evekhm/cms_iom_500 huggingface dataset:
(Medicare Claims Processing Manual)
The CORFs may provide physical therapy, speech -language pathology and occupational therapy off the CORFs premises in addition to the home evaluation.  Services provided offsite are billed separately and identified as offsite on the claim in remarks.  The charges for offsite visits include any additional charge for providing the services at a place other than the CORF premises.  There is no change in the payment method for offsite services.   100.6 - Notifying Patient of Service Denial  (Rev. 3220, Issued: 03- 16-15, Effective: ICD -10: Upon Implementation of ICD -10, ASC- X12: 01- 01-12, Implementation: 10- 01-14, ICD -10: Upon Implementation of ICD- 10 ASC X12: 09 -16-14)  Services may be noncovered because they are statutorily excluded from coverage under Medicare, or becau se they are not medically reasonable and necessary.   If a service is excluded by statute, the CORF may submit a claim for them to Medicare to obtain a denial prior to billing another insurance carrier .  It shows the charges as noncovered, and includes Condition Code 21. It may bill the beneficiary for the excluded services, and need not issue an advance beneficiary notice (ABN).  However, when providing therapy services under the financial limitations, the CORF should provide the beneficiary with the Notice  of Exclusion of Medicare Benefits (NEMB). The Medicare Claims Processing Manual, Chapter 30, Limitation on Liability, discusses ABNs for A/B MAC (A) processed claims for Part B services.   If, after reviewing the plan of care, the CORF determines that th e services to be furnished to the patient are not medically reasonable or necessary, it immediately provides the beneficiary with an ABN.  If the patient signs an ABN, the claim includes occurrence   code 32 Date Beneficiary Notified of Intent to Bill (Proc edures or Treatments) along with the date the ABN was signed.   If the beneficiary insists that a claim be submitted for payment, the CORF must indicate on the bill (billed separately from bills with covered charges) that it is being submitted at the benef iciarys request.  This is done by using condition code 20.
(Medicare Claims Processing Manual)
If during the course of the patients treatment the A/B MAC (A) advises the CORF that covered care has ceased, the CORF must notify the beneficiary (or the beneficiarys representative) immediately.   NOTE:  Information regarding the form locator numbers that correspond to these data element names is found in Chapter 25.   100.7 - Payment of Drugs, Biologicals, and Supplies in a CORF (Rev. 1459; Issued:  02- 22-08; Effective:  07- 01-08; Implementatio n:  07 -07-08)  Drugs   Drugs and biologicals generally do not apply in a CORF setting.  Therefore, contractors are to advise their CORFs not to bill for them.   Supplies   The CORFs should not bill for the supplies they furnish when such supplies are part of the practice expense for that service.  Under the MPFS, nearly all of these expenses are already taken into account in the practice expense relative values.  However, CO RFs may bill separately for certain splint and cast supplies, represented by HCPCS codes Q4001 through Q4051, when furnishing a cast/strapping application service in the CPT code series 29000 through 29750.  Vaccines   The CORFs should refer to Chapter 18, Preventive and Screening Services, for billing guidance on influenza, pneumococcal pneumonia, and Hepatitis B vaccines and their administration.   100.8 -  Billing for DME, Prosthetic and Orthotic Devices, and Surgical Dressings  (Rev. 3220, Issued: 03- 16-15, Effective: ICD -10: Upon Implementation of ICD -10, ASC- X12: 01- 01-12, Implementation: 10- 01-14, ICD -10: Upon Implementation of ICD- 10 ASC X12: 09 -16-14)  The CORFs bill DME to the DME MAC with the ASC X12 professional claim format or Form CMS -1500 except f or claims for implanted DME, which are billed to the local A/B MAC (B).  If the CORF does not have a supplier billing number from the National Supplier Clearinghouse (NSC), it may contact the NSC to secure one.  If the local A/B
(Medicare Claims Processing Manual)
MAC (B) has issued the CORF  a provider number for billing physician services, the CORF may not use the same number when billing for DME.   100.10 -  Group Therapy Services (Code 97150)  (Rev. 1145, Issued: 12- 29-06, Effective: 01- 01-07, Implementation: on or before 01-29-07)  Policies for group therapy services for CORF are the same as group therapy services for other Part B outpatient services .  See Pub 100- 02, chapter 15, section 230.   100.10.1 - Therapy Students  (Rev. 1145, Issued: 12- 29-06, Effective: 01- 01-07, Implementation: on or  before 01 -29-07)  Policies for therapy students for CORF are the same as policies for therapy students for other Part B outpatient services.  See Pub. 100- 02, chapter 15, section 230.   100.11 -  Billing for Social Work and Psychological Services in a CORF  (Rev. 2736, Issued: 06- 28-13, Effective: 10- 01-12, Implementation: 10- 07-13)  The CORF providers shall only bill social work and psychological services with the following HCPCS code:   G0409  Social work and psychological services, directly relating to and /or the patient's rehabilitation goals, each 15 minutes, face- to-face; individual (services provided by a CORF -qualified social worker or psychologist in a CORF)   In addition, HCPCS code G0409 shall only be billed with revenue code 0569 or 0911.  100.12 -  Billing for Respiratory Therapy Services in a CORF  (Rev. 1459; Issued:  02- 22-08; Effective:  07- 01-08; Implementation:  07 -07-08)  The CORF providers shall only bill respiratory therapy services with revenue codes 0410, 0412 and 0419.  See Chapter 25, Completing and Processing the CMS -1450 Data Set, for revenue code descriptions.   Exhibit 1 - Physician Fee Schedule Abstract File  (Rev. 515, Issued: 04- 01-05, Effective: 01- 03-05, Implementation: 07- 05-05)
(Medicare Claims Processing Manual)
Exhibit 1 - