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June 2006 Part B Medicare Bulletin

Posted June 5, 2006

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2006 Jurisdiction List

2006 Jurisdiction List Acrobat Document PDF File

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2006 Jurisdiction List - MML

Provider Types Affected
Physicians, providers, and suppliers who submit claims to Medicare durable medical equipment regional carriers (DMERCs) and Part B local carriers

Provider Action Needed

STOP - Impact to You
CR4363 provides notice of the spreadsheet containing the annual updated list of Healthcare Common Procedure Coding System (HCPCS) for DMERC and Part B local carrier jurisdictions.

CAUTION - What You Need to Know
The Excel spreadsheet containing these codes is available within the official instructions (CR4363) issued to your DMERC contractor and Part B carrier, which may be viewed at http://www.cms.hhs.gov/Transmittals/downloads/R893CP.pdf. The list will also be available at http://www.cms.hhs.gov/center/dme.asp on the CMS Web site.

GO - What You Need to Do
The above codes are updated on an annual basis. Be sure your billing staff is aware of these changes.

Background
The HCPCS is updated annually to reflect changes in medical practice and the provision of health care. The Centers for Medicare & Medicaid Services (CMS) provides a file containing updated HCPCS codes to Medicare carriers, DMERCs, and intermediaries and to Medicaid State Agencies 60 to 90 days before the implementation of the annual update.

CMS publishes a recurring update notification annually to notify the DMERCs and Part B carriers that the list has been updated and is available on the CMS Web site.

Both the DMERCs and the local carriers publish this list to educate providers as to which contractor—the DMERC or local Part B carrier—to bill for codes provided on that list.

Implementation
The implementation date for this instruction is June 26, 2006.

Additional Information
The official instructions issued to your DMERC and Carrier regarding this change can be found at
http://www.cms.hhs.gov/Transmittals/downloads/R893CP.pdf on the CMS Web site.

If you have questions, please contact your Medicare DMERC or carrier at their toll-free number, which may be found at http://www.cms.hhs.gov/apps/contacts/ on the CMS Web site.

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Access to the Part D Drug Benefit in Long Term Care Settings

Note: This article was revised to contain Web addresses that conform to the new CMS Web site and to show they are now MLN Matters articles. All other information remains the same.

Provider Types Affected
Skilled nursing facilities (SNFs) and nursing homes with Medicare residents

Impact on Providers
To simplify access to the Part D drug benefit in the long term care (LTC) setting, the Centers for Medicare & Medicaid Services (CMS) recommends that providers take steps to clearly differentiate those drugs which may qualify as Part B drugs and those which may qualify as Part D drugs.

Important Points to Remember
CMS released the following information via the Minimum Data Set (MDS) submission system's Welcome Page on March 14, 2006:

Drugs Administered Through a Part B Covered Item of Durable Medical Equipment (DME) Such as a Nebulizer or Pump Medicare Part B only covers the above categories of drugs when used in conjunction with Part B covered DME in the patient's home. For those LTC facilities that do not qualify as a patient's home, CMS recommends for the above categories of drugs that the following be included in the written order:

Note: See the Web site listed at the end of this document for more information regarding the definition of a home.

Certain Infusion and Injectible Drugs
 Medicare Part B covers injectible and infusible drugs that are not usually selfadministered and that are furnished incident to a physician's service. If a LTC facility, rather than a physician, furnishes and administers these drugs to a patient who is not in a Medicare Part A stay, CMS recommends including a statement of status such as "Administered by Facility, Nursing Home Part D." Certain Oral and Immunosuppressive Drugs

At this time, Part B covers three categories of drugs: oral anti-cancer, oral antiemetic, and immunosuppressive drugs listed below under certain circumstances. This does not represent an exhaustive list of Part B covered drugs. It is possible for the list of drugs covered by Part B to change over time.

The following are immunosuppressive drugs for transplants paid for by Medicare:

Cyclophosphamide - Oral Cyclosporine - Oral
Cyclosporine - Parenteral Daclizumab - Parenteral
Lymphocyte Immune Globulin, Antithymocyte Globulin - Parenteral Methotrexate - Oral
Methylprednisolone - Oral Methylprednisolone Sodium Succinate - Injection
Muromonab-Cd3 - Parenteral Mycophenolate Acid - Oral
Mycophenolate Mofetil - Oral Oral Azathioprine
Parenteral Azathioprine Prednisolone - Oral
Prednisone - Oral Sirolimus - Oral
Tacrolimus - Oral Tacrolimus - Parenteral

The following are the oral anti-cancer drugs paid for by Medicare Part B:

Busulfan Capecitabine Cyclophosphamide
Etoposide Melphalan
Methotrexate Temozolomide

The following are oral antiemetics paid for by Medicare when prescribed for use within 48 hours of chemotherapy except as noted below:

3 Oral Drug Combination of: (1) Aprepitant; (2) A 5-HT3 Antagonist (Q0166, Q0179, Q0180); and (3) Dexamethasone Chlorpromazine Hydrochloride
Diphenhydramine Hydrochloride Dolasetron Mesylate (Q0180) (Within 24 Hours)
Dronabinol Granisetron Hydrochloride (Q0166) (Within 24 Hours)
Hydroxyzine Pamoate Ondansetron Hydrochloride (Q0179)
Perphenazine Prochlorperazine Maleate - Oral
Promethazine Hydrochloride Thiethylperazine Maleate
Trimethobenzamide Hydrochloride

For these categories of drugs, CMS recommends including in the written prescription the diagnosis and the indication as well as the statement of status as "Part B" (for above indications) or for "Part D" (for all other indications).

For example, Methotrexate for rheumatoid arthritis should have the diagnosis specified, and the designation "Part D" added to the prescription. While this guidance does not guarantee payment or coverage, following the process may help pharmacists respond more readily to additional information to support Part D or Part B coverage, and facilitate processing by the appropriate plan.

Note: This Special Edition information does not supersede any existing guidance concerning documentation for Part B prescriptions.

Additional Information
For more detailed information on Part B versus Part D coverage, see
http://www.cms.hhs.gov/PrescriptionDrugCovGenIn/Downloads/PartBandPartDdoc_07.27.05.pdf on the CMS Web site.

A comprehensive list of links to agency-wide Part D resources for physicians is available at http://www.cms.hhs.gov/center/provider.asp, scroll to "Part D Tools for Health Care Professionals."

As always, the source for Part D information for Fee-For-Service (FFS) providers is located on the Medicare Learning Network's drug coverage page at http://www.cms.hhs.gov/MLNProducts/23_DrugCoverage.asp on the CMS Web site.

