evekhm/cms_iom_500 huggingface dataset:
(Medicare Claims Processing Manual)
The claims data  used for the primary care percentage calculations depend on the potential primary care practitioners date of enrollment in Medicare.  We will use Medicare claims data 2 years prior to the PCIP payment year to determine PCIP eligibility fo r those potential primary care practitioners who were enrolled in Medicare in that year.  For example, for CY 2011, we will use Medicare claims data from CY 2009 for practitioners who were already enrolled in Medicare in CY 2009. We will use claims data fr om the year immediately preceding the PCIP payment year in order to determine PCIP eligibility for potential primary care practitioners who newly enroll in Medicare in the year immediately preceding the PCIP payment year.  For example, for CY 2011, we will use the available Medicare claims data from CY 2010 only for potential primary care practitioners who newly enrolled in Medicare in CY 2010.  Eligible practitioners for PCIP payments in a given calendar year who were enrolled in Medicare 2 years earlier will be listed by eligible NPI in the Primary Care Incentive Payment Program Eligibility File, available after January 31 of the PCIP payment ye ar on their A/B MAC (B)s website.  Eligible practitioners for PCIP payments in a given calendar year who were newly enrolled in Medicare in the year immediate preceding the PCIP payment year will be identified in the PCIP Payment  for New Providers Enroll ed in Medicare File, available after October 1 of the PCIP payment year.  Practitioners should contact their A/B MAC (B) with any questions regarding their eligibility for the PCIP.   230.2 - Coordination with Other Payments (Rev. 2152, Issued: 02- 11-11, Effective: 07 -01-11, Implementation: 07- 05-11)  Section 5501(a)(3) of the Affordable Care Act authorizes payment under the PCIP as an additional payment amount for specified primary care services without regard to any additional payment for the service under Section 1833(m) of the Act.  Therefore, an eligible primary care physic ian furnishing a primary care service in a health professional shortage area (HPSA) may receive both a HPSA physician bonus payment (as described in the Medicare Claims Processing Manual, Pub. 100- 04, Chapter 12, 90.4) under the HPSA physician bonus progr am and a PCIP incentive payment under the new program beginning in CY 2011.
(Medicare Claims Processing Manual)
230.3 - Claims Processing and Payment  (Rev. 2152, Issued: 02- 11-11, Effective: 07 -01-11, Implementation: 07- 05-11)  A. General Overview   Incentive payments will be made on a quarterly basis and shall be equal to 10 percent of the amount paid for such services under the Medicare Physician Fee Schedule (PFS) for those services furnished during the incentive payment year. PCIP payments for new ly enrolled practitioners will be delayed due to the lag in their eligibility determination.  Newly enrolled primary care practitioners will receive a single cumulative PCIP payment, retroactive for primary care services furnished from the beginning of the  PCIP payment year, following the fourth quarter of the PCIP payment year after the primary care practitioner is deemed eligible.  Quarterly payments will be made for subsequent incentive payments.   For information on PCIP payments to CAHs paid under the optional method, see the Medicare Claims Processing Manual, Pub. 100- 04, Chapter 4, 250.12.   On an annual basis A/B MACs (B) shall receive a Primary Care Incentive Payment Program Eligibility File and PCIP Payment for New Providers Enrolled in Medicare File that they shall post to their websites.  The files will list the NPIs of all practitioners who are eligible to receive PCIP payments for the PCIP payment year.   