Federal Register / Vol. 79, No. 220 / Friday, November 14, 2014 / Notices 68253 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–9087–N] 

Medicare and Medicaid Programs; 

Quarterly Listing of Program 

Issuances—July Through September 

2014 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This quarterly notice lists 

CMS manual instructions, substantive 

and interpretive regulations, and other 

Federal Register notices that were 

published from July through September 

2014, relating to the Medicare and 

Medicaid programs and other programs 

administered by CMS. 

FOR FURTHER INFORMATION CONTACT: It is 

possible that an interested party may 

need specific information and not be 

able to determine from the listed 

information whether the issuance or 

regulation would fulfill that need. 

Consequently, we are providing contact 

persons to answer general questions 

concerning each of the addenda 

published in this notice. 

Addenda Contact Phone No. 

I CMS Manual Instructions ..................................................................................................... Ismael Torres ......................... (410) 786–1864 

II Regulation Documents Published in the Federal Register ............................................... Terri Plumb ............................. (410) 786–4481 

III CMS Rulings ...................................................................................................................... Tiffany Lafferty ........................ (410) 786–7548 

IV Medicare National Coverage Determinations .................................................................... Wanda Belle ........................... (410) 786–7491 

V FDA-Approved Category B IDEs ........................................................................................ John Manlove ......................... (410) 786–6877 

VI Collections of Information .................................................................................................. Mitch Bryman ......................... (410) 786–5258 

VII Medicare-Approved Carotid Stent Facilities ..................................................................... Lori Ashby .............................. (410) 786–6322 

VIII American College of Cardiology-National Cardiovascular Data Registry Sites .............. Marie Casey, BSN, MPH ....... (410) 786–7861 

IX Medicare’s Active Coverage-Related Guidance Documents ............................................ JoAnna Baldwin ...................... (410) 786–7205 

X One-time Notices Regarding National Coverage Provisions ............................................. JoAnna Baldwin ...................... (410) 786–7205 

XI National Oncologic Positron Emission Tomography Registry Sites ................................. Stuart Caplan, RN, MAS ........ (410) 786–8564 

XII Medicare-Approved Ventricular Assist Device (Destination Therapy) Facilities .............. Marie Casey, BSN, MPH ....... (410) 786–7861 

XIII Medicare-Approved Lung Volume Reduction Surgery Facilities ..................................... Marie Casey, BSN, MPH ....... (410) 786–7861 

XIV Medicare-Approved Bariatric Surgery Facilities .............................................................. Jamie Hermansen .................. (410) 786–2064 

XV Fluorodeoxyglucose Positron Emission Tomography for Dementia Trials ...................... Stuart Caplan, RN, MAS ........ (410) 786–8564 

All Other Information ................................................................................................................. Annette Brewer ....................... (410) 786–6580 

I. Background 

The Centers for Medicare & Medicaid 

Services (CMS) is responsible for 

administering the Medicare and 

Medicaid programs and coordination 

and oversight of private health 

insurance. Administration and oversight 

of these programs involves the 

following: (1) Furnishing information to 

Medicare and Medicaid beneficiaries, 

health care providers, and the public; 

and (2) maintaining effective 

communications with CMS regional 

offices, state governments, state 

Medicaid agencies, state survey 

agencies, various providers of health 

care, all Medicare contractors that 

process claims and pay bills, National 

Association of Insurance Commissioners 

(NAIC), health insurers, and other 

stakeholders. To implement the various 

statutes on which the programs are 

based, we issue regulations under the 

authority granted to the Secretary of the 

Department of Health and Human 

Services under sections 1102, 1871, 

1902, and related provisions of the 

Social Security Act (the Act) and Public 

Health Service Act. We also issue 

various manuals, memoranda, and 

statements necessary to administer and 

oversee the programs efficiently. 

Section 1871(c) of the Act requires 

that we publish a list of all Medicare 

manual instructions, interpretive rules, 

statements of policy, and guidelines of 

general applicability not issued as 

regulations at least every 3 months in 

the Federal Register. 

II. Format for the Quarterly Issuance 

Notices 

This quarterly notice provides only 

the specific updates that have occurred 

in the 3-month period along with a 

hyperlink to the full listing that is 

available on the CMS Web site or the 

appropriate data registries that are used 

as our resources. This information is the 

most current up-to-date information and 

will be available earlier than we publish 

our quarterly notice. We believe the 

Web site list provides more timely 

access for beneficiaries, providers, and 

suppliers. We also believe the Web site 

offers a more convenient tool for the 

public to find the full list of qualified 

providers for these specific services and 

offers more flexibility and ‘‘real time’’ 

accessibility. In addition, many of the 

Web sites have listservs; that is, the 

public can subscribe and receive 

immediate notification of any updates to 

the Web site. These listservs avoid the 

need to check the Web site, as 

notification of updates is automatic and 

sent to the subscriber as they occur. If 

assessing a Web site proves to be 

difficult, the contact person listed can 

provide information. 

III. How To Use the Notice 

This notice is organized into 15 

addenda so that a reader may access the 

subjects published during the quarter 

covered by the notice to determine 

whether any are of particular interest. 

We expect this notice to be used in 

concert with previously published 

notices. Those unfamiliar with a 

description of our Medicare manuals 

should view the manuals at http://

www.cms.gov/manuals. 

Dated: November 7, 2014. 

Kathleen Cantwell, 

Director, Office of Strategic Operations and 

Regulatory Affairs. 

BILLING CODE 4120–01–P 

mstockstill on DSK4VPTVN1PROD with NOTICES


EN14NO14.001</GPH>mstockstill on DSK4VPTVN1PROD with NOTICES

Publication Dates for the Previous Four Quarterly Notices 

We publish this notice at the end of each quarter reflecting 

information released by CMS during the previous quarter. The publication 

dates of the previous four Quarterly Listing of Program Issuances notices 

are: November 8, 2013 (78 FR 67153), January 31,2014 (79 FR 5419), 

April25, 2014 (79 FR 22976) and July 25,2014 (79 FR 43475). For the 

purposes of this quarterly notice, we are providing only the specific updates 

that have occurred in the 3-month period along with a hypcrlink to the 

website to access this information and a contact person for questions or 

additional information. 

Addendum 1: Medicare and Medicaid Manual Instructions 

(July through September 2014) 

The CMS Manual System is used by CMS program components, 

partners, providers, contractors, Medicare Advantage organizations, and 

State Survey Agencies to administer CMS programs. It offers day-to-day 

operating instructions, policies, and procedures based on statutes and 

regulations, guidelines, models, and directives. In 2003, we transformed the 

CMS Program Manuals into a web user-friendly presentation and renamed 

it the CMS Online Manual System. 

How to Obtain Manuals 

The Internet-only Manuals (IOMs) are a replica of the Agency's 

official record copy. Paper-based manuals are CMS manuals that were 

officially released in hardcopy. The majority of these manuals were 

transferred into the Internet-only manual (10M) or retired. Pub 15-1, Pub 

15-2 and Pub 45 are exceptions to this rule and are still active paper-based 

manuals. The remaining paper-based manuals are for reference purposes 

only. If you notice policy contained in the paper-based manuals that was 

not transferred to the IOM, send a message via the CMS Feedback tool. 

Those wishing to subscribe to old versions of CMS manuals should 

contact the National Technical Information Service, Department of 

Commerce, 5301 Shawnee Road, Alexandria, VA 22312 Telephone (703-

605-6050). You can download copies of the listed material free of charge 

at:==--"-'-'="'-"-'--'-==="'· 

How to Review Transmittals or Program Memoranda 

Those wishing to review transmittals and program memoranda can 

access this information at a local Federal Depository Library (FDL). Under 

the FDL program, government publications are sent to approximately 1,400 

designated libraries throughout the United State

arrangements to transfer material to a local libr

FDL. Contact any library to locate the nearest 

available 

In addition, individuals may contact re

that receive and retain at least one copy of mos

publications, either in printed or microfilm formpublic. These libraries provide reference servic

however, they are not sales outlets. Individuals 

about the location of the nearest regional depos

library. CMS publication and transmittal numb

entitled Medicare and Medicaid Manual Instruc

the materials, use the CMS publication and tran

example, to find the Cardiac Rehabilitation Pro

Failure use CMS-Pub. 100-03, Transmittal No. 

Addendum I lists a unique CMS transm

instruction in our manuals or program memoran

A transmittal may consist of a single or multipl

necessary to usc information in a transmittal in 

information currently in the manual. For the pu

notice, we list only the specific updates to the l

that have occurred in the 3-month period. This 

our website 

Transmittal Manual/Subject/Publ

Nnmber 

... 