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Additional Requirements for the Competitive Acquisition Program (CAP) for Part B Drugs and Biologicals - MMA

Note: This article was revised on April 3, 2006, to reflect a new CR Transmittal number, CR Web address, and CR release date. The changes were made to reflect revisions made by CMS to CR4309.

Provider Types Affected
Physicians and suppliers billing Medicare carriers for Part B drugs and biologicals not paid on a cost or prospective payment system basis

Provider Action Needed

STOP - Impact to You
This article is based on Change Request (CR) 4309, which provides additional requirement for the CAP for Part B drugs and biologicals.

CAUTION - What You Need to Know
CR4309 provides additional instructions for the implementation of the CAP program. It builds on CR4064 through business requirements that were identified through the implementation process of CR4064 and the development of the final CAP rule published on November 21, 2005.

GO - What You Need to Do
See the Background section of this article for further details regarding these additional requirements.

Background
Change Request (CR) 4309 provides new requirements that were identified both during the coding process of CR4064 (http://new.cms.hhs.gov/transmittals/downloads/R777CP.pdf) and the publication of the final rule for the CAP for Medicare Part B drugs. It provides additional instructions for the implementation of the CAP program as outlined in CR4064, and it is tied to the business requirements in CR4064. CR4309 is not a stand-alone CR and needs to be understood in conjunction with CR4064.

The Competitive Acquisition Program (CAP) for Drugs and Biologicals Not Paid on a Cost or Prospective Payment Basis
The Medicare Prescription Improvement and Modernization Act of 2003 (MMA, Section 303 (d)), requires the implementation of a CAP for Medicare Part B drugs and biologicals not paid on a cost or prospective payment system (PPS) basis. Beginning with drugs administered on or after July 1, 2006, physicians will be given a choice between buying and billing these drugs under the average sales price (ASP) system, or obtaining these drugs from vendors selected in a competitive bidding process. For a complete overview of the program, see the MLN Matters article at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM4064.pdf on the CMS Web site.

Note: For 2006, the first CAP year will run from July 1, 2006, through December 31, 2006. In subsequent years, it will run annually on a calendar year basis.

MMA, Section 303 (d) may be found at http://www.cms.hhs.gov/MMAUpdate/ on the CMS Web site. Social Security Act, Section 1861(s) is available at http://www.ssa.gov/OP_Home/ssact/title18/1861.htm.

The Centers for Medicare & Medicaid Services (CMS) may exclude drugs from the CAP if competitive pricing will not result in significant savings, or is likely to have an adverse impact on access to such drugs.

Note: Physicians will still be able to continue to purchase and bill Medicare under the Average Sales Price (ASP) system for those drugs that are covered under Medicare Part B but whose HCPCS codes are not provided by the chosen approved CAP vendor.

Providing a Drug from Physician's Stock
Under emergency situations, the CAP will allow a participating CAP physician to provide a drug to a Medicare beneficiary from his or her own stock and obtain the replacement drug from the approved CAP vendor when certain conditions are met. The local carrier will monitor drugs ordered under the emergency replacement provision to ensure that the participating CAP physician is complying with Medicare payment rules.

Physician Election and Information Transfer between Carriers and the Designated Carrier for CAP Claims

For this first CAP year, by April 17, 2006, CMS will post on its Web site:

Physicians can then elect the vendors and the categories of drugs they choose to receive drugs from under the CAP program. For this first CAP cycle, there will be one category of drugs and one geographic area.

In subsequent years, the CAP election will take place in the fall of each year and CMS will post on its Web site the updated list of vendor information. The election process will end each year approximately 45 days after the list of vendors is posted on the CMS Web site.

Additional Requirements Regarding the CAP
Additional instructions and more complete details about the CAP requirements for Part B Drugs can be found in Change Request (CR) 4309 and its attachments. Some of these important requirements to remember are as follows:

When physicians or practitioners submit a paper claim with a no-pay modifier on a line, but without a prescription number on that line, the claim will be rejected and returned with remittance advice remark code MA130, indicating "Your claim contains incomplete information, and no appeals rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information."

Implementation
The implementation date for this instruction is July 3, 2006, except where otherwise indicated in this article.

Additional Information
For complete details, please see the official instruction issued to your carrier regarding this change. That instruction may be viewed at http://www.cms.hhs.gov/Transmittals/downloads/R866CP.pdf on the CMS Web site.

In addition, you may wish to review CR4064 at
http://www.cms.hhs.gov/Transmittals/downloads/R777CP.pdf and its related article at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM4064.pdf on the CMS site.

If you have any questions, please contact your carrier at their toll-free number, which may be found at
http://www.cms.hhs.gov/apps/contacts/ on the CMS Web site.

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Additional $50 Payment for New Technology Intraocular Lenses (NTIOLs) Furnished in Ambulatory Surgical Centers (ASCs)

Provider Types Affected
Approved Ambulatory Surgical Centers (ASC) that bill Medicare for the insertion of new technology intraocular lenses (NTIOLs)

Provider Action Needed

STOP - Impact to You
Effective for dates of service on and after February 27, 2006, through February 26, 2011, Medicare will pay you an additional $50 for NTIOL Category 3 (Reduced Spherical Aberration); Advanced Medical Optics (AMO) Tecnis® IOL model numbers Z9000, Z9001, and ZA9003.

CAUTION - What You Need to Know
Your carrier will pay you an additional $50 for the insertion of NTIOL Category 3; Advanced Medical Optics (AMO) Tecnis® IOL, model numbers Z9000, Z9001, and ZA9003 (characteristic: improved contrast
sensitivity); effective for claims with dates of services on and after February 27, 2005, through February 26, 2011, when billed using HCPCS code Q1003 along with HCPCS codes 66982, 66983, 66984, 66985, or 66986.

GO - What You Need to Do
Make sure that your billing staffs are aware of this additional NTIOL payment and the required Health Care Common Procedure Coding System (HCPCS) code.

Background
Section 1833(i)(2)(A)(iii) of the Social Security Act (the Act) requires that the Centers for Medicare & Medicaid Services (CMS) establish a process for designating particular intraocular lenses (IOLs) as "new technology," and therefore eligible for additional payment. A final rule, published in the Federal Register on June 16, 1999, established the process for adjusting payment amounts for NTIOLS that ASCs furnish; a flat rate payment adjustment of $50; and a 5-year payment adjustment period beginning when CMS recognizes the first of a new IOL subset or class.

CR4361, from which this article is taken, announces the approval of NTIOL Category 3 (as defined in Federal Register Notice, 71 FR 4586, dated January 27, 2006), which applies to Advanced Medical Optics (AMO), Tecnis® IOL model numbers Z9000, Z9001, and ZA9003 (characteristic: improved contrast sensitivity). This category and the associated $50 NTIOL Medicare payment adjustment will expire on February 26, 2011.

