(Medicare Claims Processing Manual Crosswalk)

Medicare Claims Processing Manual Chapter 12 - Physicians/Nonphysician Practitioners Crosswalk Crosswalk Chap.                              Sect. Int.Pub. 13 Carrier Pub. 14-3 PMs Description12 10 B3-2020 General12 20  B3-15000  Medicare Physicians Fee Schedule (MPFS) 12 20.1  B3-15006  Method for Computing Fee Schedule Amount 12 20.2    Relative Value Units (RVUs) 12 20.3 B3-15010 Bundled Services/Supplies12 20.4  B3-15024  Summary of Adjustments to Fee Schedule Computations 12 20.4.1  B3-15032  Participating Versus Nonparticipating Differential 12 20.4.2  B3-15036  Site of Service Payment Differential 12 20.4.3  B3-15044  Assistant at Surgery Services 12 20.4.4 B3-15900.2 Supplies12 20.4.5 B3-15055 Allowable Adjustments12 20.4.6  B3-15028  Payment Change Due to Unusual Circumstances (Modifier 52)Chap. Sect. Int. Pub. 13 Carrier Pub. 14-3 PMs Description (Modifier 52) 12 20.5  B3-15054  No Adjustments in Fee Schedule Amounts 12 20.6  B3-15058 B-03-007 Update Factor for Fee Schedule Services 12 20.7  B3-15064  Comparability of Payment Provision of Delegation of Authority By CMS to Railroad Retirement Board 12 30  B3-15068  Correct Coding Policy 12 30.1  B3-15100  Digestive System (Codes 40000-49999) 12 30.2  B3-15200  Urinary and Male Genital Systems (Codes 50010-55899) 12 30.3  B3-15300  Otolaryngology and Audiology/Speech/Language Tests and Treatments (Codes V5299, V5362-V5364, 69000-69979, and 92502-92599) 12 30.4  B3-15360  Echocardiography Services (Codes 93303 - 93350) 12 30.5  B3-15400  Chemotherapy Administration (Codes 96400-96549) 12     30.6 B3-15501-  B3-15501.1  Evaluation and Management Service Codes - General (Codes 99201-99499) 12 30.6.1    Selection of Level of Evaluation and Management Service 12 30.6.2    Billing for Medically Necessary Visit on Same Occasion as Preventive Medicine Service Chap. Sect. Int. Pub. 13 Carrier Pub. 14-3 PMs Description 12 30.6.3  B3-4820 - 4824  Payment for Immunosuppressive Therapy Management 12 30.6.4     E and M Services Furnished Incident to Physicians Service by Nonphysician Practitioners 12     Physicians in Group Practice 12 30.6.6  B3-4820 - 4824  Payment for Evaluation and Management Services Provided During Global Period of Surgery 12 30.6.7  B3-15502  Payment for Office/Outpatient Visits (Codes 99201-99215) 12 30.6.8  B3-15504  Payment for Hospital Observation Services (Codes 99217-99220) 12 30.6.9  B3-15505 -     B3-15505.2  Payment for Inpatient Hospital Visits - General (Codes 99221 - 99239) 12 30.6.9.1    Payment for Initial Hospital Care Services (Codes 99221 - 99223) 12 30.6.9.2    Subsequent Hospital Visit and Hospital Discharge Management (Codes 99231-99239) 12 30.6.10  B3-15506  Consultations (Codes 99241 - 99275) 12 30.6.11  B3-15507  Emergency Department Visits (Codes 99281-99288) 12 30.6.12  B3-15508  Critical Care Visits and Neonatal Intensive Care (Codes 99291-99292) Chap. Sect. Int. Pub. 13 Carrier Pub. 14-3 PMs Description 12               30.6.13 B3-15509 -    B3-15509.1  Nursing Facility Visits (Codes 99301-99313) 12 30.6.14  B3-15510  Home Care and Domiciliary Care Visits (Codes 99348-99349) 12 30.6.15  B3-15511 -      B3-15511.3  Prolonged Services and Standby Services (Codes 99354-99360) 12 30.6.15.1    Prolonged Services (Codes 99354  99359) (ZZZ codes) 12 30.6.15.2    Prolonged Services Without Face-to-Face Service (Codes 99358-99359) 12 30.6.15.3    Physician Standby Service (Code 99360) 12 30.6.16  B3-15512  Case Management Services (Codes 99362 and 99371-99373) 12 30.6.17 B3-15515,B3-15066  Home Services (Codes 99341 - 99350) 12 40  B3-4820  Surgeons and Global Surgery 12 40.1 B3-4821,B3-15900.2, B3-15011,  B3-4820-  B3-4831  Definition of a Global Surgical Package 12 40.2  B3-4822  Billing Requirements for Global Surgeries Chap. Sect. Int. Pub. 13 Carrier Pub. 14-3 PMs Description 12 40.3  B3-4823  Claims Review for Global Surgeries 12                        40.4 B3-4824, B3-4825,B3-7100-B3-7120.7  Adjudication of Claims for Global Surgeries 12 40.5 B3-4825 Postpayment Issues12 40.6 B3-4826, B3-15038,B3-15056, B3-4826  Claims for Multiple Surgeries 12 40.7  B3-4827, B3-15040  Claims for Bilateral Surgeries 12 40.8  B3-4828, B3-15046  Claims for Co-Surgeons and Team Surgeons 12 40.9  B3-4829  Procedures Billed With Two or More Surgical Modifiers 12 50 B3-4830, B3-15018.B3-15018.K,  B3-4830C,  B3-4830D  Payment Conditions for Anesthesiology Services 12 60 B3-15020 AB-01-47   (CR1499) Payment Conditions for Pathology Services 12 70  B3-15022  Payment Conditions for Radiology Services 12 80  B3-15014  Services of Physicians Furnished in Providers or to Patients of Providers 12 80.1  B3-2220  Coverage of Physicians' Services Provided in Com prehensive Outpatient Rehabilitation FacilityChap. Sect. Int. Pub. 13 Carrier Pub. 14-3 PMs Description Comprehensive Outpatient Rehabilitation Facility 12 80.2  B3-2260- B3-2260.3  Rural Health Clinic and Federally Qualified Health Center Services 12 80.3  B3-15026  Unusual Travel (CPT Code 99082) 12 90    Physicians Practicing in Special Settings 12 90.1  B3-2020.5  Physicians in Federal Hospitals 12 90.2    Physician Billing for End-Stage Renal Disease Services 12                     90.2.1 B3-1506.2 -B3-15062.1  Inpatient Hospital Visits with Dialysis Patients 12 90.3 B3-2265,B3-2265.4  Physicians' Services Performed in Ambulatory Surgical Centers (ASC) 12 90.4 B3-3350,B3-15052  Billing and Payment in a Health Professional Shortage Areas (HPSAs) 12 90.4.1  B3-3350.1  Informing the Physician Community 12 90.4.2  B3-3350.2  Detailing HPSA Locations 12 90.4.3  B3-3350.3  Claims Coding Requirements 12 90.4.4 B3-3350.4 Payment12 90.4.5  B3-3350.5  Services Eligible for HPSA Bonus Payments Chap. Sect. Int. Pub. 13 Carrier Pub. 14-3 PMs Description 12                                           90.4.6 B3-3350.6 Remittance Messages12 90.4.7 B3-3350.7 Postpayment Review12 90.4.8 B3-3350.8,B3-13320,  B3-13320.1,  B3-13322.3 Reporting12 100  B3-2020.7, B3-8201,  B3-15016  Teaching Physician Services 12 100.1    Payment for Physician Services in Teaching Settings Under the MPFS 12 100.1.1    Evaluation and Management (E/M) Services 12 100.1.2 Surgical Procedures12 100.1.3 Psychiatry12 100.1.4 Time-Based Codes12 100.1.5    Other Complex or High-Risk Procedures 12 100.1.6 Miscellaneous12 100.1.7  B3-15016  Assistants at Surgery in Teaching Hospitals 12 100.1.8  B3-8204, B3-15016  Physician Billing in the Teaching Setting Chap. Sect. Int. Pub. 13 Carrier Pub. 14-3 PMs Description 12 100.2  B3-2020.8, B3-8030  Interns and Residents 12