(Medicare Claims Processing Manual)

Medicare Claims Processing Manual  Chapter 32  Billing Requirements for Special Services   Table of Contents   (Rev. 1 2533; Issued:  03-07-24)     Transmittals for Chapter 32  10- Diagnostic Blood Pressure Monitoring 10.1 - Ambulatory Blood Pressure Monitoring (ABPM) Billing Requirements 11 - Wound Treatments 11.1  Electrical Stimulation  11.2  Electromagnetic Therapy  11.3  Autologous Platelet-Rich Plasma (PRP) for Chronic Non-Healing Wounds  11.3.1  Policy  11.3.2  Healthcare Common Procedure Coding System (HCPCS) Codes and Diagnosis Coding 11.3.3  Types of Bill (TOB)  11.3.5 - Place of Service (POS) for Professional Claims  11.3.6  Medicare Summary Notices (MSNs), Remittance Advice Remark Codes (RARCs), Claim Adjustment Reason Codes (CARCs) and Group Codes  12 -  Counseling to Prevent Tobacco Use             12.1 -  Counseling to Prevent Tobacco Use HCPCS and Diagnosis Coding 12.2 - Counseling to Prevent Tobacco Use A/B MAC (B) Billing Requirements  12.3 - A/B MAC (A)  Billing Requirements  12.4 - Remittance Advice (RA) Notices  12.5 - Medicare Summary Notices (MSNs)  12.6 - Post-Payment Review for Counseling To Prevent Tobacco Use Services  12.7 - Common Working File (CWF) Inquiry  12.8 - Provider Access to Counseling To Prevent Tobacco Use Services Eligibility Data  20  Billing Requirements for Coverage of Kidney Disease Patient Education Services  20.1  Additional Billing Requirements Applicable to Claims Submitted to Fiscal Intermediaries (FIs)  20.2 - Healthcare Common Procedure Coding System (HCPCS) Procedure Codes and Applicable Diagnosis Codes  20.3 - Medicare Summary Notices (MSNs) and Claim Adjustment Reason Codes (CARCs)  20.4 - Advance Beneficiary Notice (ABN) Information 30 - Hyperbaric Oxygen (HBO) Therapy  30.1  Billing Requirements for HBO Therapy for the Treatment of Diabetic Wounds of the Lower Extremities  30.2 Hyperbaric Oxygen (HBO) Therapy (Section C, Topical Application of Oxygen)  40  Sacral Nerve Stimulation  40.1  Coverage Requirements  40.2  Billing Requirements  40.2.1  Healthcare Common Procedural Coding System (HCPCS)  40.2.2  Payment Requirements for Test Procedures   (HCPCS Codes 64585, 64590 and 64595)  40.2.3  Payment Requirements for Device Codes A4290, E0752 and E0756                         40.2.4 -  Payment Requirements for Codes C1767, C1778, C1820, C1883 and  C1897  40.3  Bill Types  40.4  Revenue Codes  40.5 -  Claims Editing  50  Deep Brain Stimulation for Essential Tremor and Parkinsons Disease  50.1  Coverage Requirements  50.2  Billing Requirements  50.2.1  Part A Intermediary Billing Procedures  50.3  Payment Requirements  50.3.1 -  Part A Payment Methods  50.3.2  Bill Types  50.3.3  Revenue Codes  50.4  Allowable Codes  50.4.1  Allowable Covered Diagnosis Codes  50.4.2 -  Allowable Covered Procedure Codes  50.4.3  Healthcare Common Procedure Coding System (HCPCS)  50.5  Ambulatory Surgical Centers  50.6  Claims Editing for Intermediaries  50.7  Remittance Advice Notice for A/B MACs (A)  50.8  Medicare Summary Notices (MSN) Messages for Intermediaries  50.9  Provider Notification 60  Coverage and Billing for Home Prothrombin Time (PT/INR) Monitoring for Home Anticoagulation Management  60.1  Coverage Requirements  60.2  Intermediary Payment Requirements  60.2.1  Part A Payment Methods  60.3  Intermediary Billing Procedures  60.3.1  Bill Types  60.3.2  Revenue Codes  60.4  Intermediary Allowable Codes  60.4.1  Allowable Covered Diagnosis Codes  60.4.2  Healthcare Common Procedure Coding System (HCPCS) for Intermediaries  60.5  Carrier Billing Instructions  60.5.1 -  HCPCS for Carriers  60.5.2  Applicable Diagnosis Codes for A/B MACs (B)  60.6  Carrier Claims Requirements  60.7  Carrier Payment Requirements  60.8  Carrier and Intermediary General Claims Processing Instructions  60.12 -  Coverage for PET Scans for Dementia and Neurodegenerative Diseases  60.8.1  Remittance Advice Notices  60.8.2  Medicare Summary Notice (MSN) Messages  66 - National Coverage Determination (NCDs) services that are considered a significant cost for Medicare Advantage.   