(Medicare Claims Processing Manual)

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                          140.2.1  Coding Requirements for CR Services Furnished On or After January 1, 2010  140.2.2 -  Claims Processing Requirements for Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Services Furnished On or After January 1, 2010 140.2.2.1  Correct Place of Service (POS) Codes for CR and ICR Services on Professional Claims  140.2.2.2  Requirements for CR and ICR Services on Institutional Claims  140.2.2.3  Frequency Edits for CR and ICR Claims  140.2.2.4  Edits for CR Services Exceeding 36 Sessions  140.2.2.5  Edits for ICR Services Exceeding 126 Days and 72 Sessions  140.2.2.6  Supplier Specialty Code 31 Requirements for ICR Claims  140.3  ICR Program Services  Effective for Dates of Service On or After January 1, 2024 140.3.1  Coding Requirements for ICR Services Furnished On or After January 1, 2010  140.4  PR Program Services Effective for Dates of Service On or After January 1, 2024 140.4.1  Coding Requirements for PR Services Furnished On or After January 1, 2010  140.4.2 -  Claims Processing Requirements for Pulmonary Rehabilitation (PR) Services Furnished On or After January 1, 2010  140.4.2.1  Correct Place of Service (POS) Codes for PR Services on Professional Claims  140.4.2.2  Requirements for PR Services on Institutional Claims  140.4.2.3  Daily Frequency Edits for PR Claims  140.4.2.4  Edits for PR Services Exceeding 36 Sessions  140.4.2.5  Edits for PR Services Exceeding 72 Sessions  150 -  Billing Requirements for Bariatric Surgery for Morbid Obesity  150.1 -  General  150.2 -  HCPCS Procedure Codes for Bariatric Surgery  150.3 -  ICD Procedure Codes for Bariatric Surgery for Treatment of Co -Morbid Conditions Related to Morbid Obesity (A/MACs only)  150.4 -  ICD Diagnosis Codes for Bariatric Surgery 150.5 -  ICD Diagnosis Codes for BMI  35 150.5.1  ICD Codes for Type II Diabetes Mellitus Complication  150.6 -  Claims Guidance for Payment  150.7 -  Medicare Summary Notices (MSNs) and Claim Adjustment Reason Codes  150.8 -  B/MAC Billing Requirements  150.9 -  Advance Beneficiary Notice and HINN Information 160  PTA for Implanting the Carotid Stent  160.1  Category B Investigational Device Exemption (IDE) Study Coverage  160.2  Post -Approval Study Coverage  160.2.1  Carotid Artery Stenting (CAS) Post -Approval Extension Studies  160.3  Carotid Artery Stenting (CAS) With Embolic Protection Coverage  160.4  510k Post -Approval Extension Studies using 510k- Cleared Embolic Protection Devices during Carotid Artery Stenting (CAS) Procedures  161 -  Intracranial PTA With Stenting  170 -  Billing Requirements for L umbar Artificial Disc Replacement  170.1 -  General  170.2 -  Carrier Billing Requirements  170.3 -  A/B MAC (A) Billing Requirements  170.4 -  Reasons for Denial and Medicare Summary Notice (MSN), Claim Adjustment Reason Code Messages  and Remittance Advice Remark Code  170.5 -  Advance Beneficiary Notice (ABN and Hospital Issued Notice of Noncoverage (HINN) Information 180  Cryosurgery of the Prostate Gland  180.1  Coverage Requirements  180.2  Billing Requirements  180.3  Payment Requirements  180.4 -  Claim Adjustment Reason Codes, Remittance Advice Remark Codes, Group Codes, and Medicare Summary Notice Messages  180.5  Additional CWF and Contractor Requirements  190  Billing Requirements for Extracorporeal Photopheresis  190.1 -  Applicable Intermediary Bill Types  190.2 -  Healthcare Common Procedural Coding System (HCPCS), Applicable Diagnosis Codes and Procedure Code  190.3 -  Medicare Summary Notices (MSNs), Remittance Advice Remark Codes (RAs) and Claim Adjustment Reason Coded 190.4 -  Advance Beneficiary Notice and Hospital Issued