87 Update to Pub. 100-0 I, Chapter 7 for lang

Test Case Specification Standard 

88 Rescinds/Replaces CR 7468- Updated In

Implementation Report (CRIR) and Tech

Compliance Report (TCR) 

Sample Cover Letter/Attestation Stateme

CR Implementation Report (CRJR) Tem

TDL Compliance Report (TCR) Templa

Contractor Implementation of Change R

Technical Direction letters 

z, ;; >· 

190 Beneficiary Signature Requirements tor A

191 Cardiac Rehabilitation Programs for Chro

Cardiac Rehabilitation (CR) and Intensiv

Services Furnished On or After January I

192 Clarilication of the Contined to the Home 

Mt:dkal and Other Health Scrvi<:t:s, uftl11

EN14NO14.002</GPH>mstockstill on DSK4VPTVN1PROD with NOTICES

193 Cardiac Rehabilitation Programs for Chronic Heart Failure Determining 

Whether or Not the Beneticiary is at High Risk for Developing Colorectal 

Cancer 

Partialllospitalization Services 

Coverage of Intravenous Immune Globulin for Treatment of Primmy 

Immune Deficiency Diseases in the Home Coverage of Outpatient 

Rehabilitation Therapy Services (Physical Therapy, Occupational Therapy, 

and Speech-Language Pathology Services) Under Medical Insurance 

Documentation Requirements for Therapy Services Glaucoma Screening 

Admission Requirements 

194 Pub. 100-02 Language-Only Update for ICD-10 

Limitations for Coverage 

Partial Hospitalization Services 

Coverage of Intravenous Immune Globulin for Treatment of Primary 

Immune Deficiency Diseases in the !lome 

Coverage of Outpatient Rehabilitation Therapy Services (Physical Therapy, 

Occupational Therapy, and Speech-Language Pathology Services 

Documentation Requirements for Therapy Services 

Glaucoma Screening 

Determining Whether or Not the Beneficiary is at High Risk for Developing 

Colorcctal Cancer 

Screening Pap Smears 

Admission Requirements 

195 Issued to a specific audience, not posted to Intemet/lntranet due to Sensitivity 

oflnstruction 

.••• .ij.{\i; 

170 National Coverage Determination (NCO) for Single Chamber and Dual 

Chamber Permanent Cardiac Pacemakers 

171 Cardiac Rehabilitation Programs for Chronic Heart Failure 

172 Ventricular Assist Devices for Bridge-to-Transplant and Destination Artificial 

Hearts and Related Devices (Various Etrective Dates Below) 

Ventricular Assist Devices (Various Effective Dates Below) Therapy 

173 Pub 100-03, Chapter I, language-only update 

Foreword- Purpose for National Coverage Determinations (NCD) Manual 

Cse of Visual Tests Prior to and General Anesthesia During Cataract 

Surgery 

Transcutaneous Electrical Nerve Stimulation (TENS) for Acute PostOperative Pain 

Outpatient Hospital Pain Rehabilitation Programs 

Anesthesia in Cardiac Pacemaker Surgery 

Percutaneous Transluminal Angioplasty (PTA) (Various Effective Dates 

Below) 

Cardiac Pacemakers (Various Effective Dates) 

Cardiac Pacemaker Evaluation Servkes 

Transtelephonic Monitoring of Cardiac Pacemakers 

Electrocardiographic Services 

Cardiac Output Monitoring By Thoracic Electrical Bioimpcdance (TEB)-

Various Effective Dates Below 

Speech Generating Devices 

Cochlear Implantation (Effective April4, 2005) 

Physician's Office Within an Institution

Incident to a Physician's Services 

Abarelix for the Treatment of Prostate C

Hydrophilic Contact Lens for Corneal B

Ocular Photodynamic Therapy (OPT)- 

Photosensitive Drugs 

Verteportin- Effective April3, 2013 

Hydrophilic Contact Lenses 

Laproscopic Cholecystectomy 

Certain Drugs Distributed by the Nation

Stem Cell Transplantation (Various Effe

Anticancer Chemotherapy for Colorccta

2005) 

Hospital and Skilled Nursing Facility AdErythropoiesis Stimulating Agents (ESA

Conditions 

Inpatient Hospital Stays for the Treatme

Chemical Aversion Therapy tor Treatme

Treatment of Drug Abuse (Chemical De

for Narcotic Addictions 

Laser Procedures 

Diathermy Treatment 

Lumbar Artificial Disc Replacement (LA

Supplies Used in the Delivery of Transc

Stimulation (TENS 

Induced Lesions of Nerve Tracts 

Electrical Nerve Stimulators and Neurom

(NMES) 

Enteral and Parenteral Nutritional Thera

Nesiritidc for Treatment of Heart Failure 

Nebulized Beta Adrenergic Agonist The

September I 0, 2007) 

Screening PAP Smears and Pelvic Exam

Cervical or Vaginal Cancer 

Computed Tomography (CT) 

Magnetic Resonance Imaging (MRI) (V

Ultrasound Diagnostic Procedures (Effe

FDG Positron Emission Tomography (P

Ncurodegcnerative Diseases (Effective Se

Positron Emission Tomography (PET) (

Digital Subtraction Angiography (DSA) 

Single Photon Emission Computed Tom

Percutaneous Image-Guided Breast Biop

Sterilization 

Water Purification and Softening System

Dialysis 

Home Use of Oxygen 

Pulmonary Rehabilitation Services - (Ef

Treatment of Psoriasis 

Routine Costs in Clinical Trials (Effecti

EN14NO14.003</GPH>mstockstill on DSK4VPTVN1PROD with NOTICES

Electrical Stimulation (ES) and Electromagnetic Therapy for the Treatment Partial Month Stays For Capped Rental 

of Wounds- (Effective July I, 2004) Completion of Certificate of Medical Ne

Durable Medical Equipment Reference List (Effective May 5, 2005) HHA Recertification for Home Oxygen 

Hospital Beds DME MACs Only- Appeals of Duplica

Infusion Pumps DME MACs- Billing Procedures Relate

Obsolete or Unreliable Diagnostic Tests (ABN) Upgrades 

Intravenous Immune Globulin for the Treatment of Autoimmune Providing Upgrades ofDMEPOS Witho

Mucocutaneous Blistering Diseases Whether Rented or Purchased 

174 Screening tor Hepatitis C Virus (HCV) in Adults Billing for Supplies and Drugs Related t

175 Intensive Cardiac Rehabilitation Program- Benson-Hemy Institute Cardiac Institutional Provider Reporting of Servi

Wellness Program Billing for Total Parenteral Nutrition an

;iSc'ii >\ti B Inpatients 

2980 Issued to a specific audience, not posted to lnternet/lntranet due to 

Confidentiality of Instruction 

2981 Issued to a specific audience, not posted to Internet/lntranet due to 

Confidentiality of Instruction 

Special Considerations for SNF Billing 

Billing tor Splints and Casts 

CWF Crossover Editing for DMEPOS C

DMEPOS Clinical Trials and Demonstrat

2982 Issued to a specific audience, not posted to Internct/Intranct due to 

Confidentiality of Instruction 

2994 Update to Pub. I 00-04, Chapter 35 to Pro

Updating ASC X 12 

2983 Issued to a specific audience, not posted to lnternetllHtranet due to 

Confidentiality of Instruction 

2984 Beneficiary Signature Requirements for Ambulance Services 

Items !Ia 13 Patient and Insured Information 

2995 Issued to a specific audience, not posted t

of Instruction 

2996 Remittance Advice Remark and Claims A

Medicare Remit Easy Print and PC Print U

Signature on the Request for Payment by Someone Other Than the Patient 

2985 Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System 

(PPS) Pricer Update FY 2015 

2986 National Coverage Determination (NCD) for Single Chamber and Dual 

Chamber Permanent Cardiac Pacemakers 

2997 Update to Pub. I 00-04, Chapter 12 to Pro

Updating !CD-!0 and ASC X12 

2998 Update to Pub. I 00-04, Chapter 32 to Pro

Updating ICD-10 m1d ASC Xl2 

2999 Update to Pub. 100-04, Chapter 38 to Pro

2987 Issued to a specitic audience, not posted to lnternet/lntranet due to 

Confidentiality oflnstmction 

Updating ASC Xl2 

3000 Update to Pub. I 00-04, Chapter 09 to Pro

2988 New Waived Tests Updating ASC X J 2 

2989 Cardiac Rehabilitation Programs fur Chronic Hearl Failure 

Intensive Cardiac Rehabilitation Program Services Furnished On or After 

January I, 20 I 0 

Cardiac Rehabilitation Program Services Furnished On or After January I, 

2010 

3001 Adjustment to Systematic Validation of P

Prospective Payment Systems (PPS) Base

Systematic Validation of Claims lnlormat

3002 Issued to a specit1c audience, not posted t

Confidentiality of Instruction 

Correct Place of Service (POS) Code for CR and lCR Services on 3003 Issued to a specific audience, not posted t

Professional Claims Confidentiality of Instruction 

Requirements lor CR and !CR Services on Institutional Claims 3004 Issued to a specific audience, not posted t

Edits for CR Services Exceeding 36 Sessions oflnstructiun 

Cardiac Rehabilitation Programs, Intensive Cardiac Rehabilitation Programs, 3005 Preventing Uuplicate Payments When Ov

and Pulmonary Rehabilitation Programs Health Claims Are Received Out of Sequ

2990 October 2014 Quarterly Average Sales Price (ASP) Medicare Part B Drug 3006 Issued to a specific audience, not posted t

Pricing Files and Revisions to Prior Quarterly Pricing Files ConJidentiality of Instrnction 

2991 October Qumteriy Update to 2014 Annual Update ofHCPCS Codes Used for 3007 Issued to a specific audience, not posted t

Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement ofinstruction 

2992 Issued to a speci tic audience, not posted to Internet/ Intranet due to 3oog Issued to a specific audience, not posted t

Confidentiality of Instmction Confidentiality of lnstmction 

2993 Update to Pub. 100-04, Chapter 20 to Provide Language-Only Changes for 3009 Update to Pub. 100-04, Chapter 3 7 to Pro

Updating ICD-10 and ASC Xl2 Updating ASC Xl2 

EN14NO14.004</GPH>mstockstill on DSK4VPTVN1PROD with NOTICES

3010 Preventing Payment on Requests for Anticipated Payment (RAPs) When Coding for Outpatient Services and Phy

Home Health Beneficiaries are Enrolled in Medicare Advantage (MA) Plans Inpatient Claim Diagnosis Reporting 

Request for Anticipated Payment (RAP) 3021 Update to Pub. l 00-04, Chapter l 0 to Pro

