evekhm/cms_iom_500 huggingface dataset:
(Medicare Claims Processing Manual)
Effective for claims with dates of service on or after January 25, 2005, A/B MACs (Part B) must accept and process claims for diagnostic tests subject to the anti -markup payment limitation billed by suppliers (including laboratories, physicians, and independent diagnostic testing facilities [IDTFs]) enrolled in the A/B MACs (Part B) jurisdiction, for services furnished anywhere in the United States.  For s ervices furnished outside the A/B MAC (Part B) jurisdiction in which the billing entity is enrolled, the billing entity must submit its own NPI with the name, address, and ZIP code of the performing physician or other supplier in the appropriate data field.  (The billing physician or other supplier should maintain a record of the performing physician or other suppliers NPI in the clinical record for auditing purposes.)  Effective April 1, 2005, A/B MACs (Part B) must price claims for diagnostic tests that are subject to the anti -markup payment limitation based on the ZIP Code of the location where the service was rendered, using a CMS -supplied abstract file containing the HCPCS codes that are payable under the MPFS as an anti-markup test for the calendar ye ar.  From April 1, 2005, through December 31, 2013, this was done using a CMS- supplied abstract file containing the HCPCS codes that are payable under the MPFS as an anti -markup test for the calendar year.  Beginning January 1, 2014, A/B MACs (Part B) began using the Purchased Diagnostic Test Indicator for the HCPCS codes that are payable under the MPFS as an anti -markup test for the calendar year. A/B MACs (Part B) must pay the lesser of: (a) the net acquisition price, (b) the billing entitys actual charg e, or (c) the fee schedule amount as if the test was billed by the performing supplier.
(Medicare Claims Processing Manual)
Effective for claims submitted with a receipt date on and after October 1, 2015, the billing physician or supplier must report the name, address, and NPI of the perfor ming physician or supplier in Item 32a on anti -markup and reference laboratory claims, even if the performing physician or supplier is enrolled in a different A/B MAC (Part B) jurisdiction.  See Pub. 100- 04, Chapter 1, 10.1.1 for more information regarding claims filing jurisdiction.   NOTE:   As with all services payable under the MPFS, the ZIP Code is used to determine the appropriate payment locality and corresponding fee that is used to price the service that is subject to the anti- markup payment limitation.  When a ZIP Code crosses county lines, CMS uses the dominant locality to determine the corresponding fee.   30.1 - National Provider Identification (NPI) Reported on Claims (Rev. 2994; Issued: 07- 25-14; Effective: 01- 01-12; Implementation: 08 -25-14)  Effective for dates of service May 23, 2008 and later, IDTFs must submit the NPI assigned to the ordering physician using the ASC X12 837 professional claim format or, for paper claims, on the Form CMS -1500.  40 - Interpretations Performed Off the Premise s of the IDTF  (Rev. 1987, Issued: 06- 11-10, Effective: 08- 12-10, Implementation: 08- 12-10)  If an IDTF wants to bill for an interpretation performed by an independent practitioner off the premises of the IDTF, the IDTF must meet the conditions shown in IOM  Pub. 100-04, Chapter 1, 30.2.9.  50 - Therapeutic Procedures  (Rev. 1506; Issued:  05- 16-08; Effective/Implementation Date:  06 -16-08)  An IDTF shall not be allowed to bill for any CPT or HCPCS codes that are solely  therapeutic.  Transmittals Issued for this Chapter   Rev #  Issue Date  Subject  Impl Date  CR#
(Medicare Claims Processing Manual)
An IDTF shall not be allowed to bill for any CPT or HCPCS codes that are solely  therapeutic.  Transmittals Issued for this Chapter   Rev #  Issue Date  Subject  Impl Date  CR#   12/06/2019  Update to Medicare Claims Processing Manual, Chapters 1, 23 and 35  03/09/2020  10882  R3255CP  05/08/2015  Correction to the Multi -Carrier System (MCS) Editing on the Service Location National Provider Identifier (NPI) Reported for Anti -Markup and Reference Laboratory Claims  10/05/2015  9150  R3103CP  11/03/2014  Reporting the Service Location National Provider Identifier (NPI) on Anti -Markup and Reference Laboratory Claims  04/06/2015  8806  R3098CP  10/21/2014  Reporting the Service Location National Provider Identifier (NPI) on Anti -Markup and Reference Laboratory Claims  Rescinded and replaced by Transmittal 3103  04/05/2014  8806  R3047CP  08/22/2014  Reporting the Service Location National Provider Identifier (NPI) on Anti -Markup and Reference Laboratory Claims   Rescinded and replaced by Transmittal 3098  01/05/2014  8806  R2994CP  07/25/2014  Update to Pub. 100 -04, Chapter 35 to Provide Language -Only Changes for Updating ASC X12 08/25/2014  8769  R1987CP  06/11/2010  Correction to the Claims Processing Internet Only Manual (IOM) t o Reinstate Previous Instructions Regarding Payment Jurisdiction for Reassigned Services  08/12/2010  6923  R1931CP  03/12/2010  Revision of the Internet Only Manual (IOM) to Remove References to Purchased Diagnostic Test and Replace With Language Consistent With the Anti -Markup Rule  06/14/2010  6627  R1504CP  05/15/2008  New Chapter for Independent Diagnostic Testing Facilities (IDTF)  06/16/2008  5815  Back to top of chapter
