April 2004 Medicare Bulletin - Idaho Insert

Download a PDF copy of this issue

Table of Contents

• 2004 Clinical Lab Fee Schedule-Idaho Part B
• Changes in Payment for Services Furnished in Ambulatory Surgical Centers for Fiscal Year 2004)
• End Diastolic Pneumatic Compression Therapy (A18111) - Article)
• End Diastolic Pneumatic Compression Therapy LCD
• Idaho Health Professional Shortage Areas (HPSAs)
• Scanning Computerized Ophthlamic Diagnostic Imaging (SCODI) LCD)

Changes in Payment for Services Furnished in Ambulatory Surgical Centers for Fiscal Year 2004

In fiscal year 2004, beginning with April 1, 2004, the increase in ASC payment rates shall be the 2003 Consumer Price Index for all urban consumers (U.S. city average) (CPI-U) as estimated for the 12-month period ending March 31, 2003, minus 3.0 percentage points. The forecasted inflation of the CPI-U for the 12-month period ending March 31, 2003 was 3.0 percent. Therefore, the percentage increase of fiscal year 2003 ASC payment rates for fiscal year 2004 equals a 0 percent. Effective for services furnished on or after April 1, 2004, carriers shall revert to the ASC payment group rates that were implemented effective October 1, 2002.

Effective for services furnished on or after April 1, 2004, the ASC payment group rates are as follows:

Group 1- $333 Group 5 - $717
Group 2- $446 Group 6 - $826 ($676 + $150 for intraocular lenses (IOLs)
Group 3- $510 Group 7 - $995
Group 4- $630 Group 8 - $973 ($823 + $150 for IOLs)
Group 9 - $1339
Below are the new rates effective 4/1/2004

Click here to access the PDF file showing payment rates for TN, NC and ID. (172K)

[EM 2004-0085/CR3082]

(04-0628)

End-Diastolic Pneumatic Compression Therapy (A18111) - Article

Contractor Information

Contractor Name
CIGNA Government Services

Contractor Number
05130

Contractor Type
Carrier

Article Information

Article Database ID Number
A18111

Article Type
Basic Article

Article Title
LCD Article: End-Diastolic Pneumatic Compression Therapy

Primary Geographic Jurisdiction
ID

Article Publication Date
04/01/2004

Article Beginning Effective Date
05/17/2004

Article Text
CODING GUIDELINES:
The HCPCS/CPT codes may be subject to Correct Coding Initiative (CCI) edits. This policy does not take precedence over CCI edits. Please refer to CCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.

End-diastolic pneumatic compression therapy should be reported using code 99199, Unlisted special services and procedures. Field 19 of CMS Form 1500 or its electronic equivalent must contain the statement: “end-diastolic pneumatic compression therapy.”

Code 99199 will represent all end-diastolic compression therapy provided to a patient per day. The code (99199) also encompasses the evaluation prior to, during, and post treatment for the date of service the therapy is rendered. Therefore, only (1) unit of service per day may be reported for this therapy, regardless of the time involved.

When billing for diabetic ulcers, please use an ICD-9 code from the series 250.70-250.83 as primary (line item) diagnosis and an ICD-9 code from the series 707.10-707.19 as secondary diagnosis, as applicable.

Coverage Topic
Category Undefined

(04-0684)

End-Diastolic Pneumatic Compression Therapy - LCD

End-Diastolic Pneumatic Compression Therapy - LCD

(04-0684)

Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) - LCD

Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

Idaho Part B - 2004 Clinical Lab Fee Schedule

Idaho Part B - 2004 Clinical Lab Fee Schedule

Idaho Health Professional Shortage Areas (HPSAs)

Designated Geographic Areas

COUNTY AREA NAME/PARTS Ada11 All Adams All Bannock South Bannock Division South Bannock Division Bear Lake8 Caribou/Georgetown Georgetown Division Benewah2 St. Maries Bingham2 American Falls Aberdeen (CCD) Blaine Carey Carey (CCD) Boise All Bonner Priest River Blanchard-Glengary (CCD) Priest River (CCD) Clark Fork Division Bonneville3 Swan Valley Division Swan Valley Division Boundary All Butte9 Arco/Mackay Camas All Canyon4 Nyssa (OR/ID) Parma (CCD) Wilder (CCD) Caribou8 Caribou/Georgetown Cassia4 Albion/Malta Albion (CCD) Oakley Oakley (CCD) Clark All Clearwater11 Clearwater SA C.T. 9701.00 Elk River Elk River Division Pierce/Weippe Pierce-Headquarters Division Weippe Division Custer8 Stanley Stanley (CCD) Challis Challis (CCD) Elmore3 All Franklin All Fremont All Gem4 All Gooding10 All Idaho Riggins Riggins Division Elk City Elk City Division Jefferson All Jerome11 All Kootenai2 St. Maries Harrison (CCD) Worley (CCD) Lemhi6 All Lewis Winchester Winchester Division Lincoln All Minidoka2 Minidoka Minidoka Division Oneida10 All Owyhee All Payette All Power2 American Falls American Falls (CCD) Rockland (CCD) Teton5 All Twin Falls2 Buhl Buhl (CCD) W. Salmon Falls (CCD) Valley11 Cascade C.T. 9701.00 Washington All

¹ No longer classified as HPSA, effective 3/1/98
² No longer classified as HPSA, effective 10/1/98
³ Classified as HPSA, effective 10/1/98
⁴ No longer classified as HPSA, effective 1/1/99
⁵ Classified as HPSA, effective 10/1/99
⁶ Classified as HPSA, effective 12/1/99
⁷ No longer classified as HPSA, effective 9/1/01
⁸ Classified as HPSA, effective 3/1/02
⁹ No longer classified as HPSA, efective 3/1/02
¹⁰No longer classified as HPSA, efective 9/1/03
¹¹Classified as HPSA, effective 9/1/03

(04-0770)