3011 October Quarterly Update for 2014 Durable Medical Equipment, Prosthetics, Updating ASC Xl2 

Orthotics, and Supplies (DMEPOS) Fee Schedule Completion of Form CMS 1450 for Hom

3012 October 2014 Update of the Hospital Outpatient Prospective Payment System Health Insurance Eligibility Query to De

(OPPS) 3022 Automation of the Request for Reopening 

3013 Issued to a specific audience, not posted to I nternet/Intranet due to Special Claim Types 

Confidentiality of Instruction 3023 Update to Hospice Payment Rates, Hospi

3014 Update to Pub. I 00-04, Chapter 16 to Provide Language-Only Changes for Quality Reporting Program and the Hospi

Updating !CD-10, ASC Xl2, and Medicare Administrative Contractors 3024 Issued to a specific audience, not posted t

(MAC) Implementation Confidentiality oflnstruction 

Determinations (NCDs) for Clinical Diagnostic Laboratory Services 3025 October 2014 Update of the Ambulatory 

Electronic Claim Submission to A!I3 MACs (13) System 

Hospital Billing Under Part B 3026 Issued to a specific audience, not posted t

Hospital Laboratory Services Furnished to Nonhospital Patients Confidentiality ofinstruction 

Background 3027 Update to Pub. I 00-04, Chapter 15 to Pro

Billing Updating lCD-1 0, ASC X12, and Medica

CLIA Number Submitted on Claims from Independent Labs (MAC) 

Implementation and Updates ofNcgotiated National Coverage Implementation 

Paper Claim Submission to A/B MACs (B) Medical Conditions List and Instruction

3015 Update to Pub. I 00-04, Medicare Claims Processing Manual, Chapter II to General Billing Guidelines 

Provide Language-Only Changes for Updating ICD-10 and ASC X12 Coding Instructions lor Paper and Electr

3016 Two New "K" Codes for Prefabricated Single and Double Upright Knee Fiscal Intermediary Shared System (FIS

Orthosis That Are Furnished Off-The-Shelf (OTS) B MAC (A) Bill Processing Guidelines 

3017 Date Con·ection to Diagnosis Code Reporting on Religious Nonmedical of Fee Schedule Tmplementation Definitio

Health Care Institution (RNHCI) Claims 3028 Update to Pub. 100-04, Chapters 5 and 6 

Required Data Elements on Claims for RNHCI Services for Updating ICD-1 0, ASC Xl2, and Med

3018 October 2014 Integrated Outpatient Code Editor (I/OCE) Specifications (MAC) ImplementationOther Billing Sit

Version 15.3 Application of Financial Limitations 

3019 Medicare Claims Processing Manual, Pub. I 00-04, Chapter 4 Language Only Multiple Procedure Payment Reductions 

Update for ICD-10, ASC Xl2, and Medicare Administrative Contractor Services 

(MAC) Implementation Reporting of Service Units With HCPCS 

Line Item Date of Service Reporting for Partial Hospitalization Coding Guidance for Certain CPT Code

General Rules for Reporting Outpatient Hospital Services General 

Billing for Autologous Stem Cell Transplants Off-Site CORr Services 

Optional Method for Outpatient Services: Cost-Based Facility Services Plus Notifying Patient of Service Denial Billi

115 percent Fee Schedule Payment for Professional Services Devices, and Surgical Dressings 

Billing and Payment in a Physician Scarcity Area (PSA) Addendum A- Chapter 5, Section 20.4- 

Identifying Primary Care Services Eligible for the PCIP Codes- All Claims 

Rill Review for Partial Hospitalization Services Received in Community Consolidated Billing Requirement for SN

Mental Health Centers (CMHC) Rilling SNF PPS Services 

Where to Report Modifiers on the Hospital Part B Claim Billing Procedures for Periodic Interim P

3020 Update to Pub. 100-04, Chapter 23 to Provide Language-Only Changes for Total and 1'\oncovered Charges 

Conversion to lCD-I 0 Services in Excess of Covered Services 

General Rules for Diagnosis Codes Reporting Accommodations on Claims 

Reporting lCD Diagnosis and Procedure Codes Bills with Covered and Noncovered Day

Relationship of Diagnosis Codes and Date of Service Billing in Benetits Exhaust and No-Paym

Outpatient Claim Diagnosis Reporting Part B Outpatient Rehabilitation and Co

ICD Procedure Code Rehabilitation Facility (CORF) 

EN14NO14.005</GPH>mstockstill on DSK4VPTVN1PROD with NOTICES

3029 Issued to a specific audience, not posted to Internet/ Intranet due to Application of Code First 

Confidentiality of Instruction Comorbidity Adjustments 

3030 Update to Pub. 100-04, Chapter 03 to Provide Language-Only Changes for Source of Admission for lPF PPS Claim

Updating lCD-10 and ASC X12 Electroconvulsive Therapy (ECT) Paym

Claim Formats Creneral Rules 

Payment ofNonphysician Services for Inpatients Completion of the Notice of Election for 

Outliers 3031 Update to Pub. I 00-04, Chapter 14 to Pro

Return Codes for Pricer Updating ASC X 12 

Computer Programs Used to Support Prospective Payment System ASC Procedures t(Jr Completing the AS

Medicare Code Editor (MCE) Format or the Form CMS-1500 

DRG Grouper Program Ambulatory Surgical Center Services on Payment for Blood Clotting Factor Administered to Hemophilia Inpatients List of Covered Ambulatory Surgical Ce

Payment tor Post Hospital SNF Care Furnished by a CAH Definition of Ambulatory Surgical Cent

Noncovcred Admission Followed by Covered Level of Care 3032 Hospice Manual Update for Diagnosis Re

Outpatient Servict:s Tr<::al<::J as Inpatient Services of Election (NOE) and Termination or Re

Adjustment Bills rescinds and fully replaces CR '6777. 

Tolerance Guidelines for Submitting Adjustment Requests Date Required on the Institutional Claim 

Claim Change Reasons Completing the Uniform (Institutional P

Swing-Bed Services Hospice Election 

Providers Using All Inclusive Rates tor Inpatient Part A Charges Notice of Election (NOE)- Form CMS 

The Standard Kidney Acquisition Charge 3033 Influenza Vaccine Payment Allowances - 

Billing for Kidney Transplantation and Acquisition Services Season 

Heart Transplants 3034 Update-Inpatient Psychiatric Facilities Pr

Artificial Hearts and Related Devices PPS) Fiscal Year (FY) 2015 Annual Cpda

Stem Cell Transplantation 

Allogeneic Stem Cell Transplantation 

3035 Annual Update of HCPCS Codes Used fo

Enforcement 

Autologous Stem Cell Transplantation (AuSCT) 

Billing for Stem Cell Transplantation 

3036 Issued to a speciJic audience, not posted t

of Instruction 

Billing for Liver Transplant and Acquisition Services 

Pancreas Transplants Kidney Transplants 

Intestinal and Multi-Visceral Transplants 

Billing for Abortion Services 

Lung Volume Reduction Surgery 

Nonemergency Part R Medical and Other Health Services 

Elections to Bill for Services Rendered Nonparticipating Hospitals 

Verification Process Used To Determine If the Inpatient Rehabilitation 

Facility 

Met The Classification Criteria 

Billing Requirements Under lRF PPS 

Remittance Advices Patient Classification System 

Processing Bills Between October 1, 2002 and the Implementation Date 

Billing Requirements Under L TCH PPS 

Billing Ancillary Services Under LTCH PPS 

IdentifYing Claims Eligible for the Add-On Payment for New Technology 

3037 Healthcare Provider Taxonomy Codes (H3038 Implement Operating Rules- Phase flf ER

Claim Adjustment Reason Codes (CARC

Codes 

3039 Inpatient Rehabilitation Facility (IRF) An

System (PPS) Pricer Changes for FY 201

PPS ()uality Reporting Program 

3040 Common Edits and Enhancements Modul

3041 Issued to a specific audience, not posted t

Confidentiality of Instruction 

3042 Issued to a specific audience, not posted t

of Instruction 

3043 Claim Status Claim Status C

3044 Quarterly Update to the Correct Coding I

Effective January I, 2015 

3045 Instructions for Downloading the Medica

Reporting ECT Treatments 3046 October Update to the CY 2014 Medicare 

Required Data Elements on Clams tor RNHCI Services (MPFSDB) 

Recording Determinations ofExcepted;Nonexcepted Care on Claim Records 3047 Reporting the Service Location National 

Annual Update Markup and Reference Laboratory Claim

Diagnosis Related Groups (DRGs) Adjustments Subject to the Anti-Markup Payment Lim

EN14NO14.006</GPH>mstockstill on DSK4VPTVN1PROD with NOTICES

Diagnostic Tests Subject to the Anti-Markup Payment Limitation Usual Facility 

Billing for Diagnostic Tests (Other Than Clinical Diagnostic Laboratory Physicians and Supplier (Nonfacility) Bi

Tests) Billing for Durahle Medical Equipment (D

Subject to the Anti-Markup Payment Limitation- Claims and Supplies (including Surgical Dressing

Conditional Data Element Requirements for A/B MACs and DMEMACs 3054 Replacement Accessories and Supplies fo

Carrier Specific Requirements for Certain Specialties/Services Devices or Any Ventricular Assist Device 

Paper Claim Submission To Carriers/B MAC Coding Requirements for Furnished Bef

Electronic Claim Submission to Carriers!B MAC Coding Requirements for Furnished Aft

Items 14-33 - Provider of Service or Supplier Information Ventricular Assist Devices 

