MLN
Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare &
Medicaid Services) |
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MLN Matters Number: MM6087 Revised
Related Change Request (CR) #: 6087
Related CR Release Date: May 30, 2008
Effective Date: January 1, 2008, unless otherwise noted in
CR6087
Related CR Transmittal #: R1528CP
Implementation Date: July 7, 2008
July Update to the
2008 Medicare Physician Fee Schedule Database (MPFSDB)
| Note: This article was revised on June
9, 2008, to correct the summary of CR6087 in the “Impact
to You” section below. All other information remains the
same. |
Provider Types Affected
Physicians and providers who submit claims to Medicare carriers
and Part A/B Medicare Administrative Contractors (A/B MAC)
for services rendered to Medicare beneficiaries that are paid
based on the MPFSDB
Provider Action Needed
Impact to You
Payment files for the MPFS were issued based on the 2008 Medicare
Physician Fee Schedule Final Rule. Change Request (CR) 6087
amends those files AND includes new/revised codes for the
Physician Quality Reporting Initiative (PQRI).
What You Need to Know
Physicians and providers may want to pay particular attention
to the issue that effective July 1, 2008 payments are calculated
using the conversion factor of $34.0682, update factor of
0.899 and without the work geographic adjustment, which is
the previous payment methodology that was outlined in the
2008 MPFS Final Rule but was delayed as a result of the Medicare,
Medicaid, and State Children’s Health Insurance Program (SCHIP)
Extension Act of 2007.
What You Need to Do
Make certain that your billing staffs are aware of these changes.
Background
Section 1848 (c)(4) of the Social Security Act provides for
the establishment of the policies needed in order to implement
relative values for physicians’ services. CR6087 is the official
document that announces these changes in the Medicare schedule.
Rather than duplicate all the additions, deletions and changes
in this article, the Centers for Medicare & Medicaid Services
(CMS) directs you to CR6087, which contains lengthy lists
of these items. CR6087 is available at http://www.cms.hhs.gov/Transmittals/downloads/R1528CP.pdf
on the CMS Web site.
As mentioned above, the key portions of CR6087 include the
following information:
New G-codes for the Home Sleep Study Test Portable Monitor
New G-codes effective for services performed on or after March
13, 2008 are:
Code |
Long
Descriptor |
Short
Descriptor |
| G0398 |
Home sleep study test (HST) with type
II portable monitor, unattended; minimum of seven channels:
EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort,
and oxygen saturation. |
Home sleep test/type 2 Porta |
| G0399 |
Home sleep test (HST) with type III
portable monitor, unattended; minimum of four channels:
two respiratory movement/airflow, 1 ECG/heart rate and
one oxygen saturation |
Home sleep test/type 3 Porta |
| G0400 |
Home sleep test (HST) with type IV portable
monitor, unattended; minimum of three channels |
Home sleep test/type 4 Porta |
New G-codes for the Physician Quality Reporting
Initiative (PQRI)
Effective for dates of service on or after July 1, 2008, the
following HCPCS codes will be added to the MPFSDB:
Code |
Long
Descriptor |
Short
Descriptor |
| G8485 |
Clinician intends to report the Diabetes
measure group |
Report, Diabetes Measures |
| G8486 |
Clinician intends to report the Preventive
Care measure group |
Report, Prev Care Measures |
| G8487 |
Clinician intends to report the Chronic
Kidney Disease (CKD) measure group |
Report CKD Measures |
| G8488 |
Clinician intends to report the End
Stage Renal Disease (ESRD) measure group |
Report ESRD Measures |
New Category II Codes
Effective for dates of service on or after July 1, 2008, the
following Category II Codes will be added to the MPFSDB. (These
codes are not part of the Physician Quality Reporting Initiative
for 2008.)
Code |
Long
Descriptor |
Short
Descriptor |
| 3351F |
Negative screen for depressive symptoms
as categorized by using a standardized depression screening/assessment
tool |
Neg scrn dep symp by deptool |
| 3352F |
No significant depressive symptoms as
categorized by using a standardized depression assessment
tool |
No sig dep symp by dep tool |
| 3353F |
Mild to moderate depressive symptoms
as categorized by using a standardized depression screening/assessment
tool |
Mild-mod dep symp by deptool |
| 3354F |
Clinically significant depressive symptoms
as categorized by using a standardized depression screening/assessment
tool |
Clin sig dep sym by dep tool |
Please note that G-codes and CPT Category II
codes are used to report quality measures under the PQRI program
or for measure testing. The G-codes and CPT Category II codes
applicable to the 2008 PQRI Measure Set are available in the
“2008 PQRI Quality Measures Specification” document at http://www.cms.hhs.gov/PQRI/15_MeasuresCodes.asp#TopOfPage
on the CMS Web site.
New Category III Codes
Effective for dates of service on or after July 1, 2008, the
following Category III Codes (0188T through 0192T) will be
added to the MPFSDB:
Code |
Long
Descriptor |
Short
Descriptor |
| 0188T |
Videoconferenced Critical Care First
30-74 Min |
Videoconf crit care 74 min |
| 0189T |
Videoconferenced Critical Care Ea Addl
30 Min |
Videoconf crit care addl 30 |
| 0190T |
Intraocular Radiation Src Applicator
Placement |
Place intraoc radiation src |
| 0191T |
Ant Segment Insertion Drainage W/O Reservoir
Int |
Insert ant segment drain int |
| 0192T |
Ant Segment Insertion Drainage W/O Reservoir
Ext |
Insert ant segment drain ext |
Note that your carrier or MAC will not reprocess
claims already paid prior to implementation of this update.
However, if you bring such claims to your contractor’s attention,
they will adjust such claims.
Additional Information
To see the official instruction (CR6087) issued to your Medicare
carrier or A/B MAC visit http://www.cms.hhs.gov/Transmittals/downloads/R1528CP.pdf
on the CMS Web site.
If you have questions, please contact your Medicare Carrier
or A/B MAC at their toll-free number which may be found at
http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip
on the CMS Web site.
Disclaimer This article was prepared
as a service to the public and is not intended to grant rights
or impose obligations. This article may contain references
or links to statutes, regulations, or other policy materials.
The information provided is only intended to be a general
summary. It is not intended to take the place of either the
written law or regulations. We encourage readers to review
the specific statutes, regulations and other interpretive
materials for a full and accurate statement of their contents.
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