evekhm/cms_iom_500 huggingface dataset:
(Medicare Claims Processing Manual)
08/08/2014 Update to Pub. 100- 04, Chapter 10 to Provide Language -Only Changes for Updating ASC X12 09/08/2014 8606 R3010CP  08/01/2014 Preventing Payment on Requests for Anticipated Payment (RAPs) When Home Health Beneficiaries are Enrolled in Medicare Advantage (MA) Plans  01/05/2015 8710 R3005CP  08/01/2014 Preventing Duplicate Payments When Overlapping Inpatient and Home Health Claims Are Received Out of Sequence  01/05/2015 8699 R2977CP  06/20/2014 Clarification of Billing Instructions Related to the Home Health Benefit 09/23/2014 8775 R2897CP  03/07/2014 Update to Pub. 100- 04, Chapter 10 to Provide Language -Only Changes for Updating ICD -10 and ASC X12  Rescinded and replaced by Transmittal 3021 10/01/2014 8606 R2833CP  12/06/2013 Home Health Agency Reporting Requirements for the Certifying Physician and the Physician Who Signs the Plan of Care  07/04/2014 8441 R2828CP  11/27/2013 Home Health Prospective Payment System (PPS) Low Utilization Payment Adjustment (LUPA) Add -On Factors  01/06/2014 8380 R2796CP  09/27/2013 Home Health Prospective Payment System (PPS) Low Utilization Payment Adjustment (LUPA) Add -On Factors  Rescinded and replaced by Transmittal 2828 01/06/2014 8380 R2789CP  09/20/2013 Home Health Agency Reporting Requirements for the Certifying Physician and the Physician Who Signs the Plan of Care  Rescinded and replaced by Transmittal 2833 07/07/2014 8441 R2742CP  07/25/2013 Home Health Prospective Payment System (PPS) Low Utilization Payment Adjustment (LUPA) Add -On Factors  Rescinded and replaced by Transmittal 2796 01/06/2014 8380 R2694CP  05/03/2013 Discontinuation of Home Health Type of Bill 33X  10/07/2013 8244 R2680CP  04/02/2013 Data Reporting on Home Health Prospective Payment System (HH PPS) Claims  07/01/2013 8136 R2650CP  02/01/2013 Data Reporting on Home Health Prospective Payment System (HH PPS)
(Medicare Claims Processing Manual)
04/02/2013 Data Reporting on Home Health Prospective Payment System (HH PPS) Claims  07/01/2013 8136 R2650CP  02/01/2013 Data Reporting on Home Health Prospective Payment System (HH PPS) Claims  Rescinded and replaced by Transmittal 2680  07/01/2013 8136 R2583CP  11/02/2012 Erroneous Partial Episode Payment Adjustments on Certain Home Health Dual -Eligible Claims  04/01/2013 7865 R2466CP  05/11/2012 Calendar Year 2012 and After Payments to Home Health Agencies That Do Not Submit Required Quality Data  08/13/2012 7833 R2374CP  12/22/2011 Additional Instructions Regarding Demand Bills Under the Home Health Prospective Payment System  03/22/2012 7660 R2249CP  07/01/2011 Calendar Year 2012 and After Payments to Home Health Agencies That Do Not Submit Required Quality Data  10/03/2011 7459 R2230CP  05/27/2011 Revisions to Chapter 10, Home Health Agency Billing 08/28/2011 7338 R2209CP  05/06/2011 Corrections to Home Health Prospective Payment System (HH PPS) Outlier Limitation  10/03/2011 7395 R2043CP  09/03/2010 Calendar Year 2011 Payments to Home Health Agencies That Do Not Submit Required Quality Data  10/05/2010 7114 R1988CP  06/14/2010 Enhancements to Home Health (HH) Consolidated Billing  10/04/2010 6911 R1956CP  04/28/2010 Remittance Advice Coding to Identify Claims Subject to the Limitations on Home Health Prospective Payment System (HH PPS) Outlier Payments  10/04/2010 6897 R1952CP  04/28/2010 Enhancements to Home Health(HH) Consolidated Billing -  Rescinded and replaced by Transmittal 1988 10/04/2010 6911 R1904CP  02/05/2010 Coding Patient Transfers Under the Home Health Prospective Payment System (HH PPS)  07/06/2010 6757 R1883CP  12/23/2009 Limitation on Home Health Prospective Payment System (HH PPS) Outlier Payments  01/25/2010 6759 R1773CP  07/24/2009 Revised Processing of Osteoporosis Drugs Under the Home Health Benefit  01/04/2010 6512 R1714CP
