(Medicare Claims Processing Manual)

70.3 -  TOPs Calculation for CY 2003  70.4 -  TOPs Calculation for CY 2004 and CY 2005  70.5 -  TOPs Calculation for CY 2006 -  CY 2008  70.6 -  Transitional Outpatient Payments (TOPs) for CY 2009 70.7 -  Transitional Outpatient Payments (TOPs) for CY 2010 through CY 2012 70.8 -  TOPs Overpayments  80 - Shared system Requirements to Incorporate Provider -Specific Payment -to-Cost Ratios into the Calculation of Interim Transitional Outpatient Payments Under OPPS  80.1 -  Background -  Payment -to-Cost Ratios  80.2 -  Using the Newly Calculated PCR for Determining Final TOP Amounts  80.3 -  Using the Newly Calculated PCR for Determining Interim TOPs  90 - Discontinuation of Value Code 05 Reporting  100 -  Medicare Summary Notice (MSN)  110 -  Procedures for Submitting Late Charges Under OPPS  120 -  General Rules for Reporting Outpatient Hospital Services  120.1 -  Bill Types Subject to OPPS   120.2 -  Routing of Claims  140 -  All-Inclusive Rate Hospitals  141 -  Maryland Waiver Hospitals  150 -  Hospitals That Do Not Provide Outpatient Services  160 -  Clinic and Emergency Visits  160.1- Critical Care Services  170 -  Hospital and CMHC Reporting Requirements for Services Performed on the Same Day  180 -  Accurate Reporting of Surgical and Medical Procedures  and Services  180.1 -  General Rules  180.2 -  Selecting and Reporting Procedure Codes  180.3 -  Unlisted Service or Procedure  180.4 -  Proper Reporting of Condition Code G0 (Zero)  180.5 -  Proper Reporting of Condition Codes 20 and 21 180.6 -  Emergency Room (ER) Services That Span Multiple Service Dates  180.7 -  Inpatient -only Services  190  Payer Only Codes Utilized by Medicare  200 -  Special Services  for OPPS Billing  200.1 -  Billing for Corneal Tissue  200.2 -  Hospital Dialysis Services For Patients with and without End Stage Renal Disease (ESRD)  200.3 -  Billing Codes fo r Intensity Modulated Radiation Therapy (IMRT) and Stereotactic Radiosurgery (SRS)  200.3.1 -  Billing Instructions for IMRT Planning and Delivery  200.3.2 -  Billing for Multi- Source Photon (Cobalt  60-Based) Stereotactic Radiosurgery (SRS) Planning and Delivery  200.4 -  Billing for Amniotic Membrane  200.5 -  Reserved  200.6 -  Billing and Payment for Alcohol and/or Substance Abuse Assessment and Intervention Services  200.7 -  Billing for Cardiac Echocardiography Services  200.7.1 -  Cardiac Echocardiography Without Contrast  200.7.2 -  Cardiac Echocardiography With Contrast  200.8 -  Billing for Nuclear Medicine Procedures  200.9 -  Billing for Sometimes Therapy Services that May be Paid as Non -Therapy Services for Hospital Outpatients  200.10 -  Billing for Cost Based Payment for Certified Registered Nurse Anesthetists (CRNA) Services Furnished by Outpatient Prospective Payment System (OPPS) Hospitals  200.11  Billing Advance Care P lanning (ACP)  230 -  Billing and Payment for Drugs and Drug Administration  230.1 -  Coding and Payment for Drugs and Biologicals  and Radiopharmaceuticals  230.2 -  Coding and Paym ent for Drug Administration   231 -  Billing and Payment for Blood, Blood Products, and Stem Cells and Related Services Under the Hospital Outpatient Prospective Payment System (OPPS)  231.1 -  When a Provider  Paid Under the OPPS Does Not Purchase the Blood or Blood Products That It Procures from a Community Blood Bank, or When a Provider Paid Under the OPPS Does Not Assess a Charge for Blood or Blood Products Supplied by the Providers Own Blood Bank Other Tha n Blood Processing and Storage  231.2 -  When a Provider Paid Under the OPPS Purchases Blood or Blood Products from a Community Blood Bank or When a Provider Paid Under the OPPS Assesses a Charge for Blood or Blood Products Collect ed By Its Own Blood Bank That Reflects More Than Blood Processing and