66.1  Institutional Billing for National Coverage Determination (NCDs) services that are considered a significant cost for Medicare Advantage  66.2  Services Identified as having Significant Cost for Medicare Advantage  67 - No Cost Claims  67.1 -  Practitioner Billing for No Cost Items  67.2 -  Institutional Billing for No Cost Items  67.2.1 -  Billing No Cost Items Due to Recall, Replacement, or Free Sample  68 - Investigational Device Exemption (IDE) Studies  68.1 -  Billing Requirements for Providers Billing for Routine Care Items and Services in Category A IDE Studie  68.2 -  Billing Requirements for Providers Billing for Category B IDE Devices and Routine Care Items and Services in Category B IDE Studies  68.4  Billing Requirements for Providers Billing Routine Costs of Clinical Trials Involving a Category B IDE  69 - Qualifying Clinical Trails  69.1 -  General  69.2 -  Payment for Qualifying Clinical Trial Services  69.3 -  Medical Records Documentation Requirements  69.4 -  Local Medical Review Policy  69.5 -  Billing Requirements -  General  69.6 -  Requirements for Billing Routine Costs of Clinical Trials  69.7 -  Reserved for Future Use  69.8 -  Handling Erroneous Denials of Qualifying Clinical Trial Services  69.9 -  Billing and  Processing Fee for Service Claims for Covered Clinical Trial Services Furnished to Managed Care Enrollees  69.10 -  CWF Editing Of Clinical Trial Claims For Managed Care Enrollees  69.11 -  Resolution of CWF UR 5232 Rejects  70 - Billing Requirements for Islet Cell Transplantation for Beneficiaries in a National Institutes of Health (NIH) Clinical Trial 70.1 -  Healthcare Common Procedure Coding System (HCPCS) Codes for Carriers  70.2 -  Applicable Modifier for Islet Cell Transplant Claims for Carriers  70.3 -  Special Billing and Payment Requirements for Carriers  70.4 -  Special Billing and Payment Requirements for A/B MACs (A)  70.5 -  Special Billing and Payment Requirements Medicare Advantage (MA) Beneficiaries  80  Billing of the Diagnosis and Treatment of Peripheral Neuropathy with Loss of Protective Sensation in People with Diabetes  80.1 -  General Billing Requirements  80.2 -  Applicable HCPCS Codes  80.3 -  Diagnosis Codes  80.4 -  Payment  80.5 -  Applicable Revenue Codes  80.6 -  Editing Instructions for A/B MACs (A)  80.7 -  CWF General Information  80.8 -  CWF Utilization Edits  90 - Stem Cell Transplantation  90.1 -  General  90.2 -  HCPCS and Diagnosis Coding -  ICD -9-CM Applicable  90.2.1 -  HCPCS and Diagnosis Coding for Stem Cell Transplantation -  ICD-10-CM Applicable  90.3 -  Non -Covered Conditions  90.4 -  Edits  90.5 -  Suggested MSN and RA Messages  90.6 -  Clinical Trials for Allogeneic Hematopoietic Stem Cell Transplantation  (HSCT) for Myelodysplastic Syndrome (MDS)  100  Billing Requirements for Expanded Coverage of Cochlear Implantation 100.1 A/B MACs (Part A)   Billing Procedures  100.1.1  Applicable Bill Types  100.1.2  Special Billing Requirements for A/B MACs (A) for Inpatient Billing  100.2   A/B MACs (Part A) Payment Requirements  100.3  A/B MACs (Part B) Billing  Procedures  100.4  Healthcare Common Procedural Coding System (HCPCS)  100.5  Claim Adjustment Reason Codes (CARCs), Remittance Advice Remark Codes (RARCs),   Group Codes, and Medicare Summary Notice (MSN) Messages  110 -  Coverage and Billing for Ultrasound Stimulation for Nonunion Fracture Healing 110.1 -  Coverage Requirements  110.2 -  Intermediary Billing Requirements  110.3 -  Bill Types  110.4 -  Carrier and Intermediary Billing Instructions  110.5 -  DMERC Billing Instructions  120 -  Presbyopia -Correcting (P -C IOLS) and Astigmatism- Correcting Intraocular Lenses (A -C IOLs) (General Policy Information)  120.1 -  Payment for Services and Supplies  120.2 -  Coding and General Billing Requirements  120.3 -  Provider Notification Requirements  120.4 -  Beneficiary Liability  130 -  External Counterpulsation (ECP) Therapy  130.1 -  Billing and Payment Requirements  130.2 -  Special Intermediary Billing and Payment Requirements  140 140 -  Cardiac Rehabilitation (CR) Programs, Intensive Cardiac Rehabilitation (ICR) Programs, and Pulmonary Rehabilitation (PR) Programs  On or After January 1, 2024   140.1  CR Program Services Furnished On or Before Dec. 31, 2009  140.1.1 -  Coding Requirements for CR Services Furnished On or Before Dec. 31, 2009              140.2   CR Program  Services  Effective for Dates of Service  On or After  January  1, 2024