(Medicare Claims Processing Manual)
PPS) Outlier Payments  01/25/2010 6759 R1773CP  07/24/2009 Revised Processing of Osteoporosis Drugs Under the Home Health Benefit  01/04/2010 6512 R1714CP  04/24/2009 Correction to Editing of Health Insurance Prospective Payment System (HIPPS) Codes on Home Health Prospective Payment System (HH PPS) Claims  10/05/2009 6393 R1647CP  12/12/2008 Payments to Home Health Agencies That Do Not Submit Required Quality Data  03/16/2009 6286 R1505CP  05/16/2008 Correction to Determinations of Early vs. Later Episodes Under the Home Health Prospective Payment System (HH PPS)  10/06/2008 6027 R1476CP  03/07/2008 Correction to Low Utilization Payment Adjustment Add- on Payments Under the Refined Home Health Prospective Payment System (HH PPS)  07/07/2008 5877 R1472CP  03/06/2008 Update of Institutional Claims References  04/07/2008 5893 R1443CP  02/07/2008 Home Health Prospective Payment system (HH PPS) Refinement and Rate Update for Calendar Year (CY) 2008  03/07/2008 5879 R1431CP  02/01/2008 Update to the Implementation Date for Home Health Agencies (HHAs) Providing Durable Medical Equipment (DME) in Competitive Bidding Areas  07/07/2008 5868 R1424CP  02/01/2008 Correction to Low Utilization Payment Adjustment Add- on Payments Under the Refined Home Health Prospective Payment System (HH PPS)  Rescinded and Replaced by Transmittal 1476 07/07/2008 5877 R1421CP  01/25/2008 Update of Institutional Claims References -  Rescinded and Replaced by Transmittal 1472 04/07/2008 5893 R1371CP  11/02/2007 Validation of Non- Routine Supply Reporting on Home Health Prospective Payment System (HH PPS) Claims  04/07/2008 5776 R1348CP  10/05/2007 Billing Instructions for the Home Health Prospective Payment System (HH PPS) Case Mix Refinement  11/05/2007 5746 R1246CP  05/22/2007 Home Health Agencies (HHAs) Providing Durable Medical Equipment in Competitive Bidding Areas  04/01/2008 5551 R1224CP
(Medicare Claims Processing Manual)
PPS) Case Mix Refinement  11/05/2007 5746 R1246CP  05/22/2007 Home Health Agencies (HHAs) Providing Durable Medical Equipment in Competitive Bidding Areas  04/01/2008 5551 R1224CP  04/20/2007 Home Health Agencies (HHAs) Providing Durable Medical Equipment in Competitive Bidding Areas - Replaced by Transmittal 1246 10/01/2007 5551 R1079CP  10/20/2006 Changes to the Process for Recovering Medicare Payments for Home Health Prospective Payment (HH PPS) Claims Failing to Report Prior Hospitalizations  01/18/2007 5085 R1036CP  08/18/2006 Updates to Chapter 10 of the Medicare Claims Processing Manual  10/09/2006 5242 R1025CP  08/11/2006 Revised Home Health Advance Beneficiary Notice  09/01/2006 5009 R980CP  06/14/2006 Changes Conforming to CR 3648 Instructions for Therapy Services -  Replaces Rev. 941  10/02/2006 4014 R941CP  05/05/2006 Changes Conforming to CR 3648 Instructions for Therapy Services  10/02/2006 4014 R771CP  12/02/2005 Revisions to Pub.100- 04, Medicare Claims Processing Manual in Preparation for the National Provider Identifier (NPI)  01/03/2006 4181 R635CP  08/05/2005 Financial