Payment to Physician or Other Supplier for Diagnostic Tests Subject to the Postcardiotomy 

Anti-Markup Payment Limitation- Claims Submitted to A!B MACs Bridge-To -Transplantation (BTT) 

3048 New Physician Specialty Code for lnterventional Cardiology Destination Therapy (DT ther Artificiall

Non-Physician Specialty Codes 3055 Annual Clotting Factor Furnishing Fcc U

Physician Specialtv Codes Clotting Factor Furnishing Fee 

3049 Update to Pub. 100-04, Chapter 19 to Provide Language-Only Changes for 3056 Sample Collection Fee Adjustment for Cl

ICD-1 0, ASC Xl2, and Medicare Administrative Contractors (MAC) Laboratory Services 

Implementation Coding Requirements for Specimen Col

AlB MAC (A) - Inpatient Acute Care - Medicare Part A - Claims Processing Specimen Drawing for Dialysis Patients 

AlB MAC (A) Payment Policy and Claims Processing Independent Laboratory Specimen Draw

3050 Medicare Summary Notices (MSNs), Remittance Advice Remark Codes 3057 Ambulance Inflation Factor (AI F) 

(RARCs), and Claim Adjustment Reason Codes (CARCs) 3058 Intensive Cardiac Rehabilitation Program 

Healthcare Common Procedure Coding System (HCPCS ), Applicable January I, 20 l 0 

Diagnosis Codes, and Procedure Codes Cardiac Rehabilitation Program Service

Billing Requirement for Extracorporeal Photopheresis 2010 

3051 Adjustment to Fiscal Intermediary Shared System (F!SS) Consistency Edit to Correct Place of Service (POS) Code for 

Implement National Uniform Billing Committee (NUBC) Revision to Professional Claims 

Occurrence Span Code (OSC) Definition for Code 72. Requirements for CR and ICR Services 

3052 Two New "K" Codes for Prefabricated Single and Double Upright Knee Edits for CR Services Exceeding 36 Ses

Orthosis That Are Furnished Off-Thc-Shelf(OTS) Cardiac Rehabilitation Programs, Intens

3053 Billing Formats and Pulmonary Rehabilitation Programs 

Data Elements Required on Claim for Monthly Capitation Payment Billing 3059 Int1uenza Vaccine Payment Allowances - 

Billing for Enteral and Parenteral Nutritional Therapy as a Prosthetic Device Season 

Mammography Screening 3060 Automation of the Request for Reopening 

Hospital Services Special Claim Types 

Calculation of the Basic Case-Mix Adjusted Composite Rate and the ESRD 3061 New Physician Specialty Code for Interve

Prospective Payment System Rate 3062 Issued to a specific audience, not posted t

In-Facility Dialysis Bill Processing Procedures Confidentiality of Instruction 

Required Information for In-Facility Claims Paid Under the Composite Rate 

and the ESRD PPS 

Payment for Hemodialysis Sessions 

Ultrafiltration 

Lab Services 

Separately Billable ESRD Drugs 

Physician Billing Requirements to the A/B MAC (B) 

Other Information Required on the Form CMS-1500 for Epoetin Alfa (EPO 

Other Information Required on the Form CMS-1500 for Darbepoetin Alta (Aranesp) 

General A/B MAC (A) Bill Processing Procedures for Method l Home 

Dialysis Services 

Physician's Services Furnished to a Dialysis Patient Away From Home or 

3063 Common Working File (CWF) Edits 

Institutional Billing Requirements 

Professional Billing Requirements 

Claim Adjustment Reason Codes (CARC

Codes (RARCs), Group Codes, and Medi

Messages 

Screening for Hepatitis C Virus (HCV) 

3064 October Update to the CY 2014 Medicare 

(MPFSDB) 

3065 Billing for Cost Based Payment for Certif

(CRNA) Services Furnished by Outpatien

(OPPS) Hospitals 

3066 Fiscal Year (FY) 2015 Inpatient Prospect

EN14NO14.007</GPH>mstockstill on DSK4VPTVN1PROD with NOTICES

Long Term Care Hospital (L TCH) PPS Changes 3082 Update-Inpatient Psychiatric Facilities Pr

3067 Issued to a specitic audience, not posted to Internet/ Intranet due to PPS) Fiscal Year (FY) 2015 

Confidentiality of Instruction 3083 Form CMS-1500 Instructions: Revised fo

3068 Quarterly l Jpdate tor the Durable Medical Equipment, Prosthetics. Orthotics Items 14-33 Provider of Service or Supp

Supplies (DMEPOS) Competitive Bidding Program (CBP)- January 2015 Items 1-11 Patient and Insured Informat

3069 Issued to a specific audience, not posted to Internet/ Intranet due to Items 11 a-13 Patient and Insured Inform

Conlidenlialily ofTnslruction Ilealth Insurance Claim Form CMS-150

3070 New Waived Tests 3084 Intensive Cardiac Rehabilitation Program 

3071 Manual Update to Clarify Claims Processing tor Laboratory Services Travel Wellness 

Allowance 3085 Update to Pub. I 00-04, Chapter 17 to Pro

Independent Laboratory Specimen Drawing Updating ICD-10 and ASC Xl217/100/ T

Jurisdiction of Laboratory Claims Program (CAP) for Drugs and Biological

3072 January 2015 Quarterly Average Sales Price (ASP) Medicare Pan B Drug Payment Basis 

Pricing Files and Revisions to Prior Quarterly Pricing Files Submitting the Prescription Order Numb

3073 New Physician Specialty Code for lnterventional Cardiology 

Non-Physician Specialty Codes 

Physician Specialty Codes 

3074 Issued to a specific audience, not posted to Internet/ Intranet due to 

Confidentiality of Instruction 

3075 Date Correction to Diagnosis Code Reporting on Religious Nonmedical 

Health Care Institution (RNHCI) Claims 

3076 Update to Pub. 100-04, Chapter 15 to Provide Language-Only Changes for 

Updating lCD-I 0, ASC X 12, and Medicare Administrative Contractors 

(MAC) 

Implementation 

Medical Conditions List and Instructions 

Definitions 

Coding Instructions tor Paper and Electronic Claim Forms 

Fiscal Intermediary Shared System (FISS) Guidelines 

A/B MAC (A) Bill Processing Guidelines Effective April L 2002, as a 

Result of Fee Schedule Implementation 

General Billing Guidelines 

3077 Maintenance and Update of the Temporary Hook Created to Hold OPPS 

Claims that Include Certain Drug HCPCS Codes 

3078 October 2014 Update of the Ambulatory Surgical Center (ASC) Payment 

System 

3079 Issued to a specific audience, not posted to Internet/ Intranet due to 

Confidentiality of Instruction 

3080 October 2014 Update of the Hospital Outpatient Prospective Payment System 

(OPPS) 

3081 Update to Pub. 100-04, Chapter 23 to Provide Language-Only Changes for 

Conversion to ICD-10 

Reporting !CD Diagnosis and Procedure Codes 

Relationship of Diagnosis Codes and Date of Service 

Inpatient Claim Diagnosis Reporting 

Outpatient Claim Diagnosis Reporting 

lCD Procedure Code 

Coding for Outpatient Services and Physician Offices 

General Rules for Diagnosis Codes 

Hospital Billing For Take-Home Drugs 

Hospital Outpatient Payment Under OPl

Biologicals After FDA Approval But Bef

Specific Drug or Biological HCPCS Code 

Claims Processing Rules for F.SAs Adm

Anemia Therapy 

Intravenous Immune Globulin 

MS'J/Remillance Messages for Immuno

Requirements for Billing A/B MAC (A) Billing and Payment Instructions for A/B 

MSN Denial/Claim Adjustment and Rem

Drugs 

HCPCD Codes for Oral Anti-Emetic DrMSN/Ciaim Adjustment Message Codes 

Claims Processing Requirements -Gene

Billing Drugs Electronically- NCPDP 

3086 Foreword 

Formats for Submitting Claims to Electr

liiP AA Standards for Claims Paper Clai

Where to Purchase HIP AA Standard Im

Paper Formats for Institutional Claims 

Paper Formats for Professional and Supp

Remittance Advices 

Payment Jurisdiction Among Local A/B 

Physician Fee Schedule and Anesthesia S

Claims Processing Instructions for Paym

Payment to Physician or Other Supplier 

Anti- Markup Payment Limitation/ Claim

Billing Procedures for Entities Qualified 

Reassignment/ lor A/B MACs(B) Process

Billing for Diagnostic Tests (Other Than 

Tests) 

Subject to the Anti-Markup Payment Lim

AB/MACs(B) 

Billing Form as Request for Payment Beneficiary Request for Payment on Pro

EN14NO14.008</GPH>mstockstill on DSK4VPTVN1PROD with NOTICES

ASC X12 837 Institutional Claim Format 3094 Issued to a specific audience, not posted t

Definition of a Claim for Payment of Instruction 

Policy and Billing Instructions for Condition Code 44 3095 Issued to a specific audience, not posted t

General Information on Non-covered Charges on Institutional Claims Confidentiality of Instruction 

Determining Start Date of Timely Filing Period-- Date of Service ';v,•,'.;;;,,\\1, ··Iii 

Form Prescribed by CMS 101 Additional Electronic Correspondence Re

Accordance with CMS Instructions Codes 

Handling Incomplete or Invalid Submissions Electronic Correspondence Referral Sys

Claims Forms Cv!S 1490S and CMS-1450 Electronic Correspondence Referral Sys

Data Element Requirements Matrix 

Payer Only Codes Utilized by Medicare B MAC(B) Specific Requirements 

tor Certain Specialties/ Services 

Consistency Fdits for Institutional Claims 

Inpatient Part A Hospital Adjustment Bills 

Conditional Data Element Requirements for A/B MACs (B) and DME 

MACs 

3087 2015 Annual Update for the Health Professional Shortage Area (HPSA) 