B. Method of Payment    Calculate and pay qualifying primary care practitioners an additional 10 percent incentive payment.    Calculate the payment based on the amount actually paid for the services, not the Medicare approved amount.    Combine the PCIP incentive payments, when appropriate, with other incentive payments, including the HPSA physician bonus payment, and the HPSA Surgical Incentive Payment Program (HSIP) payment;    Provide a special remittance form that is forwarded with the incentive payment so that physicians and practitioners can identify which type of incentive payment (HPSA physician and/or PCIP) was paid for which services.    Practitioners should contact their A/B MAC (B) with any questions regarding PCIP payments.   C. Changes for Contractor Systems   The Medicare Carrier System, (MCS), Common Working File (CWF) and the National Claims History (NCH) shall be modified to accept a new PCIP indicator on the claim line.  Once the type of incentive payment has been identified by the shared systems, the shared system shall modify their systems to set the indicator on the claim line as follows:
(Medicare Claims Processing Manual)
1 = HPSA;  2 = PSA;  3 = HPSA and PSA;  4 = HSIP;  5 = HPSA and HSIP;  6 = PCIP;  7 = HPSA and PCIP; and  Space = Not Applicable.   The MCS shall send the HIGLAS 810 invoice for incentive payment invoices, including the new PCIP payment.  The A/B MAC (B) shall also combine the providers HPSA physician bonus, physician scarcity (PSA) bonus (if it should become available at a later date), HSIP payment and/or PCIP payment invoice per provider.  The A/B MAC (B) shall receive the HIGLAS 835 payment file from HIGLAS showing a single incentive payment per provider.    240 - Marriage and Family Therapist (MFT) Services (Rev.12448; Issued:01- 11-24; Effective: 01 -01-24; Implementation: 02 -12-24)  See Medicare Benefit Policy Manual, Chapter 15, for coverage requirements.  Assignment of benefits is required.  Payment is at 75 percent of the amount that a clinical psychologist is paid under the physician fee schedule.    MFTs are identified on the provider file by specialty code E1.   250 - Mental Health Counselor (MHC) Services  (Rev.12448; Issued:01- 11-24; Effective: 01 -01-24; Implementation: 02 -12-24)  See Medicare Benefit Policy Manual, Chapter 15, for coverage requirements.  Assignment of benefits is required.  Payment is at 75 percent of the amount that a clinical psychologist is paid under the physician fee schedule.  MFTs are identified on the provider file by specialty code E2.
(Medicare Claims Processing Manual)
Transmittals Issued for this Chapter  Rev #  Issue Date  Subject  Impl Date  CR#  R12461CP  01/18/2024  Guidance for the Implementation of the Office and Outpatient (O/O) Evaluation and Management (E/M) Visit Complexity Add-on Code G2211  02/19/2024  13473  R12448CP  01/11/2024  Updates to Medicare Benefit Policy Manual and Medicare Claims Processing Manual for Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) 02/12/2024  13469  R12423CP  12/20/2023  Enforcing Billing Requirements for Intensive Outpatient Program (IOP) Services with New Condition Code 92 01/02/2024  13222  R12370CP  11/21/2023  Implement Edits to Prevent Payment of Complexity Add-On Code G2211 When Associated Office/Outpatient Evaluation and Management Visit (Codes 99202-99205, 99211-99215) is Reported With Modifier 25 NO LONGER SENSITIVE  01/02/2024  13272
(Medicare Claims Processing Manual)
07/28/2023  Implement Edits to Prevent Payment of Complexity Add-On Code G2211 When Associated Office/Outpatient Evaluation and Management Visit (Codes 99202-99205, 99211-99215) is Reported with Modifier 25 SENSITIVE CONTROVERSIAL  Rescinded and replaced by Transmittal  12370 01/02/2024  13272  R11842CP  02/09/2023  Internet-Only Manual (IOM) Updates to Pub. 100-04, Chapter 12 for the New Hospital Inpatient or Observation Care Code Family, Nursing Facility Visits Code Family, Billing the Substantive Portion of a Split (or Shared) Visit, Changes for Prolonged Services, and Updates to the IOM with Policies Finalized for Office/Outpatient E/M Visits in the 05/09/2023  13064  Rev #  Issue Date  Subject  Impl Date  CR#  CY2020 and CY2021 Final Rules  R11828CP  02/02/2023  Correction of Split (or Shared) Critical Care Billing Requirement in Section 30.6.12.5. of Chapter 12 of the Medicare Claims Processing Manual  03/03/2023  13065  R11732CP  12/08/2022  Billing Instructions for Home or Residence Services  01/03/2023  13004  R11288CP  03/04/2022  Internet-Only Manual Updates (IOM) for Critical Care, Split/Shared Evaluation and Management Services, Teaching Physicians, and Physician Assistants  02/15/2022  12543  R11287CP  03/02/2022  Internet- Only Manual Updates for Critical Care Evaluation and Management Services  02/22/2022  12550  R11195CP  01/20/2022  Internet- Only Manual Updates for Critical Care Evaluation and Management Services  - Rescinded and replaced by Transmittal 11287  02/22/2022  12550  R11181CP  01/14/2022  Internet-Only Manual Updates (IOM) for Critical Care, Split/Shared Evaluation and Management Services, Teaching Physicians, and Physician Assistants -Rescinded and replaced by Transmittal 11288 02/15/2022  12543  R10742CP  05/03/2021  Revisions of Sections 30.6.1(B), 30.6.12, and 30.6.13(H) of Chapter 12 of the Medicare Claims Policy Manual  05/09/2021  12275  R10716CP
(Medicare Claims Processing Manual)
Revisions of Sections 30.6.1(B), 30.6.12, and 30.6.13(H) of Chapter 12 of the Medicare Claims Policy Manual  05/09/2021  12275  R10716CP  04/06/2021  Common Working File (CWF) Edits for Medicare Telehealth Services and Manual Update  07/06/2021  12068  R10618CP  03/16/2021  Common Working File (CWF) Edits for Medicare Telehealth Services and Manual Update- Rescinded and replaced by Transmittal 10716 07/06/2021  12068  Rev #  Issue Date  Subject  Impl Date  CR#  R10639CP  03/12/2021  Update to the Manual for Telephone Services, Physician Assistant (PA) Supervision, and Medical Record Documentation for Part B Services  04/12/2021  11862  R10356CP  09/18/2020  Update to the Medicare Claims Processing Manual  10/19/2020  11958  R4431CP.  11/01/2019  Health Professional Shortage Area (HPSA) Bonus Payments for All Mental Health Specialties  02/04/2019  11327 R4339CP  07/25/2019  Documentation of Medical Necessity of the Home Visit; and Physician Management Associated with Superficial Radiation Treatment  08/27/2019  11273 R4309CP  05/24/2019  Documentation of Medical Necessity of the Home Visit; and Physician Management Associated with Superficial Radiation Treatment - Rescinded and replaced by Transmittal 4339 08/27/2019  11273 R4283CP  04/26/2019  Documentation of Evaluation and Management Services of Teaching Physicians 07/29/2019  11171 R4173CP  11/30/2018  Revision of Definition of the Physician Supervision of Diagnostic Procedures, Clarification of DSMT Telehealth Services, and Establishing a Modifier for Expanding the Use of Telehealth for Individuals with Stroke  01/02/2019  11043 R4068CP  05/31/2018  E/M Service Documentation Provided by Students (Manual Update) 03/05/2018  10412 R3971CP  02/02/2018  E/M Service Documentation Provided by Students (Manual Update)  Rescinded and replaced by Transmittal 4068 03/05/2018  10412 R3883CP  10/13/2017  Payment for Services Furnished by 01/16/2018  10275 Rev #  Issue Date  Subject  Impl Date
(Medicare Claims Processing Manual)
