evekhm/cms_iom_3000 huggingface dataset:
Article - Billing and Coding: Visual Fields (A57483)

CMS National Coverage PolicyTitle XVIII of the Social Security Act, Section 1833(e). This section prohibits Medicare payment for any claim which lacks the necessary information to process the claim.Title XVIII of the Social Security Act, Section 1862(a)(1)(A). This section allows coverage and payment for only those services that are considered to be medically reasonable and necessary.CMS Pub 100-02,Medicare Benefit Policy Manual, Chapter 16  General Exclusions From Coverage, Section 90  Routine Services and Appliances.42 CFR Section 410.32 Diagnostic tests may only be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements) and diagnostic tests payable under the Physicians Fee Schedule must be furnished under the appropriate level of supervision by the physician.Article TextThe billing and coding information in this article is dependent on the coverage indications, limitations and/or medical necessity described in the associated LCD L34615 Visual Fields.Taped and un-taped visual field testing is considered one unit of service for MUE (medically unlikely edits) purposes. MUEs are established by a separate CMS contractor, not WPS GHA.If the claim contains a separate charge for gross visual fields, it will be denied as an incidental service.If the service is performed in a hospital inpatient or outpatient setting, the modifier -26 should be used to indicate the professional component.The HCPCS/CPT code(s) may be subject to Correct Coding Initiative (CCI) edits. This policy does not take precedence over CCI edits. Please refer to the CCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.Claims submitted for visual field examinations performed at unusually frequent intervals may be reviewed in order to verify that the services were medically reasonable and necessary.For claims submitted to the Contractor or Part B MAC:Claims for Visual Fields Testing services are payable under Medicare Part B in the following places of service:The global services (technical plus professional) may be billed in the following places of service:Office (11), nursing facility (32) and independent clinic (49).The technical component may be billed in the following places of service:Office (11), nursing facility (32), independent clinic (49), federally qualified health center (50) and rural health clinic (72).The professional component may be billed at the following places of service:Office (11), off-campus outpatient hospital (19), inpatient hospital (21), on-campus outpatient hospital (22), emergency room (23), skilled nursing facility (31), nursing facility (32), independent clinic (49) and comprehensive outpatient rehabilitation facility (62).
(Medicare Claims Processing Manual)

as Still Patient (30)  130.4 -  Hospital and SNF Part B Adjustment Requests  130.4.1 -  Guidelines for Submitting Adjustment Requests  130.5 -  Home Health Adjustments  130.5.1 -  Submitting Adjustment Requests  130.6 -  Adjustments to Reprocess Certain Claims Denied Due to an Open Common Working File (CWF) Medicare Secondary Payer (MSP) Group Health Plan (GHP) Record Where the GHP Record Was Subsequently Deleted  or Terminated  130.7 -  MAC Guidance Related to Use of Adjustment Codes on Adjustment Claims  140  Fiscal Intermediary (FI) Edits Affecting Multiple Bill Types  140.1 -  Threshold Edit for Outpatient and Inpatient Part B Claims  140.2  Systematic Validation of Claims Information Using Patient Assessments  140.3 -  Verification Edit for Claims with OPPS Payments  150  Limitation of Liability Notification and Coordination With Quality Improvement Organizations (QIOs)  150.1 -  Limitation on Liability -  Overview  150.2  Hospital Claims Subject to Hospital Issued Notices of Noncoverage  150.2.1  Scope of Issuance of Hospital Issued Notices of Noncoverage (HINNs)  150.2.2 -  General Responsibilities of QIOs and Fiscal Intermediaries (FIs) Related to HINNs  150.2.3  Billing and Claims Processing Requirements Related to HINNs  150.3 Skilled Nursing Facility (SNF), Home Health Agency (HHA), Hospice and Comprehensive Outpatient Rehabilitation Facility (CORF) Claims Subject to Expedited Determinations  150.3.1  Scope of Issuance of Expedited Determination Notices  150.3.2 -  General Responsibilities of QIOs and FIs Related to Expedited Determinations  150.3.3  Billing and Claims Processing Requirements Related to Expedited Determinations  160 -  Identifying Institutional Providers  160.1 -  Reporting of Taxonomy Codes (Institutional Providers)  170 -  Payment Bases for Institutional Claims  170.1 -  Services Paid on the Medicare Physician Fee Schedule (MPFS)  170.1.1 -  Payments on the MPFS for Providers With Multiple Service Locations  180 -  Denial of Claims Due to Violations of Physician Self -Referral Prohibition  180.1 -  Background and Policy 180.2 -  Denial Code  190  Payer Only Codes Utilized by Medicare  200 -  Qualified Medicare Beneficiary (QMB)  01 - Foreword  (Rev. 3086, Issued: 10- 03-14, Effective: ICD -10: Upon Implementation of ICD-10, ASC X12: January 1, 2012, Implementation ICD-10: Upon Implementation of ICD-10; ASC X12: November 4, 2014)
(Medicare Claims Processing Manual)