Bonus Payments 

3088 2015 Annual Update ofHealthcare Common Procedure Coding System 

(HCPCS) Codes for Skilled Nursing Facility (SNF) Consolidated Billing 

(CB) Update 

3089 Issued to a specific audience, not posted to Internet/ Intranet due to 

Confidentiality of Instruction 

3090 Ambulance Inflation Factor for CY 2015 and Productivity Adjustment 

3091 Update to Pub. 100-04 Chapter 13 to Provide Language-Only Changes tor 

Updating ICD-10 and ASC Xl2 

!CD Coding for Diagnostic Tests 

A/B MAC (A)Payment tor Low Osmolar Contrast Material (LOCM) 

(Radiology) 

Special Billing Instructions for RHCs and FQHCs Payment Requirements 

Medicare Summary Notices (MSN ), Reason Codes, and Remark Codes 

Billing Instructions 

Coverage for PET Scans for Dementia and Neurodegenerative Diseases 

Place of Service (POS) Instructions for the Professional Component (PC or 

Interpretation) and the Technical Component (TC) of Diagnostic Tests 

Billing and Coverage Changes for PET Scans 

Billing and Coverage Changes for PET Scans for Cervical Cancer Effective 

for Services on or After November I 0, 2009 

Billing and Coverage Changes tor PET (1\aF-18) Scans to IdentitY Bone 

Metastasis of Cancer Effective for Claims With Dates of Services on or After 

February 26, 20 I 0 

EMC Formats 

Payment Methodology and HCPCS Coding Billing Requirements for C:MS -

Approved Clinical Trials and Coverage With Evidence Development Claims 

for PET Scans for Neurodegeneralive Diseases, Previously Specified Cancer 

lndicatiom, and All Other Cancer Indications Not Previously Specified 

3092 Annual Medicare Physician Fee Schedule (MPFS) Files Delivery and 

Implementation 

3093 Issued to a specific audience, not posted to Internet/ Intranet due to Sensitivity 

102 Issued to a specific audience, not posted t

Confidentiality of Instruction 

103 Issued to a specific audience, not posted t

Confidentiality of Instruction 

104 Issued to a specific audience, not posted t

Conlidentiality of Instruction 

105 Electronic Correspondence Referral Syste

Defense of Marriage Act (DOMA) and IC

106 Medicare Secondary Payer (MSP) Group 

Policy-- Definition of"Spouse"; Same-S

.... ''" 

237 Notice of :--Jew Interest Rate tor Medicare 

- 4th Qtr. Notification for FY 2014 

238 New Physician Specialty Code for Interve

Pari D(l )/Claims Processing Timeliness

Classification of Claims for Counting 

Physician/Limited License Physician Sp

Non-Physician Practitioner/Supplier Spe

Part E/Interest Payment Data 

239 Issued to a specific audience, not posted t

Confidentiality of Instmction 

240 Transitioning Medicare Administrative C

New Banking Contractor(s) 

241 Recovery Auuil Program Tnu;king Appe

Appeals and Reopeuings 

242 Medicare Financial Management Manual

List of CMS Contractor Control Objecti

OMR Circular A-123, Appendix A: Inte

Reporting (ICOFR) Ceriilication Stateme

CPIC- Report of Internal Control Defic

Statement on Standards for Allestation E

Reporting on Controls at Service Provid

Submission, Review, and Approval of C

Corrective Action Plan (CAP) Reports 

CMS Finding Numbers 

Quarterly CAP Report 

Certification Package for Internal Contro

243 Notice of New Interest Rate for Medicare 

- 1st Qtr Notification for FY 2015 

of Instruction 

EN14NO14.009</GPH>mstockstill on DSK4VPTVN1PROD with NOTICES

\ ? 

119 Rehabilitation Agencies -Fire Alarm Systems 

Standard: Disaster Plan 

Standard: Safety of Patients 

120 Revisions to State Operations Manual (SOM) Chapter 5 

Maximum Time Frames Related to the Federal Onsite Investigation of 

Complaints/Incidents 

Priority Definitions for Nursing Homes, Deemed and Non-Deemed NonLong Term Care Providers/Suppliers, and EMTALA 

Immediate Jeopardy (for Nursing Homes, Deemed and Non-Deemed NonLong Term Care Providers/Suppliers, and EMTALA) 

Non-Immediate Jeopardy- High Priority (tor Nursing Homes and Deemed 

and Non-Deemed Non-Long Term Care Providers/Suppliers) 

Non-Immediate Jeopardy- Medium Priority (tor Nursing Homes and 

Deemed and Nun-Deemed Non-Long Term Care Provid<.:rs/Supplicrs) 

Non-Immediate Jeopardy- Low Priority (for Nursing Homes and Deemed 

and Non-Deemed Non-Long Term Care Providers/Suppliers) 

Administrative Review/Offsite Investigation (for Nursing Homes and 

Deemed and Non-Deemed Non-Long Term Care Providers/Suppliers) 

Referral Immediate (for Nursing Homes, Deemed and Non-Deemed NonLong Term Care Providers/Suppliers, and EMTALA) 

Referral- Other (for Nursing Homes, Deemed and Non-Deemed Non-Long 

Term Care Providers/Suppliers, and EMTALA) 

No Action Necessary (for Nursing Homes, Deemed and Non-Deemed NonLong Term Care Providers/Suppliers, and EMTALA) 

Priority Assignment for Nursing Homes, Deemed and Non-Deemed Non1 ,ong Term Care Providers/Suppliers, and EMT A I ,A 

121 Update to State Operations Manual (SOM), Publication 100-07, Chapter 3, to 

Provide Language-Only Changes for Updating ICD-10 

Specific Criteria for Psychiatric Units/31 06B 1 - Patient Criteria 

122 Revisions to State Operations Manual (SOM), Appendix A Survey Protocol, 

Regulations and Interpretive Guidelines for Hospitals 

123 Medicaid Provisions 

Clinical Laboratory Improvement Amendments (CLIA 

Look-Behind Authority 

Certification Related Functions of SA Accredited CLIA Laboratories 

CMS and AO Information Exchange Regarding Deemed Providers/Suppliers 

(Excluding CLlA) 

AO Reporting Requirements 

RO Requirements for Review of AO Reporting 

RO Reporting Requirements to AOs 

Assisting Applicant Providers and Suppliers 

Initial Certification "Kits 

Deemed Status Providers Suppliers, Exduding CLIA 

Provider-Based Determinations 

Medicare Health Care Provider Supplier Enrollment 

Approval or Denial 

Enrollment Denial Based on MAC Review 

Approval or Denial of Certification Based on Survey Findings 

Reconsideration of Denial 

Deemed Providers/Suppliers, Excluding 

Deemed Providers/Suppliers Except CL

Surveys of New Providers and Suppliers 

Effective Date of Medicare Provider Agre

Reasonable Assurance Surveys 

Effective Date of Provider Agreement A

Non-deemed Hospitals 

Recertification ofNon-deemed Hospitals 

Deemed Status: Hospitals Accredited by a

CMS-approved Medicare Hospital or Me

Accreditation Program 

Notice that a Participating Hospital Has B

for Deemed Status 

Recertification 

Medicaid Provisions 

Clinkal Laboratory Improvement Amend

Look-Behind Authority 

Certification Related Functions of SA 

Accredited CLlA Laboratories 

CMS and AO Information Exchange Reg

(Excluding CLIA) 

AO Reporting Requirements 

RO Requirements for Review of AO Rep

RO Reporting Requirements to AOs 

Assisting Applicant Providers and Suppli

Initial Certification "Kits 

Deemed Status Providers Suppliers. Excl

Provider-Based Determinations Medicare Health Care Provider Supplier E

Approval or Denial 

Enrollment Denial Based on MAC Revie

Approval or Denial of Certification Based 

Reconsideration of Denial 

Deemed Providers/Suppliers, Excluding C

Deemed Providers/Suppliers Except CLIA

Surveys ofl\ew Providers and Suppliers 

Effective Date of Medicare Provider Agre

Reasonable Assurance Surveys 

Effective Date of Provider Agreement A

Non-deemed Hospitals 

Recertification of Non-deemed Hospitals 

Deemed Status: Hospitals Accredited by 

CMS-approved Medicare Hospital or Me

Accreditation Program 

Notice that a Participating Hospital Has B

tor Deemed Status 

Recertification 

Notification of Withdrawal or Loss of Ac

Psychiatric and Deemed Status 

EN14NO14.010</GPH>mstockstill on DSK4VPTVN1PROD with NOTICES

Medicaid-Only Hospitals 

Initial Certification of Medicaid-Only Hospitals 

Certification Surveys of Medicaid-Only Hospitals 

Change in Certification 

Termination 

Complaint Investigation 

Determining Compliance with OASIS Transmission Requirements 

HHAs Seeking Initial Certification Participation through Deemed Status 

Exceptions to Demonstrating Compliance with OASIS Submission 

Requirements Prior to Approval 

Compliance Dates and PPS 

Instructions for Handling Medicare Patients in HHAs Seeking Initial 

Certification 

Instructions to New HHAs Concerning all Other Patients 

Survey Team Workload 

Completion Instructions for Certification and Transmittal, Fom1 CMS-1539 

RO Completion Instructions for Certification and Transmittal, Form CMS1539, Items 19-32 

