2016 Coding Guide. Hospital Outpatient Physician Freestanding Facility. Reimbursement Hotline

Size: px
Start display at page:

Download "2016 Coding Guide. Hospital Outpatient Physician Freestanding Facility. Reimbursement Hotline"

Transcription

1 2016 Coding Guide Hospital Outpatient Physician Freestanding Facility Reimbursement Hotline solutions.com Ph:

2 2016 Coding & Payment Options Hospital Outpatient, Physician And Freestanding Center The codes listed in this guide are options only and not intended to drive coding or reimbursement. Some codes may be considered a component of another code and not separately payable (e.g., CCI edits). Codes/procedures shown may not always be performed, multiple payment reduction, physician specific coding options, etc. Coding of diagnoses and procedure codes is dependent on the documentation in the patient s medical record. Current Procedural Terminology () is copyright 2015 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. Medicare 2016 National Average Hospital Outpatient Payment Rates Possible Coding Options In the Hospital Outpatient Setting APC Group/ Indicator Medicare 2016 National Average CT for treatment planning (optional) N $ Simulation, complex 5613 / S $ Simulation, 3-D 5614 / S $1, Special medical physics consult 5612 / S $ Special treatment procedure 5623 / S $ Unlisted breast procedure (application of catheter) 5091 / T $2, Simulation, simple 5612/ S $ / S $ Treatment device 5611 / S $ * Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; 2-12 channels 5624 / S $696 C1717 Radiation source (Ir-192) 2646 / U $294 APC Indicators: N = Packaged; S = Procedure not discounted when multiple; T = Procedure, Multiple Reduction Applies when performed in conjunction with another T status indicator; U = Brachytherapy Source Page 2 January 2016

3 Medicare 2016 National Average Physician Facility Payment Rates Possible Coding Options - Physician Services Provided In the Hospital Outpatient Setting (Facility) The following 2016 Medicare national average payment rates are specific to physician services provided in the facility (e.g., hospital outpatient) setting. Off-site hospital-owned sites are also considered as facilities in the context of payment. Non-facility services are generally provided in a freestanding physician s office and are discussed on the next page. code Medicare 2016 National Average Physician Payment (Facility setting) CT for treatment planning (optional) $ Therapeutic radiology treatment planning, complex $ Simulation, complex $ Simulation, 3-D $ Special medical physics consult $ Special treatment procedure $ Unlisted breast procedure (application of catheter) Paid by Report Simulation, simple $ Treatment device $ * Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; 2-12 channels National average physician payment rates are based on the Medicare Physician Fee Schedule (MPFS) rates and conversion factor $ as outlined in the CY2016 MPFS Final Rule. Note: CCI edits should be checked quarterly when using any of the coding options presented. $96 $199 Page 3 January 2016

4 Medicare 2016 National Average Physician Non-Facility Payment Rates Possible Coding Options - Physician Services Provided in the Physician Freestanding Office (Non-Facility) The following 2016 Medicare national average payment rates are specific to physician services provided in the non-facility setting. The term non-facility setting refers to physician-owned freestanding offices or centers. National average physician payment rates are based on the Medicare Physician Fee Schedule (MPFS) rates and conversion factor $ as outlined in the CY2016 MPFS Final Rule. Note: CCI edits should be checked quarterly when using any of the coding options presented. code Medicare 2016 National Average Physician Payment (Non-Facility setting / Freestanding Office) CT for treatment planning (optional) $ Therapeutic radiology treatment planning, complex $ Simulation, complex $ Simulation, 3-D $ Special treatment procedure $ Special medical physics consult $ Unlisted breast procedure (application of catheter) Paid by Report Simulation, simple $ Treatment device $ * Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; 2-12 channels Q3001** HDR source ** **Medicare does not pay separately for HDR sources in the Freestanding office. Private payors should be contacted for their billing and payment guidelines in this site of service. $248 $604 Page 4 January 2016

5 FREQUENTLY ASKED QUESTIONS ALL PROVIDERS 1. Why is AccuBoost described as interstitial brachytherapy rather than surface brachytherapy? Brachytherapy can be delivered with needles or catheters within the tumor (interstitial), an applicator within a cavity (intracavitary), or an applicator adjacent to the tumor (surface). New codes were developed effective January 1, 2016 to better describe the work performed for each method of delivery. The new codes and various brachytherapy delivery methods are described as follows: HDR radionuclide surface brachytherapy treatments for skin cancer needed to be accurately described, as the work of treating skin cancers with HDR radionuclide surface brachytherapy is different than the work of treating other tumors with HDR radionuclide brachytherapy. Therefore, two new codes (77767, 77768) specifically for HDR radionuclide skin surface brachytherapy treatment, including basic dosimetry, have been established. In addition, existing codes were revised and renumbered to 77770, 77771, and to describe HDR radionuclide brachytherapy for treating tumors other than skin, and include the work of basic dosimetry calculation (77300). (AMA 2016 Change) 2. Why isn t code (basic dosimetry calculation) included as a coding option? The new 2016 codes used to describe remote afterloading ( 77770, 77771, 77772) include the work of basic dosimetry calculation. An exclusionary parenthetical note indicating that all of the HDR radionuclide brachytherapy codes should not be reported in conjunction with code has been added to the new codes. PHYSICIANS 3. In regards to physician payment, what is meant by freestanding office or non-facility and why is there a difference payment amount? Under the Medicare Physician Fee Schedule (MPFS), some procedures have different payment amounts for physician s professional services when provided in a facility (hospital setting) or a nonfacility (e.g., office). Facility services are generally provided within a hospital, hospital-owned surgery center, ambulatory surgery center, or skilled nursing facility. In the Facility setting the costs of supplies and personnel that assist with services - such as interventional procedures - are borne by the hospital whereas those same costs are borne by the provider of services in a Non-Facility setting. Non-Facility services include, but are not limited to, physician clinics, urgent care centers, home services, etc. In some instances, additional payment is made to physicians for procedures performed in their office (non-facility) to compensate for providing clinical staff, supplies, and equipment. Medicare does not make separate or additional payment for the HDR source in the Freestanding office. Private payors should be consulted for their coding and payment guidelines. Page 5 January 2016