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CMS Manual System  Department of Health & Human Services (DHHS)  Pub 100 -20 One -Time Notification  Centers for Medicare & Medicaid Services (CMS)  Transmittal  727 Date: July 9, 2010   Change Request 6912   Transmittal 725, dated July 2, 2010 is rescinded  and replaced by Transmittal 727, dated July 9, 2010. The implementation date and July 2010 reporting requirements are being changed in order to give contractors sufficient time to mail the notification letters to the affected providers. Additionally, Code 72200 is being removed from the list of CPT codes because it is a standard x- ray code and is not a code used for advanced diagnostic im aging services.  All other information remains the same.  SUBJECT: Mailing To All Individual Practitioners, Medical Groups and Clinics and Independent Diagnostic Testing Facilities (IDTF) Who Are Billing or Have Billed For Advanced Diagnostic Imaging Services.  I. SUMMARY OF CHANGES: The Centers for Medicare and Medicaid Services (CMS) and its Medicare carriers and Medicare Administrative Contractors (A/B MACs) provide general outreach to physicians, non-physician practitioners and other provider and supplier types about their enrollment and reporting responsibili ties.  The attached letter will inform enrolled physicians, non -physician practitioners and independent diagnostic testing facilities (IDTFs) about the need to become accredited to continue to furnish advanced diagnostic imaging services to Medicare benefi ciaries on or after January 1, 2012.  EFFECTIVE DATE: August 2, 2010  IMPLEMENTATION DATE: August 13, 2010  Disclaimer for manual changes only: The revision date and transmittal number apply only to red i talicized material. Any other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents.  II. CHANGES IN MANUAL I NSTRUCTIONS: (N/A if manual is not updated)  R=REVISED, N=NEW, D=DELETED- Only One Per Row.   R/N/D  CHAPTER / SECTION / SUBSECTION / TITLE  N/A   III. FUNDING:  For Fiscal Intermediaries (FIs), Regional Home Health Intermediaries (RHHIs) and/or Carriers:  No additional funding will be provided by CMS; Contractor activities are to be carried out within their operating budgets.
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For Medicare Administrative Contractors (MACs):  The Medicare Administrative Contractor is hereby advised that this constitutes tec hnical direction as defined in your contract. CMS does not construe this as a change to the MAC Statement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by  the Contracting Officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the Contracting Officer, in wr iting or by e -mail, and request formal directions regarding continued performance requirements.   IV. ATTACHMENTS:   One-Time Notification     *Unless otherwise specified, the effective date is the date of service.  Attachment  One-Time Notification   Pub. 100 -20 Transmittal: 727 Date: July 9 , 2010  Change Request:  6912   Transmittal 725, dated July 2, 2010 is rescinded  and replaced by Transmittal 727, dated July 9, 2010. The implementation date and July 2010 reporting requirements are being changed in order to give contractors sufficient time to mail the notification letters to the affected providers. Additionally, Code 72200 is being removed from the list of CPT codes because it is a standard x- ray code and is not a c ode used for advanced diagnostic imaging services.  All other information remains the same.  SUBJECT :  Mailing T o All Individual Practitioners, Medical Groups and Clinics and Independent Diagnostic Testing Facilities (IDTF) Who Are Billing or Have Billed For  Advanced Diagnostic Imaging Services    Effective Date:  August 2, 2010  Implementation Date:   August 13, 2010   I. GENERAL INFORMATION  A. Background :  The  Centers for Medicare & M edicaid S ervices  (CMS) and its  Medicare carriers and Medicare Administrative Contractors (A/B MACs)  provide  general outreach  to physicians , non- physician practitioners and other provider and supplier types about the ir enrollment and reporting responsibilities.   The attached  letter will inform enrolled physicians, n on-physician practitioners and i ndependent diagnostic t esting facilities  (IDTFs) about the need to become accredited to continue to furnish a dvanced diagnostic i maging services to Medicare beneficiaries on or after January 1, 2012.
