April 2004 Medicare Bulletin - North Carolina Insert
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Table of Contents
- 2004 Clinical Lab Fee Schedule - North Carolina Part B
- Changes in Payment for Services Furnished in Ambulatory Surgical Centers
- North Carolina Health Professional Shortage Areas (HPSAs)
- Policy Updates
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)
Policy Updates
Magnetic Resonance Angiography (MRA)(LMRP 98-008-07)
Added MRA of Pelvis, to include following CPT code:
72198 Magnetic Resonance Angiography, Pelvis, with or without contrast
Cataract Extraction (LMRP 97-019)
Policy was updated for formatting and clarification reasons. There were no codes or verbiage added or deleted.
Patient Demand Cardiac Event Recording (LMRP 98-011)
The following codes were deleted from this LMRP:
| G0004 | ECG Transmission Physician Review & Interpret |
| G0005 | ECG 24 hour Recording |
| G0006 | ECG Transmission & Analysis |
| G0007 | ECG Physician Review & Interpret |
| G0015 | Post Symptom ECG Tracing |
| G0016 | Post Symptom ECG MD Review |
The following code was added to those that support medical necessity:
| 786.05 | Shortness of Breath |
Electrocardiogram (LMRP 98-011)
The following codes were deleted from this LMRP:
| G0004 | ECG Transmission Physician Review & Interpret |
| G0005 | ECG 24 hour Recording |
| G0006 | ECG Transmission & Analysis |
| G0007 | ECG Physician Review & Interpret |
| G0015 | Post Symptom ECG Tracing |
| G0016 | Post Symptom ECG MD Review |
| 93224 | ECG monitor/report, 24 hours |
| 93225 | ECG monitor/record, 24 hours |
| 93226 | ECG monitor/report, 24 hours |
| 93227 | ECG monitor/review, 24 hours |
Stress Echocardiography (LMRP 2000-003-01 )
The following codes were added to policy to correct typographical error. These codes should have been included as diagnoses supporting medical necessity.
| 428.0-428.9 | Congestive Heart Failure |
Independent Diagnostic Testing Facilities (IDTF) (LMRP 99-011)
The following codes were added to those that support medical necessity:
| 70542 &TC | Magnetic image, head (MRI) 2 |
| 70543 &TC | Magnetic image, head (MRI) 2 |
| 70544 &TC | Magnetic image, head (MRI) 2 |
| 70545 &TC | Magnetic image, head (MRI) 2 |
| 70546 &TC | Magnetic image, head (MRI) 2 |
| 73218 &TC | X-ray exam of upper extremity 1 |
| 73219 &TC | X-ray exam of upper extremity 1 |
| 73220 &TC | X-ray exam of upper extremity 1 |
| 73221 &TC | X-ray exam of joint of upper extremity 1 |
| 73222 &TC | X-ray exam of joint of upper extremity 1 |
| 73223 &TC | X-ray exam of joint of upper extremity 1 |
The following code was deleted from the policy:
70541 Magnetic resonance angiography, head and/or neck, with or without contrast material (s)
Cytogenetic Studies (LMRP 2003-005)
The following codes were added to those that support medical necessity:
| 318.0 | Moderate Mental Retardation |
| 318.1 | Severe Mental Retardation |
| 318.2 | Profound Mental Retardation |
| 740.0-759.9 | Congenital Anomalies |
| 792.3 | Nonspecific abnormal findings in amniotic fluid |
Serum Magnesium (LMRP 96-015)
The following codes were added to those that support medical necessity:
| 783.21 | Loss of Weight |
| 783.22 | Underweight |
Ionized Calcium (LMRP 96-017)
The following code was added to those that support medical necessity:
| 401.1 | Benign Essential Hypertension |
(04-0628)
2004 Clinical Lab Fee Schedule - North Carolina Part B
2004 Clinical Lab Fee Schedule - North Carolina Part B
North Carolina Health Professional Shortage Areas (HPSAs)
Designated Geographic Areas
|
1 No longer classified as a HPSA, effective December 1, 1999.
2 Classifed as a HPSA, effective March 1, 2001.
3 Classifed as a HPSA, effective July 1, 2001.
4 No longer classified as a HPSA, effective September 1, 2001.
5 No longer classified as a HPSA, effective August 1, 2002.
(04-0771)
