(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 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 O wn 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 in a Method II CAH  250.12 -  Primary Care Incentive Payment Program (PCIP) 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 Professional 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), Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs)  in a Method II CAH 250.15 -  Coding and Payment of Multiple 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 Split 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                                                          261 -  Intensive Outpatient Program Services  261.1 -  Special Intensive Outpatient Program Billing Requirements for Hospitals, Community Mental Health Centers, and Critical Access Hospitals  261.1.1 -  Bill Review for Intensive Outpatient Program Services Received in Community Mental Health Centers (CMHC)  261.2 -  Professional Services Related to Intensive Outpatient Program  261.3 -  Outpatient Mental Health Treatment Limitation for Intensive Outpatient Program Services  261.4 -  Reporting Service Units for Intensive Outpatient Program  261.5 -  Line Item Date of Service Reporting for Intensive Outpatient Program  261.6 -  Payment for Intensive Outpatient Program Services