants are suggesting that providers consider switching from electronic transmission to paper claims. Their advice is extremely shortsighted and certainly not a panacea, especially for Medicare providers. Consider the following:
Requirement to Go to Electronic Claims
Medicare will not accept paper claims, effective October 16, 2003. There will be exceptions for small providers and under other limited situations. Regulations are expected soon.
Negative Fiscal Impact of Paper Claims
Processing paper claims takes longer than electronic claims and has an increased rate of error. Faster payment can be made for electronic claims submitted to Medicare. Electronic Medicare claims can be paid 14 days after they are received while paper claims cannot be paid before 28 days after receipt. In addition, processing paper claims has increased administrative, postage and handling costs.
Changes to Business Processes
Switching from electronic transmission to paper claims would have numerous repercussions on the business processes of your office. Remember that HIPAA transactions include more than just claims submission. Providers often conduct eligibility queries, claim status queries, and referral transmission electronically. All of these would have to be done on paper to avoid being a HIPAA covered entity, ultimately leaving less time for patient care and more time devoted to administration. However, you could decide to do some paper transactions and some electronic transactions, but remember that the electronic transactions must be HIPAA compliant.
General HIPAA Information
What is HIPAA?
Congress passed the Health Insurance Portability and Accountability Act (HIPAA) in 1996. There are four main areas that comprise administrative simplification:
1. Electronic Transactions and code sets
2. Unique Identifiers
3. Privacy
4. Security
What are the HIPAA transactions?
Electronic Transaction Standards have been developed for the following exchanges of information that providers conduct:
1. Health care claims or equivalent encounter information;
2. Health care payment and remittance advice;
3. Health care claims status
4. Eligibility inquiry
5. Referral certification and authorization
6. Claims attachment (standards forthcoming)
7. First report of injury (standards forthcoming)
What is a HIPAA Covered Entity?
Under HIPAA, all health care clearinghouses, all health plans, and those health care providers that conduct certain transactions in electronic form or who use a billing service to conduct transactions on their behalf are considered covered entities.
What is "Electronic?"
The term "electronic" is used to describe moving health care data via the Internet, an extranet, leased lines, dial-up lines such as for "direct data entry", or DDE, private networks, point of service, and health data that is physically moved from one location to another using magnetic tape, disk or CD media. For example, if a provider transmits information electronically by transmitting claims, conducting eligibility queries, conducting claim status queries or referrals, they would be considered a covered entity under HIPAA.
A Benefit to Consider
HIPAA efficiencies include using the same format for all payers rather than separate formats for each payer, as is often done today.
HIPAA Deadlines:
April 14, 2003
Privacy - all covered entities except small health plans.
April 16, 2003
Electronic Health Care Transactions and Code Sets - all covered entities
must have started internal software and systems testing.
October 16, 2003
Electronic Health Care Transactions and Code Sets - all covered entities
that filed for an extension and small health plans.
April 14, 2004
Privacy - small health plans.
April 21, 2005
Security - all covered entities except small health plans.
April 21, 2006
Security - small health plans.
Where to go for help:
CMS Web site: http://www.cms.hhs.gov/HIPAAGenInfo/
HIPAA hotline: 1.866.282.0659
AskHIPAA mailbox, send an e-mail to askhipaa@cms.hhs.gov
For more information on privacy, visit http://www.hhs.gov/ocr/hipaa.
For privacy questions, call 1.866.627.7748
[EM 2003-0375]
Ten Steps to HIPAA Compliance
If you have not started to comply with HIPAA standards, time may be running out for you to become completely aware of your obligations under the federal HIPAA laws. That should not prevent you however, from reading the various summaries and public "white papers" available on the subject. At this late date, anything you can do to familiarize yourself with your compliance obligations under the law will help you avoid potentially catastrophic business implications as a result of non-compliance and may help you avoid penalties for failing to comply with federal regulations. Those implications can include your inability to submit claims to any insurer and delays in your payments as a result of non-compliance. Quite simply – if you cannot submit a claim, you will not get paid for services provided.
The following ten steps are part of a much larger educational tool currently available on the SHARP (Southern HIPAA Administrative Regional Process) Web site – These steps are not-inclusive of all your obligations under the law but they will certainly help you advance toward HIPAA compliance. HIPAA workshops, seminars, and other educational opportunities exist throughout Tennessee, North Carolina, and Idaho. Visit www.cignamedicare.com for detailed information.
Ten Steps to HIPAA Compliance
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Appoint someone to be the Transactions Point Person.
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Determine how you interact with health plans and trading partners for administrative transactions.
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Contact your health plans and vendors, technology and billing services vendors and clearinghouses.
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Determine how the new claim formats will affect your operations.
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Determine how the HIPAA code sets will affect you.
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Make compliance pay for itself – use the EDI ROI (Return on Investment) tool to see how HIPAA can save your office money (available at www.sharpworkgroup.com).
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Start testing with payers and clearinghouses as soon as you can and test with each payer or clearinghouse.
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Establish a contingency plan for getting claims paid.
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Document and train staff for new content changes – establish crosswalks from the old information to the new required information.
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Leverage HIPAA transactions for a more efficient operation.
Comprehensive HIPAA information is available at the following internet locations:
www.cignamedicare.com/hipaa
www.cms.hhs.gov/hipaa/
www.SHARPworkgroup.com
www.aspe.hhs.gov/admnsimp/
April Quarterly Update for 2003 DMEPOS Fee Schedule
The DMEPOS fee schedules are updated on a quarterly basis in order to implement fee schedule amounts for new codes and to revise any fee schedule amounts for existing codes that were calculated in error.
Code A4632, replacement battery for external infusion pump, any type, each, was added to the Healthcare Common Procedure Coding System (HCPCS) effective January 1, 2003. This code should be used to bill Medicare for replacement batteries furnished for patient-owned infusion pumps from January 1, 2003, through March 31, 2003. Effective for items furnished on or after April 1, 2003, new codes for five different types of infusion pump batteries must be used instead of code A4632 for the purpose of billing the Medicare program for these items.
Effective for items furnished on or after April 1, 2003, the following codes are being added to the HCPCS:
| K0560 | Metacarpal Phalangeal Joint Replacement, Two Pieces, Metal (e.g., Stainless Steel or Cobalt Chrome), Ceramic-Like Material (e.g., Pyrocarbon), For Surgical Implantation (All Sizes, Includes Entire System) |
| K0600 | Functional Neuromuscular Stimulator, Transcutaneous Stimulation of Muscles of Ambulation with Computer Control, Used For Walking By Spinal Cord Injured, Entire System, After Completion of Training Program |
| K0601 | Replacement Battery For External Infusion Pump Owned By Patient, Silver Oxide, 1.5 Volt, Each |
| K0602 | Replacement Battery For External Infusion Pump Owned By Patient, Silver Oxide, 3 Volt, Each |
| K0603 | Replacement Battery For External Infusion Pump Owned By Patient, Alkaline, 1.5 Volt, Each |
| K0604 | Replacement Battery For External Infusion Pump Owned By Patient, Lithium, 3.6 Volt, Each |
| K0605 | Replacement Battery For External Infusion Pump Owned By Patient, Lithium, 4.5 Volt, Each |
Code K0560 is to billed to the Part B Carrier. Codes K0600 through K0605 are filed through the DMERC carrier.
[EM 2003-059/CR 2535]
" You want me to order WHAT?" – Marketing Schemes
You've all seen the television ads. You've even likely been approached by at least one of your patients who hands you some literature and forms from a medical equipment supply company or pharmacy with a request that you order them XYZ widget or medication. And you ask yourself - "Is this legal? Are these guys allowed to mess with my patients?" Answer: Maybe.
Medicare regulations specifically address telemarketing to Medicare beneficiaries by medical equipment suppliers and pharmacies. There are only three circumstances where telephone solicitations are permitted:
- The beneficiary has given the supplier written permission to make contact by telephone.
- The phone contact involves a covered item that the supplier has already provided to the beneficiary.
- The supplier has furnished at least one covered item to the beneficiary during the preceding 15 months.
As you can see, there are clearly some gaps in the regulations leaving room for contact that is not prohibited. For example, a company may have a broad product line and "cross market" items to beneficiaries they already service. Others choose to advertise in print media or run television ads enticing beneficiaries with offers of "free" products or guaranteed coverage by Medicare. In some cases, like the first example, this practice may not be a bad thing and can benefit your patient by helping identify needed equipment or services. However, in other situations like offers of "free" products, it can confuse your patient and raise unnecessary concerns about the treatment plan you've designed.
What can you do? First, educate your patients about these practices, especially mail order, television, and internet-based marketing promotions. Second, be open and honest with your patient when they propose changes in their medications or ask you to order a piece of medical equipment based on a marketing contact. Initiate a discussion about their medical needs and whether the item or service being promoted is really appropriate for their medical condition. New and glitzy doesn't always equate to better care. Finally, remember that you are ultimately in control of whether your patient receives this new service, medication or medical device. Before submitting a claim to Medicare, the DME provider MUST have your signature on the order. If you don't think the item or service is necessary, don't sign the order!
If you feel that you or your patients have been approached by a medical equipment supplier or pharmacy in a manner that might be prohibited by Medicare rules and regulations, you may report this to CIGNA Government Services's Customer Service department, toll-free, at 1.866.243.7272.
Updated Information on the Implementation of the Financial Limitation for Outpatient Rehabilitation Services
This article is to instruct providers/suppliers about the new and revised MSN messages and their use. Additional information on this subject can be found in the March 2003 Medicare Bulletin.
Background
Section 4541(a)(2) of the Balanced Budget Act (BBA) (P.L. 105-33) of 1997, which added §1834(k)(5) to the Social Security Act (the Act), required payment under a prospective payment system for outpatient rehabilitation services. Outpatient rehabilitation services include the following services:
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Physical therapy (which includes outpatient speech-language pathology); and
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Occupational therapy.
The BBA provided that the $1500 limits be indexed by the Medicare Economic Index (MEI) each year beginning in 2002. This indexed amount is $1590 for 2003.
The limitation is based on the services the Medicare beneficiary receives, not the type of practitioner who provides the service. Therefore, physical therapists, speech-language pathologists, occupational therapists as well as physicians and non-physicians practitioners could render a therapy service.
MSN Messages
Existing MSN messages 17.13, and the new MSN messages 17.18 and 17.19 shall be issued on all claims containing outpatient rehabilitation services as noted in this PM.
MSN 17.13 has been revised to read:
17.13 - Medicare approves up to ( $ ) a year for physical therapy and speech-language pathology services and a separate ( $ ) a year for occupational therapy services when billed by providers, physical and occupational therapists, physicians, and other non-physician practitioners. Medically necessary therapy over these limits is covered when received at a hospital outpatient department.
Spanish translation
17.13 - Medicare aprueba hasta ($) al año por servicios de terapia
física y patología del lenguaje hablado y la cantidad separada
de ($) al año por servicios de terapia ocupacional cuando son facturados
por proveedores, terapistas físicos y ocupacionales, médicos
y otros practicantes no médicos. La terapia que es medicamente necesaria
y que sobrepasa estas cantidades límites está cubierta cuando
se recibe en una unidad de hospital ambulatorio.
17.18 - ($) has been applied during this calendar year (CCYY) towards the ($) limit on outpatient physical therapy and speech-language pathology benefits.
Spanish Translation
17.18 - En este año (CCYY), ($) han sido deducidos de la cantidad
límite de ($) por los beneficios de terapia física ambulatoria
y de patología del lenguage hablado.
17.19 - ($) has been applied during this calendar year (CCYY) towards the ($) limit on outpatient occupational therapy benefits.
Spanish Translation
17.19 - En este año (CCYY), ($) han sido deducidos de la cantidad
límite de ($) por los beneficios de terapia ocupacional ambulatoria.
Carriers and intermediaries shall use the existing Medicare Summary Notice message 17.6 to inform the beneficiaries that they have reached the financial limitation.
17.6 - Full payment was not made for this service because the yearly limit has been met.
Spanish translation
17.6 - Debido a que usted alcanzó su límite anual por este
servicio, no se hará un pago completo.
Additional Information
Once the limitation is reached, if a claim is submitted, the outpatient rehabilitation therapy services will be denied. Group code PR and claim adjustment reason code 119, benefit maximum for this time period has been reached will be used in the provider remittance advice to establish the reason for denial. The provider/physician/supplier should advise the beneficiary that a claim for services that exceeds the $1590 limitation is being denied pursuant to §1833(g) of the Social Security Act (42 U.S.C. §1395(g)). The providers/suppliers should inform the beneficiary that any additional outpatient rehabilitation services in this setting would result in the beneficiary exceeding the financial limitation, but medically necessary services above the limit may be obtained at an outpatient hospital. Such notification will allow the beneficiary to make an informed choice about continuing to receive services from the provider/physician/supplier or to change to a hospital outpatient department. This is advised because the beneficiary is responsible for payment of all outpatient rehabilitation services that exceeded the financial limitation on an annual basis.
In situations where a beneficiary is close to reaching the financial limitation and a particular claim might exceed the limitation, the provider should bill the usual and customary charge for the service furnished even though such charge might exceed the $1590 limit. When the financial limitation has been exceeded and the beneficiary chooses to continue treatment at a setting other than the outpatient hospital where medically necessary services are covered, the services may be billed at the rate the provider/supplier determines.
Services provided in a capped setting after the limitation has been reached are not Medicare benefits and are not governed by Medicare policies.
Beneficiaries may appeal claims denied due to exceeding therapy caps. The beneficiary is to be advised of his or her appeal rights set forth in 42 CFR Part 405, subpart G. Physicians, therapists and other suppliers who accept assignment may also appeal denials. Physicians, therapists and other suppliers who do not accept assignment and institutional providers do not have the right to appeal.