Complex 2015 Changes to Radiation Oncology Coding

Complex 2015 Changes to Radiation Oncology Coding Complex 2015 Changes to Radiation Oncology Coding The Centers for Medicare & Medicaid Services (CMS) issued its Final Rule on October 31 outlining the codes it would recognize in calendar year (CY) 2015.

More information

Radiation Oncology Centers Participating in MassHealth. Daniel Tsai, Assistant Secretary and Director of MassHealth

Radiation Oncology Centers Participating in MassHealth. Daniel Tsai, Assistant Secretary and Director of MassHealth Executive Office of Health and Human s Office of Medicaid www.mass.gov/masshealth May 2015 TO: FROM: RE: Radiation Oncology Centers Participating in Daniel Tsai, Assistant Secretary and Director of (2015

More information

MVP/Care Core National 2015 Radiation Therapy Prior Authorization List (Effective January 1, 2015)

MVP/Care Core National 2015 Radiation Therapy Prior Authorization List (Effective January 1, 2015) MVP/Care Core National 2015 Radiation Therapy Prior Authorization List (Effective January 1, 2015) CODE CODE TYPE Description 0330 REVCODE RADIOLOGY/THERAPEUTIC - GENERAL CLASSIFICATION 0333 REVCODE RADIOLOGY/THERAPEUTIC

More information

Horizon Blue Cross Blue Shield of New Jersey 2012 Radiation Therapy Payment Rules

Horizon Blue Cross Blue Shield of New Jersey 2012 Radiation Therapy Payment Rules 55875 55876 55876 Description Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or wout cytosocopy 55920 Placement of interstitial device(s)

More information

CODING SHEETS CHRONIC INTRACTABLE SPASTICITY. Effective January 1, 2009 CODMAN 3000 NEUROMODULATION AND ONCOLOGY REIMBURSEMENT HOTLINE

CODING SHEETS CHRONIC INTRACTABLE SPASTICITY. Effective January 1, 2009 CODMAN 3000 NEUROMODULATION AND ONCOLOGY REIMBURSEMENT HOTLINE CODING SHEETS CHRONIC INTRACTABLE SPASTICITY Effective January 1, 2009 CODMAN 3000 NEUROMODULATION AND ONCOLOGY REIMBURSEMENT HOTLINE Phone: 800-609-1108 Email: codmanpump@aol.com Fax: 303-703-1572 CODMAN

More information

Understanding brachytherapy

Understanding brachytherapy Understanding brachytherapy Brachytherapy Cancer Treatment Legacy Cancer Institute Your health care provider has requested that you receive a type of radiation treatment called brachytherapy as part of

More information

Supply Policy. Approved By 1/27/2014

Supply Policy. Approved By 1/27/2014 Supply Policy Policy Number 2014R0006A Annual Approval Date 1/27/2014 Approved By National Reimbursement Forum United HealthCare Community & State Payment Policy Committee IMPORTANT NOTE ABOUT THIS You

More information

NIA RADIATION ONCOLOGY CODING STANDARD. Dosimetry Planning

NIA RADIATION ONCOLOGY CODING STANDARD. Dosimetry Planning NIA RADIATION ONCOLOGY CODING STANDARD Dosimetry Planning CPT Codes: 77295, 77300, 77301, 77306, 77307, 77321, 77316, 77317, 77318, 77331, 77399 Original Date: April, 2011 Last Reviewed Date: November,

More information

Intraoperative Nerve Monitoring Coding Guide. March 1, 2010

Intraoperative Nerve Monitoring Coding Guide. March 1, 2010 Intraoperative Nerve Monitoring Coding Guide March 1, 2010 Please direct any questions to: Kim Brew Manager Reimbursement and Therapy Access Medtronic ENT (904) 279-7569 Rev 9/10 KB TO OUR PARTNERS IN

More information

Coalition For The Advancement Of Brachytherapy 660 Pennsylvania Avenue, S.E. Suite 201 Washington, D.C. 20003 (202) 548-2307 Fax: (202) 547-4658

Coalition For The Advancement Of Brachytherapy 660 Pennsylvania Avenue, S.E. Suite 201 Washington, D.C. 20003 (202) 548-2307 Fax: (202) 547-4658 Coalition For The Advancement Of Brachytherapy 660 Pennsylvania Avenue, S.E. Suite 201 Washington, D.C. 20003 (202) 548-2307 Fax: (202) 547-4658 September 25, 2002 The Honorable Thomas A. Scully Administrator

More information

CODING SHEETS CHRONIC INTRACTABLE PAIN MANAGEMENT. Effective January 1, 2011 CODMAN 3000 NEUROMODULATION AND ONCOLOGY REIMBURSEMENT HOTLINE

CODING SHEETS CHRONIC INTRACTABLE PAIN MANAGEMENT. Effective January 1, 2011 CODMAN 3000 NEUROMODULATION AND ONCOLOGY REIMBURSEMENT HOTLINE CODING SHEETS CHRONIC INTRACTABLE PAIN MANAGEMENT Effective January 1, 2011 CODMAN 3000 NEUROMODULATION AND ONCOLOGY REIMBURSEMENT HOTLINE Phone: 800-609-1108 Email: codmanpump@aol.com Fax: 303-703-1572