Update)  Rescinded and replaced by Transmittal 4068 03/05/2018  10412 R3883CP  10/13/2017  Payment for Services Furnished by 01/16/2018  10275 Rev #  Issue Date  Subject  Impl Date  CR#  Qualified Nonphysician Anesthetists
(Medicare Claims Processing Manual)
10/06/2017  Place of Service Codes  04/02/2018  10272 R3820CP  07/28/2017  Payment Reduction for X- Rays Taken Using Computed Radiography- No Longer Sensitive  01/02/2018  10188 R3817CP  07/28/2017  Elimination of the GT Modifier for Telehealth Services  01/02/2018  10152 R3747CP  04/14/2017  Payment for Moderate Sedation Services  05/15/2017  10001 R3721CP  02/24/2017  Updates to Pub. 100-04, Chapters 12, 17 and 23 to Correct Remittance Advice Messages  05/25/2017  9906 R3678CP  12/16/2016  Prolonged Services Without Direct Face -to-Face Patient Contact Separately Payable Under the Physician Fee Schedule (Manual Update)  01/03/2016  9905 R3586CP  08/12/2016  New Place of Service (POS) Code for Telehealth and Distant Site Payment Policy  01/03/2017  9726 R3583CP  08/12/2016  Payment Reduction for X- Rays Taken Using Film 01/03/2017  9727 R3476CP  03/11/2016  Telehealth Services  04/11/2016  9428 R3402CP  11/06/2015  Payment Reduction for Computed Tomography (CT) Diagnostic Imaging  01/04/2016  9250 R3368CP  10/09/2015  New Values for Incomplete Colonoscopies Billed with Modifier 53 01/01/2016  9317 R3315CP  08/06/2015  New and Revised Place of Service Codes (POS) for Outpatient Hospital 01/04/2016  9231 Rev #  Issue Date  Subject  Impl Date  CR#  R3299CP  08/06/2015  Payment Reduction for Computed Tomography (CT) Diagnostic Imaging Services  Rescinded and replaced by Transmittal 3402  01/04/2016  9250 R3096CP  10/17/2014  Medicare Coverage of Ultrasound Screening for Abdominal Aortic Aneurysms (AAA) and Screening Fecal-Occult Blood Tests (FOBT) 11/18/2014  8881 R2997CP  07/25/2014  Update to Pub. 100-04, Chapter 12 to Provide Language-Only Changes for Updating ICD -10 and ASC X12 08/25/2014  8688 R2914CP
(Medicare Claims Processing Manual)
R2997CP  07/25/2014  Update to Pub. 100-04, Chapter 12 to Provide Language-Only Changes for Updating ICD -10 and ASC X12 08/25/2014  8688 R2914CP  03/25/14 Health Professional Shortage Area (HPSA) Post -payment Review Process  03/31/2014  8608 R2890CP  02/28/2014  Health Professional Shortage Area (HPSA) Post -payment Review Process  Rescinded and replaced by Transmittal 2914 03/31/2014  8608 R2848CP  12/30/2013  Expansion of Medicare Telehealth Services for CY 2014 01/06/2014  8553 R2716CP  05/30/2013  Internet Only Manual (IOM) Update to Payment for Medical or Surgical Services Furnished by CRNAs. This CR rescinds and fully replaces CR 8027.  Rescinded and replaced by Transmittal 2668. 02/12/2013  8180 R2714CP  05/24/2013  Updates to Chapter 12 and Chapter 16 of the Medicare Claims Processing Manual to Revise Instructions Regarding the Technical Component (TC) of Pathology Services Furnished to Hospital Patients  06/25/2013  8013 R2679CP  03/29/2013  Revised and Clarified Place of Service (POS) Coding Instructions 04/01/2013  7631 R2668CP  03/08/2013  Internet Only Manual (IOM) Update to Payment for Medical or Surgical Services 02/12/2013  8180 Rev #  Issue Date  Subject  Impl Date  CR#  Furnished by CRNAs. This CR rescinds and fully replaces CR 8027.  Rescinded and replaced by Transmittal 2716. R2657CP  02/12/2013  Expansion of Medicare Telehealth Services for CY 2012 01/25/2013  7900 R2656CP  02/07/2013  Update To Publication 100-04, Claims Processing Instructions For Chapter 12, Non-Physician Practitioners (NPPs)  02/19/2013  8010 R2652CP  02/06/2013  Expansion of Medicare Telehealth Services for CY 2012  Rescinded and replaced by Transmittal 2657 01/25/2013  7900 R2634CP  01/11/2013  Internet Only Manual (IOM) Update to Payment for Medical or Surgical Services Furnished by CRNAs. This CR rescinds and fully replaces CR 8027.  Rescinded and replaced by