Liability for Services Subject to Home Health Consolidated Billing  11/03/2005 3948 R481CP  02/25/2005 Updated Manual Instructions for the Medicare Claims Processing Manual, Chapter 10  03/28/2005 3691 R427CP  01/14/2005 Revision of Change Request 2928: Implementation of Payment Safeguards for Home Health Prospective Payment System (HH PPS) Claims Failing to Report Prior Hospitalizations  07/05/2005 3616 R362CP  11/05/2004 Update to the Prospective Payment System (PPS) for Home Health Agencies for Calendar Year (CY) 2005  01/03/2005 3556 R358CP  11/05/2004 Inclusion of Forteo as a Covered Osteoporosis Drug and Clarification of Manual Instructions Regarding Osteoporosis Drugs  04/04/2005 3524 R226CP  07/09/2004 Quarterly Update of HCPCS Codes for Home Health Consolidated Billing Enforcement  10/04/2004 3350 R165CP
(Medicare Claims Processing Manual)
of Manual Instructions Regarding Osteoporosis Drugs  04/04/2005 3524 R226CP  07/09/2004 Quarterly Update of HCPCS Codes for Home Health Consolidated Billing Enforcement  10/04/2004 3350 R165CP  04/30/2004 Enhancement to Home Health Consolidated Billing Edits  10/04/2004 3186 R061CP  01/16/2004 Requests for Anticipated Payment  02/16/2004 2992 R025CP  10/31/2003 Billing Non -Covered Charges to Fiscal Intermediaries -Summary and New Instructions  04/05/2004 2634 R017CP  10/31/2003 Billing and Payment Procedures Regarding Ownership and Provider Numbers  04/05/2004 2927 R013CP  10/24/2003 Implementation of Payment Safeguards for Home Health Prospective Payment System Claims Failing to Report Prior Hospitalization  04/01/2004 2928 R001CP  10/01/2003 Initial Publication of Manual  NA NA Back to top of Chapter
(Medicare Claims Processing Manual Crosswalk)
Medicare Claims Processing Manual Home Health Agency Billing Crosswalk New. Chap. New. Sect. Int.  Pub. 13. HH Pub. 11 Program Memos Other          Description10 10 A3-3638.20  HH-401-402,HH-429   General Guidelines for Payment of HHA Claims 10 10.1 A3-3639 HH-467   Home Health Prospective Payment System (HH PPS) 10 10.1.1 A3-3639.1 HH-467.1   Creation of HH PPS 10 10.1.2 A3-3639.3 HH-467.3,    Commonalities of the Cost Payment and HH PPS Environments 10 10.1.3 A3-3639.5,A3-3639.6  HH-467.5, HH-467.6,    Configuration of the HH PPS Environment 10 10.1.4 A3-3639.7 HH-467.7,    The HH PPS Episode - Unit of Payment 10 10.1.5 A3-3639.8 HH-467.8,    Number, Duration, and Claims Submission of HH PPS Episodes 10 10.1.5.1  A3-3638.16,A3-3638.5  HH-439, 440   More Than One Agency Furnished Home Health Services 10 10.1.5.2 A3-3639.9 HH-467.9,    Effect of Election of HMO and Eligibility Changes on HH PPS Episodes New. Chap. New. Sect. Int.  Pub. 13. HH Pub. 11 Program Memos Other Description 10 10.1.6 A3-3639.10 HH-467.10,    Split Percentage Payment of Episodes and Development of Episode Rates 10 10.1.7 A3-3639.11 HH-467.11,    Basis of Medicare Prospective Payment Systems and Case-Mix 10 10.1.8 A3-3639.12 HH-467.12,    Coding of HH PPS Episode Case-Mix Groups on HH PPS Claims: (H)HRGs and HIPPS Codes 10
(Medicare Claims Processing Manual Crosswalk)
