evekhm/cms_iom_500 huggingface dataset:
(Medicare Claims Processing Manual)
-lyophilized,  (e.g.,  liquid),  500 mg J1575  JB Injection,  immune  globulin/hyaluronidase,  (hyqvia),  100 mg immune  globulin  J7799  JB This NOC  code  may be used to identify  the subcutaneous  immune  globulin (cutaquig)  Category  3 J-Code  Description  J9000  Injection,  doxorubicin  hydrochloride,  10 mg J9039  Injection,  blinatumomab,  1 microgram  J9040  Injection,  bleomycin  sulfate,  15 units  J9065  Injection,  cladribine,  per 1  mg J9100  Injection,  cytarabine,  100 mg  J9190  Injection,  fluorouracil,  500 mg J9360  Injection,  vinblastine  sulfate,  1 mg J9370  Injection,  vincristine  sulfate,  1 mg
(Medicare Claims Processing Manual)
It is important to note that this list is not static. The payment category may be determined by the contractor  for any new home  infusion drug additions  to the Local  Coverage Determination  (LCD) for External Infusion Pumps as identified by the following not-otherwise- classified  (NOC)  codes :  - J7799 - Not otherwise classified  drugs, other than inhalation drugs, administered through DME   - J7999 - Compounded drug, not otherwise classified.  Attachment  A: Billing  for Home  Infusion  Therapy  Services  on or  After  January 1, 2021   Table 1 shows  the time increments  providers  should report  visit length in  15-minute  increments  (15 minutes  = 1 unit). See  the table  below  for the  rounding of units:   Table  1: Time  Increments   Unit Time  1 <23 minutes  2 = 23 minutes  to <38  minutes  3 = 38 minutes  to <53  minutes  4 = 53 minutes  to <68  minutes  5 = 68 minutes  to <83  minutes  6 = 83 minutes  to <98  minutes  7 = 98 minutes  to <113  minutes  8 = 113 minutes  to <128  minutes  9 = 128 minutes  to <143  minutes  10 = 143 minutes  to <158  minutes   Table 2 shows the  use of the  three G-codes  established  for the  home  infusion therapy  benefit,  and reflects the  therapy  type and complexity of the drug administration.   Table  2: Payment  Categories  for Home  Infusion  Therapy  Professional  Services  (G-Codes)    Category  1 Category  2 Category  3 Description    G-Code  Intravenous anti -infective,  pain management, chelation, pulmonary hypertension,  inotropic, and other certain intravenous  infusion drugs  Subcutaneous  immunotherapy and other certain  Subcutaneous infusion drugs  Chemotherapy and other certain  highly complex intravenous  drugs  Initial  Visit  G0088  G0089  G0090  Subsequent  Visit  G0068  G0069  G0070   Table 3 provides  a list of  J-codes  associated  with the home  infusion drugs  that fall within  each category.   Table  3: Payment  Categories  for Home  Infusion  Drugs  (J-Codes)
(Medicare Claims Processing Manual)
Table 3 provides  a list of  J-codes  associated  with the home  infusion drugs  that fall within  each category.   Table  3: Payment  Categories  for Home  Infusion  Drugs  (J-Codes)   Category  1 J-Code  Description  J0133  Injection,  acyclovir,  5 mg J0285  Injection,  amphotericin  b, 50 mg J0287  Injection,  amphotericin  b lipid complex,  10 mg J0288  Injection,  amphotericin  b cholesteryl  sulfate  complex,  10 mg J0289  Injection,  amphotericin  b liposome,  10 mg J0895  Injection,  deferoxamine  mesylate,  500 mg J1170  Injection,  hydromorphone,  up to 4 mg J1250  Injection,  dobutamine  hydrochloride,  per 250 mg J1265  Injection,  dopamine  hcl, 40 mg J1325  Injection,  epoprostenol,  0.5 mg J1455  Injection,  foscarnet  sodium,  per 1000  mg J1457  Injection,  gallium  nitrate,  1 mg J1570  Injection,  ganciclovir  sodium,  500 mg