The payment adjustment is allowed when Medicare-approved ASCs (place of service 24) insert this IOL and submit HCPCS code Q1003 (created for this purpose) on the same claim as the surgical insertion procedure (HCPCS codes 66982, 66983, 66984, 66985, or 66986). HCPCS code Q1003 is already established and listed in the HCPCS file, and the Medicare Claims Processing Manual, Chapter 14, Sections 10.2 & 40.3, has been updated to reflect this change.

Please be aware that carriers will deny payment for Q1003 when submitted by ASCs not approved by Medicare. If denied, the carrier will use appropriate messages such as MSN# 16.2 (This service cannot be paid when provided in this location/facility) and Claims Adjustment Reason Code #58 (Payment adjusted because treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service).

Carriers will return as unprocessable claims for NTIOLs with Q1003 alone or with a code other than 66982, 66983, 66984, 66985, or 66986. When such claims are returned, claim adjustment reason code 16 (Claim/service lacks information needed for adjudication. Additional information is supplied using remittance advice codes whenever appropriate) will be used. The remittance advice remark code of M67 (Missing/Incomplete/Invalid other procedure codes) and remark code MA130 (Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information) will be used as appropriate.

Further, payment will be denied if submitted for services rendered after the discontinued date (February 26, 2011). If denied, they will use messages such as: MSN # 21.11 (This service was not covered by Medicare at the time you received it) and Claims Adjustment Reason Code # 27 (Expenses incurred after coverage terminated).

Additional Information
You can find more information about approval of the $50 additional payment for NTIOL Category 3 by reviewing CR4361, which is available at http://www.cms.hhs.gov/Transmittals/downloads/R914CP.pdf on the CMS Web site. The revised Medicare Claims Processing Manual, Chapter 14 (Ambulatory Surgical Centers), Sections 10.2 (10.2 - Ambulatory Surgical Center Services on ASC List) and40.3 - (Payment for Intraocular Lens (IOL)) are attached to CR4361.

If you have any questions, please contact your carrier at their toll-free number, which may be found at
http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.pdf

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Announcement of Competitive Acquisition Program (CAP) Vendor Selection

CMS has announced approved drug vendor information for the Competitive Acquisition Program (CAP.) View the CMS Web page dedicated to providing all the latest CAP news for health care providers at http://www.cms.hhs.gov/CompetitiveAcquisforBios on the Web. This page is your source for news on CAP including how to participate in the CAP program. Bookmark this page as new information and resources will continue to be posted.

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Announcing a New Name for Medicare's Provider Education Articles - MLN Matters

Provider Types Affected
All Medicare physicians, providers, and suppliers

Background
The Medicare Learning Network is pleased to announce a new name for our very popular provider education articles. To more closely associate these articles with the Medicare Learning Network, i.e., the official educational information source for Medicare Fee-for-Service (FFS) providers, the articles previously known as "Medlearn Matters" articles will now be known as "MLN Matters" articles (the MLN standing for "Medicare Learning Network").

You will also notice a new logo at the top of the articles indicating the name change. The Centers for Medicare & Medicaid Services (CMS) knows that you have come to rely on these articles to help you more easily understand new or changed Medicare policy and to help you gain quick access to accurate Medicare program information.

The articles can now be accessed from http://www.cms.hhs.gov/MLNMattersArticles on the CMS Web site. If you have previously bookmarked the "Medlearn Matters" page, please update your bookmark to the new URL.

We hope that you will continue to utilize these articles that are always prepared with the affected provider audience in mind.

In conjunction with the above referenced change, the urls for the Medicare Learning Network (MLN) Web pages have also been changed. You can reach our MLN Web pages from the cms.hhs.gov main page - just click on "Outreach and Education." The full URLs to access the various MLN sections on the CMS Web site are:

MLN General Information -
http://www.cms.hhs.gov/MLNGenInfo
MLN Products -
http://www.cms.hhs.gov/MLNProducts

Additional Information
Also, note that if you know the specific number of an article you are after, such as SE0620, you can go directly to the specific URL for an article by using the format below. For example, the Web site for SE0620 is http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0620.pdf.

For any other article, just substitute its number for the SE0620 in this URL to go directly to the PDF version of the article on the CMS Web site.

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April Update to the 2006 Medicare Physician Fee Schedule (MPFS) Database

Note: This article was revised on April 3, 2006, to reflect changes made to related CR4399. As a result, on page 2 of this article, information has been added regarding Category II modifiers 1P, 2P, and 3P. The CR transmittal number, release date, and the Web address for CR4399 were also changed.

Provider Types Affected
Physicians, suppliers, and providers billing Medicare carriers, and/or fiscal intermediaries (FIs) for services paid under the Medicare Physician Fee Schedule (MPFS)

Provider Action Needed
This article is based on Change Request (CR) 4399, which informs your carrier/intermediary that payment files were issued to carriers based upon the November 21, 2005, Medicare Physician Fee Schedule Final Rule. CR4399 amends those payment files and includes new G-codes for the Low Vision Rehabilitation Demonstration Project and new Category II codes 3046F through 3050F and 3076F through 3080F.

Background
The Social Security Act (Section 1848(c)(4); http://www.ssa.gov/OP_Home/ssact/title18/1848.htm), authorizes the Centers for Medicare & Medicaid Services (CMS) to establish ancillary policies necessary to implement relative values for physicians' services. CMS issued payment files to carriers/intermediaries based upon the November 21, 2005, MPFS Final Rule.

Note: CR4399 amends those payment files and includes new G-codes for the Low Vision Rehabilitation Demonstration Project and new Category II codes 3046F through 3050F and 3076F through 3080F.

In the October 2005 update to the Medicare Physician Fee Schedule Database (MPFSDB), the multiple procedure indicators were inadvertently changed from a "0" to a "2" for CPT codes 20931, 20937, and 20938. The emergency update to the 2006 MPFSDB reinstated the multiple procedure indicators for these codes to a "0" effective January 1, 2006. Also, in the October 2005 update to the MPFSDB, the bilateral surgical indicators were inadvertently changed from "1" to "0" for CPT codes 63035, 63043, 63044, 64480, and 64484. This CR reinstates the bilateral surgical indicators for these codes to a "1" effective January 1, 2006.

Your carrier will not search their files for claims paid incorrectly from October 1, 2005, through December 31, 2005, but will adjust claims brought to their attention. In addition, your carrier will manually adjust their systems and the 2005 MPFSDB to reflect a multiple procedure indicator of a "0" for CPT codes 20931, 20937, and 20938 and a bilateral surgical indicator of a "1" for CPT codes 63035, 63043, 63044, 64480, and 64484. CR4399 instructs that:

Note: Your carrier/intermediary will not search their files to either retract payment for claims already paid or to retroactively pay claims. However, your carrier/intermediary will adjust claims brought to their attention.