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B. Policy:   Section 135(a) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) amended section 1834(e) of the Social Security Act and required the Secretary to designate organizations to accredit suppliers, including but not limited to physicians, non- physician practit ioners and Independent Diagnostic Testing Facilities, that furnish the technical component (TC) of advanced diagnostic imaging services.   MIPPA specifically defines advanced diagnostic imaging procedures as including diagnostic magnetic resonance imaging ( MRI), computed tomography (CT), and nuclear medicine imaging such as positron emission tomography (PET).  The law also authorizes the Secretary to specify other diagnostic imaging services in consultation with physician specialty organizations and other st akeholders.  MIPPA expressly excludes from the accreditation requirement x -ray, ultrasound, and fluoroscopy procedures.  The law also excludes from the CMS accreditation requirement diagnostic and screening mammography which are subject to quality oversight by the Food and Drug Administration under the Mammography Quality Standards Act.  II. BUSINESS REQUIREMENTS  TABLE   Use Shall"  to denote  a mandatory requirement   Number  Requirement  Responsibility (place an X in each applicable column)
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A/B DME FI CARRHHShared -System Maintainers  OTHER  MAC  MAC RIER I FISS MCS VMS CWF 6912. 1 Contractors shall send the attached letter 5 times to enrolled physician s, non- physician practitioner s, including single and multi -specialty clinics,  and IDTFs  who have bil led the Medicare program for advanced diagnostic testing services (see attached related CPT Codes) within the preceding six month period and continues to have Medicare billing privileges with the contractor.  X   X       6912. 1.1 The mailing s shall occur i n August  and October of 2010 and January, April and July of 2011.  X   X       6912. 1.2 When more than one physician or non -physician practitioner is operating within a group, such as a single specialty or multispecialty clinic, only the group shall  receiv e the letter, not each of the individual physicians or non- physician practitioners working for the group.  X   X       6912. 1.3 If any additional suppliers not listed above submit claims for advanced diagnostic testing  during this initiative, the contracto r shall include that supplier in the next quarterly mailing.  X   X       6912. 2 Contractors shall not mail the attached letter to any supplier with an inactive Medicare billing status . X   X       6912. 3 Contractors shall use the Pay To or Practice Locat ion address found in the Multi -Carrier  System ( MCS ) when mailing this letter to a physician, non- physician practitioner or IDTF with approved PECOS enrollment record.  X   X       6912. 3.1 Contractors shall retrieve and use the Pay To or Practice Location address found in the  Multi- Carrier System for suppliers described above furnishing advance diagnostic testing services that  do not have an enrollment record in PECOS. X   X       6912.3.2  To simplify operations, the contractor shall  extract all addresses for these mailings from the MCS.  X   X       6912. 4 Contractors shall reproduce the attached letter on their own Medicare letterhead  and mail in standard envelope s. X   X       6912. 4.1 Contractors shall complete the letter with the appropriate date, nam e, address, contact and signature prior to mailing.  X   X       6912. 5 Contractors shall not take any action for returned letters outside of placing them in the provider file . X   X       6912. 6 Contractors shall complete the first mailing by August
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address, contact and signature prior to mailing.  X   X       6912. 5 Contractors shall not take any action for returned letters outside of placing them in the provider file . X   X       6912. 6 Contractors shall complete the first mailing by August 13, 2010 and each subsequent  mailing within 10 days of the calendar quarter  through July 2011.  X   X