Notice of Noncoverage Information  200 -  Billing Requirements for Vagus Nerve Stimulation (VNS)  200.1 -  General  200.2 -  ICD-9 Diagnosis Codes for Vagus Nerve Stimulation (Covered since DOS on and after July 1, 1999)  200.3 -  Carrier/MAC Billing Requirements  200.4 -  Fiscal Intermediary Billing Requirements  200.5 -  Medicare Summary Notice (MSN), Remittance Advice Remark Code (RARC) and Claims Adjustment Reason Code (CARC) Messages  200.6 -  Advance Beneficiary Notice and HINN Information 210  Billing Requirements for Continuous Positive Airway Pressure (CPAP) for Obstructive Sleep Apnea (OSA)  220  Billing Requirements for Thermal Intradiscal Procedures (TIPs) Claims  220.1 -  General  220.2 -  Contractors, A/B Medicare Administrative Contractors (MACs)  220.3 -  Medicare Summary Notice (MSN), Claim Adjustment Reason Code (CARC), and Remittance Advise Remark Code (RARC)  220.4 -  Advanced Beneficiary Notice (ABN)  230 -  Billing Wrong Surgical or Other Invasive Procedures Performed on a Patient, Surgical or Other Invasive Procedures Performed on the Wrong Body Part, and Surgical or Other Invasive Procedures Performed on the Wrong Patient  240  Special Instructions for Certain Claims with a Gender/Procedure Conflict 240.1 -  Billing Instructions for Institutional Providers  240.2  Billing Instructions for Physicians and Non- Physician Practitioners  250  Pharmacogenomic Testing for Warfarin Response  250.1  Coverage Requirements  250.2  Billing Requirements  250.3  Payment Requirements  260  Dermal Injections for Treatment of Facial Lipodystophy Syndrome (FLS)  260.1  Policy  260.2  Billing Instructions  260.2.1  Hospital Billing Instructions  260.2.2.  Practitioner Billing Instructions  260.3  Claims Processing System Editing  270 -  Claims Processing for Implantable Automatic Defibrillators  270.1 -  Coding Requirements for Implantable Automatic Defibrillators  270.2 -  Billing Requirements for Patients Enrolled in a Data Collection System 280  Autologous Cellular Immunotherapy Treatment of Metastatic Prostate Cancer  280.1 -  Policy  280.2  Healthcare Common Procedure Coding System (HCPCS) Codes and Diagnosis Coding 280.3 -  Types of Bill (TOB) and Revenue Codes  280.4 -  Payment Method 280.5 -  Medicare Summary Notices (MSNs), Remittance Advice Remark Codes (RARCs), Claims Adjustment Reason Codes (CARCs), and Group Codes  290 -  Transcatheter Aortic Valve Replacement (TAVR) Furnished on or After May 1, 2012  290.1 -  Coding Requirements for TAVR Furnished on or After May 1, 2012, through December 31, 2012  290.1.1-  Coding Requirements for TAVR Services Furnished On or After January 1, 2013 290.2 -  Claims Processing Requirements for TAVR Services on Professional Claims  290.3 -  Claims Processing Requirements for TAVR Services on Inpatient Hospital Claims  290.4 -  Claims Processing Requirements for TAVR Services for Medicare Advantage (MA) Plan Participants  300 -  Billing Requirements for Ocular Photodynamic Therapy (OPT) with Verteporfin 300.1 -  Coding Requirements for OPT with Verteporfin 300.2 -  Claims Processing Requirements for OPT with Verteporfin Services on Professional Claims and Outpatient Facility Claims  300.3 -  Claims Processing Requirements for OPT with Verteporfin Services on Inpatient Facility Claims  300.4 -  Medicare Summary Notice (MSN) and Remittance Advice (RA)  Messages  310 -  Transesophageal Doppler Used for Cardiac Monitoring 310.1  Coding Requirements for Transesophageal Doppler Cardiac Monitoring Furnished Before October 1, 2012 310.2  Coding Requirements for Transesophageal Doppler Monitoring Furnished On or After October 1, 2012  310.3  Correct Place of Service (POS) Code for Transesophageal Doppler Cardiac Monitor Services