More information

Accelerated Partial Breast Irradiation (APBI) for Breast Cancer [Preauthorization Required]

Accelerated Partial Breast Irradiation (APBI) for Breast Cancer [Preauthorization Required] Accelerated Partial Breast Irradiation (APBI) for Breast Cancer [Preauthorization Required] Medical Policy: MP-SU-01-11 Original Effective Date: February 24, 2011 Reviewed: Revised: This policy applies

More information

January 2015. Coding Sheet. Pre-Treatment Mapping and Microspheres Administration. Hospital Outpatient and Physician Services

January 2015. Coding Sheet. Pre-Treatment Mapping and Microspheres Administration. Hospital Outpatient and Physician Services January 2015 Coding Sheet Pre-Treatment Mapping and Microspheres Administration Hospital Outpatient and Physician Services 1 SIR-Spheres microspheres Treatment Flow Chart (Performed in Outpatient Department)

More information

January 2015 Update. Coding Sheet. Pre-Treatment Mapping and Microspheres Administration. Hospital Outpatient and Physician Services

January 2015 Update. Coding Sheet. Pre-Treatment Mapping and Microspheres Administration. Hospital Outpatient and Physician Services January 2015 Update Coding Sheet Pre-Treatment Mapping and Microspheres Administration Hospital Outpatient and Physician Services 1 SIR-Spheres microspheres Treatment Flow Chart (Performed in Outpatient

More information

Local Coverage Article: Cardiovascular Stress Testing (A53123)

Local Coverage Article: Cardiovascular Stress Testing (A53123) Local Coverage Article: Cardiovascular Stress Testing (A53123) Contractor Information Contractor Name Novitas Solutions, Inc. Article Information General Information Article ID A53123 Original ICD-9 Article

More information

Accelerated Partial Breast Irradiation (APBI) for Breast Cancer [Pre-authorization Required]

Accelerated Partial Breast Irradiation (APBI) for Breast Cancer [Pre-authorization Required] Accelerated Partial Breast Irradiation (APBI) for Breast Cancer [Pre-authorization Required] Medical Policy: MP-SU-01-11 Original Effective Date: February 24, 2011 Reviewed: February 24, 2012 Revised:

More information

Accelerated Partial Breast Irradiation (APBI) for Breast Cancer

Accelerated Partial Breast Irradiation (APBI) for Breast Cancer Accelerated Partial Breast Irradiation (APBI) for Breast Cancer [For the list of services and procedures that need preauthorization, please refer to www.mcs.pr Go to Comunicados a Proveedores, and click

More information

Non-coronary Brachytherapy

Non-coronary Brachytherapy Non-coronary Brachytherapy I. Policy University Health Alliance (UHA) will reimburse for non-coronary brachytherapy when it is determined to be medically necessary and when it meets the medical criteria

More information

Diagnostic Radiology. Contrast Enema 74270

Diagnostic Radiology. Contrast Enema 74270 CPT Code* Update *(Current Procedural Terminology 2008 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.) As of January 1,, radiology

More information

Patient Guide. Brachytherapy: The precise answer for tackling breast cancer. Because life is for living

Patient Guide. Brachytherapy: The precise answer for tackling breast cancer. Because life is for living Patient Guide Brachytherapy: The precise answer for tackling breast cancer Because life is for living This booklet is designed to provide information that helps women who have been diagnosed with early

More information

The following is a description of the fields that appear on the results page for the Procedure Code Search.

The following is a description of the fields that appear on the results page for the Procedure Code Search. Fee Schedule Legend Updated: 9/21/2015 The following is a description of the fields that appear on the results page for the Procedure Code Search. Procedure Code the five-character procedure code as listed

More information

76641 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete 76642 limited

76641 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete 76642 limited 2015 CPT Code Update The ACR, either alone or in conjunction with other specialty societies, worked on a number of code proposals for the 2015 code cycle. This update provides a listing of code changes

More information

August 29, 2014. Dear Administrator Tavenner:

August 29, 2014. Dear Administrator Tavenner: Ms. Marilyn Tavenner Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Attention: CMS-1612-P 7500 Security Boulevard Baltimore, MD 21244-1850 Submitted electronically:

More information

Radiation therapy involves using many terms you may have never heard before. Below is a list of words you could hear during your treatment.

Radiation therapy involves using many terms you may have never heard before. Below is a list of words you could hear during your treatment. Dictionary Radiation therapy involves using many terms you may have never heard before. Below is a list of words you could hear during your treatment. Applicator A device used to hold a radioactive source

More information

Stereotactic Radiosurgery & Stereotactic Body Radiation Therapy - Billing Basics. Presented: June 19, 2013 AAMD Annual Meeting San Antonio, TX

Stereotactic Radiosurgery & Stereotactic Body Radiation Therapy - Billing Basics. Presented: June 19, 2013 AAMD Annual Meeting San Antonio, TX Stereotactic Radiosurgery & Stereotactic Body Radiation Therapy - Billing Basics Presented: June 19, 2013 AAMD Annual Meeting San Antonio, TX Presenters Kelli Weiss, RT(R)(T) Executive Director Tamara

More information

2016 Medicare Reimbursement Proposals for the TomoTherapy System

2016 Medicare Reimbursement Proposals for the TomoTherapy System 2016 Medicare Reimbursement Proposals for the TomoTherapy System On July 1, 2015, and July 8, 2015, CMS released the 2016 Medicare Proposed Rules for Hospitals, Physicians, and Freestanding Centers. Below

More information

There must be an appropriate administrative structure for each residency program.