Unless otherwise stated in CR4399, changes are retroactive to January 1, 2006.

Implementation
The implementation date for this instruction is April 3, 2006.

Additional Information
Other changes included in the April update of the MPFS are attached to CR4399. To see that official instruction issued to your carrier/intermediary, go to http://www.cms.hhs.gov/Transmittals/downloads/R897CP.pdf on the CMS Web site.

If you have any questions, please contact your carrier/intermediary at their toll-free number, which may be found at http://www.cms.hhs.gov/apps/contacts/ on the CMS Web site.

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Assignment of Physicians, Providers, and Suppliers to the Medicare Administrative Contractors (MACs) - MMA

Provider Types Affected
Providers, physicians, and suppliers who bill Medicare contractors (fiscal intermediaries (FIs) including regional home health intermediaries (RHHIs), and carriers, including durable medical equipment regional carriers (DMERCs)) for their services

Key Points
The Centers for Medicare & Medicaid Services (CMS) is implementing significant changes to the Medicare fee-for-service program's administrative structure. This Medicare Contracting Reform (MCR) will:

Under MCR, there will be 23 Medicare Administrative Contractors (MACs) with no national MAC. These new MACs will include:

MACs will serve as the primary point of contact for provider enrollment, Medicare coverage and billing requirements training for providers, and the receipt, processing and payment of Medicare fee-for-service claims for Medicare providers' respective jurisdictions.

Medicare providers will be assigned to the local designated MAC based on their geographic location to the MAC which has jurisdiction for that benefit category and location.

Note: Please be aware that in the event that your current FI does not win the contract to serve the area where you are located, you will be required to be reassigned to the MAC that has won the jurisdiction for your area.

The new MAC jurisdictions will be more similar to each other in size than the existing fiscal intermediary (FI) and carrier jurisdictions. The workload allocation and the number of fee-for-service beneficiaries and providers in each MAC jurisdiction will be reasonably balanced. The jurisdictions of the eight specialty MACs will overlay the boundaries of the fifteen primary A/B MAC jurisdictions.

Background
The Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA) (P.L. 108-173) allows the CMS to take appropriate steps to transition from agreements under Section 1816 of the Social Security Act to contracts with Medicare Administrative Contractors (MACs) under section 1874A. The changes to Medicare's administration are designed to increase the efficiency of Medicare's claims processing and related functions. They will benefit Medicare providers and Medicare's enrollee population.

Additional Information
During the initial implementation phase (2005-2011) of the Medicare fee-for-service administrative contracting reform, CMS intends to issue Requests for Proposals (RFPs) to compete and award contracts for 23 MACs (four DME and four Home Health/Hospice MACs, and 15 primary A/B MACs).

The transition to the MAC administrative structure will be implemented through a series of acquisition cycles (9-12 months from solicitation to award). The subsequent workload transition to the new MAC system is projected to take 6-13 months after contract award.

Medicare's MAC Jurisdictions

Jurisdiction States Included in Jurisdiction Procurement Schedule
Specialty MAC Jurisdictions (DME and Home Health/Hospice) RFP
Issuance		 Award Date
A Connecticut, Delaware, District of Columbia,
Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont

DME
March 2005

Home
Health/
Hospice
Sept. 2007

DME
Jan. 2006
Home
Health/
Hospice
Sept. 20
B Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, and Wisconsin

DME
March 2005

Home
Health/
Hospice
Sept. 2007

 DME
Jan. 2006
Home
Health/
Hospice
Sept. 20
C Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, U.S. Virgin
Islands, Virginia, and West Virginia

DME
March 2005

Home
Health/
Hospice
Sept. 2007

 DME
Jan. 2006
Home
Health/
Hospice
Sept. 20
D Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington, and Wyoming
DME
March 2005		 Home
Health/
Hospice
Sept. 2007 DME
Jan. 2006
Home
Health/
Hospice
Sept. 20
Jurisdiction Primary A/B MAC Jurisdictions RFP
Issuance		 Award
Date
1 American Samoa, California, Guam, Hawaii, Nevada, and Northern Mariana Islands Sept. 2006 Sept. 2007
2 Alaska, Idaho, Oregon, and Washington Sept. 2006 Sept. 2007
3 Arizona, Montana, North Dakota, South Dakota, Utah, and Wyoming Sept. 2005 June 2006
4 Colorado, New Mexico, Oklahoma, and Texas Sept. 2006 Sept. 2007
5 Iowa, Kansas, Missouri, and Nebraska Sept. 2006 Sept. 2007
6 Illinois, Minnesota, and Wisconsin Sept. 2007 Sept. 2008
7 Arkansas, Louisiana, and Mississippi Sept. 2006 Sept. 2007
8 Indiana and Michigan Sept. 2007 Sept. 2008
9 Florida, Puerto Rico, and U.S. Virgin Islands Sept. 2007 Sept. 2008
10 Alabama, Georgia, and Tennessee Sept. 2007 Sept. 2008
11 North Carolina, South Carolina, Virginia, and West Virginia Sept. 2007 Sept. 2008
12 Delaware, District of Columbia, Maryland, New Jersey, and Pennsylvania Sept. 2006 Sept. 2007
13 Connecticut and New York Sept. 2006 Sept. 2007
14 Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont Sept. 2007 Sept. 2008
15 Kentucky and Ohio Sept. 2007 Sept. 2008

For additional information about the MCR process, please refer to http://www.cms.hhs.gov/Medicare ContractingReform/ on the CMS Web site.

CR4002, transmittal 670, Realignment of States and Medicare Claims Processing Workload from DMERC Regions A, B, C and D to the DME MAC Jurisdictions A, B, C, and D discusses phase 1 of the MAC acquisition and transition schedule. It can be found at http://www.cms.hhs.gov/transmittals/downloads/R670CP.pdf on the CMS Web site.

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Botoulinum Toxin - LCD Revision

The LCD for Botulinum Toxin has been revised for all Part B states. To view the policy in its entirety for your particular state, please refer to the CIGNA Government Services Web site at:

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Cardiac Rehabilitation Programs

Provider Types Affected
All providers who bill Medicare for cardiac rehabilitation services

Provider Action Needed

STOP - Impact to You
Effective on and after March 22, 2006, Medicare has expanded coverage for cardiac rehabilitation programs to include three new indications, and has extended the time frame for performing the services to include up to 36 sessions.

CAUTION - What You Need to Know
CR4401 updates the National Coverage Determination (NCD) Manual, Publication 100-03, Section 20.10, Cardiac Rehabilitation Programs (March 22, 2006), to include three newly covered indications: 1) heart valve repair/replacement; 2) percutaneous transluminal coronary angioplasty (PTCA) or coronary stenting; and 3) heart or heart-lung transplant. It also extends the program's possible duration to a total of 36 sessions (generally, two to three sessions per week for 12 to 18 weeks) and lists the services required to provide a comprehensive program. CR4401 also updates the Medicare Claims Processing Manual, Publication 100-04, Chapter 32, Section 140 to include billing requirements and language regarding physician supervision.

GO - What You Need to Do
Make sure that your billing staffs are aware of these coverage changes in the Cardiac Rehabilitation Program.

Background
Phase II cardiac rehabilitation, as described by the U.S. Public Health Service, is a comprehensive, long-term program including medical evaluation, prescribed exercise, cardiac risk factor modification, education, and counseling. Phase II refers to outpatient, medically supervised programs that are typically initiated 1-3 weeks after hospital discharge and provide appropriate electrocardiographic monitoring.

CR4401 updates National Coverage Determinations (NCD) Manual (100-03), Section 20.10 (effective for cardiac rehabilitation services provided on or after March 22, 2006) to:

CMS has historically covered cardiac rehabilitation services for patients who have: (1) a documented diagnosis of acute myocardial infarction (MI) within the preceding 12 months; (2) coronary artery bypass surgery; and /or (3) stable angina pectoris. The updated NCD now provides coverage for these three indications and adds three additional ones.

Expanded Coverage
Effective for services performed on or after March 22, 2006, Medicare covers cardiac rehabilitation exercise programs for patients who meet the following criteria:

Further, the updated policy also now allows up to 18 weeks for a beneficiary to receive their maximum of 36 cardiac rehabilitation services (Patients generally receive two to three sessions per week for 12 to 18 weeks).

Please note that additional services may be covered at the discretion of the local Medicare contractor, but may not exceed 72 sessions within a 36-week period.

Clarification of Physician and Facility Requirements
The updated policy also clarifies language regarding physician supervision and facility requirements and the physician's physical location during the rehabilitation services. Specifically the NCD requires that:

The Medicare Claims Processing Manual instructs that:

Coding Requirements
This CR also changes the Medicare Claims Processing Manual, Publication 100-04, Chapter 32, Section 140, to update the relevant billing and claims related instructions, and points out the following applicable HCPCS codes:

You should note that your carriers and FIs will apply current payment methodologies, rates, and payments policies for cardiac rehabilitation services when these services are performed according to the new policy stated in this CR. However, they will not search and adjust claims that have already been processed unless brought to their attention.

Additional Information
The revision of Section 20.10 of the Medicare National Coverage Determinations Manual (Publication 100-03) is a national coverage determination (NCD) made under section 1862(a)(1) of the Social Security Act. Remember that:

You may view CR4401, Transmittal 52, the revised Medicare National Coverage Determinations Manual, Chapter 1 - Coverage Determinations, Part 1, Section 20.10 (Cardiac Rehabilitation Programs - effective March 22, 2006), at http://www.cms.hhs.gov/Transmittals/downloads/R52NCD.pdf on the CMS Web site.

You may view CR4401, Transmittal 909, the revised Medicare Claims Processing Manual, Chapter 32 (Billing Requirements for Special Services), Sections 140 (Cardiac Rehabilitation Programs) and 140.1 (Coding Requirements), at http://www.cms.hhs.gov/Transmittals/downloads/R909CP.pdf on the CMS Web site.

If you have any questions, please contact your carrier at their toll-free number, which may be found at
http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.pdf.

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Clarification on Billing Requirements for Percutaneous Transluminal Angioplasty (PTA) Concurrent with the Placement of an FDA-Approved Carotid Stent

Provider Types Affected
Providers, physicians, and suppliers that bill Medicare contractors (fiscal intermediaries (FIs) and carriers) for their services

Key Points

Background
Percutaneous Transluminal Angioplasty (PTA) involves inserting a balloon catheter into a narrow or occluded blood vessel to recanalize and dilate the vessel by inflating the balloon. The objective of PTA is to improve the blood flow through the diseased segment of a vessel so that vessel patency is increased and embolization is decreased. With the development and use of balloon angioplasty for treatment of atherosclerotic and other vascular stenoses, PTA (with and without the placement of a stent) is a widely used technique for dilating lesions of peripheral, renal, and coronary arteries.

Please refer to the manual attachment to CR5022, Transmittal 53, (Publication 100-03, The Medicare National Coverage Determinations Manual, Chapter 1, Part 1, Section 20.7) for more information about the nationally covered indications for PTA concurrent with carotid stent placement, and for facilities accepted for services related to CAS with embolic protection. This is available at http://www.cms.hhs.gov/Transmittals/downloads/R53NCD.pdf on the CMS Web site.

Category B IDE Study Claims and Post-approval Study Claims
Effective for dates of service on or after March 17, 2005, the following claims are not subject to the approved facility list. These are CAS claims:

CAS with Embolic Protection Claims

Related Links
CR1660, Claims Processing Instructions for Clinical Trials on Carotid Stenting With Category B Investigational Device Exemptions (IDEs) can be found at http://www.cms.hhs.gov/Transmittals/Downloads/AB0174.pdf on the CMS Web site.

MM3489, Percutaneous Transluminal Angioplasty (PTA) can be found at the following link
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM3489.pdf on the CMS Web site.

MM3811, Expansion of Coverage for Percutaneous Transluminal Angioplasty (PTA) is located at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM3811.pdf on the CMS Web site.

CR5022 is the official instruction issued to your FI or carrier regarding changes mentioned in this article, MM5022. CR5022 may be found by going to Transmittal 911CP at http://www.cms.hhs.gov/Transmittals/downloads/R911CP.pdf for the claims
processing instructions and to Transmittal 53NCD for the NCD Manual section, which is at http://www.cms.hhs.gov/Transmittals/downloads/R53NCD.pdf on the CMS Web site.

Please refer to your local FI or carrier if you have questions about this issue. To find their toll-free phone number, go to http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.pdf on the CMS Web site.