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III. PROVIDER EDUCATION TABLE   Number Requirement  Responsibility (place an X in each applicable column)    A/B  MAC DME  MAC FI CARRIER RHHI Shared -System Maintainers  OTHER FISS MCS VMS CWF 6912. 7 A provider education article related to this instruction will be available at http://www.cms .hhs.gov/MLNMattersArticles/  shortly after this CR is released.  You will receive notification of the article release via the established "MLN Matters" listserv.  Contractors shall post this article, or a direct link to this article, on their Web site and  include information about it in a listserv message within one week of the availability of the provider education article.  In addition, the provider education article shall be included in your next regularly scheduled bulletin.  Contractors are free to supplement MLN Matters articles with localized information that would benefit their provider community in maintaining Medicare provider enrollment data correctly.  X   X         IV. SUPPORTING INFORMATION  Section A:  For any recommendations and supporting information associated with listed requirements , use the box below:  Use "Should" to denote a recommendation.  X-Ref  Requirement Number  Recommendations or other supporting information:  N/A    Section B :  For all other recommendations and supporting informa tion,  use this space :    N/A   V. CONTACTS   Pre-Implementation Contact(s):  August Nemec  OFM/DPSE ( 410) 786- 0612  Post-Implementation Contact(s):  August Nemec  OFM/DPSE ( 410) 786- 0612   VI. FUNDING   Section A:  For Fiscal Intermediaries  (FIs) , Carri ers, a nd Regional Home Health  Intermediaries  (RHHIs) :  No additional funding will be provided by CMS; contractor activities are to be carried out within their operating budgets.
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No additional funding will be provided by CMS; contractor activities are to be carried out within their operating budgets.   Section B:  For Medicare Administrative Contractors (MAC s): The Medicare Administrativ e Contractor is hereby advised that this constitutes technical direction  as defined in your contract. CMS  does  not construe this as a change to the MAC Statement of W ork. The contractor is not obligated to incur costs in excess of the amounts allot ted in your contract unless and until specifically authorized by the Contracting Officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in questi on and immediately notify the Contracting Officer, in writing or by e -mail, and request formal directions regarding continued performance requirements.    ATTACHMENTS (2)  Supplier Billed Advanced Medical Imaging CPT codes for Section 135 (a) of the MIPPA t o Receive Accreditation Requirement Notification Letter   70336  70540  71250  72125  73200  74150 70450  70542  71260  72126  73201  74160 70460  70543  71270  72127  73202  74170 70470  70544  71275  72128  73206  74175 70480  70545  71550  72129  73218  74181 70481  70546  71551  72130  73219  74182 70482  70547  71552  72131  73220  74183 70486  70548  71555  72132  73221  74185 70487  70549    72133  73222 70488  70551    72141  73223 70490  70552    72142  73225 70491  70553    72146  73700 70492  70554    72147  73701 70496  70555    72148  73702 70498  70557    72149  73706   70558    72156  73718   70559    72157  73719       72158  73720       72159  73721       72191  73722       72192  73723       72193  73725       72194       72195       72196       72197       72198
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70559    72157  73719       72158  73720       72159  73721       72191  73722       72192  73723       72193  73725       72194       72195       72196       72197       72198         75557  76360  77011  78000  78811 75559  76376  77012  78001  78812 75561  76377  77021  78003  78813 75563  76380  77058  78006  78814 76390  77059  78007  78815 76497  77078  78010  78816 76498  77079  78011  78891 78015 78016 78018 78020 78070 78075 78099 Letter to be sent to all enrolled suppliers (individuals, groups and IDTFs)  that have billed for advanced diagnostic imaging services within  the past six months.  When more than one physician or non- physician practitioner  is operating within a group, such as a single specialty or multispecialty clinic, only the group will receive the letter.  ---------------------------------------------------------------------------------------------------------------------   [DATE]   [Suppl ier Name and Address]