10.1.9 A3-3639.13,A3-3639.14  HH-467.13, HH-467.14   Composition of HIPPS Codes for HH PPS 10 10.1.10 A3-3639.15 HH-467.15,    Provider Billing Process Under HH PPS 10 10.1.10.1 A3-3639.16 HH-467.16,    Grouper Links Assessment and Payment 10 10.1.10.2 A3-3639.17 HH-467.17,    Health Insurance Query for Home Health Agencies (HIQH) Inquiry System Shows Primary HHA 10 10.1.10.3 A3-3639.18 HH-467.18,    Submission of Request for Anticipated Payment (RAP) 10 10.1.10.4 A3-3639.19 HH-467.19,    Claim Submission and Processing 10 10.1.11 A3-3639.20 HH-467.20,    Payment, Claim Adjustments and Cancellations 10 10.1.12 A3-3639.21 HH-467.21,    Request for Anticipated Payment (RAP) 10 10.1.13  A3-3639.22  HH-201.8E,  HH46722  Transfer Situation - Payment Effects New. Chap. New. Sect. Int.  Pub. 13. HH Pub. 11 Program Memos Other Description HH-467.22,  10 10.1.14 A3-3639.23 HH-467.23,    Discharge and Readmission Situation Under HH PPS - Payment Effects 10 10.1.15 A3-3639.28 HH-467.28,    Adjustments of Episode Payment - Partial Episode Payment (PEP) 10 10.1.16 A3-3639.24 HH-467.24,    Payment When Death Occurs During an HH PPS Episode 10 10.1.17 A3-3639.25 HH-467.25,    Adjustments of Episode Payment - Low Utilization Payment Adjustments (LUPAs) 10 10.1.18 A3-3639.26 HH-467.26,    Adjustments of Episode Payment - Special Submission Case: "No-RAP" LUPAs 10 10.1.19
(Medicare Claims Processing Manual Crosswalk)
Utilization Payment Adjustments (LUPAs) 10 10.1.18 A3-3639.26 HH-467.26,    Adjustments of Episode Payment - Special Submission Case: "No-RAP" LUPAs 10 10.1.19 A3-3639.27 HH-467.27,    Adjustments of Episode Payment - Therapy Threshold 10 10.1.20 A3-3639.29 HH-467.29,    Adjustments of Episode Payment - Significant Change in Condition (SCIC) 10 10.1.21 A3-3639.30 HH-467.30,    Adjustments of Episode Payment - Outlier Payments 10 10.1.22 A3-3639.31 HH-467.31,    Adjustments of Episode Payment - Exclusivity and Multiplicity of Adjustments 10 10.1.23 A3-3639.33 HH-467.33,    Exhibit: General Guidance on Line Item Billing Under HH PPS New. Chap. New. Sect. Int.  Pub. 13. HH Pub. 11 Program Memos Other Description 10 10.1.24 A3-3639.34 HH-467.34,    Exhibit: Acronym List 10 10.1.25 A3-3639.35, HH-467.35,  PM-AB-00-112  HH PPS Consolidated Billing and Primary HHAs 10
(Medicare Claims Processing Manual Crosswalk)
20 PM-AB-01-111,PM AB-01-65, Dated 4/26/01  Completion of Home Health Prospective Payment System (HH PPS) Consolidated Billing Enforcement 10 20.1     Exception of Supplies from Consolidated Billing Edits on Institutional Claims 10 20.2 PM-AB-01-70,Dated 5/1/01  Only RAP Received and Services Fall Within 60 Days after RAP Start Date 10 30 A3-3640 HH-468,    Common Working File (CWF) Requirements for the Home Health Prospective Payment System (HH PPS) 10 30.1 A3-3640.1 HH-468.1,    Health Insurance Query for Home Health Agencies (HIQH) 10 30.2 A3-3640.2 HH468.2,    HIQH Inquiry and Response 10 30.3 A3-3640.3 HH-468.3,    Timeliness and Limitations of HIQH Responses 10 30.4 A3-3640.4 HH-468.4,    Inquiries to RHHIs Based on HIQH Responses 10 30.5 A3-3640.5 HH-468.5,    National Home Health Prospective Payment Episode History File New. Chap. New. Sect. Int.  Pub. 13. HH Pub. 11 Program Memos Other Description 10 30.6 A3-3640.6 HH-468.6,    Opening and Length of HH PPS Episodes 10 30.7 A3-3640.7 HH-468.7   Closing, Adjusting and Prioritizing HH PPS Episodes Based on RAPs and HHA Claim Activity 10 30.8 A3-3640.8 HH-468.8,    Other Editing and Changes for HH PPS Episodes 10 30.9 A3-3640.9 HH-468.9,    Priority Among Other Claim Types and HH PPS Consolidating Billing for Episodes 10 30.10 A3-3640.10 HH-468.10,    Medicare Secondary Payment (MSP) and the HH PPS Episodes File 10 30.11 A3-3640.11 HH-468.11,    Exhibit: Chart Summarizing the Effects of RAP/Claim Actions on the HH PPS Episode File 10  40