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CMS Has Revised the Average Sales Price (ASP) and Not Otherwise Classified (NOC) Drug Lists for 2005 and 2006

***UPDATE***

The revised lists may be found by following the link below: http://www.cignagovernmentservices.com/ medicare_dynamic/clickwrap/clickwrap.asp?url=partbfees

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CMS - Keeping in Touch with Medicare Fee-for-Service Providers

Mailing Lists

Keeping Medicare Fee-for-Service Providers Informed through E-mail

Let CMS keep you up-to-date!
In the fast-paced, ever-changing world in which we live, it's all too easy to find yourself inundated with information. The Centers for Medicare & Medicaid Services (CMS) offers a way for you to receive consistent and accurate information regarding recent news, policy changes, and updates: CMS Mailing Lists. Also referred to as listservs, these electronic mailing lists enable you to receive e-mails about the latest CMS Fee-for-Service (FFS) initiatives. All that is required to subscribe is your name and a valid e-mail address, and you can start receiving electronic updates automatically!

So many choices…
There is a CMS Mailing List for everyone! To subscribe, visit the CMS Mailing Lists Web page at www.cms.hhs.gov/apps/mailinglists/ on the CMS Web site to see all available listservs, specifically the following that are targeted to Medicare FFS providers:

If, at any time after subscribing, you find that certain listservs are not helpful to you, return to the CMS Mailing Lists page to unsubscribe.

For more specialized information and additional ways to stay informed, visit any of the following FFS provider center Web pages:

Already signed up?
Great! Then you already know how helpful these e-mail updates can be. Help us spread the word - after all, the sooner everyone knows about new initiatives, regulations, and policy changes, the less time Medicare FFS providers will need to spend researching recent updates, re-filing claims, and trying to keep up-to-date on the latest happenings at CMS.

For additional FFS-related information, please visit the following resources:
The Medicare Learning Network (MLN) is the brand name for official CMS educational products and information for FFS Medicare providers. For additional information visit the Medicare Learning Network's new Web page at www.cms.hhs.gov/MLNGenInfo on the CMS Web site.

For general FFS provider/supplier information and resources, visit the Provider Center page at www.cms.hhs.gov/center/provider.asp on the CMS Web site. Check out the Spotlight section for new information.

For information regarding the privacy of your e-mail address and other sensitive information, visit CMS' Privacy Policy Web page at www.cms.hhs.gov/AboutWebsite/02_Privacy%20Policy.asp on the CMS Web site.

To participate in live dialogue discussions between CMS and the provider community, visit the Open Door Forums Web page at www.cms.hhs.gov/OpenDoorForums on the CMS Web site.

To subscribe to any of CMS' mailing lists, visit the CMS Mailing Lists Web page at
www.cms.hhs.gov/apps/mailinglists/ on the CMS Web site to see all available listservs.

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Competitive Acquisition Program (CAP) for Part B Drugs and Biologicals

GENERAL INFORMATION

Keywords
CAP, Physicians, Approved Vendor, Drugs, Biologicals, Administration, Election Period, Delivery

Provider Types Affected
Physicians billing Medicare carriers for Medicare Part B drugs and biologicals.

Background
Physicians who administer drugs in their offices to Medicare beneficiaries will have the option of obtaining certain drugs from approved vendors who are selected in a competitive bidding process under the new voluntary competitive acquisition program (CAP) starting on July 1, 2006. The CAP was established by Section 303(d) of the Medicare Modernization Act.

Key Points

Benefits to physicians who participate in the CAP

For More Detailed Information
Providers should contact the designated CAP contractor, Noridian Administrative Services (NAS), for questions that cannot be answered by CAP job aids at 888.671.0536 (CSR line) or 877.807.3686 (IVR line.)

Important Links
http://www.cms.hhs.gov/CompetitiveAcquisforBios CMS'CAP Web page

http://www.cms.hhs.gov/CompetitiveAcquisforBios/04_cap_regs.asp CMS Regulations and Notices

http://www.noridianmedicare.com/cap_drug Noridian's CAP Web page

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Expansion of Coverage for Percutaneous Transluminal Angioplasty (PTA)

Note: This article was revised on April 3, 2006, to clarify that reporting of both 433.30 and 433.10, in either diagnosis position, needs to be done in the same claim as noted in the "Note" box at the top of page 5 of this article. All other information remains the same.

Provider Types Affected
Hospitals, physicians, and suppliers billing Medicare carriers or fiscal intermediaries (FIs) for Percutaneous Transluminal Angioplasty (PTA) services provided to Medicare beneficiaries

Provider Action Needed

STOP - Impact to You
MM3811 and related CR3811 announce the expansion of Medicare coverage for PTA of the carotid artery.

CAUTION - What You Need to Know
Effective March 17, 2005, Medicare revised its coverage of PTA of the carotid artery as detailed in this article and CR 3811.

GO - What You Need to Do
If you are a provider of PTA services, be aware of the coverage changes and make certain that your billing staff is aware of the expanded national coverage allowed to Medicare beneficiaries receiving PTA Services

Background
Medicare covers PTA of the carotid artery concurrent with carotid stent placement when all the requirements stipulated by the Food and Drug Administration (FDA)- approved policies for Category B Investigational Device Exemption (IDE) clinical trials are met, effective for dates of service on or after July 1, 2001. PTA of the carotid artery concurrent with the placement of an FDA-approved carotid stent for an FDA-approved indication is covered, when all the requirements stipulated by the FDA-approved policies for post-approval studies are met, for dates of service on or after October 12, 2004.

Expanded Coverage
Effective March 17, 2005, The Centers for Medicare & Medicaid Services (CMS) expanded the coverage of PTA of the carotid artery concurrent with placement of an FDA-approved carotid stent with embolic protection for the following:

Significant Comorbidities
CMS defines high risk patients as those having significant comorbidities and/or anatomic risk factors and are considered by a surgeon to be poor candidates for CEA. The significant comorbidities, include, but are not limited to, those listed in Section 20.7 of the Medicare NCD Manual as follows:

Carotid Artery Stenosis
Symptoms of carotid artery stenosis include carotid transient ischemic attack (distinct focal neurologic dysfunction persisting less than 24 hours), focal cerebral ischemia producing a non-disabling stroke (modified Rankin scale < 3 with symptoms for 24 hours or more), and transient molecular blindness (amaurosis fugax). Patients who have had a disabling stroke (modified Rankin > 3) would be excluded from coverage. The appropriate documentation confirming that a patient is at high risk for CEA and records of the patient's symptoms of carotid artery stenosis should be available in the patient medical records prior to performing any procedure.

The degree of carotid artery stenosis should be measured by duplex Doppler ultrasound or carotid artery angiography and recorded in the patient medical records. If the stenosis is measured by ultrasound prior to the procedure, then the degree of stenosis must be confirmed by angiography at the start of the procedure. If the stenosis is determined to be less than 70% by angiography, the CAS should not proceed.

Examples of standards and clinical competence guidelines include those published in the December 2004 edition of the American Journal of Neuroradiology and those published in the August 18, 2004, Journal of the American College of Cardiology.