(Medicare Claims Processing Manual)
J2175  Injection,  meperidine  hydrochloride,  per 100 mg J2260  Injection,  milrinone  lactate,  5 mg J2270  Injection,  morphine  sulfate,  up to 10 mg  J3010  Injection,  fentanyl citrate,  0.1 mg J3285  Injection,  treprostinil,  1 mg Category  2 J-Code  Description  J1551 JB  Injection, immune globulin (cutaquig), 100mg  J1555  JB Injection,  immune  globulin  (cuvitru),  100 mg J1558  JB Injection,  immune  globulin  (xembify),  100mg  J1559  JB Injection,  immune  globulin  (hizentra),  100mg  J1561  JB Injection,  immune  globulin,  (gamunex -c/gammaked),  non-lyophilized  (e.g. liquid),  500 m J1562  JB Injection,  immune  globulin  (vivaglobin),  100 mg J1569  JB Injection,  immune  globulin,  (gammagard  liquid), non -lyophilized,  (e.g.,  liquid),  500 mg J1575  JB Injection,  immune  globulin/hyaluronidase,  (hyqvia),  100 mg immune  globulin  J7799  JB This NOC  code  may be used to identify  the subcutaneous  immune  globulin (cutaquig)  Category  3 J-Code  Description  J9000  Injection,  doxorubicin  hydrochloride,  10 mg J9039  Injection,  blinatumomab,  1 microgram  J9040  Injection,  bleomycin  sulfate,  15 units  J9065  Injection,  cladribine,  per 1  mg J9100  Injection,  cytarabine,  100 mg  J9190  Injection,  fluorouracil,  500 mg J9360  Injection,  vinblastine  sulfate,  1 mg J9370  Injection,  vincristine  sulfate,  1 mg  The payment category may be determined by the contractor for any new home infusion drug additions to the Local Coverage Determination (LCD) for External Infusion Pumps as identified by the following not- otherwise- classified (NOC)  codes :
(Medicare Claims Processing Manual)
The payment category may be determined by the contractor for any new home infusion drug additions to the Local Coverage Determination (LCD) for External Infusion Pumps as identified by the following not- otherwise- classified (NOC)  codes :  - J7799 - Not otherwise classified drugs, other than inhalation drugs, administered through DME  - J7999 - Compounded drug, not otherwise classified   411.4 - Billing and Payment Requirements  (Rev. 10269, Issued: 08-07-2020, Effective: 01- 01-2021, Implementation: 01-04-2021)  Contractors shall accept and pay for home infusion therapy services to eligible home infusion therapy suppliers (new specialty D6 ) effective for claim lines with dates of service on or after January 1, 2021 using the one of the following G codes and applicable J codes listed in section 411.3 of this chapter. Claims for the home infusion therapy service G -codes are billed to the A/B MACs and are payable to home infusion therapy suppli ers; this service is no longer payable to DME suppliers.  The applicable J codes are billed to the DME MACs by the DME supplier.  Contractors shall use Type of Service (TOS) Code 1 for all six G -codes.  Contractors shall pay only one of the G -codes per line item date of service when one of the drugs from the applicable category is billed with the same line item date of service or a d ate of service within 30 days prior to the G -code visit.    NOTE:   The fees associated with the G -codes on the MPFSD fee file will be a per day rate; therefore, the units on the line should not be multiplied by the rate.  The drug remains separately payable from the G -code line item  Home infusion therapy suppliers will report the following HCPCS G -codes associated with the payment categories for the professional services furnished in the individuals home and on an infusion drug administration calendar day.
