April 2004 Medicare Bulletin - Tennessee Insert

Download a PDF copy of this issue

Table of Contents

• 2004 Clinical Lab Fee Schedule - Tennessee Part B
• Changes in Payment for Services Furnished in Ambulatory Surgical Centers for Fiscal Year 2004
• LMRP for Chest X-Ray (L6097)
• LMRP for Fundus Photography (L6471)
• LMRP for Independent Diagnostic Testing and Facility (IDTF) L6181)
• LMRP for Measurement of Bone Density IL5803)
• Tennessee Health Professional Shortage Areas (HPSAs)
• Tennessee Part B Announces Medicare Workshop

Tennessee Part B Announces Medicare Workshop Dates & Locations

CIGNA Government Services will host the 2004 Tennessee Part B Medicare Workshop, highlighting Medicare updates and changes that affect all specialties.

Workshop Registration: 8:00 – 8:30 AM.
Workshop: 8:30 – 12:30

The FREE seminars will be held:

May 5, 2004 Millennium Maxwell House 2025 MetroCenter Boulevard Nashville, TN 37228	May 28, 2004 Ridgeway Inn 5679 Poplar Avenue Memphis, TN. 38119
May 6, 2004 Millennium Maxwell House 2025 MetroCenter Boulevard Nashville, TN 37228	June 9, 2004 Marriott Hotels & Resorts 600 Marriott Drive Nashville, TN 37214
May 12, 2004 Marriott Hotel & Resorts 2 Carter Plaza Chattanooga, TN 37402	June 10, 2004 Marriott Hotel & Resorts 600 Marriott Drive Nashville, TN 37214
May 13, 2004 Marriott Hotel 2 Carter Plaza Chattanooga, TN 37402	June 15, 2004 Hilton Knoxville Airport 2001 Alcoa Airport Alcoa, TN 37701
May 26, 2004 Old English Inn Hotel & Conference Center 2267 North Highland Avenue Jackson, TN 38305	June 16, 2004 Holiday Inn 101 W. Springbrook Drive Johnson City, TN 37604

May 27, 2004 Ridgeway Inn 5679 Poplar Avenue Memphis, TN 38119

Topics to be discussed include:

· Medicare Prescription Drug, Improvement, and Modernization Act of 2003
· Jurisdictional Payments
· Claims Filing Instructions Changes
· Purchased Diagnostic Tests
· Reference Labs
· HPSA News
· Coordination of Benefits (Crossovers)
· HIPAA/ASCA
· Mandatory Electronic Billing
· Medical Review Issues
· Electronic Data Interchange
· Claim Submission Errors
· Local Issues
· Resources

Register Today!

Registration will be available by Internet only. Please visit http://www.cignamedicare.com/wrkshp/tn /index.html for more information and registration. If you do not have Internet access, please call 615.782.4566 for further instructions.

(04-0725)

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)

LMRP for Chest X-Ray (L6097)– Revision

LMRP for Chest X-Ray (L6097) – Revision

(04-0728)

LMRP for Fundus Photography (L6471) – Revision

LMRP for Fundus Photography (L6471) – Revision

(04-0712)

LMRP for Independent Diagnostice Testing Facility (IDTF) (L6181)– Revision

LMRP for Independent Diagnostice Testing Facility (IDTF) (L6181)– Revision

(04-0622)

LMRP for Measurement of Bone Density (L5803)– Revision

LMRP Measurement of Bone Density (L5803) – Revision

(04-0711)

Tennessee Part B - 2004 Clincial Lab Fee Schedule

Tennessee Part B - 2004 Clinical Lab Fee Schedule

Tennessee Health Professional Shortage Areas (HPSAs)

Designated Geographic Areas

COUNTY AREA NAME/PARTS RURAL/URBAN Anderson Briceville - Lake City Lake City West City Division New River City Division Lake City East City Division Urban Bledsoe Dayton/Pikeville/Decataur Rural Cheatham All Rural Chester11 All Rural Claiborne8 All Rural Crockett7 All Rural Decatur5 All Rural Dickson Vanleer/Shiloh Vanleer CCD Urban Fayette All Rural Grainger9 All Urban Greene5 Baileyton Baileyton CCD Jearoldstown Division Rural Grundy All Rural Hamilton Middle Valley Soddy Daisy Division Middle Valley Division Sale Creek Division Urban Hancock All Rural Hardeman All Rural Hawkins All Urban Haywood All Rural Henderson9 All Rural Hickman All Rural Jackson All Rural Johnson All Rural Knox Mechanicsville - Census Tracts 1, 2, 3, 4, 5, 6, 7, 11, 12, 13, 14, 20, 28 Urban Lake9 All Rural Lauderdale All Rural Lincoln3 Cash Point - Blanche Cash Point/Blanche CCD Rural Macon All Rural Madison East Jackson - Census Tracts 5 and 8-12 Rural Maury7 Fairview/Boston/Santa Fe/Santa Fe Division Rural Meigs Dayton/Pikeville/Decatur Rural Montgomery Vanleer/Shiloh Palmyra/Shiloh CCD Urban Moore All Rural Morgan All Rural Obion4 Hornbeak/Samburg Hornbeak/Samburg CCD Dixie Division Elbridge-Cloverdale Division Rural Perry1 All Rural Pickett All Rural Polk8 Benton/Parkville Benton Division Parkville Division Rural Rhea Dayton/Pikeville/Decatur Rural Rutherford Eagleville Eagleville CCD Bethesda/Eagleville Urban Unicoi All Urban Union All Urban Van Buren7 All Rural Wayne2 All Rural White6 All Rural Williamson5 Bethesda/Eagleville Bethesda Division/Fairview/Boston/Santa Fe/Fairview Division Rural

¹ Classified as a HPSA, effective March 1, 2001.
² No longer classified as a HPSA, effective January 1, 2001.
³ No longer classified as a HPSA, effective July 1, 2001.
⁴ Classified as a HPSA, effective July 1, 2001.
⁵ Classified as a HPSA, effective September 1, 2001.
⁶ No longer classified as a HPSA, effective February 1, 2001.
⁷ Classified as a HPSA, effective December 1, 2001.
⁸ Classified as a HPSA, effective March 1, 2002.
⁹ No longer classified as a HPSA, effective March 1, 2002.
¹⁰ Classified as a HPSA, effective April 1, 2002.
¹¹ Classified as a HPSA, effective June 1, 2002.
¹² Classified as a HPSA, effective February 1, 2004.

(04-0772)