There must be an appropriate administrative structure for each residency program. Specific Standards of Accreditation for Residency Programs in Radiation Oncology 2015 VERSION 3.0 INTRODUCTION The purpose of this document is to provide program directors and surveyors with an interpretation

More information

DEC 2 2 2005. The three components of the Axxent Electronic Brachytherapy System include the Controller, Balloon Applicators-BR and X-ray Source.

DEC 2 2 2005. The three components of the Axxent Electronic Brachytherapy System include the Controller, Balloon Applicators-BR and X-ray Source. DEC 2 2 2005 Xoft, Inc. Fremont, California Premarket Notification March 31, 2005 II. 510(k) Summary A. Name of Device Trade name: AxxentTM Electronic Brachytherapy System Common name: X-Ray Radiation

More information

KYPHON. Reimbursement Guide. Physician Reimbursement. Balloon Kyphoplasty Procedure. ICD-9-CM Diagnosis Codes. CPT Codes and Payment

KYPHON. Reimbursement Guide. Physician Reimbursement. Balloon Kyphoplasty Procedure. ICD-9-CM Diagnosis Codes. CPT Codes and Payment KYPHON Balloon Kyphoplasty Procedure Reimbursement Guide ICD-9-CM Diagnosis Codes Providers should report the ICD-9-CM diagnosis code that most accurately describes the patient s condition. Please refer

More information

ChurchillUpdates. Newsletter Topics 2009-2014

ChurchillUpdates. Newsletter Topics 2009-2014 2014 NEWSLETTERS April 2014: Volume #3 2014, Issue 134 ICD-10 on Hold Documenting 99205 Rate Increase 77293 Review of System Documentation Frequency Analysis Level of Decision-Making February-March 2014:

More information

Psychotherapy Professional Services

Psychotherapy Professional Services Status Active Reimbursement Policy Section: Behavioral Health Section Policy Number: RP - Behavioral Health - 001 Psychotherapy Professional Services Effective Date: June 1, 2015 Psychotherapy Professional

More information

Brachytherapy of the Uterine Corpus: Some Physical Considerations. Bruce Thomadsen. University of Wisconsin -Madison

Brachytherapy of the Uterine Corpus: Some Physical Considerations. Bruce Thomadsen. University of Wisconsin -Madison Brachytherapy of the Uterine Corpus: Some Physical Considerations Bruce Thomadsen University of Wisconsin -Madison Conflicts of Interest The author has no known conflicts involving this presentation Learning

More information

2016 PERITONEAL DIALYSIS CATHETERS CODING AND REIMBURSEMENT GUIDE

2016 PERITONEAL DIALYSIS CATHETERS CODING AND REIMBURSEMENT GUIDE 2016 PERITONEAL DIALYSIS CATHETERS CODING AND REIMBURSEMENT GUIDE Contents Overview of Peritoneal Dialysis 2 Physician Reimbursement for Peritoneal Dialysis s Under Resource-based Relative Value Scale

More information

NOVEL USES OF A CT-ON-RAILS IN AN INTEGRATED BRACHYTHERAPY OR SUITE

NOVEL USES OF A CT-ON-RAILS IN AN INTEGRATED BRACHYTHERAPY OR SUITE NOVEL USES OF A CT-ON-RAILS IN AN INTEGRATED BRACHYTHERAPY OR SUITE OPTMIZING YOUR BRACHYTHERAPY WORKFLOW WITH CT-ON-RAILS SYSTEM Marc Gaudet MD, MSc, MHA FRCPC Chief, Radiation Oncology Director, Oncology

More information

Rotator Cuff Repair Surgical Procedures

Rotator Cuff Repair Surgical Procedures Rotator Cuff Repair Surgical Procedures 2011 Reimbursement and Coding Reference Guide for Physicians and Hospitals This coding reference guide is intended to illustrate the common CPT * codes, ICD-9 CM

More information

Crime Victims Compensation Program Mental Health Fees Effective January 1, 2014

Crime Victims Compensation Program Mental Health Fees Effective January 1, 2014 Copyright Information Physicians Current Procedural Terminology (CPT ) five-digit codes, descriptions, and other data only are copyright 2012 American Medical Association. All Rights Reserved. CPT is a

More information

How To Know If You Should Get A Brachytherapy Or Radioactive Seed Implantation

How To Know If You Should Get A Brachytherapy Or Radioactive Seed Implantation MEDICAL POLICY SUBJECT: BRACHYTHERAPY OR PAGE: 1 OF: 5 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases, medical policy

More information

Radiation Therapy Coverage, Coding, and Reimbursement for New Technologies

Radiation Therapy Coverage, Coding, and Reimbursement for New Technologies Radiation Therapy Coverage, Coding, and Reimbursement for New Technologies Presented by Susan Granucci, Healthcare Reimbursement Specialist Topics 1. Intensity Modulated Radiation Therapy (IMRT) 2. Tomotherapy

More information

Intra-operative Nerve Monitoring Coding Guide. March 1, 2011

Intra-operative Nerve Monitoring Coding Guide. March 1, 2011 Intra-operative Nerve Monitoring Coding Guide March 1, 2011 Please direct any questions to: Patty Telgener, RN Vice President, Reimbursement Services Emerson Consultants (303) 526-7604 (office) (303) 570-2159