on Professional Claims  320 -  Artificial Hearts and Related Devices  320.1  Coding Requirements for Artificial Hearts Furnished Before May 1, 2008 320.2  Coding Requirements for Artificial Hearts Furnished After May 1, 2008 320.3  Ventricular Assist Devices (VADs)  320.3.1  Postcardiotomy 320.3.2  Bridge - to-Transplantation (BTT)  320.3.3  Other  320.3.4  Replacement Accessories and Supplies for External VADs or Any VAD  330  Percutaneous Image- guided Lumbar Decompression (PILD) for Lumbar Spinal Stenosis (LSS)   330.1  Claims Processing Requirements for Percutaneous Image -guided Lumbar Decompression (PILD) for Lumbar Spinal Stenosis (LSS) on Professional Claims  330.2 -  Claims Processing Requirements for PILD for Outpatient Facilities  340  Transcatheter Mitral Valve Repair (TMVR)  340.1  Coding Requirements for TMVR for Mitral Valve TEER  Claims Furnished on or After August 7, 2014  340.2  Claims Processing Requirements for Mitral Valve TEER  Services on Professional Claims  340.3 -  Claims Processing Requirements for Mitral Valve TEER  Services on Inpatient Hospital Claims  340.4 -  Claims Processing Requirements for  Mitral Valve TEER  Services for Medicare Advantage (MA) Plan Participants  350 -  Emergency and Foreign Hospital Services  350.1 -  Services Rendered By Nonparticipating Providers  350.2 -  Establishing an Emergency  350.3 -  Qualifications of an Emergency Services Hospital  350.4 -  Coverage Requirements for Emergency Hospital Services Furnished Outside of the United States  350.5 -  Services Furnished in a Foreign Hospital Nearest to Beneficiary's U.S. Residence  350.6 -  Coverage of Physician and Ambulance Services Furnished Outside U.S. 350.7 -  Claims for Services Furnished in Canada to Qualified Railroad Retirement Beneficiaries  350.8 -  Claims from Hospital- Leased Laboratories Not Meeting Conditions of Participation  350.9 -  Nonemergency Part B Medical and Other Health Services  350.10 -  Elections to Bill for Services Rendered By Nonparticipating Hospitals  350.11 -  Processing Claims  350.11.1 -  Contractors Designated to Process Foreign Claims  350.11.2 -  Contractor Processing Guidelines  350.11.3 -  Medicare Approved Charges for Services Rendered in Canada or Mexico  350.11.4 -  Accessibility Criteria  350.11.5 -  Medical Necessity  350.11.6 -  Time Limitation on Emergency and Foreign Claims  350.11.7 -  Payment Denial for Medicare Services Furnished to Alien Beneficiaries Who Are Not Lawfully Present in the United States  350.12 -  Appeals on Claims for Emergency and Foreign Services  360 -  Payment for Services Received By Nonparticipating Providers  360.1 -  Payment for Services from Foreign Hospitals  360.1.1 -  Attending Physician's Statement and Documentation of Medicare Emergency  360.2 -  Designated Contractors  360.3 -  Model Letters, Nonparticipating Hospital and Emergency Claims  360.3.1 -  Model Letter to Nonparticipating Hospital That Elected to Bill For Current Year  360.3.2 -  Model Letter to Nonparticipating Hospital That Did Not Elect to Bill for Current Year  360.3.3 -  Model Letter to Nonparticipating Hospital That Requests to Bill the Program  360.3.4 -  Full Denial -  Hospital -Filed or Beneficiary -Filed Emergency Claim 360.3.5 -  Partial Denial -  Hospital -Filed or Beneficiary -Filed Emergency Claim  360.3.6 -  Denial -  Military Personnel/Eligible Dependents  360.3.7 -  Full Denial -  Shipboard Claim -  Beneficiary filed  360.3.8 -  Full Denial -  Foreign Claim -  Beneficiary Filed  370 -  Microvolt T -wave Alternans (MTWA)  370.1 -  Coding and Claims Processing for MTWA  370.2 -  Messaging for MTWA  380--Leadless Pacemakers   380.1 -  Leadless Pacemaker Coding and Billing Requirements for Professional   Claims