Medicaid-Only Certification 

Change in Certification 

Medicaid NF and Medicaid Distinct Part NF Providers Seeking to Participate 

as Medicare SNF Provider 

Medicare- and :vtedicaid-Participating Hospitals Seeking to Become 

Medicaid-Only Hospital 

2/2777D3-Medicaid-Only Hospitals Seeking to Participate in Medicare and 

Medicaid 

2/2778-0bjectives of RO Certification Review 

CMS Certification Numbers for Medicaid Providers 

EtTective Date ofProvider Agreement, Form CMS-1561, and Supplier 

Approval 

Compliance with All Federal Requirements 

All Health and Safety Standards Are Not Met on the Day of the Survey 

CMS Authority to Terminate Medicare and Medicaid Participation 

Termination of Title XIX-Only NFs, ICFslliD, Hospitals and Psychiatric 

Hospitals 

Termination Action Based Upon Onsite Survey by RO, or Validation Survey 

of a Deemed Provider or Supplier by RO or SA 

Services for which Federal Financial Participation (FFP) May Be Temporarily 

Continued After Termination of a Medicaid Provider or Nonrenewal or 

Cancellation of an ICFIIID Provider Agreement 

Processing of Immediate Jeopardy Terminations 

fermination Procedures Substantial Noncompliance; No Immediate 

Jeopardy (Medicare) 

Termination of Psychiatric Hospitals 

Termination Action Based on Onsite Survey of Medicare Provider or Supplier 

(Excluding SNFs) Conducted by RO Stall 

Plan ofCotTection (PoC) 

General Information on IPPS Exclusion Deemed Providers and Suppliers 

Validation Surveys - General 

Objective ofValidation Surveys 

Representative Sample Validation Survey

Substantial Allegation Validation Survey

SA Preparation for Validation Survey 

Provider Supplier Authorization for ValidProvider Supplier Refusal to Permit Valid

Forwarding Validation Survey Records to 

Actions Following Validation Survey 

Providers Suppliers Found in Complianc

3/3254B-Providcrs Suppliers Found Not i

Conditions Following Validation Survey 

Immediate Jeopardy 

Condition-level Deficiencies That Do No

Plans of Correction 

Termination or Other Adverse Accreditat

Supplier 

Reinstatement to Accrediting Accreditatio

RO Provision oflnformation to Accrediti

Psychiatric Hospitals and Deemed Status 

Medicaid-Only Hospitals 

Initial Certification of Medicaid-Only Ho

Certification Surveys of Medicaid-Only H

Change in Certification 

Termination 

Complaint Investigation 

Determining Compliance with OASIS Tr

HHAs Seeking Initial Certification Partic

Exceptions to Demonstrating Compliance 

Requirements Prior to Approval 

Compliance Dates and PPS 

Instructions for Handling Medicare Patien

Certification 

Instructions to New HHAs Concerning al

Survey Team Workload 

Completion Instructions for Certification 

RO Completion Instructions for Certifica

1539, Items 19- 32 

Medicaid-Only Certification 

Change in Certification 

Medicaid NF and Medicaid Distinct Part 

as Medicare SNF Provider 

Medicare- and \lledicaid-Participating Ho

Medicaid-Only Hospital 

2/2777D3-Medicaid-Only Hospitals Seek

Medicaid 

2/2778-0bjectives of RO Certification Re

CMS Certification Numbers for Medicaid 

Effective Dale of Provider Agreement, Fo

Approval 

Compliance with All Federal Requiremen

All Health and Safety Standards Are Not 

EN14NO14.011</GPH>mstockstill on DSK4VPTVN1PROD with NOTICES

526 

527 

528 529 530 531 

I 532 

CMS Authority to Terminate Medicare and Medicaid Participation 

rermination of Title XIX-Only NFs, lCFs!IID, Hospitals and Psychiatric 

Hospitals 

Termination Action Based Upon Onsite Survey by RO, or Validation Survey 

of a Deemed Provider or Supplier by RO or SA 

Services for which Federal Financial Participation (FFP) May Be Temporarily 

Continued After Termination of a Medicaid Provider or Nonrenewal or 

Cancellation of an ICF/IID Provider Agreement 

Processing of Immediate Jeopardy Terminations 

Termination Procedures- Substantial Noncompliance; No Immediate 

Jeopardy (Medicare) 

Termination of Psychiatric Hospitals 

Termination Action Based on Onsite Survey of Medicare Provider or Supplier 

(Excluding SNfs) Conducted by RO Staff 

Plan of Correction (PoC) 

Generallntormation on IPPS Exclusion Deemed Providers and Suppliers 

Validation Surveys- General 

Objective of Validation Surveys 

Representative Sample Validation Surveys of Deemed Providers Suppliers 

Substantial Allegation Validation Surveys of Deemed Providers Suppliers 

SA Preparation for Validation Survey 

Provider Supplier Authorization for Validation Survey 

Provider Supplier Refusal to Permit Validation Survey 

Forwarding Validation Survey Records to RO 

Actions Following Validation Survey 

Providers Suppliers Found in Compliance following Validation Survey 

3!3254B-Providcrs Suppliers Found Not in Compliance with One or More 

Conditions Following Validation Survey and \loncompliance Constitutes 

Immediate Jeopardy 

Condition-level Deficiencies That Do Not Pose Immediate Jeopardy 

Plans of Conection 

Termination or Other Adverse Accreditation Action for a Deemed Provider or 

Supplier 

Reinstatement to Accrediting Accreditation Organization Jurisdiction 

RO Provision oflnformation to Accrediting Organizations 

Issued to a specific audience not posted to Internet/ Intranet due to 

Conlidcntiality of Instruction 

Provider Notice on MAC Web Sites 

Proof of Delivery--Supplier Documentation 

Issued to a specific audience not posted to Internet/ Intranet due to 

Confidentiality of lnstrnction 

Cardiac Rehabilitation Programs for Chronic Heart Failure 

Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) 

Issued to a specific audience not posted to Internet/ Intranet due to 

Confidentiality oflnstruction 

Incorporation of Various Form CMS-855 Processing Activities into Pub. I 00-

08, Program Integrity Manual (PIM), Chapter 15 

533 534 535 536 537 538 539 

540 

541 542 543 

544 545 

)}\\ 

18 

'.lc::£·•· 

·'''•·•·•····;' 

.••... 

\ 

•• 

;. ;.:· ...... ·. 

1395 1396 

Documentation for Durable Medical Equi

Supplies (DMEPOS) Repair Claims 

Claims that are related 

Issued to a specific audience not posted to 

Confidentiality of Instruction 

Issued to a specific audience not posted to 

Confidentiality of Instruction 

Issued to a specific audience not posted to 

Confidentiality ofinstruction 

Issued to a specific audience not posted to 

Confidentiality of lnstmction 

Cardiac Rehabilitation Programs for Chro

Cardiac Rehabilitation (CR) and Intensiv

Claims that are related 

Requesting Additional Documentation D

Review 

Claims that arc related 

Issued to a specific audience not posted to 

Confidentiality of lnstrnction 

Defending Medical Review Decisions at A

Hearings 

The ALJ Hearing Collaboration 

Participation in the ALI Hearing 

Party in the ALJ Hearing 

Defending Medical Review Decisions at 

Hearings 

Issued to a specific audience not posted to 

Confidentiality of Instmction 

Issued to a specific audience not posted to 

of Instmction 

None 

Update to Pub. I 00-10, Chapters 04 and 0

Cl1angcs for Updating ICD-10 

None 

None None 

None 

i'i 

Nunc 

• .. 

Implementation of a Prospective Paymen

Qualified Health Centers (FQIICs) 

Clarification of Remittance Advice Code 

EN14NO14.012</GPH>mstockstill on DSK4VPTVN1PROD with NOTICES

Shared Systems 

1397 Consolidation of HIULAS Organizations tor a MAC- Organization Merges 

1398 Issued to a specific audience not posted to Internet/ Intranet due to 

Confidentiality of Instructions 

1399 Federally Qualified Health Centers Prospective Payment System- Recurring 

File Updates 

1400 Issued to a specific audience not posted to Internet/ Intranet due to Sensitivity 

of Instructions 

1401 Fee for Service Beneficiary Data Streamlining (FFS BDS)- Phase IIAuxiliary Data 

1402 Issued to a specific audience not posted to Intemet/ Intranet due to Sensitivity 

oflnstructions 

1403 Change in Applying Co-insurance and Lifetime Reserve (L TR) Amounts on 

Informational Only Claims with Condition Code (CC) 04 

1404 Modify the Daily Common Working File (CWF) to Medicare Beneticiary 

Database (MBD) File to no longer include Preventive Healthcarc Common 

Procedure Coding System (HCPCS) Codes that have been terminated. 

1405 Diagnosis Reporting on Home Health Claims Coding System (HCPCS) 

Codes that have been terminated. 

1406 Add Smoking Cessation Initial Session Date to the Common Working File 

(CWF) to Medicare Beneticimy Database (MBD) Extract File. 