More information

Autoradiograph of Ra-223

Autoradiograph of Ra-223 Session 4 Radiation protection of patients, staff and the public during therapeutic use of sealed and unsealed radioactive sources Summary of Contributed Papers Makoto Hosono, MD PhD Kinki University School

More information

Ambulatory Surgery Center Coding and Payment Guide 2015

Ambulatory Surgery Center Coding and Payment Guide 2015 Targeted Drug Delivery Ambulatory Surgery Center Coding and Payment Guide 2015 Flowonix Medical has compiled this coding information for your convenience. This information is gathered from third party

More information

Status Active. Reimbursement Policy Section: Anesthesia Services Policy Number: RP - Anesthesia - 001 Anesthesia Effective Date: June 1, 2015

Status Active. Reimbursement Policy Section: Anesthesia Services Policy Number: RP - Anesthesia - 001 Anesthesia Effective Date: June 1, 2015 Status Active Reimbursement Policy Section: Anesthesia Services Policy Number: RP - Anesthesia - 001 Anesthesia Effective Date: June 1, 2015 Anesthesia Policy Description: Definitions: This policy addresses

More information

Reimbursement & Coding for Radiation Oncology. November 16 th, 2013 Radiation Oncology Update Kahala HSCO

Reimbursement & Coding for Radiation Oncology. November 16 th, 2013 Radiation Oncology Update Kahala HSCO Reimbursement & Coding for Radiation Oncology November 16 th, 2013 Radiation Oncology Update Kahala HSCO Contact Information Revenue Cycle Inc. 1817 W. Braker Lane Bldg. F, Suite 200 Austin, Texas 78758

More information

Update to Second-Quarter Procedure Code Review Updates

Update to Second-Quarter Procedure Code Review Updates Update to Second-Quarter Procedure Review Updates Information posted September 11, 2009 This is an update to an article posted on this website on the TMHP Updates Procedure Review web page on May 15, 2009,

More information

NATIONAL PHYSICIAN FEE SCHEDULE RELATIVE VALUE FILE CALENDAR YEAR 2016

NATIONAL PHYSICIAN FEE SCHEDULE RELATIVE VALUE FILE CALENDAR YEAR 2016 NATIONAL PHYSICIAN FEE SCHEDULE RELATIVE VALUE FILE CALENDAR YEAR 2016 Contents: This file contains information on services covered by the Medicare Physician Fee Schedule (MPFS) in 2016. For more than

More information

Medicare 101: Basics of Modifier Billing. Part B Provider Outreach and Education February 26, 2014

Medicare 101: Basics of Modifier Billing. Part B Provider Outreach and Education February 26, 2014 Medicare 101: Basics of Modifier Billing Part B Provider Outreach and Education February 26, 2014 Housekeeping Tips When you called in, did you enter your attendee code? Dial-in number: 1-800-791-2345

More information

Reporting of Devices and Leads When a Credit is Received

Reporting of Devices and Leads When a Credit is Received Reporting of Devices and Leads When a Credit is Received Cardiac Rhythm Management and Electrophysiology Updated January 2014 Medicare Reporting Requirements For Full or Partial Credits of Devices and

More information

Inpatient Hospital (21) Office (11) Home (12) June 4, 2014

Inpatient Hospital (21) Office (11) Home (12) June 4, 2014 Inpatient Hospital (21) Home (12) Office (11) 1 June 4, 2014 Today s event is a teleconference Slides will not be advanced during the presentation Attendees are instructed to refer to their handout material

More information

RADIATION THERAPY guide. Guiding you through your treatment

RADIATION THERAPY guide. Guiding you through your treatment RADIATION THERAPY guide Guiding you through your treatment 2013_RADIATION_GUIDE_6PG.indd 1 Before Treatment Consultation with the Radiation Oncologist During your first visit with the radiation oncologist,

More information

Status Active. Assistant Surgeons. This policy addresses reimbursement for assistant surgical procedures during the same operative session.

Status Active. Assistant Surgeons. This policy addresses reimbursement for assistant surgical procedures during the same operative session. Status Active Reimbursement Policy Section: Surgery/Interventional Procedure Policy Number: RP - Surgery/Interventional Procedure - 001 Assistant Surgeons Effective Date: June 1, 2015 Assistant Surgeons

More information

EMR Documentation & Coding Updates for Radiation Oncology

EMR Documentation & Coding Updates for Radiation Oncology EMR Documentation & Coding Updates for Radiation Oncology Presented: August 16, 2013 AAMD Region I Meeting Anchorage, AK Contact Information Revenue Cycle Inc. 1817 W. Braker Lane Bldg. F, Suite 200 Austin,

More information

Coding Companion for Radiology. A comprehensive illustrated guide to coding and reimbursement

Coding Companion for Radiology. A comprehensive illustrated guide to coding and reimbursement Coding Companion for Radiology A comprehensive illustrated guide to coding and reimbursement 2013 Contents Getting Started with Coding Companion...i Diagnostic Radiology Head/Neck...1 Chest...38 Spine/Pelvis...51

More information

Advanced Monitoring Parameters 2015 Quick Guide to Hospital Coding, Coverage and Payment

Advanced Monitoring Parameters 2015 Quick Guide to Hospital Coding, Coverage and Payment Advanced Monitoring Parameters 2015 Quick Guide to Hospital Coding, Coverage and Payment The information in this quick guide is provided by our Healthcare Economics Department, which supports Respiratory

More information

HDR Brachytherapy. Patient Information

HDR Brachytherapy. Patient Information HDR Brachytherapy Patient Information 1 About Brachytherapy Cancer is a term used for diseases in which abnormal cells divide without control and then invade other tissues. This disease can affect many