(Medicare Claims Processing Manual)
7900 R2634CP  01/11/2013  Internet Only Manual (IOM) Update to Payment for Medical or Surgical Services Furnished by CRNAs. This CR rescinds and fully replaces CR 8027.  Rescinded and replaced by Transmittal 2668. 02/12/2013  8180 R2613CP  12/14/2012  Revised and Clarified Place of Service (POS) Coding Instructions  Rescinded and replaced by Transmittal 2679 04/01/2013  7631 R2610CP  12/14/2012  Update To Publication 100-04, Claims Processing Instructions For Chapter 12, Non-Physician Practitioners (NPPs)  Rescinded and replaced by Transmittal 2656 02/19/2013  8010 R2606CP  11/30/2012  Expansion of Medicare Telehealth Services for CY 2012  Rescinded and replaced by Transmittal 2652 01/07/2013  7900 R2563CP  10/11/2012  Revised and Clarified Place of Service (POS) Coding Instructions  Rescinded and replaced by Transmittal 2613 04/01/2013  7631 R2561CP  09/28/2012  Revised and Clarified Place of Service (POS) Coding Instructions  Rescinded and replaced by Transmittal 2563 04/01/2013  7631 Rev #  Issue Date  Subject  Impl Date  CR#  R2538CP  08/31/2012  Expansion of Medicare Telehealth Services for CY 2012  Rescinded and replaced by Transmittal 2606 01/07/2013  7900 R2464CP  05/04/2012  Enhance the Multi- Carrier System (MCS) and ViPS Medicare System (VMS) to Maintain Five Full Years of Pricing Data and to Automatically Price Claims/Adjustments at the Rates in Effect at the Dates of Service  10/01/2012 for VMS  7383 R2435CP  03/29/2012  Revised and Clarified Place of Service (POS) Coding Instructions  Rescinded and replaced by Transmittal 2561 10/01/2012  7631 R2407CP  02/03/2012  Revised and Clarified Place of Service (POS) Coding Instructions  Rescinded and replaced by Transmittal 2435 04/02/2012  7631 R2373CP  12/21/2011  Bundling of Payments for Services Provided to Outpatients Who Later Are Admitted as Inpatients: 3 -Day Payment Window Policy and the Impact on Wholly
(Medicare Claims Processing Manual)
2435 04/02/2012  7631 R2373CP  12/21/2011  Bundling of Payments for Services Provided to Outpatients Who Later Are Admitted as Inpatients: 3 -Day Payment Window Policy and the Impact on Wholly Owned or Wholly Operated Physician Practices  01/03/2012  7502 R2354CP  11/18/2011  Expansion of Medicare Telehealth Services for CY 2012 01/03/2012  7504 R2303CP  09/14/2011  Teaching Physician Services  07/26/2011  7378 R2299CP  09/08/2011  Enhance the Multi- Carrier System (MCS) and ViPS Medicare System (VMS) to Maintain Five Full Years of Pricing Data and to Automatically Price Claims/Adjustments at the Rates in Effect at the Dates of Service  Rescinded and replaced by Transmittal 2464. 10/03/2011  7383 R2297CP  09/02/2011  Bundling of Payments for Services Provided to Outpatients Who Later Are Admitted as Inpatients: 3 -Day Payment 01/03/2012  7502 Rev #  Issue Date  Subject  Impl Date  CR#  Window Policy and the Impact on Wholly Owned or Wholly Operated Physician Practices  Rescinded and replaced by Transmittal 2373  R2282CP  08/26/2011  Clarification of Evaluation and Management Payment Policy  11/28/2011  7405 R2273CP  08/12/2011  Expansion of Medicare Telehealth Services for CY 2012  Rescinded and replaced by Transmittal 2354 01/03/2012  7504 R2247CP  06/24/2011  Teaching Physician Services  Rescinded and replaced by Transmittal 2303 07/25/2011  7378 R2210CP  05/06/2011  Enhance the Multi- Carrier System (MCS) and ViPS Medicare System (VMS) to Maintain Five Full Years of Pricing Data and to Automatically Price Claims/Adjustments at the Rates in Effect at the Dates of Service  Rescinded and replaced by Transmittal 2299 10/03/2011  7383 R2168CP  02/28/2011  Expansion of Medicare Telehealth Services for CY 2011 01/03/2011 & 04/04/2011  7049 R2166CP  02/25/2011  Clarification to CR 6686- Outpatient Mental Health Treatment Limitation  03/25/2011  7307 R2161CP  02/25/2011