Provider Notification of Beneficiary Responsibility
Providers/suppliers may use the Notice of Exclusions from Medicare Benefits (NEMB Form No. CMS-20007 & Formulario No. CMS-2007) or a similar form of their own design to notify beneficiaries of the therapy financial limitations and that these limits are applied in all settings except hospital outpatient departments. ABNs cannot be used because of the statutory nature of the financial limitations. Therefore, providers/suppliers should inform beneficiaries that beneficiaries are responsible for 100 percent of the costs of therapy services above each respective therapy $1590 limit, unless this outpatient care is furnished directly or under arrangement by a hospital. It is the provider's responsibility to present each beneficiary with accurate information about the therapy limits and that, where necessary, appropriate care above the $1590 limit can be obtained at a hospital outpatient therapy department. Providers/suppliers should use the Notice of Exclusion from Medicare Benefits (NEMB) form to inform beneficiaries of the therapy financial limitation at their first therapy encounter with the beneficiary. When using the NEMB form, the practitioner checks box #1 and writes the reason for denial in the space provided at the top of the form. For CY 2003, provide the following: "Medicare will not pay for: physical therapy and speech-language pathology services over $1590 (including dates of service from July 1, 2003, through December 31, 2003)." This same information is provided for occupational therapy services over the $1590 limit for the same time period, as appropriate.
The NEMB form can be found at: http://www.cms.hhs.gov/medlearn/refabn.asp.
Providers who bill to intermediaries will find the amount a beneficiary has accrued toward the financial limitations on the HIQA. Suppliers who bill to carriers may call the contractor to obtain the amount accrued until the HIPAA system is operational. When the HIPAA system goes into effect, all providers/suppliers and contractors may access the accrued amount of therapy services from the ELGA and ELGB screens.
[EM 2003-0408/CR 2709]
Magnetic Resonance Angiography
Section 50-14, Magnetic Resonance Angiography, provides coverage,
billing, and payment instructions for MRA. Previously, Medicare provided
limited coverage for MRA of the abdomen and chest. For claims with dates
of service on or after July 1, 2003, Medicare coverage has been expanded
for the use of MRA for diagnosing pathology in the renal or aortoiliac arteries.
Among the advantages of MRI are the absence of ionizing radiation and the
ability to achieve high levels of tissue contrast resolution without injected
iodinated radiological contrast agents. Recent advances in technology have
resulted in development and FDA approval of new paramagnetic contrast agents
for MRI which allow even better visualization in some instances. Multislice
imaging and the ability to image in multiple planes, especially sagittal
and coronal, have provided a flexibility not easily available with other
modalities. Because cortical (outer layer) bone and metallic prostheses do
not cause distortion of MR images, it has been possible to visualize certain
lesions and body regions with greater certainty than has been possible with
CT. The use of MRI on certain soft tissue structures for the purpose of detecting
disruptive, neoplastic, degenerative, or inflammatory lesions has now become
established in medical practice.
B. Covered Clinical Applications.—Although several uses of MRI are still considered investigational and some uses are clearly contraindicated (see subsection D), MRI is considered medically efficacious for a number of uses. Use the following descriptions as general guidelines or examples of what may be considered covered rather than as a restrictive list of specific coverages. Coverage is limited to MRI units which have received FDA premarket approval, and such units must be operated within the parameters specified by the approval. As with all items and services, the services must be reasonable and necessary for the diagnosis or treatment of the specific patient involved.
MRI is useful in examining the head, central nervous system, and spine. Multiple sclerosis can be diagnosed with MRI and the contents of the posterior fossa are visible. The inherent tissue contrast resolution of MRI makes it an appropriate standard diagnostic modality for general neuroradiology.
MRI can assist in the differential diagnosis of mediastinal and retroperitoneal masses, including abnormalities of the large vessels such as aneurysms and dissection. When a clinical need exists to visualize the parenchyma of solid organs to detect anatomic disruption or neoplasia, this can be accomplished in the liver, urogenital system, adrenals, and pelvic organs without the use of radiological contrast materials. When MRI is considered reasonable and necessary, the use of paramagnetic contrast materials may be covered as part of the study. MRI may also be used to detect and stage pelvic and retroperitoneal neoplasms and to evaluate disorders of cancellous bone and soft tissues. It may also be used in the detection of pericardial thickening. Primary and secondary bone neoplasm and aseptic necrosis can be detected at an early stage and monitored with MRI. Patients with metallic prostheses, especially of the hip, can be imaged in order to detect the early stages of infection of the bone to which the prothesis is attached.
Effective for services provided on or after March 22, 1994, MRI may also be covered to diagnose disc disease without regard to whether radiological imaging has been tried first to diagnose the problem.
C. Gating Devices and Surface Coils (Effective for Services On or After March 4, 1991).—Gating devices which eliminate distorted images caused by cardiac and respiratory movement cycles are now considered state of the art techniques and may be covered. Surface and other specialty coils may also be covered, as they are used routinely for high resolution imaging where small limited regions of the body are studied. They produce high signal-to-noise ratios resulting in images of enhanced anatomic detail.
D. Contraindications and Noncovered Uses.—
1. Contraindications.—MRI is not covered when the following
patient-specific contraindications are present. It is not covered for patients
with cardiac pacemakers or with metallic clips on vascular aneurysms. MRI
during a viable pregnancy is also contraindicated at this time. The danger
inherent in bringing ferromagnetic materials within range of MRI units generally
constrains the use of MRI on acutely ill patients requiring life support
systems and monitoring devices which employ ferromagnetic materials. In addition,
the long imaging time and the enclosed position of the patient may result
in claustrophobia, making patients who have a history of claustrophobia unsuitable
candidates for MRI procedures.
2. Noncovered Uses.—Several uses of MRI have been identified as investigational and are not covered. These include measurement of blood flow and spectroscopy. In addition, MRI is not suitable for the imaging of cortical bone and calcifications and for procedures involving spatial resolution of bone or calcifications.
50-14 MAGNETIC RESONANCE ANGIOGRAPHY
Magnetic resonance angiography (MRA) is a non-invasive diagnostic test that is an application of magnetic resonance imaging (MRI). By analyzing the amount of energy released from tissues exposed to a strong magnetic field, MRA provides images of normal and diseased blood vessels as well as visualization and quantification of blood flow through these vessels.
Phase contrast (PC) and time-of-flight (TOF) are the available MRA techniques at the time these instructions are being issued. PC measures the difference between the phases of proton spins in tissue and blood and measures both the venous and arterial blood flow at any point in the cardiac cycle. TOF measures the difference between the amount of magnetization of tissue and blood and provides information on the structure of blood vessels, thus indirectly indicating blood flow. Two-dimensional (2D) and three-dimensional (3D) images can be obtained using each method.
Contrast-enhanced MRA (CE-MRA) involves blood flow imaging after the patient receives an intravenous injection of a contrast agent. Gadolinium, a non-ionic element, is the foundation of all contrast agents currently in use. Gadolinium affects the way in which tissues respond to magnetization, resulting in better visualization of structures when compared to un-enhanced studies. Unlike ionic (i.e. iodine-based) contrast agents used in conventional contrast angiography (CA), allergic reactions to gadolinium are extremely rare. Additionally, gadolinium does not cause the kidney failure occasionally seen with ionic contrast agents. Digital subtraction angiography (DSA) is a computer-augmented form of CA that obtains digital blood flow images as contrast agent courses through a blood vessel. The computer "subtracts" bone and other tissue from the image, thereby improving visualization of blood vessels. Physicians elect to use a specific MRA or CA technique based upon clinical information from each patient.
In a National Coverage Analysis decision memorandum (#CAG-00142N), issued on April 15, 2003, CMS reviewed scientific and clinical literature on MRA, and set forth its basis for the following coverage policy. Below are the only indications for which Medicare coverage is allowed for MRA. All other uses of MRA not listed in this manual are not covered.