More information

New Patient Visit. UnitedHealthcare Medicare Reimbursement Policy Committee

New Patient Visit. UnitedHealthcare Medicare Reimbursement Policy Committee New Patient Visit Policy Number NPV04242013RP Approved By UnitedHealthcare Medicare Committee Current Approval Date 12/16/2015 IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable to

More information

Methods for Analyzing and Valuing Oncology Businesses

Methods for Analyzing and Valuing Oncology Businesses Methods for Analyzing and Valuing Oncology Businesses The following article, Methods for Analyzing and Valuing Oncology Businesses, by PYA Principals W. James Lloyd and Tynan P. Olechny appears in Valuation

More information

ZEPHYRLIFE REMOTE PATIENT MONITORING REIMBURSEMENT REFERENCE GUIDE

ZEPHYRLIFE REMOTE PATIENT MONITORING REIMBURSEMENT REFERENCE GUIDE ZEPHYRLIFE REMOTE PATIENT MONITORING REIMBURSEMENT REFERENCE GUIDE Overview This guide includes an overview of Medicare reimbursement methodologies and potential coding options for the use of select remote

More information

Reimbursement Policy General Coding Section Policy Number: RP - General Coding - 005 Unlisted Procedure Code Effective Date: June 1, 2015

Reimbursement Policy General Coding Section Policy Number: RP - General Coding - 005 Unlisted Procedure Code Effective Date: June 1, 2015 Status Active Reimbursement Policy Section: General Coding Section Policy Number: RP - General Coding - 005 Unlisted Procedure Code Effective Date: June 1, 2015 Unlisted Procedure Code Policy Description:

More information

New Cardiothoracic Surgery CPT Codes for 2013

New Cardiothoracic Surgery CPT Codes for 2013 New Cardiothoracic Surgery CPT Codes for 2013 There were several changes to the cardiothoracic surgery CPT codes for 2013. There are five new codes in the general thoracic surgery section, with one revised

More information

DERMABOND Portfolio 2012 LACERATION REPAIR REIMBURSEMENT GUIDE

DERMABOND Portfolio 2012 LACERATION REPAIR REIMBURSEMENT GUIDE 2012 LACERATION REPAIR REIMBURSEMENT GUIDE ETHICON, INC. IS PLEASED TO PROVIDE THIS LACERATION REPAIR REIMBURSEMENT GUIDE AS A RESOURCE FOR HEALTHCARE PROVIDERS. This guide is intended for informational

More information

Radiation Oncology Solutions Program. Note! Contents are subject to change and are not a guarantee of payment.

Radiation Oncology Solutions Program. Note! Contents are subject to change and are not a guarantee of payment. Radiation Oncology Solutions Program Note! Contents are subject to change and are not a guarantee of payment. Agenda Introduction Services and Treatments Authorization Process Notification of Determination

More information

Goals and Objectives: Breast Cancer Service Department of Radiation Oncology

Goals and Objectives: Breast Cancer Service Department of Radiation Oncology Goals and Objectives: Breast Cancer Service Department of Radiation Oncology The breast cancer service provides training in the diagnosis, management, treatment, and follow-up of breast malignancies, including

More information

Subtitle 09 WORKERS' COMPENSATION COMMISSION. 14.09.03 Guide of Medical and Surgical Fees

Subtitle 09 WORKERS' COMPENSATION COMMISSION. 14.09.03 Guide of Medical and Surgical Fees Subtitle 09 WORKERS' COMPENSATION COMMISSION 14.09.03 Guide of Medical and Surgical Fees Authority: Labor and Employment Article, 9-309, 9-663 and 9-731, Annotated Code of Maryland Notice of Proposed Action

More information

American Association of Physicists in Medicine

American Association of Physicists in Medicine 001@umn.edu American Association of Physicists in Medicine One Physics Ellipse College Park, MD 20740-3846 (301) 209-3350 Fax (301) 209-0862 http://www.aapm.org September 2, 2015 Andrew Slavitt Acting

More information

Therefore, a physician should only bill for new patient services when the elements of the definition is met.

Therefore, a physician should only bill for new patient services when the elements of the definition is met. Private Property of Florida Blue. This payment policy is Copyright 2012, Florida Blue. All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission

More information

CODE AUDITING RULES. SAMPLE Medical Policy Rationale

CODE AUDITING RULES. SAMPLE Medical Policy Rationale CODE AUDITING RULES As part of Coventry Health Care of Missouri, Inc s commitment to improve business processes, we are implemented a new payment policy program that applies to claims processed on August

More information

SAME DAY/SAME SERVICE

SAME DAY/SAME SERVICE SAME DAY/SAME SERVICE REIMBURSEMENT POLICY Policy Number: ADMINISTRATIVE 7. T0 Effective Date: June, 20 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS... APPLICATION... OVERVIEW... REIMBURSEMENT

More information

RADIOLOGY HOUSE STAFF MANUAL

RADIOLOGY HOUSE STAFF MANUAL RADIOLOGY HOUSE STAFF MANUAL The Department of Radiology offers a wide range of services/procedures and operates 12 divisions/sections, which are listed separately below. The procedures offered are listed

More information

January 27, 2014. Dear Administrator Tavenner:

January 27, 2014. Dear Administrator Tavenner: Ms. Marilyn Tavenner Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1600-FC Mail Stop C4-26-05 7500 Security Boulevard Baltimore, MD 21244-1850

More information

Local Coverage Article: Venipuncture Necessitating Physician s Skill for Specimen Collection Supplemental Instructions Article (A50852)