Written Documentation
For evaluation purposes, all facilities must provide written documentation to CMS indicating it meets one of the following criteria:

The affidavit should be sent to:
Director, Coverage and Analysis Group
7500 Security Boulevard, Mail-stop C1-09-06
Baltimore, MD 21244

Note: Performance of PTA to treat obstructive lesions of the vertebral and cerebral arteries remains non-covered. All other indications of PTA for which CMS has not specifically indicated coverage remain non-covered.

Additional Information
All providers should note that the following relate to services on or after March 17, 2005:

Note: Providers must also bill V70.7 (Exam - clinical trial) as a secondary diagnosis for claims with "From" dates before October 1, 2005. Providers must bill V70.7 in order to avoid unintentional Medicare Code Editor (MCE) editing. For claims that have "From" dates on or after October 1, 2005, hospitals are not required to bill V70.7 as the unintentional MCE editing will be corrected.

Coding for Carotid Artery Stents
In the American Hospital Association's (AHA's) publication Coding Clinic for ICD-9-CM, First Quarter 2002, page 10 (and corrected in Second Quarter 2002, page 19), there is a Q&A regarding coding of bilateral carotid artery stenosis. The answer said, "Assign only code 433.10, (Occlusion and stenosis of precerebral arteries, Carotid artery, without mention of cerebral infarction) as the principal diagnosis." The correction notice changed that advice to use code 433.30 (Occlusion and stenosis of precerebral arteries, multiple and bilateral, without mention of cerebral infarction) instead of 433.10.

In an effort to reduce the confusion, CMS has decided to allow hospitals to be able to code both 433.30 and 433.10, in any diagnosis positions, on the same claim. Code 433.30 will identify the bilateral condition, while 433.10 will specifically identify the carotid vessel.

You may also want to review the following MLN Matters article MM3489 and CR3489 for additional information relating to Medicare coverage of PTA. They are available at http://www.cms.hhs.gov /MLNMattersArticles/downloads/MM3489.pdf and http://www.cms.hhs.gov/Transmittals/downloads /R314CP.pdf on the CMS Web site.

The official instruction issued to your carrier/FI regarding this change may be found at http://www.cms.hhs.gov/Transmittals/downloads/R33NCD.pdf on the CMS Web site. That site contains the NCD manual revision. The changes to the Medicare Claims Processing Manual are at http://www.cms.hhs.gov/Transmittals/downloads/R531CP.pdf on the CMS Web site.

If you have questions regarding this issue, contact your carrier/intermediary on their toll-free number, which is available at http://www.cms.hhs.gov/apps/contacts/ on the CMS Web site.

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Expansion of Glaucoma Screening Services

Provider Types Affected
Physicians and providers who submit claims to Medicare fiscal intermediaries (FIs) and carriers for glaucoma screening examinations

Important Points to Remember

Background
On January 1, 2002, CMS implemented regulations at 42 CFR, Section 410.23(a)(2). The regulations set conditions for and limitations on coverage of screening for glaucoma, requiring that the term "eligible beneficiary" be defined to include individuals in the following high-risk categories:

The Physician Fee Schedule for Calendar Year 2006 Final Rule, 70 FR 70270, dated November 21, 2005, expands Medicare coverage of high-risk individuals eligible to receive glaucoma screening services to include Hispanic Americans age 65 and over.

This expansion of coverage is effective for services performed on or after January 1, 2006, and revises 42 CFR, section 410.23(a)(2) accordingly.

Implementation
The implementation date for this instruction is April 3, 2006.

Additional Information
The official instructions (CR4365) issued to your FI or Carrier regarding this change can be found at http://www.cms.hhs.gov/Transmittals/downloads/R48BP.pdf and http://www.cms.hhs.gov/Transmittals/downloads/R895CP.pdf on the CMS Web site.

If you have questions, please contact your Medicare FI or Carrier at their toll-free number which may be found at http://www.cms.hhs.gov/apps/contacts/ on the CMS Web site

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External Counterpulsation (ECP) Therapy

Provider Types Affected
Providers, physicians, and suppliers who bill Medicare contractors (fiscal intermediaries (FIs) and carriers) for external counterpulsation (ECP) therapy services

Key Points

Background
Prior to July 1999, ECP therapy was non-covered for all indications. The coverage policy was amended, effective July 1, 1999, to allow coverage for ECP therapy under certain circumstances. Coverage for ECP was provided only for patients who were diagnosed with disabling angina (Class III or Class IV, CCSC or equivalent classification) and who, in the opinion of a cardiologist or cardiothoracic surgeon, are not readily amenable to surgical intervention. Under this policy decision, the therapy was identified as Enhanced External Counterpulsation. Subsequent reconsiderations of the NCD in February 2000 and October 2001:

Additional Information
Publication 100-04, The Medicare Claims Processing Manual, Chapter 32, Section 130, is updated to manualize current billing and payment requirements for both FIs and carriers. The revised section is attached to CR4350, which is the official instruction issued to your FI or carrier regarding changes mentioned in this article, MM4350. There are two transmittals related to CR4350. The first is the transmittal conveying the NCD, which is available at http://www.cms.hhs.gov/Transmittals/downloads/R50NCD.pdf, and the second, which revises the Medicare Claims Processing Manual, is at http://www.cms.hhs.gov/Transmittals/downloads/R898CP.pdf on the CMS Web site.

Please refer to your local FI or carrier if you have questions about this issue. To find their toll-free phone number, go to http://www.cms.hhs.gov/apps/contacts/ on the CMS Web site.

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Full Replacement for Change Request (CR) 4266, Revision for Health Professional Shortage Area (HPSA) and Physician Scarcity Area (PSA) Bonus Billing for Some Globally Billed Services, CR4266 Is Rescinded

Provider Types Affected
Physicians billing Medicare carriers for the Health Professional Shortage Area (HPSA) and Physician Scarcity Area (PSA) bonus

Provider Action Needed
This article is based on Change Request (CR) 5015, which will allow physicians to submit global services and receive the HPSA and PSA bonuses without having to submit the professional component and technical component (PC/TC) separately.

Background
Currently, components of services with a professional component/technical component of four must be submitted separately in order to receive the HPSA and PSA bonus payments. CR5015 is similar to CR4266 (Transmittal 834) in that it also allows you to submit the global service and receive the bonus payment on all professional component/technical component (PC/TC) 4 codes.

However, CR5015 further instructs that payment is excluded for the following Current Procedural Terminology (CPT) code:

CPT Code 93015 (cardiovascular stress test using maximal or sub maximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision; with interpretation and report)

Note: The "technical component" of services relates to facilities, equipment, and technical staff required for the delivery of those services, and the "professional component" consists of fees paid to the physician for providing those services. When combined, the "professional and technical" components of a service are referred to as "global" service.