Payment Denial for Medicare Services Furnished to Alien Beneficiaries Who Are Not Lawfully Present in the U. S.  N/A 2825  R170CP  05/07/2004  Filing Request for Payment -Medicare Part B  N/A 2815  R169CP  05/07/2004  Claims Jurisdiction  N/A 2631  R167CP  04/30/2004  Discontinued Use of Revenue Code 0910  10/04/2004  3194  R156CP  04/30/2004  Clarification of payments and billing procedures for hospitals subject to the Maryland Waiver  10/04/2004  3200  R145CP  04/23/2004  Data Element Requirements Matrix - Carrier  05/24/2004  3164  R142CP  04/16/2004  Claims for RRB and UMWA Beneficiaries  N/A 2502  R133CP  04/02/2004  Billing Non -covered Charges to FIs -Clarification to CR 2634  04/16/2004  3115  R114CP  02/27/2004  Modification of CMS' Medicare Contingency Plan for HIPPA Implementation  07/06/2004  2981  R111CP  02/27/2004  Payment For Services Provided Under a Contractual Agreement  03/12/2004  3083  R091CP  02/06/2004  Revisions to Processing of Non -covered Charges on Certain Home Health Prospective Payment System Claims  07/06/2004  3077  Rev #  Issue Date  Subject  Impl Date  CR#  R072CP  01/23/2004  Update of Address for the Railroad Retirement Board (RRB)  02/23/2004  3034  R067CP  01/16/2004  Claims Processing Instructions for Payment Jurisdiction and Payment to Physician for Purchased Diagnostic Tests  04/05/2004  3039  R047CP  12/19/2003  Carrier Data Element Requirements  01/20/2004  2956  R025CP  10/31/2003 Billing Non -Covered Charges to Fiscal Intermediaries Summary and New Instruction  04/05/2004  2634  R001CP  10/01/2003  Initial Publication of Manual  NA NA Back to top of Chapter
Article - Billing and Coding: MolDX: NRAS Genetic Testing (A57486)

CMS National Coverage PolicyTitle XVIII of the Social Security Act, 1833(e). Prohibits Medicare payment for any claim which lacks the necessary information to process the claim.CMS On-Line Manual, Publication 100-08, Medicare Benefit Policy Manual, Chapter 3,  3.4.1.3, Diagnosis Code Requirements.Article TextThe following coding and billing guidance is to be used with its associated Local coverage determination.To report a NRAS Genetic Testing service, please submit the following claim information:Select appropriate CPTcodeEnter 1 unit of service (UOS)Enter the appropriate DEX Z-Code identifier adjacent to the CPTcode in the comment/narrative field for the following Part B claim field/types:Loop 2400 or SV101-7 for the 5010A1 837PItem19 for paper claimEnter the appropriate DEX Z-Code identifier adjacent to the CPTcode in the comment/narrative field for the following Part A claim field/types:Line SV202-7 for 837I electronic claimBlock 80 for the UB04 claim formSelect the appropriate ICD-10-CM code
Article - Billing and Coding: MolDX: NRAS Genetic Testing (A57487)

CMS National Coverage PolicyTitle XVIII of the Social Security Act, 1833(e). Prohibits Medicare payment for any claim which lacks the necessary information to process the claim.CMS On-Line Manual, Publication 100-08, Medicare Benefit Policy Manual, Chapter 3,  3.4.1.3, Diagnosis Code Requirements.Article TextThe following coding and billing guidance is to be used with its associated Local coverage determination.To report a NRAS Genetic Testing service, please submit the following claim information:Select appropriate CPT codeEnter 1 unit of service (UOS)Enter the appropriate DEX Z-Code identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types:Loop 2400 or SV101-7 for the 5010A1 837PItem19 for paper claimEnter the appropriate DEX Z-Code identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types:Line SV202-7 for 837I electronic claimBlock 80 for the UB04 claim formSelect the appropriate ICD-10-CM code
Article - Billing and Coding: Chest X-Ray Policy (A57497)

CMS National Coverage PolicyTitle XVIII of the Social Security Act (SSA), 1862(a)(1)(A), states that no Medicare payment shall be made for items or services which "are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member."Title XVIII of the Social Security Act, 1862(a)(7) and 42 Code of Federal Regulations (CFR) 411.15(a)(1), exclude routine physical examinations.Title XVIII of the Social Security Act, 1833(e), prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.CMS Manual System, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, 80, Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests, sets forth the levels of physician supervision required for furnishing the technical component of diagnostic tests for a Medicare beneficiary who is not a hospital inpatient or outpatient.CMS Manual System, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, 80.4-80.4.4, Coverage of Portable X-Ray Services Not Under the Direct Supervision of a Physician applicability of health and safety standards apply to all suppliers of portable x-ray services and the scope of portable x-ray benefit and exclusions from coverage as portable x-ray services.CMS Manual System, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, 250, Medical and Other Health Services Furnished to Inpatients of Hospitals and Skilled Nursing Facilities including payments under arrangement.42 CFR 486.100, stipulates that portable X-rays must comply with Federal, State, and local laws and regulations.CMS Manual System, Pub. 100-08, Medicare Program Integrity Manual, Chapter 3, 3.4.1.3, Diagnoses Code Requirement.42 Code of Federal Regulations, 410.32, addresses diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions.CMS Manual System, Pub. 100-04, Medicare Claims Processing Manual, Chapter 13, 100 and 100.1, Interpretation of Diagnostic Tests describes how physicians should handle billing when two providers read a chest X-ray. Medicare will pay for the interpretation and report that directly contributes to the diagnosis and treatment of the individual patient.CMS Manual System, Pub, 100-02, Medicare Benefit Policy Manual, Chapter 15, 80.6.1, Definitions.Article TextThe following coding and billing guidance is to be used with its associated Local coverage determination.
Article - Billing and Coding: Chest X-Ray Policy (A57498)

CMS National Coverage PolicyTitle XVIII of the Social Security Act (SSA), 1862(a)(1)(A), states that no Medicare payment shall be made for items or services which "are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member."Title XVIII of the Social Security Act, 1862(a)(7) and 42 Code of Federal Regulations (CFR) 411.15(a)(1), exclude routine physical examinations.Title XVIII of the Social Security Act, 1833(e), prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.CMS Manual System, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, 80, Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests, sets forth the levels of physician supervision required for furnishing the technical component of diagnostic tests for a Medicare beneficiary who is not a hospital inpatient or outpatient.CMS Manual System, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, 80.4-80.4.4, Coverage of Portable X-Ray Services Not Under the Direct Supervision of a Physician applicability of health and safety standards apply to all suppliers of portable x-ray services and the scope of portable x-ray benefit and exclusions from coverage as portable x-ray services.CMS Manual System, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, 250, Medical and Other Health Services Furnished to Inpatients of Hospitals and Skilled Nursing Facilities including payments under arrangement.42 CFR 486.100, stipulates that portable X-rays must comply with Federal, State, and local laws and regulations.CMS Manual System, Pub. 100-08, Medicare Program Integrity Manual, Chapter 3, 3.4.1.3, Diagnoses Code Requirement.42 Code of Federal Regulations, 410.32, addresses diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions.CMS Manual System, Pub. 100-04, Medicare Claims Processing Manual, Chapter 13, 100 and 100.1, Interpretation of Diagnostic Tests describes how physicians should handle billing when two providers read a chest X-ray. Medicare will pay for the interpretation and report that directly contributes to the diagnosis and treatment of the individual patient.CMS Manual System, Pub, 100-02, Medicare Benefit Policy Manual, Chapter 15, 80.6.1, Definitions.Article TextThe following coding and billing guidance is to be used with its associated Local coverage determination.
Article - Billing and Coding: MolDX: Percepta© Bronchial Genomic Classifier (A57502)

CMS National Coverage PolicyTitle XVIII of the Social Security Act (SSA), 1862(a)(1)(A), states that no Medicare payment shall be made for items or services that are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.Title XVIII of the Social Security Act, 1833(e), prohibits Medicare payment for any claim lacking the necessary documentation to process the claim. 42 Code of Federal Regulations (CFR) 410.32 Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests:Conditions.CMS Internet Only Manuals, Publication 10004, Medicare Claims Processing Manual Ch. 16, 50.5 Jurisdiction of Laboratory Claims, 60.12 Independent Laboratory Specimen Drawing, 60.2. Travel Allowance.Article TextThe following coding and billing guidance is to be used with its associated Local coverage determination.To report a PerceptaBronchial Genomic Classifier service, please submit the following claim information:Enter 1 unit of service (UOS).Enter the appropriate DEX Z-Code identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types:Loop 2400 or SV101-7 for the 5010A1 837Item19 for paper claimEnter the appropriate DEX Z-Code identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types:Line SV202-7 for 837I electronic claimBlock 80 for the UB04 claim formSelect the appropriate ICD-10-CM code.
Article - Billing and Coding: MolDX: Percepta© Bronchial Genomic Classifier (A57504)