A. Head and Neck.—Studies have proven that MRA is effective for evaluating flow in internal carotid vessels of the head and neck. However, not all potential applications of MRA have been shown to be reasonable and necessary. All of the following criteria must apply in order for Medicare to provide coverage for MRA of the head and neck:
1. MRA is used to evaluate the carotid arteries, the circle of Willis, the anterior, middle or posterior cerebral arteries, the vertebral or basilar arteries or the venous sinuses;
2. MRA is used to verify the need for anticipated surgery for conditions that include, but are not limited to, tumor, aneurysms, vascular malformations, vascular occlusion, or thrombosis. Within this broad category of disorders, medical necessity is the underlying determinant of the need for an MRA. Because MRA and CA perform the same diagnostic function, the medical records should clearly justify and demonstrate the existence of medical necessity.
3. MRA and contrast angiography (CA) are not expected to be performed on the same patient for diagnostic purposes prior to the application of anticipated therapy. Only one of these tests will be covered routinely unless the physician can demonstrate the medical need to perform both tests.
B. Peripheral Arteries of Lower Extremities.—Studies have proven that MRA of peripheral arteries is useful in determining the presence and extent of peripheral vascular disease in lower extremities. This procedure is non-invasive and has been shown to find occult vessels in some patients for which those vessels were not apparent when CA was performed. Medicare will cover either MRA or CA to evaluate peripheral arteries of the lower extremities. However, both MRA and CA may be useful is some cases, such as:
1. A patient has had CA and this test was unable to identify a viable run-off vessel for bypass. When exploratory surgery is not believed to be a reasonable medical course of action for this patient, MRA may be performed to identify the viable runoff vessel.
2. A patient has had MRA, but the results are inconclusive.
C. Abdomen and Pelvis. — Effective for dates of service on or after July 1, 1999, MRA is covered for pre-operative evaluation of patients undergoing elective abdominal aortic aneurysm (AAA) repair. Scientific evidence reveals MRA is considered comparable to CA in determining the extent of AAA, as well as evaluating aortoiliac occlusion disease and renal artery pathology that may be necessary in the surgical planning of AAA repair. These studies also reveal that MRA could provide a net benefit to the patient. If preoperative CA is avoided, then patients are not exposed to the risks associated with invasive procedures, contrast media, end-organ damage, or arterial injury.
Effective for dates of service on or after July 1, 2003, MRA coverage has been expanded to include imaging the renal arteries and the aortoiliac arteries in the absence of AAA or aortic dissection. MRA should be obtained in those circumstances in which using MRA is expected to avoid obtaining CA, when physician history, physical examination, and standard assessment tools provide insufficient information for patient management, and obtaining an MRA has a high probability of positively affecting patient management. However, CA may be ordered after obtaining the results of an MRA in those rare instances where medical necessity is demonstrated.
D. Chest.—
1. Diagnosis of Pulmonary Embolism.—Current scientific data has shown that diagnostic pulmonary MRAs are improving due to recent developments such as faster imaging capabilities and gadolinium-enhancement. However, these advances in MRA are not significant enough to warrant replacement of pulmonary angiography in the diagnosis of pulmonary embolism for patients who have no contraindication to receiving intravenous iodinated contrast material. Patients who are allergic to iodinated contrast material face a high risk of developing complications if they undergo pulmonary angiography or computed tomography angiography. Therefore, Medicare will cover MRA of the chest for diagnosing a suspected pulmonary embolism only when it is contraindicated for the patient to receive intravascular iodinated contrast material.
2. Evaluation of Thoracic Aortic Dissection and Aneurysm.—Studies have shown that MRA of the chest has a high level of diagnostic accuracy for pre-operative and post-operative evaluation of aortic dissection of aneurysm. Depending on the clinical presentation, MRA is used as an alternative to other non-invasive imaging technologies, such as transesophageal echocardiography and CT. Generally, Medicare will provide coverage only for MRA or for CA when used as a diagnostic test. However, if both MRA and CA of the chest are used, the physician must demonstrate the medical need for performing these tests.
While the intent of this policy is to provide reimbursement for either MRA or CA, CMS is also allowing flexibility for physicians to make appropriate decisions concerning the use of these tests based on the needs of individual patients. CMS anticipates, however, low utilization of the combined use of MRA and CA. As a result, CMS encourages contractors to monitor the use of these tests and, where indicated, requires evidence of the need to perform both MRA and CA.
HCPCS Code Reporting. – The following HCPCS codes should be used to report these services:
| MRA of head | 70544, 70544-26, 70544-TC, 70545, 70545-26, 70545-TC, 70546, 70546-26, 70546-TC |
| MRA of neck | 70547, 70547-26, 70547-TC, 70548, 70548-26, 70548-TC, 70549, 70549- 26, 70549-TC |
| MRA of chest | 71555, 71555-26, 71555-TC |
| MRA of abdomen | 74185, 74185-26, 74185-TC |
| MRA of peripheral vessels of lower extremities | 73725, 73724-26, 73724-TC |
[EM 2003-0461/CR 2673; EM 2003-0462/CR 2673]
Mammography Computer Aided Detection (CAD) Equipment
Mammography-related CAD equipment does not require Food and Drug Administration (FDA) certification. Certification from the FDA is needed only for screening and diagnostic mammograms (film and digital). The CAD add-on codes involved in this process are 76085 and G0236.
The CAD process can provide either digitization of film radiographic images with computer analysis OR computer analysis of direct digital mammography. [EM 2003-0476/CR 2743; AB-03-072]
Managed Care Reasonable Charge Data Disclosure Requirements for Ambulance Services
Beginning in CY 2003, and continuing through CY 2005, Carriers must prepare an annual managed care disclosure file in text file format (e.g., ASCII) containing the prevailing IIC reasonable charge amounts for each ambulance HCPCS code by locality.During the transition to the ambulance fee schedule CY 2003 through 2005, CMS-contracted managed care operations will be able to access reasonable charge pricing data on the CMS ambulance services Web site located at http://www.cms.hhs.gov/suppliers/ambulance/. Managed care operations may request additional reasonable charge data (e.g., supplier-specific customary reasonable charge amounts) from their Carrier for each locality in which the managed care operation provides ambulance services. [EM 2003-0369/CR 2561]
Managing Medicare Appeals
In an effort to manage incoming appeal requests in FY 2003 with the given resources, the Centers for Medicare & Medicaid Services (CMS) has provided guidance relative to processing appeals. Incoming appeal requests submitted without necessary supporting documentation will be given secondary priority to appeal requests submitted with appropriate documentation. Consequently, determinations or decisions on appeal requests that are submitted without appropriate documentation to support the contention that the initial determination was incorrect could possibly be delayed. [EM 2003-0397/CR 2330]
New Health Care Claims Status Category Codes for Use with the Health Care Claim Status Request and Response ASC X12N 276/277
In February 2003, five new Health Care Claims Status Category Codes for use with the Health Care Claim Status Request and Response ASC X12N 276/277 were added. These are codes you could expect to receive in a 277 transaction in response to a 276 Claim Status Inquiry transaction. The new codes are as follows:
| Code | Description |
| 490 | Other Procedure Code for Services Rendered |
| 491 | Entity not eligible for encounter submission |
| 492 | Other Procedure Data |
| 493 | Version/Release/Industry ID code not currently supported by information holder |
| 494 | Real-Time requests not supported by the information holder, resubmit as batch request |
For a complete list of Health Care Claim Status Codes, visit www.wpc-edi.com/.