Storage  231.3 -  Billing for Autologous Blood (Including Salvaged Blood) and Directed Donor Blood  231.4 -  Billing for Split Unit of B lood 231.5 -  Billing for Irradiation of Blood Products  231.6 -  Billing for Frozen and Thawed Blood and Blood Products  231.7 -  Billing for Unused Blood  231.8 -  Billing for Transfusion Services  231.9 -  Billing for Pheresis and Apheresis Services  231.10 -  Billing for Autologous Stem Cell Transplants  231.11 -  Billing for Allogeneic Stem Cell Transplants  231.12 -  Correct Coding Initiative (CCI) Edits  240 -  Inpatient Part B Hospital Services  240.1 -  Editing of Hospital Part B Inpatient Services : Reasonable and Necessary Part A Hospital Inpatient Denials  240.2 -  Editing Of Hospital Part B Inpatient Services: Other Circumstances in Which Payment Cannot Be Made under Part A  240.3 -  Implantable Prosthetic Devices  240.4 -  Indian Health Service/Tribal Hospital Inpatient Social Admits  240.5 -  Payment of Part B Services in the Payment Window for Outpatient Services Treated as Inpatient Services when Part A Payment Cannot Be Made  240.6 -  Submitting Provider -Liable No -Pay Part A Claims and Beneficiary Liability  250 -  Special Rules for Critical Access Hospital Outpatient Billing  250.1 -  Standard Method -  Cost -Based Facility Services, With Billing of A/B MAC (B) for Professional Services  250.1.1 -  Special Instructions for Non- covered Time Increments in Standard Method Critical Access Hospitals (CAHs)  250.2 -  Optional Method for Outpatient Services: Cost -Based Facility Services Plus 115 percent Fee Schedule Payment for Professional Services  250.2.1 -  Billing and Payment in a  Physician Scarcity Area (PSA)  250.2.2 -  Zip Code Files  250.3 -  Payment for Anesthesia in a Critical Access Hospital 250.3.1 -  Anesthesia File  250.3.2 -  Physician Rendering Anesthesia in a Hospital Outpatient Setting   250.3.3 -  Anesthesia and CRNA Services in a Critical Access Hospital (CAH)  250.3.3.1 -  Payment for CRNA Pass -Through Services  250.3.3.2 -  Payment for Anesthesia Services by a CRNA (Method II CAH only)  250.4 -  CAH Outpatient Services Part B Deductible and Coinsurance  250.5 -  Medicare Payment for Ambulance Services Furnished by Certain CAHs  250.6 -  Clinical Diagnostic Laboratory Tests Furnished by CAHs  250.7 -  Payment for Outpatient Services Furnished by an Indi an Health Service (IHS) or Tribal CAH  250.8 -  Coding for Administering Drugs in a Method II CAH  250.8.1 -  Coding for Low Osmolar Contrast Material (LOCM)  250.8.2 -  Coding for the Administration of Other Drugs and Biologicals  250.9 -  Coding Assistant at Surgery Services Rendered in a Method II CAH  250.9.1 -  Use of Payment Policy Indicators for Determining Procedures Eli gible for Payment of Assistants at Surgery  250.9.2 -  Payment of Assistant at Surgery Services Rendered in a Method II CAH  250.9.3 -  Assistant at Surgery Medicare Summary Notice (MSN) and Remittance Advice (RA) Messages  250.9.4 -  Assistant at Surgery Services in a Method II CAH Teaching Hospital 250.9.5 -  Review of Supporting Documentation for Assistants at Surgery Services in a Method II CAH  250.10 -  Coding Co- surgeon Services Rendered in a Method II CAH  250.10.1 -  Use of Payment Policy Indicators for Determining Procedures Eligible for Payment of Co- surgeons  250.10.2 -  Payment of Co- surgeon Services Rendered in a Method II CAH  250.10.3 -  Co-surgeon Medicare Summary Notice (MSN) and Remittance Advice (RA) Messages  250.10.4 -  Review of Supporting Documentation for Co- surgeon Services in a Method II CAH 250.11 -  Coding Bilateral Procedures Performed in a Method II CAH  250.11.1 -  Use of Payment Policy Indicators for Determining Bilateral Procedures Eligible for 150 Percent Payment Adjustment  250.11.2 -  Payment of Bilateral