1407 Inpatient Hospital Claims and Medicare Secondary Payer (MSP) Claims with 

Medicare Coinsurance Days and/or Medicare Lifetime Reserve Days 

Occurring in the Seventh or More Calendar Years- Analysis and Design 

Only 

1408 Fee for Service Beneficiary Data Streamlining (FFS BDS) Updates to 

Operational Issues 

1409 !DR Shared Systems Daily Claims Feeds Expansion to Accommodate 

Ambulance Data Elements 

1410 Instructions for Removing Logic Involving the IUR Implemented with 

CR8271 

1411 Removal of User-Controlled Effective Dale lu Apply Therapy Caps to Critical 

Access Hospital (CAH) Claims 

1412 Modifying FISS Part B Claims Overlap to CJIIIS-1592::!' ____ 

___ Medicare Remit Easy Print (MREP) Enhancement 

1414 Health Insurance Portability and Accountability Act (HIPAA) EDT Front End 

Updates for January 2015 

1415 Issued to a specific audience not posted to Internet/ Intranet due to Sensitivity 

of Instructions 

1416 Issued to a specitic audience not posted to Internet/ Intranet due to Sensitivity 

oflnstructions 

1417 Issued to a specific audience not posted to Internet/ Intranet due to Sensitivity 

of Instructions 

1418 Implement Operating Rules- Phase III ERA EFT: CORE 360 Uniform Use of 

Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark 

Codes (RARC) Rule- Update ftom CAQH CORE- July 1, 2014 version 3.1.1 

1419 Clarification of Remittance Advice Code Combination Reports Generated by 

Shared Systems 

1420 DMEPOS Competitive Bidding Program (CBP): Correction to VMS 

Processing of Wheelchair Accessory Clai

1421 Revised Modification to the Medically Ln

1422 Specific Modifiers for Distinct Procedura1421 lntemational Classification of Diseases, I 

Acknowledgement Testing with Provider

1424 !DR Shared Systems Daily Claims Feeds 

Medical Review Data Element 

1425 Issued to a specific audience, not posted t

Sensitivity of Instruction 

1426 Issued to a specific audience, not posted t

Sensitivity of lnstmction 

1427 Issued to a specific audience, not posted t

Sensitivity oflnstruction 

l42X Correction to Hospice Notice of Kevocati

1429 Fee for Service Beneficiary Data Streaml

Operational Issues 

25 Issued to a specific audience not posted to 

Confidentiality of Instructions 

26 Issued to a specific audience not posted to 

Confidentiality of Instructions 

27 Issued to a specific audience not posted to 

Confidentiality oflnstructions 

28 Issued to a specific audience not posted to 

Confidentiality of Instructions 

29 Issued to a specific audience not posted to 

Confidentiality of Instructions 

30 Issued to a specific audience not posted to 

Confidentiality oflnstructions 

31 Language-Only Changes for Updating IC

Pub 100-22, Chapters 1 and 2 

32 Coding and Reporting Principles for Clai

33 Issued to a speci fie audience not posted to 

Confidentiality of Instructions 

34 Issued to a specific audience not posted to 

ConJidentiality oflnstructions 

Addendum II: Regulation Doc

in the Federal Register (July throu

Regulations and Notices 

Regulations and notices are published 

Register. To purchase individual copies or sub

Register, contact GPO at 

copies, it is necessary to cite either the date of p

number and page number. 

EN14NO14.013</GPH>mstockstill on DSK4VPTVN1PROD with NOTICES

The Federal Register is available as an online database through 

GPO Access. The online database is updated by 6 a.m. each day the 

Federal Register is published. The database includes both text and 

graphics from Volume 59, Number 1 (January 2, 1994) through the present 

following website provides 

infonnation on how to access electronic editions, printed editions, and 

reference copies. 

This information is available on our website at: 

For questions or additional infonnation, contact Terri Plumb 

( 410-786-4481 ). 

Addendum III: CMS Rulings 

CMS Rulings are decisions of the Administrator that serve as 

precedent final opinions and orders and statements of policy and 

interpretation. They provide clarification and interpretation of complex or 

ambiguous provisions of the law or regulations relating to Medicare, 

Medicaid, Utilization and Quality Control Peer Review, private health 

insurance, and related matters. 

The rulings can be accessed at unp.11 vv wvv .L"'"·!:b"v' ''""'!:bmauu""-

For questions or additional infom1ation, 

contact Tiffany Lafferty ( 41 0-786-7548). 

Addendum IV: Medicare National Coverage Determinations 

(July through September 2014) 

Addendum IV includes completed national coverage 

determinations (NCDs ), or reconsiderations of completed NCDs, from the 

quarter covered by this notice. Completed decisions are identified by the 

section of the NCD Manual (NCDM) in which the decision appears, the 

title, the date the publication was issued, and the effective date ofthe 

decision. An NCD is a detennination by the Secretary for whether or not a 

particular item or service is covered nationally under the Medicare Program 

(title XVlll of the Act), but does not include a detennination of the code, if 

any, that is assigned to a particular covered item or service, or payment 

determination for a particular covered item or service. The entries below 

include information concerning completed decisions, as well as sections on 

program and decision memoranda, which also announce decisions or, in 

some cases, explain why it was not appropriate to issue an NCD. 

Infom1ation on completed decisions as well as pending decisions has also 

been posted on the CMS website. For the purp

we list only the specific updates that have occu

This information is available at: 

For questions or additional informat

(410-786-7491 ). 

Title NCDM Transmit

Section Number 

Cardiac Rehabilitation 

Programs -Chronic Heart NCD 20.10 Rl71 

Failure 

Bridge-toti Destination NCD20.9 RI72 

Ua..-..'""-t-;t-;.,r 

NCD210.13 R174 

Addendum V: FDA-Approved Category 

Exemptions (IDEs) (July through 

Addendum V includes listings of the F

investigational device exemption (IDE) number

listings are organized according to the categorie

assigned (that is, Category A or Category B), an

number. For the purposes of this quarterly noti

updates to the Category BIDEs as of the endin

by this notice and a contact person for question

For questions or additional information, contac

6877). 

Under the Food, Drug, and Cosmetic A

fall into one of three classes. To assist CMS un

process, the FDA assigns one of two categories 

investigational device exemption (IDE). Categ

IDEs, and Category B refers to non-experimentinfonnation about the classes or categories, ple

published in the April 21, 1997 Federal Regist

IDE Device 

G140004 INFUSE Bone Graft Gl40016 Veniti Vici Venous Stet System l2mm x 60m

x 90mm x IOOcm, 12mm x 120mm x !OOcm, 

I OOcm, 14mm x 60mm x 1 OOcm, 14mm x 12

16mm x 60mm x I OOcm, 16mm x 90mm x 1 

120mm x I OOcm 

EN14NO14.014</GPH>mstockstill on DSK4VPTVN1PROD with NOTICES

Gl40121 DLBCL IHC Classification PARHMDX Assay Gl40106 TEOSYAL RHA Ultradeep (TPUL) 

0140108 Repair of Complex Abdominal Aortic Aneurysms Using Custom 

Made Device (CMD) 

Gl40110 Ancora LLC lnterbody Fusion Device 

Gl40111 TransMedics Organ Care System-Heart; TransMedics Organ 

Care System Heart Console; TransMedics OCS Heart Perfusion 

Set; TransMcdics OCS Hcan Perfusion Module; TransMedics 

OCS Heart Solution Set 

Gl40113 THORATEC HEARTMATE lil LEFT VENTRICULAR 

ASSIST SYSTEM (L VAS) 

Gl40114 VLcAblate System 

G140116 Apollo Onyx Delivery Micro Catheter 

G140117 Protocol2013-0232: Pilot Study ofRobotic-Assisted Harvest Of 

The Latissimus Dorsi Muscles 

0140090 Lotus Valve System 

Gl40123 miraDry Svstem Gl40079 Therakos Cellex Photopheresis System 

0140124 Abbott Sensor Based Glucose Monitoring System -Personal and 

Pro 

Gl40132 Low Dose External Beam Irradiation 

Gl40131 Heterotopic lmplantatin of The Edwards-Sapien XT 

Transcatheter Valve in The Interim Vena Cava For 'T'he 

Treatment of Severe Tricuspid Regurgitation (Hover) Trial 

Gl40103 Boston Scientific Precision Plus Spinal Cord Stimulator System 

with Artisan Epidural Array 

0140135 NovoTTF-IOOA System 

Gl40138 LiteStream Balloon Expandable Vascular Covered Stent Gl40145 Barostim NEO Implantable Pulse Generator (lPG) Model 2 I 02, 

Barostim NEO Carotid Sinus Lead (CSL) Model1036 and 1037, 

Programmer System Model90!0 

0140139 Dako PD-L I 22C3 pharmDx kit 0140140 Spincology Intcrbody Fusion System (SIFS) 

Gl40141 Turbo-Elite RX Laser Athcrcctomy Catheters 410-154,4140159, 

417-156, 420-159; Turbo-Elite OJW Laser A1therectomy 

Catheters 410-1 SO, 414-152, 420-006, 423-001, 425-011 

(1140136 The Mitral Trial 

Gl40037 Extremity Exsanguination Device (EED) Gl30154 Exalherm-TBH 

0130282 Samfilcon A Soft (hydrophilic) Contact Lens 0140149 Bipolar-VI: Bipolar Catheter Ablation 

G140152 Novilase System 

0140098 Tablo Hemodialvsis Svstem 

Gl40153 High-Resolution MicroenJoseopy (HRME) in patienb with 

adenocarcinoma in-situ (AIS) of the cervix 

Gl40155 EPI Procolon 

G140157 Glucoclear System 

Gl40159 St Jude Medical Sti111u1ator (NITS) Syste111 

07/03/2014 07/09/2014 

07/16/2014 

07/14/2014 

07/23/2014 

07/24/2014 

07/25/2014 07/25/2014 

07/31/2014 

08/01/2014 08/07/2014 08/07/2014 08/08/2014 08/15/2014 08/20/2014 

08/22/2014 

08/22/2014 08/27/2014 

08/28/2014 

08/28/2014 08/28/2014 08/28/2014 09/04/2014 09/05/2014 09/05/2014 09/05/2014 09/08/2014 09/10/2014 09/11/2014 

09/12/2014 

09/17/2014 09/19/2014 09/19/2014 

Addendum VI: Approval Numbers for C

(July through Septembe

All approval numbers are available to 

Under the review process, approved informatio

assigned OMB control numbers. A single cont

several related information collections. This in

For qu

information, contact Mitch Bryman ( 410-786-5

Addendum VII: Medicare-Approved C

(July through Septembe

Addendum VII includes listings of Me

stent facilities. All facilities listed meet CMS s

carotid artery stenting for high risk patients. O

our decision memorandum on carotid artery ste

carotid artery stenting with embolic protection 

only if performed in facilities that have been de

performing the evaluation, procedure, and follo

optimal patient outcomes. We have created a l

facilities modeled in part on professional societ

All facilities must at least meet our standards in 

for carotid artery stenting for high risk patients

quarterly notice, we are providing only the spe

occurred in the 3-month period. This informat

For questions or additional information, contac

( 410-nl6-6322 ). 