[EM 2003-0187/CR 2555]
Program Integrity Manual Update
The Program Integrity Manual (PIM) is available only on the Internet in HTML format. Notifications will be included in the Medicare Bulletin anytime there is an update to the PIM.
The Internet address for the PIM is: www.cms.hhs.gov/manuals/108_pim/pim83toc.asp.
| CHAPTER | REVISED SECTIONS | NEW SECTIONS | DELETED SECTIONS | DESCRIPTION |
| 1 | 2 | Local Provider Education and Training (LPET) Program, provides overview of LPET program and lists LPET activities |
[EM 2003-0478/CR 2466]
Diagnosis Code for Screening Pap Smear and Pelvic Examination Services
Effective January 1, 1998, §1861(nn) of the Social Security Act (42 USC 1395x(nn)) provided coverage for a screening Pap smear for women under certain conditions. See the Medicare Carriers Manual (MCM) §4603.1A and the Medicare Intermediary Manual (MIM) §3628.1 for the applicable conditions for coverage and allowable frequencies.
The purpose of this Program Memorandum (PM) is to add the diagnosis codes for low risk patients to the Common Working File edits for Pap smear and Pelvic examinations effective October 1, 2003. The two new additional diagnosis codes for low risk are V76.47 and V76.49. V76.49 has been added for providers to use for women without a cervix.
The following chart list the diagnosis codes that CWF must recognize for low risk or high risk patients for pap smear and pelvic examinations.
| Low Risk Diagnosis Codes | Definitions |
| V76.2 | Cervix (routine cervical papanicolaou smear) |
| V76.47 | Special screening for malignant neoplasm, vagina |
| V76.49 | Special screening for malignant neoplasm, other sites |
| High Risk Diagnosis Code | |
| V15.89 | Other |
There are no changes to the HCPCS codes used to bill screening Pap smear.
[EM 2003-0422/CR 2637]
Single Drug Pricer (SDP) Updates
Beginning January 1, 2003, CMS established the SDP to establish a uniform payment allowance as a reflection of the average wholesale price (AWP) for Medicare-covered drugs. Under SDP, CXMS established prices centrally, thereby resulting in greater consistency in drug pricing nationally. Below are additional changes to correct the SDP file.
| J1563 | changed to $76.00 effective January 1, 2003 |
| J1260 | changed to $16.45 effective January 1, 2003 |
[EM 2003-0358/CR 2659]
Stem Cell Transplantation
Section 35-30.1, Stem Cell Transplantation, of the Coverage Issues Manual is revised to alter the existing substance of §35-30.1 by removing the reference to age as a limitation on coverage of stem cell transplantation for patients with multiple myeloma.
immunodeficiency disease (SCID) (ICD-9-CM code 279.2), and for the treatment of Wiskott - Aldrich syndrome (ICD-9-CM 279.12).
Noncovered Conditions.--Effective May 24, 1996, allogeneic stem cell transplantation is not covered as treatment for multiple myeloma (ICD-9-CM codes 203.0 and 238.6).
Autologous Stem Cell Transplantation (Effective for Services Performed on or After 04/28/89).
Autologous stem cell transplantation (ICD-9-CM procedure codes 41.01, 41.04, 41.07, and 41.09) is a technique for restoring stem cells using the patient's own previously stored cells.
- Covered Conditions.--Autologous stem cell transplantation (ICD-9-
CM codes 41.01, 41.04, 41.07, 41.09, CPT-4 code 38241) is considered reasonable
and necessary under §l862(a)(1)(A) of the Act for the following conditions
and is covered under Medicare for patients with:
- Acute leukemia in remission (ICD-9-CM codes 204.01, lymphoid; 205.01, myeloid; 206.01, monocytic; 207.01, acute erythremia and erythroleukemia; and 208.01 unspecified cell type) who have a high probability of relapse and who have no human leucocyte antigens (HLA)-matched;
- Resistant non-Hodgkin's lymphomas (ICD-9-CM codes 200.00- 200.08, 200.10-200.18, 200.20-200.28, 200.80-200.88, 202.00-202.08, 202.80-202.88, and 202.90-202.98) or those presenting with poor prognostic features following an initial response;
- Recurrent or refractory neuroblastoma (see ICD-9-CM Neoplasm by site, malignant); or
- Advanced Hodgkin's disease (ICD-9-CM codes 201.00- 201.98) who have failed conventional therapy and have no HLA-matched donor;
- Effective October 1, 2000, single AuSCT is only covered for Durie-Salmon
Stage II or III patients that fit the following requirement:
a. Newly diagnosed or responsive multiple myeloma. This includes those patients with previously untreated disease, those with at least a partial response to prior chemotherapy (defined as a 50 percent decrease either in measurable paraprotein [serum and/or urine] or in bone marrow infiltration, sustained for at least 1 month), and those in responsive relapse; and
b. Adequate cardiac, renal, pulmonary, and hepatic function.
NOTE: Tandem transplantation for multiple myeloma remains non-covered.
- Noncovered Conditions.--Insufficient data exist to establish
definite conclusions regarding the efficacy of autologous stem cell transplantation
for the following conditions:
- Acute leukemia not in remission (ICD-9-CM codes 204.00, 205.00, 206.00, 207.00 and 208.00);
- Chronic granulocytic leukemia (ICD-9-CM codes 205.10 and 205.11);
- Solid tumors (other than neuroblastoma) (ICD-9-CM codes 140.0 l99.1);
- Up to October 1, 2000, multiple myeloma;
- Tandem transplantation (multiple rounds of autologous stem cell transplantation) for patients with multiple myeloma;
- Effective October 1, 2000, non primary (AL) amyloidosis (ICD-9-CM 277.3);
- Effective October 1, 2000, primary (AL) amyloidosis (ICD-9-CM 277.3) for Medicare beneficiaries age 64 or older.
In these cases, autologous stem cell transplantation is not considered reasonable and necessary within the meaning of §l862(a)(1)(A) of the Act and is not covered under Medicare.