(Medicare Claims Processing Manual)
Home infusion therapy suppliers will report the following HCPCS G -codes associated with the payment categories for the professional services furnished in the individuals home and on an infusion drug administration calendar day.    Because the home infusion therapy services are contingent upon a home infusion drug J -code, home infusion therapy suppliers must ensure that the appropriate drug associated with the visit is billed no more than 30 days prior to the visit. In the event that multiple visits occur on the same date of service, or multiple drugs, which are not all ass igned to the same payment category, are administered on the same infusion drug administration calendar day, a single payment would be made that is equal to the highest payment category. Suppliers must only bill for one visit and should report the highest paying visit with the applicable drug.    To differentiate the first visit from all subsequent visits, h ome infusion therapy suppliers may only bill one of the initial visit G -codes to indicate an visit for a new patient who had previously received their last home infusion therapy service visit more than 60 days prior to the new initial home infusion therapy service visit.    Home infusion therapy suppliers should report visit length in 15- minute increments (15 minutes=1 unit). See the Table 1 below for the rounding of units.      Table 1: Time Increments   Unit  Time  1 <23 minutes  2 = 23 minutes to <38 minutes  3 = 38 minutes to <53 minutes  4 = 53 minutes to <68 minutes  5 = 68 minutes to <83 minutes  6 = 83 minutes to <98 minutes  7 = 98 minutes to <113 minutes  8 = 113 minutes to <128 minutes  9 = 128 minutes to <143 minutes  10 = 143 minutes to <158 minutes    Table 2 shows the use of the G-codes established for the home infusion therapy benefit, and reflects the therapy type and complexity of the drug administration.   Table 2: Payment Categories for Home Infusion Therapy Professional Services (G-Codes)     Category 1  Category 2  Category 3  Description     G-Code  Intravenous anti- infective, pain management, chelation, pulmonary hypertension, inotropic, and other certain intravenous infusion drugs  Subcutaneous immunotherapy and other certain Subcutaneous infusion drugs  Chemotherapy and other certain highly complex intravenous drugs Initial Visit  G0088  G0089  G0090  Subsequent Visit  G0068  G0069  G0070
(Medicare Claims Processing Manual)
 G0068: Professional services for the administration of anti- infective, pain management, chelation, pulmonary hypertension, inotropic, or other intravenous infusion drug or biological (excluding chemotherapy or other highly complex drug or biological) for each infusion drug administration calendar day in the individuals home, each 15 minutes  Short Descriptor: Adm IV infusion drug in home   G0069: Professional services for the administration of subcutaneous immunotherapy or other subcutaneous infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes  Short Descriptor: Adm SQ infusion drug in home    G0070: Professional services for the administration of intravenous chemotherapy or other intravenous highly complex drug or biological infusion for each infusion drug administration calendar day in the individual's home, each 15 minutes.   Short Descriptor: Adm of IV chemo drug in home    G0088: Professional services, initial visit, for the administration of anti- infective, pain management, chelation, pulmonary hypertension, inotropic, or other intravenous infusion drug or biological (excluding chemotherapy or other highly complex drug or biologic al) for each infusion drug administration calendar day in the individuals home, each 15 minutes.   Short Descriptor:  Adm IV drug 1st home visit     G0089: Professional services, initial visit, for the administration of subcutaneous immunotherapy or other subcutaneous infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes.   Short Descriptor:  Adm SubQ drug 1st home visit    G0090: Professional services, initial visit, for the administration of intravenous chemotherapy or other highly complex infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes.   Short Descriptor:  Adm IV chemo 1st home visit   411.5  Claim Adjustment Reason Codes, Remittance Advice Remark Codes, Group Codes, and Medicare Summary Notice Messages  (Rev. 10269, Issued: 08- 07-2020, Effective: 01 -01-2021, Implementation: 01- 04-2021)
(Medicare Claims Processing Manual)