Local Coverage Article: Venipuncture Necessitating Physician s Skill for Specimen Collection Supplemental Instructions Article (A50852) Local Coverage Article: Venipuncture Necessitating Physician s Skill for Specimen Collection Supplemental Instructions Article (A50852) Contractor Information Contractor Name CGS Administrators, LLC Article

More information

BRACHYTHERAPY FOR TREATMENT OF BREAST CANCER

BRACHYTHERAPY FOR TREATMENT OF BREAST CANCER BRACHYTHERAPY FOR TREATMENT OF BREAST CANCER Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This

More information

Measure #145: Radiology: Exposure Time Reported for Procedures Using Fluoroscopy National Quality Strategy Domain: Patient Safety

Measure #145: Radiology: Exposure Time Reported for Procedures Using Fluoroscopy National Quality Strategy Domain: Patient Safety Measure #145: Radiology: Exposure Time Reported for Procedures Using Fluoroscopy National Quality Strategy Domain: Patient Safety 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS, REGISTRY DESCRIPTION:

More information

There is a popular song by Demi

There is a popular song by Demi compliance Oncology Reimbursement Update 2016 BY CINDY PARMAN, CPC, CPC-H, RCC There is a popular song by Demi Lovato called Here We Go Again that includes the lyrics You think that by now I d know, cause

More information

MMA - April 2004 Update of the Hospital Outpatient Prospective Payment System (OPPS)

MMA - April 2004 Update of the Hospital Outpatient Prospective Payment System (OPPS) Related Change Request (CR) #: 3154 Related CR Release Date: March 30, 2004 Related CR Transmittal #: 132 Effective Date: April 1, 2004, except as otherwise noted Implementation Date: April 5, 2004 MMA

More information

Physical Therapy (PT) Modalities and Evaluation

Physical Therapy (PT) Modalities and Evaluation Status Active Reimbursement Policy Section: Rehabilitative Services Policy Number: RP - Rehabilitative Services - 001 PT Modalities and Evaluation Effective Date: June 1, 2015 Physical Therapy (PT) Modalities

More information

Physician rates effective January 1, 2016 through December 31, 2016.

Physician rates effective January 1, 2016 through December 31, 2016. Endovascular Repair of Abdominal Aortic Aneurysm Coverage, Coding and Reimbursement Overview Physician 2016 Edition Reimbursement Amounts are Listed at National Medicare Rates and Do Not Include the 2%

More information

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY 1200 Colonial Life Boulevard, P. O. Box 1365 Columbia, South Carolina 29202 (800) 325-4368

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY 1200 Colonial Life Boulevard, P. O. Box 1365 Columbia, South Carolina 29202 (800) 325-4368 COLONIAL LIFE & ACCIDENT INSURANCE COMPANY 1200 Colonial Life Boulevard, P. O. Box 1365 Columbia, South Carolina 29202 (800) 325-4368 GROUP SPECIFIED DISEASE INSURANCE Outline of Coverage (Applicable to

More information

UNRAVELING THE MYSTERIES OF SPLIT

UNRAVELING THE MYSTERIES OF SPLIT UNRAVELING THE MYSTERIES OF SPLIT BILLING FOR HOSPITAL-BASED DEPARTMENTS AND CLINICS AUGUST 23, 2012 JEAN RUSSELL, MS, RHIT 518-369-4986 JRUSSELL@EPOCHHEALTH.COM AGENDA Based on Medicare and NY Medicaid

More information

Routine Venipuncture and/or Collection of Specimens

Routine Venipuncture and/or Collection of Specimens Manual: Policy Title: Reimbursement Policy Routine Venipuncture and/or Collection of Specimens Section: Laboratory & Pathology Subsection: None Date of Origin: 1/1/2000 Policy Number: RPM012 Last Updated:

More information

1. Provide clinical training in radiation oncology physics within a structured clinical environment.

1. Provide clinical training in radiation oncology physics within a structured clinical environment. Medical Physics Residency Program Overview Our Physics Residency Training is a 2 year program typically beginning July 1 each year. The first year resident will work closely with medical physicists responsible

More information

GEORGIA. The MEDICAL FEE SCHEDULE WORKERS' COMPENSATION. Effective 04/01/2011 FOR SERVICES PROVIDED UNDER THE GEORGIA WORKERS' COMPENSATION LAW

GEORGIA. The MEDICAL FEE SCHEDULE WORKERS' COMPENSATION. Effective 04/01/2011 FOR SERVICES PROVIDED UNDER THE GEORGIA WORKERS' COMPENSATION LAW The GEORGIA WORKERS' COMPENSATION MEDICAL FEE SCHEDULE Effective 04/01/2011 FOR SERVICES PROVIDED UNDER THE GEORGIA WORKERS' COMPENSATION LAW Adopted by: State Board of Workers' Compensation 270 Peachtree

More information

The Canadian National System for Incident Reporting in Radiation Treatment (NSIR-RT) Taxonomy March 2, 2015 V2

The Canadian National System for Incident Reporting in Radiation Treatment (NSIR-RT) Taxonomy March 2, 2015 V2 The Canadian National System for Incident Reporting in Radiation Treatment (NSIR-RT) Taxonomy March 2, 2015 V2 Taxonomy Data Category Number Description Data Fields and Menu Choices 1. Impact 1.1 Incident

More information

Common Misunderstandings & Mistakes in Dosimetry Coding & Documentation

Common Misunderstandings & Mistakes in Dosimetry Coding & Documentation Common Misunderstandings & Mistakes in Dosimetry Coding & Documentation AAMD Annual Meeting San Antonio, Texas June 2013 Presenters Kelli Weiss, RT(R)(T) Executive Director Adam Brown, BSRT(T), CMD Consultant

