(Medicare Claims Processing Manual)

50 - Outpatient PRICER  50.1 -  Outpatient Provider Specific File  50.2 -  Deductible Application  50.3 -  Transitional Pass -Through Payments for Designated Devices  50.4 -  Changes to Pricer Logic Effective April 1, 2002 50.5 -  Changes to the OPPS Pricer Logic Effective January 1, 2003  50.6 -  Changes to the OPPS Pricer Logic Effective January 1, 2003 Through  January 1, 2006  50.7-  Annual Updates to the OPPS Pricer for Calendar Year (CY) 2007 and Later  50.8 -  Annual Updates to the OPPS Pricer for Calendar Year (CY) 2007 and Later  60 - Billing for Devices Eligible for Transitional Pass -Through Payments and Items Classified in New Technology APCs  60.1 -  Categories for Use in Coding Devices Eligible for Transitional Pass -Through Payments Under the Hospital OPPS  60.2 -  Roles of Hospitals, Manufacturers, and CMS in Billing for Transitional Pass-Through Items  60.3 -  Devices Eligible for Transitional Pass -Through Payments  60.4 -   General Coding and Billing Instructions and Explanations                                     60.4.1 -  Explanations of Terms  60.4.2 -  Complete List of Device Pass -through Category Codes  60.4.3. -  Explanations of Certain Terms/Definitions Related to Device Pass -Through Category Codes  60.5 -  Services Eligible for New Technology APC Assignment and Payments  61 - Billing for Devices under the OPPS  61.1 -  Requirements that Hospitals Report Device Codes on Claims on Which They Report Specified Procedures  61.2 -  Edits for Claims on Which Specified Procedures are to be Reported With Device Codes and For Which Specified Devices are to be Reported With Procedure Codes  61.2.1  Bypass Edit Modifier CG for Claims on Which Specified Procedures are to be Reported With Device Codes  61.3 -  Billing for Devices Furnished Without Cost to an OPPS Hospital or Beneficiary or for Which the Hospital Receives a Full or Partial Credit and Payment for OPPS Services Required to Furnish the Device  61.3.1 -  Reporting and Charging Requirements When a Device is Furnished Without Cost to the Hospital  Prior to January 1, 2014  61.3.2 -  Reporting and Charging Requirements When the Hospital Receives Full Credit for the Replaced Device against the Cost of a More Expensive Replacement Device Prior to January 1, 2014 61.3.3 -  Reporting Requirements When the Hospital Receives Partial Credit for the Replaced Device Prior to January 1, 2014 61.3.4 -  Medicare Payment Adjustment  Prior to January 1, 2014  61.3.5 -  Reporting and Charging Requirements When a Device is Furnished Without Cost to the Hospital or When the Hospital Receives a Full or Partial Credit for the Replacement Device Beginning January 1, 2014 61.3.6 -  Medicare Payment Adjustment Beginning January 1, 2014  61.4 -  Billing and Payment for Brachytherapy Sources  61.4.1 -  Billing for Brachytherapy Sources -  General  61.4.2 -  Definition of Brachytherapy Source for Separate Payment  61.4.3 -  Billing of Brachytherapy Sources Ordered for a Specific Patient  61.4.4 -  Billing for Brachytherapy Source Supervision, Handling and Loading Costs  61.4.5 -  Payment for New Brachytherapy Sources  61.5 -  Billing for Intracoronary Stent Placement  70 - Transitional Corridor Payments  70.1 -  TOPs Calculation for CY 2000 and CY 2001 70.2 -  TOPs Calculation for CY 2002  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 for 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 Planning (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 Payment 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 Than 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 Collected 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 Blood  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 Indian 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 Eligible 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