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and the HH PPS Episodes File 10 30.11 A3-3640.11 HH-468.11,    Exhibit: Chart Summarizing the Effects of RAP/Claim Actions on the HH PPS Episode File 10  40 A3-3638.22,A3-3638.13  HH-475,    Completion of Form CMS-1450 for Home Health Agency Billing 10 40.1 A3-3638.23 HH-475.1,    Request for Anticipated Payment (RAP) 10 40.2 A3-3638.24 HH-475.2,    HH PPS Claims 10 40.3 A3-3638.25 HH-475.3,    HH PPS Claims When No RAP is Submitted - "No-RAP" LUPAs New. Chap. New. Sect. Int.  Pub. 13. HH Pub. 11 Program Memos Other Description 10
(Medicare Claims Processing Manual Crosswalk)
40.4 A3-3638.10  HH-400,HH-463 Def. of nom. Chg. from 42 CFR 410.2  Collection of Deductible and Coinsurance from Patient 10 40.5 A3-3638.14    Billing for Nonvisit Charges 10 50 A3-3638.30, PM-A-01-05 Benefici ary-Driven Demand Billing Under HH PPS 10 70  HH-475.4   HH PPS Pricer Program 10 70.1 HH-475.4.A  General10 70.2  HH-475.4.B   Input/Output Record Layout 10 70.3  HH-475.4.C   Decision Logic Used by the Pricer on RAPs 10 70.4  HH-475.4.D   Decision Logic Used by the Pricer on Claims 10 70.5  HH-475.4.E   Annual Updates to the HH Pricer 10 80  HHA 475.5   Special Billing Situations Involving OASIS Assessments 10 90 A3-3638.9,A3-3638.19 HH-461,    Medical and Other Health Services Not Covered Under the Plan of Care (Bill Type 34X) 10 90.1 A3-3638.21    Osteoporosis Injections as HHA Benefit 10 90.2     Billing Instructions for Pneumococcal Pneumonia, Influenza Virus, and Hepatitis B Vaccines New. Chap. New. Sect. Int.  Pub. 13. HH Pub. 11 Program Memos Other Description 10 100 A3-3638.17    Temporary Suspension of Home Health Services 10 110  HH-432   Billing Procedures for an Agency Being Assigned Multiple Provider Numbers or a Change in Provider Number
(Medicare Claims Processing Manual)
Medicare Claims Processing Manual  Chapter 11 - Processing Hospice Claims   Table of Contents  (Rev. 12083, 06-15-23)  Transmittals for Chapter 11   10 - Overview  10.1 - Hospice Pre -Election Evaluation and Counseling Services  20 - Hospice Notice of Election  20.1 - Procedures for Hospice Election  and Related Transactions  20.1.1 - Notice of Election (NOE)  20.1.2 - Notice of Termination/Revocation (NOTR)  20.1.3 -  Change of Provider/Transfer Notice 20.1.4  Cancellation of an Election  20.1.5  Change of Ownership Notice
(Medicare Claims Processing Manual)
20.1.6  Hospice Election Periods and Benefit Periods in Medicare Systems  30 - Billing and Payment for General Hospice Services  30.1 - Levels of Care Data Required on the Intuitional Claim to A/B MAC (HHH)  30.2 - Payment Rates  30.2.1 - Payments to Hospice Agencies That Do Not Submit Required Quality Data  30.2.2  Service Intensity Add-on (SIA) Payments  30.3 - Data Required on the Institutional Claim to A/B MAC (HHH)  30.4 - Claims From Medicare Advantage Organizations  30.5  Hospice Claims for Vaccine Services  40 - Billing and Payment for Hospice Services Provided by a Physician 40.1 - Types of Physician Services  40.1.1 - Administrative Activities  40.1.2 - Hospice Attending Physician Services  40.1.3 - Independent Attending Physician Services  40.1.3.1 - Care Plan Oversight  40.2 - Processing Professional Claims for Hospice Beneficiaries  40.2.1 -  Claims After the End of Hospice Election Period  50 - Billing and Payment for Services Unrelated to Terminal Illness  60 - Billing and Payment for Services Provided by Hospices