Contractors shall deny the CWF rejected claim if a new G -code is received for the same date of service as a previous claim was paid for the same line item date of service.   NOTE: The provider should submit an adjustment to the original claim to receive the higher payment.     Contractors shall use the following CARC/RARC codes when denying claims:   CARC 97 -  The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.   RARC N111 -  No appeal right except duplicate claim/service issue. This service was included in a claim that has been previously billed and adjudicated.   Claim Adjustment Group Code -  CO (Contractual Obligation)   MSN message: 41.14: This service/item was billed incorrectly. 41.14-  Este servicio o artculo fue facturado incorrectamente.   Contractors shall deny the CWF rejected G -code line when the claim has recycled three times without finding the associated drug J -code claim and use the following messages:   CARC 16 -  Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or R emittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.   RARC N657 -  This should be billed with the appropriate code for these services. Claim Adjustment Group Code -  CO (Contractual Obligation)   MSN message: 41.14: This service/item was billed incorrectly. 41.14-  Este servicio o artculo fue facturado incorrectamente.   Contractors shall deny CWF rejected claims for more than one claim line service of G0088, G0089, or G0090 within a 60 day period and use the following messages:
(Medicare Claims Processing Manual)
Contractors shall deny CWF rejected claims for more than one claim line service of G0088, G0089, or G0090 within a 60 day period and use the following messages:   CARC 96 -  Non -covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason [sic] Code, or Remittance Advice Remark Code that is not an ALERT.) Note: Refer to the 835 Healthcare Policy Identification Segme nt (loop 2110 Service Payment Information REF), if present.   RARC N640 -  Exceeds number/frequency approved/allowed within time period.  Group Code -  CO (Contractual Obligation)   411.6  CWF and MCS Editing Requirements  (Rev. 10269, Issued: 08- 07-2020, Effective: 01 -01-2021, Implementation: 01- 04-2021)   MCS shall create a new edit to identify when there is more than one of the following six HCPCS G0068, G0069 G0070, G0088, G0089, or G0090 with Date of Service on or after 1/1/2021 for the same Date of Service on the same Part B Professional cla im.  CWF shall create a new reject for a Part B Professional claim with one of the following six HCPCS codes G0068, G0069 G0070, G0088, G0089, or G0090 with Date of Service on or after 1/1/2021 and there is no DME claim in history with one of the identified J-codes within 30 days prior to the incoming Date of Service.   NOTE :  This edit shall have override capability at the claim detail line   CWF and contractors shall recycle G0068, G0069 G0070, G0088, G0089, or G0090 claim up to three times for a total of 15 days until a claim containing an allowable drug J -code from above is received with the same line item date of service or with in 30 days prior to the line item date of service of the G -code.
(Medicare Claims Processing Manual)
CWF shall create a new reject for a Part B Professional claim with one of the following six G0068, G0069 G0070, G0088, G0089, or G0090 codes with a Date of Service on or after 1/1/2021 when there is a Part B claim in history with one of the ide ntified six G0068, G0069 G0070, G0088, G0089, or G0090 codes for the same Date of Service.   NOTE :  This edit shall have override capability at the claim detail line   CWF shall create a new reject for a Part B Professional claim with one of the new G0088, G0089, or G0090 codes and in history is an allowed DME or Part B Professional claim with any of the six G0068, G0069 G0070, G0088, G0089, or G0090  codes and the Dates of Service is within 60 days prior to the incoming claims Dates of Service. The incoming claim has Dates of Service on or after 1/1/2021.   CWF should still subject an incoming Part B Professional claim to the edit if it is within 60 days of posted DME claim, and if the claim in history is DME and has one of the three existing G0068, G0069 G0070  codes and has Dates of Service prior to 1/1/2021.  CWF shall create a new Informational Unsolicited Response (IUR) when a Part B Professional claim or a DME claim with one of the six G0068, G0069 G0070, G0088, G0089, or G0090  codes is received and in history is a Part B Professional claim with one of the three new G0088, G0089, or G0090 codes with Dates of Service within 60 days after the incoming claims Dates of Service.