More information

December 20, 2012. Dear Ms. Tavenner:

December 20, 2012. Dear Ms. Tavenner: Ms. Marilyn Tavenner Acting Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Attention: CMS-1590-FC Mail Stop C4-26-05 7500 Security Boulevard Baltimore,

More information

HDR Brachytherapy 1: Overview of QA. Disclosures: Learning Objectives 7/23/2014

HDR Brachytherapy 1: Overview of QA. Disclosures: Learning Objectives 7/23/2014 HDR Brachytherapy 1: Overview of QA Bruce Libby Department of Radiation Oncology University of Virginia Health System Disclosures: Nondisclosure agreement with Varian Brachytherapy Shareholder- Varian,

More information

GYNECOLOGIC CANCERS Facts to Help Patients Make an Informed Decision

GYNECOLOGIC CANCERS Facts to Help Patients Make an Informed Decision RADIATION THERAPY FOR GYNECOLOGIC CANCERS Facts to Help Patients Make an Informed Decision TARGETING CANCER CARE AMERICAN SOCIETY FOR RADIATION ONCOLOGY FACTS ABOUT GYNECOLOGIC CANCERS Gynecologic cancers

More information

Medicare Outpatient Therapy Billing

Medicare Outpatient Therapy Billing DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services R Medicare Outpatient Therapy Billing August 2010 / ICN: 903663 DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare

More information

WELLCARE CLAIM PAYMENT POLICIES

WELLCARE CLAIM PAYMENT POLICIES WellCare and Harmony Health Plan s claim payment policies are based on publicly distributed guidelines from established industry sources such as the Centers for Medicare and Medicaid Services (CMS), the

More information

PROFORMA ACCEPTANCE / QUALITY ASSURANCE TESTS OF REMOTE AFTERLOADING BRACHYTHERAPY UNIT

PROFORMA ACCEPTANCE / QUALITY ASSURANCE TESTS OF REMOTE AFTERLOADING BRACHYTHERAPY UNIT RP&AD /Remote QA/ 01 PROFORMA FOR ACCEPTANCE / QUALITY ASSURANCE TESTS OF REMOTE AFTERLOADING BRACHYTHERAPY UNIT BHABHA ATOMIC RESEARCH CENTRE Radiological Physics & Advisory Division CT & CRS Building,

More information

The Global Surgery Package Part I. Riva Lee Asbell

The Global Surgery Package Part I. Riva Lee Asbell The Global Surgery Package Part I Riva Lee Asbell Introduction One of the least understood concepts in surgical coding concerns the details involved in the Global Surgery Package. Some of the rules were

More information

Subject: Bundled Services and Supplies

Subject: Bundled Services and Supplies Blue Cross and Blue Shield of Georgia Inc, and Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. (hereinafter referred to collectively as BCBSGA ) Professional Reimbursement Policy Subject: Bundled

More information

Highlights of the Florida Medicaid Ambulatory Surgical Center Services Coverage and Limitations Handbook

Highlights of the Florida Medicaid Ambulatory Surgical Center Services Coverage and Limitations Handbook Highlights of the Florida Medicaid Ambulatory Surgical Center Services Coverage and Limitations Handbook Agency for Health Care Administration July 2013 1 Learning Objectives Provide an overview of the

More information

Local Coverage Article: Endovascular Repair of Aortic Aneurysms (A53124)

Local Coverage Article: Endovascular Repair of Aortic Aneurysms (A53124) Local Coverage Article: Endovascular Repair of Aortic Aneurysms (A53124) Contractor Information Contractor Name Novitas Solutions, Inc. Article Information General Information Article ID A53124 Original

More information

2014 Procedural Reimbursement Guide Select Percutaneous Coronary Interventions

2014 Procedural Reimbursement Guide Select Percutaneous Coronary Interventions 2014 Procedural Reimbursement Guide Select Percutaneous Coronary Interventions IC-221010-AA Jan 2014 Page 1 of 10 Interventional Cardiology This for interventional cardiology procedures provides coding

More information

September 19, 2012. Dialysis Facility Reimbursement

September 19, 2012. Dialysis Facility Reimbursement September 19, 2012 Dialysis Facility Reimbursement Current EGID Reimbursement Dialysis providers are currently reimbursed under the outpatient portion of EGID s facility contract. Network providers receive

More information

Report of Independent Auditors and Consolidated Financial Statements. Kaweah Delta Health Care District

Report of Independent Auditors and Consolidated Financial Statements. Kaweah Delta Health Care District Report of Independent Auditors and Consolidated Financial Statements Kaweah Delta Health Care District June 30, 2014 and 2013 CONTENTS MANAGEMENT S DISCUSSION AND ANALYSIS 1 16 PAGE REPORT OF INDEPENDENT

More information

Basic Radiation Therapy Terms

Basic Radiation Therapy Terms Basic Radiation Therapy Terms accelerated radiation: radiation schedule in which the total dose is given over a shorter period of time. (Compare to hyperfractionated radiation.) adjuvant therapy (add-joo-vunt):

More information

Incident To Services

Incident To Services Policy Number INT04242013RP Approved By Incident To Services UnitedHealthcare Medicare Committee Current Approval Date 11/18/2015 IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable

More information

A guide for the patient

A guide for the patient Understanding series LUNG CANCER CLINICAL TRIALS 1-800-298-2436 LungCancerAlliance.org A guide for the patient TABLE OF CONTENTS The Basics What is a Clinical Trial?...3 Types of Clinical Trials... 3 Phases

More information