CR5015 instructs that, effective for claims received on or after July 1, 2006:

The bonus payment amount is calculated based on the payment amount for the associated professional component code.

Your carrier will make any necessary revision to their systems to be able to calculate the bonus payment just for the professional component of the service.

This action will be taken for bonuses paid automatically as well as bonuses paid based on the submission of the QB, QU, AR, or AQ modifiers. Because there are two associated professional components to 93015, your carrier will follow the instructions in the Medicare Claims Processing Manual and return claims for 93015 as unprocessable. The services must then be resubmitted as separate components in order to receive the bonus on the appropriate professional component.

Carriers will continue to allow the option of withholding HPSA/PSA bonuses if that is requested by physicians and the carriers will not pay the bonus on PCTC 4 to physicians who have already notified them of their decision to not receive HPSA/PSA bonuses.

Note: CR5015 does not affect current HPSA or PSA payment policy.

Implementation
The implementation date for the instruction is July 3, 2006.

Additional Information
The revised Medicare Claims Processing Manual - Publication 100.4, Chapter 12 (Physician Practitioner Billing), Section 90.4.5 (Services Eligible for HPSA and Physician Scarcity Bonus Payments), is attached to CR5015, which is the official instruction issued to your carrier regarding this change. That instruction may be viewed at http://www.cms.hhs.gov/Transmittals/downloads/R906CP.pdf on the CMS Web site.

If you have any questions, please contact your carrier at their toll-free number, which may be found at
http://www.cms.hhs.gov/apps/contacts/ on the CMS Web site.

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Instructions for Provider Notification Regarding Streamlined Drug Coverage Materials for Health Care Professionals, a New Fact Sheet and Script for Recent Audio Conference

Note: This article was revised to contain Web addresses that conform to the new CMS Web site and to show they are now MLN Matters articles. The Web address on page two for the fact sheet was also changed.

All other information remains the same.

Provider Types Affected
Providers, physicians, and suppliers and their staff who prescribe medications for Medicare patients

Key Points
The Centers for Medicare & Medicaid Services (CMS) has developed three new products as part of the Medicare Prescription Drug Coverage (Part D) campaign for health care professionals:

Consolidated List of Links
A consolidated list of links to resources for prescribers is located at http://www.cms.hhs.gov/center/provider.asp on the CMS Web site.

At this Web page, offices can get access to direct telephone numbers to a Medicare drug plan's coverage determination staff, as well as to obtain model forms that will help speed this process.

Educational information for Fee-For-Service (FFS) providers is always available through our Medicare Learning Network drug coverage page at http://www.cms.hhs.gov/MLNProducts/23_DrugCoverage.asp on the CMS Web site.

Transition Policy Fact Sheet
A new fact sheet regarding the new transition policy, as well as the exceptions and appeals process for Medicare Prescription Drug Coverage, is available for use in prescriber offices. This resource fact sheet provides ready links to tools that will streamline the prescribing process under the new coverage.

CMS continues to work with groups representing physicians, pharmacists, patients, and Part D plans to simplify and standardize the information that physicians need to provide to plans.

The fact sheet is at http://www.cms.hhs.gov/MLNProducts/downloads/Part_D_Resource_Fact_sheet_revised.pdf on the CMS Web site.

An Important Message for Providers Regarding Medicare Part D from CMS Administrator Dr. Mark McClellan
Dr. McClellan's message to providers describes the steps CMS is taking to implement the new Medicare prescription drug coverage. Dr. McClellan also discusses helpful resources for providers. Streaming video of this message is available at http://media.cms.hhs.gov/cms/McClellanPartDProvider.wmv on the CMS Web site.

Phone Conference Training Session
A PowerPoint presentation and audio replay of a recent phone conference training session is available, entitled "Working with Plan Formularies: Transition Supplies, Prior Authorization, Quantity Limits, Step Therapy, and Exceptions." This training session is geared towards guiding office staff through the exceptions process. These materials are located at http://media.cms.hhs.gov/cms/partner03022006.wma on the CMS Web site.

Other Special Edition Articles
Other special edition articles regarding the prescription drug program include, but are not limited to, the following:

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Medicare Remit Easy Print (MREP) Reminder

Are you receiving an Electronic Remittance Advice (ERA)?  Have you tried Medicare Remit Easy Print (MREP) software?

As of June 1, 2006, if you have been receiving both an Electronic Remittance Advice (ERA), either directly from your Medicare carrier/DMERC or indirectly from a clearinghouse, billing agent, or other entity representing you, and a Standard Paper Remittance (SPR) from your carrier/DMERC for 45 days or more, you will no longer be mailed an SPR by your carrier/DMERC, in accordance with Change Request (CR) 4376.  Check out Special Edition MLN Matters article SE0627 which outlines some of the options available to providers who will no longer receive the SPR directly from their carrier/DMERC.  The article is located at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0627.pdf on the CMS Web site.

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Medicare to Stop Mailing Standard Paper Remittance (SPR) for Those Providers/Suppliers Also Receiving the Electronic Remittance Advice (ERA)

Beginning June 1, 2006, the SPR received through the mail will no longer be available to providers/suppliers who also receive an ERA, whether the ERA is received directly or through a billing agent, clearing house, or other entity representing a provider/supplier. In response to the provider/supplier communities continued need for SPRs, CMS has developed free software call Medicare Remit Easy Print (MREP) that gives providers/suppliers a tool to read and print a remittance advice (RA) from the HIPAA compliant Health Care Claim Payment/Advice (835) file. The MREP software was designed to incorporate new functionality to save providers/suppliers time and money. The paper output generated by MREP is similar to the SPR format. The CMS has worked with other payers to insure their acceptance of the SPR generated by the MREP software for Coordination of Benefit claim submission. Additionally, CMS has worked with clearinghouses to assure similar software is available to read and print an ERA for those providers/suppliers that utilize clearinghouse services. We encourage providers/suppliers currently receiving the ERA, who don't use software to read and print RAs from these files, to begin using MREP or other similar software before the June 1st cutoff. Please go to http://www.cignagovernmentservices.com/edi/partb/easy_print.html for further information regarding MREP software. We appreciate your continued cooperation as the Medicare program moves toward a more electronic environment.

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Microvolt T-wave Alternans (MTWA) Diagnostic Testing

Provider Types Affected
Physicians, suppliers, and providers billing Medicare carriers and/or fiscal intermediaries (FIs) for MTWA diagnostic testing services

Provider Action Needed
This article is based on Change Request (CR) 4351, which announces that effective for dates of service on or after March 21, 2006, MTWA diagnostic testing is covered fo