(Medicare Claims Processing Manual)
CWF shall ensure that all new edits and the IUR appear on the ORPN Report.                Transmittals Issued for this Chapter   Rev #  Issue Date  Subject  Impl Date  CR#  R12533CP  03/07/2024  Update to the Internet Only Manual (IOM) Publication (Pub.) 100-04, Chapter 32, Section 90 for Coding Revisions to the National Coverage Determinations (NCDs) --July 2024 Change Request (CR) 13507.  04/08/2024  13545  R12497CP  02/08/2024  Pulmonary Rehabilitation, Cardiac Rehabilitation and Intensive Cardiac Rehabilitation (PR/CR/ICR) Expansion of Supervising Practitioners  03/12/2024  13513  R12435CP  12/28/2023  Update to the Internet Only Manual (IOM) Publication (Pub.) 100-04, Chapter 18, Sections 20.2, 60.3 and Chapter 32, Sections 50.4.1, 200.2 for Coding Revisions to the National Coverage Determinations (NCDs) --April 2024 Change Request (CR) 13391  01/29/2024  12435  R12396CP  12/07/2023  Update to the Internet Only Manual (IOM) Publication (Pub.) 100-04, Chapter 32 Sections 320.3.3 and 370.1 for Coding Revisions to the National Coverage Determinations (NCDs) --April 2024 Change Request (CR) 13390  01/09/2024  13438  R12109CP  06/29/2023  Update to the Internet Only Manual (IOM) Publication (Pub.) 100-04, Chapter 32 Sections 130.1, for International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs) --October 2023 Update Change Request (CR) 13166
(Medicare Claims Processing Manual)
10/02/2023  13227  R11902CP  03/16/2023  Update to the Internet Only Manual (IOM) Publication (Pub.) 100-04, Chapter 18 Sections 50.3-50.4, and Chapter 32 Sections 130.1, 170.2 for Coding Revisions to National Coverage Determinations (NCDs) --July 2023 Change Request (CR) 13070  04/17/2023  13104  R11875CP  02/23/2023  National Coverage Determination (NCD) 50.3 - Cochlear Implantation Manual Update  03/24/2023  13073  Rev #  Issue Date  Subject  Impl Date  CR#  R11789CP  01/19/2023  Update to the Internet Only Manual (IOM) For Alpha-Numerical Order in Publication (Pub.) 100-04, Chapter 32, Index, Sections 40.2.1 and 40.2.4  02/21/2023  13025  R11759CP  12/21/2022  Update to the Internet Only Manual (IOM) Publication (Pub.) 100-04, Chapter 18 Section 170.1 and Chapter 32 Section 270.2 due to the National Coverage Determinations (NCDs) April 2023 Change Request (CR) 12960  01/23/2023  12993  R11721CP  11/28/2022  National Coverage Determination (NCD 110.24): Chimeric Antigen Receptor (CAR) T-cell Therapy  01/03/2023  12928  R11430CP  05/24/2022  Update to 'J' Drug Code List for Billing Home Infusion Therapy (HIT) Services  07/05/2022  12667  R11426CP   05/20/2022  An Omnibus CR Covering: (1) Removal of Two National Coverage Determination (NCDs), (2) Updates to the Medical Nutrition Therapy (MNT) Policy, and (3) Updates to the Pulmonary Rehabilitation (PR), Cardiac Rehabilitation (CR), and Intensive Cardiac Rehabilitation (ICR) Conditions of Coverage- Rescinded and replaced by transmittal 11426
(Medicare Claims Processing Manual)
07/05/2022  12613  R11272CP  02/18/2022  An Omnibus CR Covering: (1) Removal of Two National Coverage Determination (NCDs), (2) Updates to the Medical Nutrition Therapy (MNT) Policy, and (3) Updates to the Pulmonary Rehabilitation (PR), Cardiac Rehabilitation (CR), and Intensive Cardiac Rehabilitation (ICR) Conditions of Coverage
(Medicare Claims Processing Manual)
07/05/2022  12613  R11214CP  01/20/2022  National Coverage Determination (NCD) 270.3 Blood-Derived Products for Chronic, Non-Healing Wounds  01/03/2022  12403  R11171CP  01/12/2022  National Coverage Determination (NCD) 270.3 Blood-Derived Products for Chronic, Non-Healing Wounds Rescinded and replaced by transmittal 11 214 01/03/2022  12403  R11119CP  11/13/2021  National Coverage Determination (NCD) 270.3 Blood-Derived Products for Chronic, Non-Healing Wounds Rescinded and replaced 01/03/2022  12403  Rev #  Issue Date  Subject  Impl Date  CR#  by transmittal 111 71 R11035CP  10/13/2021  Revisions to  Chapters  3, 18, and  32 to  Update Coding  10/13/2021  12377  R11021CP  10/01/2021  Revisions To Chapters 13, 18 And 32 To Update Coding 10/29/2021  12376  R10981CP  09/10/2021  National Coverage Determination (NCD) 270.3 Blood-Derived Products for Chronic, Non-Healing Wounds - Rescinded and replaced by transmittal 11119  01/03/2022  12403  R10985CP  09/08/2021  Claims Processing Instructions for National Coverage Determination 20.33 - Transcatheter Edge- to-Edge Repair [TEER] for Mitral Valve Regurgitation  10/08/2021  12361  R10881CP  08/06/2021  REVISIONS TO CHAPTERS 13 AND 32 TO UPDATE CODING  09/07/2021  12069  R10891CP  07/20/2021  National Coverage Determination (NCD 110.24): Chimeric Antigen Receptor (CAR) T-cell Therapy - This CR Rescinds and Fully Replaces CR 11783.  230.2222  09/20/2021  12177  R10796CP   National Coverage Determination (NCD 110.24): Chimeric Antigen Receptor (CAR) T-cell Therapy - This CR Rescinds and Fully Replaces CR 11783- Rescinded and replaced by transmittal 10891  07/23/2021  12177  R10837CP
(Medicare Claims Processing Manual)
06/11/2021  National Coverage Determination (NCD) 20.9.1 Ventricular Assist Devices (VADs)  07/27/2021  12290  R10796CP  05/20/2021  National Coverage Determination (NCD 110.24): Chimeric Antigen Receptor (CAR) T-cell Therapy - This CR Rescinds and Fully Replaces CR 11783. - Rescinded and replaced by transmittal 10891  07/23/2021  12177  R10573CP  03/24/2021  Update to Pulmonary Rehabilitation (PR), Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Program Manual Sections  04/26/2021  12115  R10547CP  12/31/2020  Billing for Home Infusion Therapy Services On or After January 1, 2021  01/04/2021  11880  R10463CP  11/13/2020  Billing for Home Infusion Therapy Services On or After January 1, 2021  01/04/2021  11880  Rev #  Issue Date  Subject  Impl Date  CR#  R10343CP  09/04/2020  Update to the Internet Only Manual (IOM) Publication (Pub.) 100-04, Chapter 32, Section 40.2.1 and 40.2.4  10/06/2020  11950  R10337CP  08/27/2020  National Coverage Determination (NCD30.3.3): Acupuncture for Chronic Low Back Pain (cLBP)  01/04/2021  11755  R10269CP  08/07/2020  Billing for Home Infusion Therapy Services On or After January 1, 2021- Rescinded and replaced by transmittal 10463  01/04/2021  11880  R10229CP  07/21/2020  Modify Edits in the Fee for Service (FFS) System When a Beneficiary has a Medicare Advantage (MA) Plan  10/05/2020  11580  R10179CP  06/10/2020  NCD (20.32) Transcatheter Aortic Valve Replacement (TAVR)  06/12/2020  11660  R10128CP  05/08/2020  National Coverage Determination (NCD30.3.3): Acupuncture for Chronic Low Back Pain (cLBP) Rescinded and replaced by transmittal 10337