[EM 2003-0370/CR 2604; Transmittal 169]
CMS Ambulatory Surgical Center Approved Codes & Groupings
All
| Code | Category | Code | Category | Code | Category | Code | Category | Code | Category |
| 10121 | 2 | 25035 | 2 | 27848 | 3 | 42450 | 2 | 55535 | 4 |
| 10180 | 2 | 25040 | 5 | 27860 | 1 | 42500 | 3 | 55540 | 5 |
| 11010 | 2 | 25066 | 2 | 27870 | 4 | 42505 | 4 | 55550 | 9 |
| 11011 | 2 | 25075 | 2 | 27871 | 4 | 42507 | 3 | 55680 | 1 |
| 11012 | 2 | 25076 | 3 | 27884 | 3 | 42508 | 4 | 55700 | 2 |
| 11042 | 2 | 25077 | 3 | 27889 | 3 | 42509 | 4 | 55705 | 2 |
| 11043 | 2 | 25085 | 3 | 27892 | 3 | 42510 | 4 | 55720 | 1 |
| 11044 | 2 | 25100 | 2 | 27893 | 3 | 42600 | 1 | 55725 | 2 |
| 11404 | 1 | 25101 | 3 | 27894 | 3 | 42700 | 1 | 55859 | 9 |
| 11406 | 2 | 25105 | 4 | 28002 | 3 | 42720 | 1 | 56440 | 2 |
| 11424 | 2 | 25107 | 3 | 28003 | 3 | 42725 | 2 | 56441 | 1 |
| 11426 | 2 | 25110 | 3 | 28005 | 3 | 42802 | 1 | 56515 | 3 |
| 11444 | 1 | 25111 | 3 | 28008 | 3 | 42804 | 1 | 56620 | 5 |
| 11446 | 2 | 25112 | 4 | 28011 | 3 | 42806 | 2 | 56625 | 7 |
| 11450 | 2 | 25115 | 4 | 28020 | 2 | 42808 | 2 | 56700 | 1 |
| 11451 | 2 | 25116 | 4 | 28022 | 2 | 42810 | 3 | 56720 | 1 |
| 11462 | 2 | 25118 | 2 | 28024 | 2 | 42815 | 5 | 56740 | 3 |
| 11463 | 2 | 25119 | 3 | 28030 | 4 | 42820 | 3 | 56800 | 3 |
| 11470 | 2 | 25120 | 3 | 28035 | 4 | 42821 | 5 | 56810 | 5 |
| 11471 | 2 | 25125 | 3 | 28043 | 2 | 42825 | 4 | 57000 | 1 |
| 11604 | 2 | 25126 | 3 | 28045 | 3 | 42826 | 4 | 57010 | 2 |
| 11606 | 2 | 25130 | 3 | 28046 | 3 | 42830 | 4 | 57020 | 2 |
| 11624 | 2 | 25135 | 3 | 28050 | 2 | 42831 | 4 | 57023 | 1 |
| 11626 | 2 | 25136 | 3 | 28052 | 2 | 42835 | 4 | 57065 | 1 |
| 11644 | 2 | 25145 | 2 | 28054 | 2 | 42836 | 4 | 57105 | 2 |
| 11646 | 2 | 25150 | 2 | 28060 | 2 | 42860 | 3 | 57130 | 2 |
| 11770 | 3 | 25151 | 2 | 28062 | 3 | 42870 | 3 | 57135 | 2 |
| 11771 | 3 | 25210 | 3 | 28070 | 3 | 42890 | 7 | 57180 | 1 |
| 11772 | 3 | 25215 | 4 | 28072 | 3 | 42892 | 7 | 57200 | 1 |
| 11960 | 2 | 25230 | 4 | 28080 | 3 | 42900 | 1 | 57210 | 2 |
| 11970 | 3 | 25240 | 4 | 28086 | 2 | 42950 | 2 | 57220 | 3 |
| 11971 | 1 | 25248 | 2 | 28088 | 2 | 42955 | 2 | 57230 | 3 |
| 12005 | 2 | 25250 | 1 | 28090 | 3 | 42960 | 1 | 57240 | 5 |
| 12006 | 2 | 25251 | 1 | 28092 | 3 | 42962 | 2 | 57250 | 5 |
| 12007 | 2 | 25260 | 4 | 28100 | 2 | 42972 | 3 | 57260 | 5 |
| 12016 | 2 | 25263 | 2 | 28102 | 3 | 43200 | 1 | 57265 | 7 |
| 12017 | 2 | 25265 | 3 | 28103 | 3 | 43201 | 1 | 57268 | 3 |
| 12018 | 2 | 25270 | 4 | 28104 | 2 | 43202 | 1 | 57289 | 5 |
| 12020 | 1 | 25272 | 3 | 28106 | 3 | 43204 | 1 | 57291 | 5 |
| 12021 | 1 | 25274 | 4 | 28107 | 3 | 43205 | 1 | 57300 | 3 |
| 12034 | 2 | 25275 | 4 | 28110 | 3 | 43215 | 1 | 57400 | 2 |
| 12035 | 2 | 25280 | 4 | 28111 | 3 | 43216 | 1 | 57410 | 2 |
| 12036 | 2 | 25290 | 3 | 28112 | 3 | 43217 | 1 | 57415 | 2 |
| 12037 | 2 | 25295 | 3 | 28113 | 3 | 43219 | 1 | 57513 | 2 |
| 12044 | 2 | 25300 | 3 | 28114 | 3 | 43220 | 1 | 57520 | 2 |
| 12045 | 2 | 25301 | 3 | 28116 | 3 | 43226 | 1 | 57522 | 2 |
| 12046 | 2 | 25310 | 3 | 28118 | 4 | 43227 | 2 | 57530 | 3 |
| 12047 | 2 | 25312 | 4 | 28119 | 4 | 43228 | 2 | 57550 | 3 |
| 12054 | 2 | 25315 | 3 | 28120 | 7 | 43231 | 2 | 57556 | 5 |
| 12055 | 2 | 25316 | 3 | 28122 | 3 | 43232 | 2 | 57700 | 1 |
| 12056 | 2 | 25320 | 3 | 28126 | 3 | 43234 | 1 | 57720 | 3 |
| 12057 | 2 | 25332 | 5 | 28130 | 3 | 43235 | 1 | 57820 | 3 |
| 13100 | 2 | 25335 | 3 | 28140 | 3 | 43236 | 2 | 58120 | 2 |
| 13101 | 3 | 25337 | 5 | 28150 | 3 | 43239 | 2 | 58145 | 5 |
| 13120 | 2 | 25350 | 3 | 28153 | 3 | 43240 | 2 | 58350 | 3 |
| 13121 | 3 | 25355 | 3 | 28160 | 3 | 43241 | 2 | 58353 | 4 |
| 13131 | 2 | 25360 | 3 | 28171 | 3 | 43242 | 2 | 58545 | 9 |
| 13132 | 3 | 25365 | 3 | 28173 | 3 | 43243 | 2 | 58546 | 9 |
| 13150 | 3 | 25370 | 3 | 28175 | 3 | 43244 | 2 | 58550 | 9 |
| 13151 | 3 | 25375 | 4 | 28192 | 2 | 43245 | 2 | 58555 | 1 |
| 13152 | 3 | 25390 | 3 | 28193 | 4 | 43246 | 2 | 58558 | 3 |
| 13160 | 2 | 25391 | 4 | 28200 | 3 | 43247 | 2 | 58559 | 2 |
| 14000 | 2 | 25392 | 3 | 28202 | 3 | 43248 | 2 | 58560 | 3 |