CMS National Coverage PolicyTitle XVIII of the Social Security Act (SSA), 1862(a)(1)(A), states that no Medicare payment shall be made for items or services that are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.Title XVIII of the Social Security Act, 1833(e), prohibits Medicare payment for any claim lacking the necessary documentation to process the claim. 42 Code of Federal Regulations (CFR) 410.32 Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests:Conditions.CMS Internet Only Manuals, Publication 10004, Medicare Claims Processing Manual Ch. 16, 50.5 Jurisdiction of Laboratory Claims, 60.12 Independent Laboratory Specimen Drawing, 60.2. Travel Allowance.Article TextThe following coding and billing guidance is to be used with its associated Local coverage determination.To report a PerceptaBronchial Genomic Classifier service, please submit the following claim information:Enter 1 unit of service (UOS).Enter the appropriate DEX Z-Code identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types:Loop 2400 or SV101-7 for the 5010A1 837Item19 for paper claimEnter the appropriate DEX Z-Code identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types:Line SV202-7 for 837I electronic claimBlock 80 for the UB04 claim formSelect the appropriate ICD-10-CM code.
Article - Billing and Coding: Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Essential Tremor and Tremor Dominant Parkinson's Disease (A57512)

CMS National Coverage PolicyLanguage quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the LCD Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See Section 1869(f)(1)(A)(i) of the Social Security Act.Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources:Title XVIII of the Social Security Act (SSA):Section 1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.Section 1862(a)(1)(D) refers to limitations on items or devices that are investigational or experimental.Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.Article TextThe following coding and billing guidance is to be used with its associated Local coverage determination.
Article - Billing and Coding: Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Essential Tremor and Tremor Dominant Parkinson's Disease (A57513)

CMS National Coverage PolicyLanguage quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the LCD Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See Section 1869(f)(1)(A)(i) of the Social Security Act.Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources:Title XVIII of the Social Security Act (SSA):Section 1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.Section 1862(a)(1)(D) refers to limitations on items or devices that are investigational or experimental.Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.Article TextThe following coding and billing guidance is to be used with its associated Local coverage determination.
Article - Billing and Coding: ProMark® Risk Score (A57515)

CMS National Coverage PolicyCMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 23, 10, Reporting ICD Diagnosis and Procedure CodesCMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 16, 50.5 Jurisdiction of Laboratory Claims, 60.1.2 Independent Laboratory Specimen Drawing, 60.2 Travel AllowanceTitle XVIII of the Social Security Act, 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claimCMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, 80.1.2 A/B MAC (B) Contacts With Independent Clinical LaboratoriesArticle TextThe information in this article contains billing, coding, or other guidelines that complement the Local Coverage Determination (LCD).To report a ProMark assay service, please submit the following claim information:Select CPT code 81479Enter 1 unit of service (UOS)Enter the appropriate DEX Z-Code identifier adjacent to the CPTcode in the comment/narrative field for the following Part B claim field/types:Loop 2400 or SV101-7 for the 5010A1 837PItem 19 for paper claimEnter the appropriate DEX Z-Code identifier adjacent to the CPTcode in the comment/narrative field for the following Part A claim field/types:Line SV202-7 for 837I electronic claimBlock 80 for the UB04 claim formSelect ICD-10 CM code C61
Article - Billing and Coding: MolDX: Prometheus IBD sgi Diagnostic Policy (A57516)

CMS National Coverage PolicyCMS Internet-Only Manual Pub. 100-04, Medicare Claims Processing Manual, Chapter 23 10 Reporting ICD Diagnosis and Procedure CodesCMS Internet-Only Manual Pub. 100-04, Medicare Claims Processing Manual, Chapter 16, 50.5 Jurisdiction of Laboratory Claims, 60.1.2 Independent Laboratory Specimen Drawing, 60.2 Travel AllowanceTitle XVIII of the Social Security Act, 1833(e) Prohibits Medicare payment for any claim which lacks the necessary information to process the claimArticle TextThe following coding and billing guidance is to be used with its associated Local coverage determination.To receive a Prometheus IBD sgi Diagnostic denial, please submit the following claim information:Select the applicable CPTcodeEnter 1 unit of service (UOS)An Advance Beneficiary Notice (ABN) is not required for statutorily excluded servicesFor a voluntary issued ABN, append with GX modifierTo indicate a statutorily excluded service, append with a GY modifierIf submitting a DEX Z-Code identifier, enter the appropriate DEX Z-Code identifier adjacent to the CPTcode in the comment/narrative field for the following Part B claim field/types:Loop 2400 or SV101-7 for the 5010A1 837PBox 19 for paper claimIf submitting a DEX Z-Code identifier, enter the appropriate DEX Z-Code identifier adjacent to the CPTcode in the comment/narrative field for the following Part A claim field/types:Line SV202-7 for 837I electronic claimBlock 80 for the UB 04