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[DATE]   [Suppl ier Name and Address]   Dear Physician/Non -Physician Practitioner/IDTF owner:  In accordance with Section 135(a) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), suppliers, including but not limited to physicians, non -physician pr actitioners and Independent Diagnostic Testing Facilities that furnish the technical component (TC) of advanced diagnostic imaging services must be accredited by January 1, 2012 in order to continue to furnish these services to Medicare beneficiaries.  Our records indicate that you have furnished advanced diagnostic imaging procedures such as diagnostic magnetic resonance imaging (MRI), computed tomography (CT), and nuclear medicine imaging such as positron emission tomography (PET) within the last six mont hs.  If you are not accredited by one of the organizations  shown below  by January 1, 2012, you will not be eligible to bill the Medicare program for advanced diagnostic imaging services .  This letter requests that you take the necessary action to become accredited by the January 1, 2012 deadline.  Since we expect it can take up to nine months from the time you initiate the accreditation process to completion, we urge you to begin the accreditation process for advanced diagnostic imaging services as soon as possible.  MIPPA expressly excludes from the accreditation requirement x -ray, ultrasound, and fluoroscopy procedures.   The law also excludes from the CMS accreditation requirement diagnostic and screening mammography which are already subject to quality ove rsight by the Food and Drug Administration under the Mammography Quality Standards Act.  The Centers for Medicare & Medicaid Services (CMS) approved three national accreditation organizations  the American College of Radiology, the Intersocietal Accreditation Commission, and The Joint Commission -  to provide accreditation services for suppliers of the TC of advanced diagnostic imaging procedures.  The accreditation will apply only to the suppliers of the images themselves, and not to the physician interpret ing the image.  All accreditation organizations have quality standards that address the safety of the equipment as well as the safety of the patients and staff.  The accrediting organization that issues your accreditation will notify Medicare once your accreditation is complete and approved.   To obtain additional information about the accreditation process, please contact the accreditation organizations shown below.    American College of Radiology (ACR)  1891 Preston White Drive  Reston, VA 20191- 4326  1-800-770-0145  www.acr.org
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American College of Radiology (ACR)  1891 Preston White Drive  Reston, VA 20191- 4326  1-800-770-0145  www.acr.org    Intersocietal Accreditation Commission (IAC)  6021 University Boulevard, Suite 500 Ellicott City, MD 21043  800-838-2110  www.intersocietal.org    The Joint C ommission (TJC)  Ambulatory Care Accreditation Program  One Renaissance Boulevard  Oakbrook Terrace, IL 60181 1-630-792-5286  www.jointcommission.org/AdvImaging2012    If you have questions about thi s letter, contact [carrier or A/B MAC phone number/contact person].            Sincerely,            [Name of carrier or A/B MAC]
NCA - Screening for Lung Cancer with Low Dose Computed Tomography (LDCT) (CAG-00439R) - Decision Memo
htmlRequired meta tagsNCA - Screening for Lung Cancer with Low Dose Computed Tomography (LDCT) (CAG-00439R) - Decision MemoBootstrap is used with permission under the MIT license: https://github.com/twbs/bootstrap/blob/master/LICENSEjQuery is used with permission under the MIT license: https://jquery.org/license/New RelicThe page could not be loaded. The CMS.gov Web site currently does not fully support browsers with"JavaScript" disabled. Please enable "JavaScript" and revisit this page or proceed with browsing CMS.gov with"JavaScript" disabled.Instructions for enabling "JavaScript" can be found here.Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.Skip to main contentAn official website of the United States governmentHere's how you knowHere's how you knowThe .gov means it's official.Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.The site is secure.Thehttps://ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.Resource NavigationSearchReportsDownloadsArchiveAPIopens in new window<button id="toggle-mobile-search" class="mobile-search-btn" aria-expanded="false"><span class="ds-u-visibility--screen-reader">Toggle Mobile Search</span></button>Close SearchCenters for Medicare & Medicaid ServicesMain headerAbout UsNewsroomData & ResearchMCDMedicare Coverage DatabaseSearchReportsNational CoverageWhat's New ReportAnnual ReportNCA/CAL ReportsNCA/CAL Status ReportNCA/CAL Open for Public Comment ReportNCD ReportMedicare Coverage Documents ReportsMedicare Coverage Documents ReportMed Cov Docs Open for Public Comment ReportOther National Coverage ReportsMEDCAC Meetings ReportTechnology Assessments ReportLocal CoverageWhat's New ReportFinal LCD ReportsFinal LCDs by Contractor ReportFinal LCDs by State ReportFinal LCDs Alphabetical ReportProposed LCD ReportsProposed LCDs by Contractor ReportProposed LCDs by State ReportProposed LCDs Alphabetical ReportArticle Reports