| 14001 | 3 | 25393 | 4 | 28208 | 3 | 43249 | 2 | 58561 | 3 |
| 14020 | 3 | 25400 | 3 | 28210 | 3 | 43250 | 2 | 58562 | 3 |
| 14021 | 3 | 25405 | 4 | 28222 | 1 | 43251 | 2 | 58563 | 4 |
| 14040 | 2 | 25415 | 3 | 28225 | 1 | 43255 | 2 | 58660 | 5 |
| 14041 | 3 | 25420 | 4 | 28226 | 1 | 43256 | 3 | 58661 | 5 |
| 14060 | 3 | 25425 | 3 | 28234 | 2 | 43258 | 3 | 58662 | 5 |
| 14061 | 3 | 25426 | 4 | 28238 | 3 | 43259 | 3 | 58670 | 3 |
| 14300 | 4 | 25440 | 4 | 28240 | 2 | 43260 | 2 | 58671 | 3 |
| 14350 | 3 | 25441 | 5 | 28250 | 3 | 43261 | 2 | 58672 | 5 |
| 15000 | 2 | 25442 | 5 | 28260 | 3 | 43262 | 2 | 58673 | 5 |
| 15050 | 2 | 25443 | 5 | 28261 | 3 | 43263 | 2 | 58800 | 3 |
| 15100 | 2 | 25444 | 5 | 28262 | 4 | 43264 | 2 | 58820 | 3 |
| 15101 | 3 | 25445 | 5 | 28264 | 1 | 43265 | 2 | 58900 | 3 |
| 15120 | 2 | 25446 | 7 | 28270 | 3 | 43267 | 2 | 59160 | 3 |
| 15121 | 3 | 25447 | 5 | 28280 | 2 | 43268 | 2 | 59320 | 1 |
| 15200 | 3 | 25449 | 5 | 28285 | 3 | 43269 | 2 | 59812 | 5 |
| 15201 | 2 | 25450 | 3 | 28286 | 4 | 43271 | 2 | 59820 | 5 |
| 15220 | 2 | 25455 | 3 | 28288 | 3 | 43272 | 2 | 59821 | 5 |
| 15221 | 2 | 25490 | 3 | 28289 | 3 | 43450 | 1 | 59840 | 5 |
| 15240 | 3 | 25491 | 3 | 28290 | 2 | 43453 | 1 | 59841 | 5 |
| 15241 | 3 | 25492 | 3 | 28292 | 2 | 43456 | 2 | 59870 | 5 |
| 15260 | 2 | 25505 | 1 | 28293 | 3 | 43458 | 2 | 59871 | 5 |
| 15261 | 2 | 25515 | 3 | 28294 | 3 | 43600 | 1 | 60000 | 1 |
| 15350 | 2 | 25520 | 1 | 28296 | 3 | 43653 | 9 | 60200 | 2 |
| 15351 | 2 | 25525 | 4 | 28297 | 3 | 43750 | 2 | 60280 | 4 |
| 15400 | 2 | 25526 | 5 | 28298 | 3 | 43760 | 1 | 60281 | 4 |
| 15401 | 2 | 25535 | 1 | 28299 | 5 | 43870 | 1 | 61020 | 1 |
| 15570 | 3 | 25545 | 3 | 28300 | 2 | 44100 | 1 | 61026 | 1 |
| 15572 | 3 | 25565 | 2 | 28302 | 2 | 44312 | 1 | 61050 | 1 |
| 15574 | 3 | 25574 | 3 | 28304 | 2 | 44340 | 3 | 61055 | 1 |
| 15576 | 3 | 25575 | 3 | 28305 | 3 | 44360 | 2 | 61070 | 1 |
| 15600 | 3 | 25605 | 3 | 28306 | 4 | 44361 | 2 | 61215 | 3 |
| 15610 | 3 | 25611 | 3 | 28307 | 4 | 44363 | 2 | 61790 | 3 |
| 15620 | 4 | 25620 | 5 | 28308 | 2 | 44364 | 2 | 61791 | 3 |
| 15630 | 3 | 25624 | 2 | 28309 | 4 | 44365 | 2 | 61885 | 2 |
| 15650 | 5 | 25628 | 3 | 28310 | 3 | 44366 | 2 | 61886 | 3 |
| 15732 | 3 | 25635 | 1 | 28312 | 3 | 44369 | 2 | 61888 | 1 |
| 15734 | 3 | 25645 | 3 | 28313 | 2 | 44370 | 9 | 62194 | 1 |
| 15736 | 3 | 25660 | 1 | 28315 | 4 | 44372 | 2 | 62225 | 1 |
| 15738 | 3 | 25670 | 3 | 28320 | 4 | 44373 | 2 | 62230 | 2 |
| 15740 | 2 | 25671 | 1 | 28322 | 4 | 44376 | 2 | 62263 | 1 |
| 15750 | 2 | 25675 | 1 | 28340 | 4 | 44377 | 2 | 62268 | 1 |
| 15760 | 2 | 25676 | 2 | 28341 | 4 | 44378 | 2 | 62269 | 1 |
| 15770 | 3 | 25680 | 2 | 28344 | 4 | 44379 | 9 | 62270 | 1 |
| 15775 | 3 | 25685 | 3 | 28345 | 4 | 44380 | 1 | 62272 | 1 |
| 15776 | 3 | 25690 | 1 | 28400 | 1 | 44382 | 1 | 62273 | 1 |
| 15820 | 3 | 25695 | 2 | 28405 | 2 | 44383 | 9 | 62280 | 1 |
| 15821 | 3 | 25800 | 4 | 28406 | 2 | 44385 | 1 | 62281 | 1 |
| 15822 | 3 | 25805 | 5 | 28415 | 3 | 44386 | 1 | 62282 | 1 |
| 15823 | 5 | 25810 | 5 | 28420 | 4 | 44388 | 1 | 62287 | 9 |
| 15824 | 3 | 25820 | 4 | 28435 | 2 | 44389 | 1 | 62294 | 3 |
| 15825 | 3 | 25825 | 5 | 28436 | 2 | 44390 | 1 | 62310 | 1 |
| 15826 | 3 | 25830 | 5 | 28445 | 3 | 44391 | 1 | 62311 | 1 |
| 15828 | 3 | 25907 | 3 | 28456 | 2 | 44392 | 1 | 62318 | 1 |
| 15829 | 5 | 25922 | 3 | 28465 | 3 | 44393 | 1 | 62319 | 1 |
| 15831 | 3 | 25929 | 3 | 28476 | 2 | 44394 | 1 | 62350 | 2 |
| 15832 | 3 | 26011 | 1 | 28485 | 4 | 45000 | 1 | 62355 | 2 |
| 15833 | 3 | 26020 | 2 | 28496 | 2 | 45005 | 2 | 62360 | 2 |
| 15834 | 3 | 26025 | 1 | 28505 | 3 | 45020 | 2 | 62361 | 2 |
| 15835 | 3 | 26030 | 2 | 28525 | 3 | 45100 | 1 | 62362 | 2 |
| 15840 | 4 | 26034 | 2 | 28531 | 3 | 45108 | 2 | 62365 | 2 |
| 15841 | 4 | 26040 | 4 | 28545 | 1 | 45150 | 2 | 63600 | 2 |
| 15845 | 4 | 26045 | 3 | 28546 | 2 | 45160 | 2 | 63610 | 1 |
| 15876 | 3 | 26055 | 2 | 28555 | 2 | 45170 | 2 | 63650 | 2 |
| 15877 | 3 | 26060 | 2 | 28575 | 1 | 45190 | 9 | 63660 | 1 |
| 15878 | 3 | 26070 | 2 | 28576 | 3 | 45305 | 1 | 63685 | 2 |