290 I Swann Avenue Tampa FL 33609-4057 

FROM: University Hospital 

TO: UC Medical Center 

234 Goodman Street Cincinnati, OH 45219-2364 

P

N

4

3

EN14NO14.015</GPH>mstockstill on DSK4VPTVN1PROD with NOTICES

Facility Provider Effective State 

Number Date 

FROM: St. John's Regional Medical Center 260001 04/19/2005 MO 

TO: Mercy Hospital Joplin 

2817 St. John's Boulevard Joplin, MO 64804 

Addendum Vlll: 

American College of Cardiology's National Cardiovascular Data 

Registry Sites (July through September 2014) 

Addendum VIII includes a list of the American College of 

Cardiology's National Cardiovascular Data Registry Sites. We cover 

implantable cardioverter defibrillators (ICDs) for certain clinical 

indications, as long as information about the procedures is reported to a 

central registry. Detailed descriptions ofthe covered indications are 

available in the NCD. In January 2005, CMS established the ICD 

Abstraction Tool through the Quality Network Exchange (QNet) as a 

temporary data collection mechanism. On October 27, 2005, CMS 

announced that the American College of Cardiology's National 

Cardiovascular Data Registry (ACC-NCDR) lCD Registry satisfies the data 

reporting requirements in the NCO. Hospitals needed to transition to the 

ACC-NCDR lCD Registry by April2006. 

Effective January 27, 2005, to obtain reimbursement, Medicare 

NCD policy requires that providers implanting ICDs for primary prevention 

clinical indications (that is, patients without a history of cardiac arrest or 

spontaneous arrhythmia) report data on each primary prevention ICD 

procedure. Details of the clinical indications that are covered by Medicare 

and their respective data reporting requirements are available in the 

Medicare NCD Manual, which is on the CMS website at 

A provider can use either of two mechanisms to satisfY the data 

reporting requirement. Patients may be enrolled either in an Investigational 

Device Exemption trial studying ICDs as identified by the FDA or in the 

ACC-NCDR ICD registry. Therefore, for a beneficiary to receive a 

Medicare-covered ICD implantation for primary prevention, the beneficiary 

must receive the scan in a facility that participates in the ACC-NCDR ICD 

registry. The entire list of facilities that participate in the ACC-NCDR ICD 

registry can be found at 

For the purposes of this quarterly notice, we arc providing only the 

specific updates that have occurred in the 3-month period. This information 

is available by accessing our website and clicking on the link for the 

American College of Cardiology's National Ca

at: For ques

information, contact Marie Casey, BSN, MPH 

Baptist Health Medical Center 

Centinela Medical Center 

Providence Saint John's Health Center 

Interfaith Medical Center 

Putnam Community Medical Center 

Kearney Regional Medical Center 

Oak Bend Medical Center 

West Valley Medical Center 

Texas Regional Medical Center at Sunnyvale 

Banner Ogallala Community Hospital Pinnacle Health System: West Shore Hospital 

Emanuel Medical Center 

Huntsville Memorial 

Kaiser Foundation Hospital-Santa Rosa 

Weirton Medical Center 

Scott & White HealthCare-Round Rock 

Connecticut Children's Medical Center 

SSM Cardinal Glennon Children's Medical 

Campbell County Memorial 

Scott & White Hospital - College Station 

Guadalupe Regional Medical Center 

Addendum IX: Active CMS Coverage-Rel

(July through Septembe

There were no CMS coverage-related 

published in the July through September 2014 q

document, visit the CMS coverage website at 

information, contact JoAnna Baldwin ( 41 0-786

Addendum X: 

List of Special One-Time Notices Regard

Provisions (July through Sept

There were no special one-time notice

coverage provisions published in the July throu

EN14NO14.016</GPH>mstockstill on DSK4VPTVN1PROD with NOTICES

This information is available at For questions 

or additional infonnation, contact JoAnna Baldwin (410 786 7205). 

Addendum XI: National Oncologic PET Registry (NOPR) 

(July through September 2014) 

Addendum XI includes a listing of National Oncologic Positron 

Emission Tomography Registry (NOPR) sites. We cover positron emission 

tomography (PET) scans for particular oncologic indications when they are 

performed in a facility that participates in the NOPR. 

In January 2005, we issued our decision memorandum on positron 

emission tomography (PET) scans, which stated that CMS would cover 

PET scans for particular oncologic indications, as long as they were 

perfonned in the context of a clinical study. We have since recognized the 

National Oncologic PET Registry as one of these clinical studies. 

Therefore, in order for a beneficiary to receive a Medicare-covered PET 

scan, the beneficiary must receive the scan in a tacility that participates in 

the registry. There were no additions, deletions, or editorial changes to the 

listing ofNational Oncologic Positron Emission Tomography Registry 

(NOPR) in the July through September 2014 quarter. This infonnation is 

available at 

For questions or additional information, contact Stuart Caplan, RN, MAS 

( 41 0-786-8564). 

Addendum XII: Medicare-Approved Ventricular Assist Device 

(Destination Therapy) Facilities (July through September 2014) 

Addendum XII includes a listing of Medicare-approved facilities 

that receive coverage for ventricular assist devices (V ADs) used as 

destination therapy. All facilities were required to meet our standards in 

order to receive coverage for VADs implanted as destination therapy. On 

October 1, 2003, we issued our decision memorandum on VADs for the 

clinical indication of destination therapy. We determined that VA Ds used 

as destination therapy are reasonable and necessary only if performed in 

facilities that have been detennined to have the experience and 

infrastructure to ensure optimal patient outcomes. We established facility 

standards and an application process. All facilities were required to meet 

our standards in order to receive coverage for V ADs implanted as 

destination therapy. 

For the purposes of this quarterly notice, we are providing only the 

specific updates that have occurred to the list of Medicare-approved 

facilities that meet our standards in the 3-month 

available at 

For questions or additional infommtion, contac

(410-786-7861). 

Provider N

Memorial Regional Hospital I I 0-0038 

3501 Johnson Street Hollywood, FL 33021 

PeaceHealth Medical Center I 50-0030 

101 West 8th Avenue Sookane, WA 99220 

Addendum XIII: Lung Volume Reduc

(July through Septembe

Addendum XIII includes a listing of M

that are eligible to receive coverage tor lung vo

Until May 17, 2007, facilities that participated 

Treatment Trial were also eligible to receive co

types of facilities are eligible for reimbursemen

Reduction Surgery (LVRS): 

• National Emphysema Treatment Trial (N

05/07/2007, these will no longer automatically 

with the other programs); 

• Credentialed by the Joint Commission (

Commision on Accreditation ofHealthcare Org

their Disease Specific Certification Program fo

• Medicare approved for lung transplants. 

Only the first two types are in the list. 

the listing of facilities for lung volume reductio

July through September 2014 quarter. This inf

questions or additional information, contact Ma

(410-786-7861 ). 

Addendum XIV: Medicare-Approved Ba

(July through Septembe

Addendum XIV includes a listing of M

that meet minimum standards for facilities mod

society statements on competency. All facilitie

order to receive coverage for bariatric surgery p
BILLING CODE 4120–01–C 

[FR Doc. 2014–26989 Filed 11–13–14; 8:45 am] 


EN14NO14.017</GPH>mstockstill on DSK4VPTVN1PROD with NOTICES

2006, we issued our decision memorandum on bariatric surgery procedures. 

W c determined that bariatric surgical procedures are reasonable and 

necessary for Medicare beneficiaries who have a body-mass index (BMI) 

greater than or equal to 35, have at least one co-morbidity related to obesity 

and have been previously unsuccessful with medical treatment for obesity. 

This decision also stipulated that covered bariatric surgery procedures are 

reasonable and necessary only when performed at facilities that are: (I) 

certified by the American College of Surgeons (ACS) as a Levell Bariatric 

Surgery Center (program standards and requirements in effect on February 

15, 2006); or (2) certified by the American Society for Bariatric Surgery 

(ASBS) as a Bariatric Surgery Center of Excellence (BSCOE) (program 

standards and requirements in effect on February 15, 2006). 

There were no additions, deletions, or editorial changes to 

Medicare-approved facilities that meet CMS 's minimum facility standards 

for bariatric surgery that have been certified by ACS and/or ASMBS in the 

July through September 2014 period. This information is available at 

For 

questions or additional information, contact Jamie Hermansen 

( 410-786-2064). 

Addendum XV: FDG-PET for Dementia and Neurodegenerative 

Diseases Clinical Trials (July through September 2014) 

There were no FOG-PET for Dementia and Neurodegenerative 

Diseases Clinical Trials published in the July through September 2014 

quarter. 

This information is available on our website at 

For questions or additional information, contact Stuart Caplan, RN, MAS 

( 41 0-786-8564).