Under Contractual Arrangements With Other Institutions  60.1 -  Instructions for the Contractual Arrangement  60.2 -  Clarification of the Payment for Contracted Services  70 - Deductible and Coinsurance for Hospice Benefit  70.1 -  General  70.2 -  Coinsurance on Outpatient Drugs and Biologicals  70.3 -  Coinsurance on Inpatient Respite Care  80 - Caps and Limitations on Hospice Payments  90 - Frequency of Billing and Same Day Billing  100 -  Billing for Hospice Denials  100.1 -  Billing for Denial of Room and Board Charges  100.2 -  Demand Billing for Hospice General Inpatient Care  120 -  Contractor Responsibilities for Publishing Hospice Information 130 HOSPICE Pricer Program  130.1 Input/Output Record Layout  130.2 Decision Logic Used by the Pricer on Claims        10  Overview  (Rev. 4280, Issued: 04 -19-2019, Effective: 07 -21-19, Implementation: 07- 21-19)
(Medicare Claims Processing Manual)
10  Overview  (Rev. 4280, Issued: 04 -19-2019, Effective: 07 -21-19, Implementation: 07- 21-19)  Medicare beneficiaries entitled to hospital insurance (Part A) who have terminal illnesses and a life expectancy of six months or less have the option of electing hospice benefits in lieu of standard Medicare coverage for treatment and management of their terminal condition.  Only care provided by a Medicare certified hospice is covered under the hospice benefit provisions.  Hospice care is available for two 90 -day periods and an unlimited number of 60- day periods during the remainder of the hospice patients lifetime. However, a  beneficiary  may voluntarily terminate  his hospice  election  period. Election/termination  dates  are retained  on CWF.   When hospice coverage is elected, the beneficiary waives all rights to Medicare Part B payments for services that are related to the treatment and management of his/her terminal illness during any period his/her hospice benefit election is in force, except  for professional services of an attending physician, which may include a nurse practitioner or physician assistant.  If the attending physician, is an employee of the designated hospice, he or she may not receive compensation from the hospice for those se rvices under Part B.  These physician professional services are billed to Medicare Part A by the hospice.  To be covered, hospice services must be reasonable and necessary for the palliation or management of the terminal illness and related conditions. The individual must elect hospice care and a certification that the individual is terminally ill must be completed by the patients attending physician (if there is one), and the Medical Director (or the physician member of the Interdisciplinary Group (IDG)).  Nurse practitioners or physician assistants serving as the attending physician may not certify or re -certify the terminal illness. A plan of care must be established before services are provided. To be covered, services must be consistent with the plan of care.  C ertification of terminal illness is based on the physicians or medical directors clinical judgment regarding the normal course of an individuals illness. It should be noted that predicting life expectancy is not always exact.   See the Medicare Benefit Policy Manual, Chapter 9, for additional general information about the Hospice benefit.  See Chapter 29 of this manual for information on the appeals process that should be followed when an entity is dissatisfied with the determination made on a claim.
(Medicare Claims Processing Manual)
See the Medicare Benefit Policy Manual, Chapter 9, for additional general information about the Hospice benefit.  See Chapter 29 of this manual for information on the appeals process that should be followed when an entity is dissatisfied with the determination made on a claim.   See Chapter 9 of the Medicare Benefit Policy Manual for hospice eligibility requirements and election of hospice care.   10.1 - Hospice Pre -Election Evaluation and Counseling Services (Rev. 3577, Issued: 08- 05-16; Effective: 01- 01-17; Implementation: 01 -03-17)  Effective January 1, 2005, Medicare allows payment to a hospice for specified hospice pre-election evaluation and counseling services when furnished by a physician who is either the medical director of or employee of the hospice.  Medicare covers a one- time only  payment on behalf of a beneficiary who is terminally ill, (defined as having a prognosis of 6 months or less if the disease follows its normal course), has no previous hospice elections, and has not previously received hospice pre-election evaluation and counseling services.  HCPCS code G0337 Hospice Pre-Election Evaluation and Counseling Services is used to designate that these services have been provided by the medical director or a physician employed by the hospice.  Hospice agencies bill their A/B MAC (HHH) with home health and hospice jurisdiction directly using HCPCS G0337 with Revenue Code 0657. No other revenue codes may appear on the claim.
(Medicare Claims Processing Manual)
Claims for Hospice Pre -Election and Counseling Services, HCPCS code G0337, are not subject to the editing usually required on hospice claims to match the claim to an established hospice period.  Further, A/B MACs (HHH) do not apply payments for hospice pre -election evaluation and counseling consultation services to the overall hospice cap amount.  Medicare must ensure that this counseling service occurs only one time per beneficiary by imposing safeguards to detect and prevent duplicate billing for similar services.  If new patient physician services (HCPCS codes 99201-99205) are submitted by a A/ B MAC (HHH) to CWF for payment authorization but HCPCS code G0337 (Hospice Pre-Election Evaluation and Counseling Services) has already been approved for a hospice claim for the same beneficiary, for the same date of service, by the same physician, the physician service will be rejected by CWF and the service shall be denied as a duplicate.    The contractor shall use the following remittance advice messages and associated codes when rejecting/denying claims under this policy.  This CARC/RARC combination is compliant with CAQH CORE Business Scenario Four.  Group Code: CO CARC: 97  RARC: M86  MSN: 16.45  Likewise, if a new patient claim for HCPCS codes 99201 -99205 has been approved and subsequently, a hospice claim is submitted to CWF for payment authorization for HCPCS code G0337, (for same beneficiary, same date of service, same physician), CWF shall r eject the claim and the contractor shall deny the bill and use the messages above.   HCPCS code G0337 is only payable when billed on a hospice claim.  Contractors shall not make payment for HCPCS code G0337 on professional claims.  Contractors shall deny line items on professional claims for HCPCS code G0337.   The contractor shall use the following remittance advice messages and associated codes when rejecting/denying claims under this policy.  This CARC/RARC combination is compliant with CAQH CORE Business Scenario Three.   Group Code: CO  CARC: 109  RARC: N/A  MSN: 17.9  20 - Hospice Notice of Election  (Rev. 1, 10- 01-03) HSP-201