Procedures Rendered in a Method II CAH  250.12 -  Primary Care Incentive Payment Program (P CIP) Payments to Critical Access Hospitals (CAHs) Paid Under the Optional Method 250.12.1 -  Definition of Primary Care Practitioners and Primary Care Services  250.12.2 -  Identifying Services Eligible for the PCIP  250.12.3 -  Coordination with Other Payments  250.12.4 -  Claims Processing and Payment for CAHs Paid Under the Optional Method 250.13 -  Health Profession al Shortage Areas (HPSA) Surgical Incentive Payment Program (HSIP) for Surgical Services Rendered in Critical Access Hospitals (CAHs) Paid under the Optional Method 250.13.1 Overview of the HSIP  250.13.2  - HPSA Identification   250.13.3 -  Coordination with Other Payments  250.13.4 -  General Surgeon and Surgical Procedure Identification for Professional Services Paid under the Physician Fee Schedule (PFS)  250.13.5 -  Claims Processing and Payment  250.14 -  Payment of Licensed Clinical Social Workers (LCSWs) in a Method II CAH  250.15 -  Coding and Payment of Mul tiple Surgeries Performed in a Method II CAH  250.16 -  Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Imaging Procedures Rendered by Physicians  250.17 -  Payment of Global Surgical Sp lit Care in a Method II CAH Submitted with Modifier 54 and/or 55 260 -  Outpatient Partial Hospitalization Services  260.1 -  Special Partial Hospitalization Billing Requirements for Hospitals, Community Mental Health Centers, and Critical Access Hospitals  260.1.1 -  Bill Review for Partial Hospitalization Services Received in Community Mental Health Centers (CMHC)  260.2 -  Professional Services Related to Partial Hospitalization  260.3 -  Outpatient Mental Health Treatment Limitation for Partial Hospitalization Services  260.4 -  Reporting Service Units for Partial Hospitalization  260.5 -  Line Item Date of Service Reporting for Partial Hospitalization  260.6 -  Payment for Partial Hospitalization Services  270 -  Billing for Hospital Outpatient Services Furnished by Clinical Social Workers (CSW)  270.1 -  Fee Schedule to be Used for Payment for CSW Services  270.2 -  Outpatient Mental Health Payment Limitation for CSW Services  270.3 -  Coinsur ance and Deductible for CSW Services  280 -  Hospital -Based Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Billing for Non RHC/FQHC Services  290 -  Outpatient Observation Services  290.1 -  Observation Services Overview  290.2 -  General Billing Requirements for Observation Services  290.2.1 -  Revenue Code Reporting 290.2.2 -  Reporting Hours of Observation  290.4 -  Billing and Payment for Observation Services Furnished Between January 1, 2006 and December 31, 2007  290.4.1 -  Billing and Payment for All Hospital Observation  Services Furnished Between January 1, 2006 and December 31, 2007  290.4.2 -  Separate and Packaged Payment for Direct Referral for Observation Services Furnished Between January 1, 2006 and December 31, 2007  290.4.3 -  Separate and Packaged Payment for Observation Services Furnished Between January 1, 2006 and December 31, 2007  290.5 -  Billing and Payment for Observation Services Furnished on or After January 1, 2008   290.5.1 -  Billing and Payment for Observation Services Furnished Between January 1, 2008 and December 31, 2015  290.5.2 -  Billing and Payment for Direct Referral for Observation Care Furnished Beginning January 1, 2008  290.5.3 -  Billing and Payment for Observation Services Furnished Beginning January 1, 2016  290.6 -  Services Not Covered as Observation Services  300 -  Medical Nut rition Therapy (MNT) Services  300.1 -  General Conditions and Limitations on Coverage  300.2 -  Referrals for MNT Services  300.3 -  Dietitians and Nutritionists Performing MNT Services  300.4 -  Payment for MNT Services  300.5 -  General Claims Processing Information