| 15879 | 3 | 26075 | 4 | 28585 | 3 | 45307 | 1 | 63688 | 1 |
| 15920 | 3 | 26080 | 4 | 28605 | 1 | 45308 | 1 | 63744 | 3 |
| 15922 | 4 | 26100 | 2 | 28606 | 2 | 45309 | 1 | 63746 | 2 |
| 15931 | 3 | 26105 | 1 | 28615 | 3 | 45315 | 1 | 64410 | 1 |
| 15933 | 3 | 26110 | 1 | 28635 | 1 | 45317 | 1 | 64415 | 1 |
| 15934 | 3 | 26115 | 2 | 28636 | 3 | 45320 | 1 | 64417 | 1 |
| 15935 | 4 | 26116 | 2 | 28645 | 3 | 45321 | 1 | 64420 | 1 |
| 15936 | 4 | 26117 | 3 | 28665 | 1 | 45331 | 1 | 64421 | 1 |
| 15937 | 4 | 26121 | 4 | 28666 | 3 | 45332 | 1 | 64430 | 1 |
| 15940 | 3 | 26123 | 4 | 28675 | 3 | 45333 | 1 | 64470 | 1 |
| 15941 | 3 | 26125 | 4 | 28705 | 4 | 45334 | 1 | 64472 | 1 |
| 15944 | 3 | 26130 | 3 | 28715 | 4 | 45335 | 1 | 64475 | 1 |
| 15945 | 4 | 26135 | 4 | 28725 | 4 | 45337 | 1 | 64476 | 1 |
| 15946 | 4 | 26140 | 2 | 28730 | 4 | 45338 | 1 | 64479 | 1 |
| 15950 | 3 | 26145 | 3 | 28735 | 4 | 45339 | 1 | 64480 | 1 |
| 15951 | 4 | 26160 | 3 | 28737 | 5 | 45340 | 1 | 64483 | 1 |
| 15952 | 3 | 26170 | 3 | 28740 | 4 | 45355 | 1 | 64484 | 1 |
| 15953 | 4 | 26180 | 3 | 28750 | 4 | 45378 | 2 | 64510 | 1 |
| 15956 | 3 | 26185 | 4 | 28755 | 4 | 45379 | 2 | 64520 | 1 |
| 15958 | 4 | 26200 | 2 | 28760 | 4 | 45380 | 2 | 64530 | 1 |
| 16015 | 2 | 26205 | 3 | 28810 | 2 | 45381 | 2 | 64553 | 1 |
| 19020 | 2 | 26210 | 2 | 28820 | 2 | 45382 | 2 | 64573 | 1 |
| 19100 | 1 | 26215 | 3 | 28825 | 2 | 45383 | 2 | 64575 | 1 |
| 19101 | 2 | 26230 | 7 | 29800 | 3 | 45384 | 2 | 64577 | 1 |
| 19102 | 2 | 26235 | 3 | 29804 | 3 | 45385 | 2 | 64580 | 1 |
| 19103 | 2 | 26236 | 3 | 29805 | 3 | 45386 | 2 | 64585 | 1 |
| 19110 | 2 | 26250 | 3 | 29806 | 3 | 45500 | 2 | 64590 | 2 |
| 19112 | 3 | 26255 | 3 | 29807 | 3 | 45505 | 2 | 64595 | 1 |
| 19120 | 3 | 26260 | 3 | 29819 | 3 | 45560 | 2 | 64600 | 1 |
| 19125 | 3 | 26261 | 3 | 29820 | 3 | 45900 | 1 | 64605 | 1 |
| 19126 | 3 | 26262 | 2 | 29821 | 3 | 45905 | 1 | 64610 | 1 |
| 19140 | 4 | 26320 | 2 | 29822 | 3 | 45910 | 1 | 64620 | 1 |
| 19160 | 3 | 26350 | 1 | 29823 | 3 | 45915 | 1 | 64622 | 1 |
| 19162 | 7 | 26352 | 4 | 29824 | 5 | 46020 | 3 | 64623 | 1 |
| 19180 | 4 | 26356 | 4 | 29825 | 3 | 46030 | 1 | 64626 | 1 |
| 19182 | 4 | 26357 | 4 | 29826 | 3 | 46040 | 3 | 64627 | 1 |
| 19290 | 1 | 26358 | 4 | 29827 | 5 | 46045 | 2 | 64630 | 2 |
| 19291 | 1 | 26370 | 4 | 29830 | 3 | 46050 | 1 | 64680 | 2 |
| 19316 | 4 | 26372 | 4 | 29834 | 3 | 46060 | 2 | 64702 | 1 |
| 19318 | 4 | 26373 | 3 | 29835 | 3 | 46080 | 3 | 64704 | 1 |
| 19324 | 4 | 26390 | 4 | 29836 | 3 | 46200 | 2 | 64708 | 2 |
| 19325 | 9 | 26392 | 3 | 29837 | 3 | 46210 | 2 | 64712 | 2 |
| 19328 | 1 | 26410 | 3 | 29838 | 3 | 46211 | 2 | 64713 | 2 |
| 19330 | 1 | 26412 | 3 | 29840 | 3 | 46220 | 1 | 64714 | 2 |
| 19340 | 2 | 26415 | 4 | 29843 | 3 | 46250 | 3 | 64716 | 3 |
| 19342 | 3 | 26416 | 3 | 29844 | 3 | 46255 | 3 | 64718 | 2 |
| 19350 | 4 | 26418 | 4 | 29845 | 3 | 46257 | 3 | 64719 | 2 |
| 19355 | 4 | 26420 | 4 | 29846 | 3 | 46258 | 3 | 64721 | 2 |
| 19357 | 5 | 26426 | 3 | 29847 | 3 | 46260 | 3 | 64722 | 1 |
| 19366 | 5 | 26428 | 3 | 29848 | 9 | 46261 | 4 | 64726 | 1 |
| 19370 | 4 | 26432 | 3 | 29850 | 4 | 46262 | 4 | 64727 | 1 |
| 19371 | 4 | 26433 | 3 | 29851 | 4 | 46270 | 3 | 64732 | 2 |
| 19380 | 5 | 26434 | 3 | 29855 | 4 | 46275 | 3 | 64734 | 2 |
| 20005 | 2 | 26437 | 3 | 29856 | 4 | 46280 | 4 | 64736 | 2 |
| 20200 | 2 | 26440 | 3 | 29860 | 4 | 46285 | 1 | 64738 | 2 |
| 20205 | 3 | 26442 | 3 | 29861 | 4 | 46288 | 4 | 64740 | 2 |
| 20206 | 1 | 26445 | 3 | 29862 | 9 | 46608 | 1 | 64742 | 2 |
| 20220 | 1 | 26449 | 3 | 29863 | 4 | 46610 | 1 | 64744 | 2 |
| 20225 | 2 | 26450 | 3 | 29870 | 3 | 46611 | 1 | 64746 | 2 |
| 20240 | 2 | 26455 | 3 | 29871 | 3 | 46612 | 1 | 64771 | 2 |
| 20245 | 3 | 26460 | 3 | 29874 | 3 | 46615 | 2 | 64772 | 2 |
| 20250 | 3 | 26471 | 2 | 29875 | 4 | 46700 | 3 | 64774 | 2 |
| 20251 | 3 | 26474 | 2 | 29876 | 4 | 46750 | 3 | 64776 | 3 |
| 20525 | 3 | 26476 | 1 | 29877 | 4 | 46753 | 3 | 64778 | 2 |
| 20650 | 3 | 26477 | 1 | 29879 | 3 | 46754 | 2 | 64782 | 3 |
| 20670 | 1 | 26478 | 1 | 29880 | 4 | 46760 | 2 | 64783 | 2 |