(Medicare Claims Processing Manual)
& 04/04/2011  7049 R2166CP  02/25/2011  Clarification to CR 6686- Outpatient Mental Health Treatment Limitation  03/25/2011  7307 R2161CP  02/25/2011  Incentive Payment Program for Primary Care Services, Section 5501(a) of the ACA 01/03/2011 & 04/04/2011  7060 R2159CP  02/15/2011  Annual Wellness Visit (AWV), Including Personalized Prevention Plan Services (PPPS)  04/04/2011  7079 R2152CP  02/11/2011  Primary Care Incentive Payment Program (PCIP) Eligibility for New Providers Enrolled in Medicare 07/05/2011  7267 Rev #  Issue Date  Subject  Impl Date  CR#  R2109CP  12/03/2010  Annual Wellness Visit (AWV), Including Personalized Prevention Plan Services (PPPS)  Rescinded and replaced by Transmittal 2159  04/04/2011  7079 R2044CP  09/03/2010  Revisions and Re-issuance of Audiology Policies  09/30/2010  6447 R2040CP  08/27/2010  Section 5501(b) Incentive Payment Program for Major Surgical Procedures Furnished in Health Professional Shortage Areas of the Affordable Care Act (ACA)  01/03/2011 & 04/04/2011  7063 R2039CP  08/27/2010  Primary Care Incentive Payment Program (PCIP), Section 5501(a) of the Affordable Care Act  (ACA)  Rescinded and replaced by Transmittal 2161 01/03/2011 & 04/04/2011  7060 R2032CP  08/20/2010  Expansion of Medicare Telehealth Services for CY 2011  Rescinded and replaced by Transmittal 2168 01/03/2011  7049 R2024CP  08/06/2010  Payment for Certified Nurse -Midwife Services  01/03/2011  7005 R2007CP  07/23/2007  Revisions and Re-issuance of Audiology Policies  Rescinded and replaced by Transmittal 2044  08/11/2010  6447 R1975CP  05/28/2010  Revisions and Re-issuance of Audiology Policies - Rescinded and replaced by Transmittal 2007  07/28/2010  6447 R1931CP  03/12/2010  Revision of the Internet Only Manual (IOM) to Remove References to Purchased Diagnostic
(Medicare Claims Processing Manual)
of Audiology Policies - Rescinded and replaced by Transmittal 2007  07/28/2010  6447 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 R1881CP  12/18/2009  Expansion of Medicare Telehealth Services for CY 2010 01/04/2010  6705 Rev #  Issue Date  Subject  Impl Date  CR#  R1875CP  12/14/2009  Revisions to Consultation Services Payment Policy  01/04/2010  6740 R1859CP  11/20/2009  MIPAA Section 139 Teaching Anesthesiologists 01/04/2010  6706 R1843CP  10/30/2009  Outpatient Mental Health Treatment Limitation  01/04/2010  6686 R1716CP  04/24/2009  List of Medicare Telehealth Services  05/26/2009  6458 R1643CP  12/05/2008  Indian Health Service (IHS) Provider Payment to Non-IHS Physicians for Teleradiology Interpretations  03/09/2009  6162 R1639CP  11/21/2008  Health Professional Shortage Area (HPSA) Bonus Payment Policy Changes 01/05/2009  6106 R1635CP  11/14/2008  Adding Certain Entities as Originating Sites for Payment of Telehealth Services -Section 149 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) 01/05/2009  6215 R1615CP  10/17/2008  Update to the Initial Preventive Physical Examination (IPPE) Benefit 01/05/2009  6223 R1604CP  09/26/2008  Physician Payment Amounts When Physicians Furnish Excluded Procedures in Ambulatory Surgical Centers (ASCs) 01/05/2009  6052 R1550CP  07/18/2008  Clarifications to Audiology Update Transmittal 1470, Change Request 5717 08/18/2008  6061 R1548CP  07/09/2008  Critical Care Visits and Neonatal Intensive Care (Codes 99291-99292) 07/07/2008  5993 R1545CP  06/27/2008  Payment for Inpatient Hospital Visits (Codes 99221-99239)  Rescinds and replaces Transmittal 1473.  04/07/2008  5792 Rev #  Issue Date  Subject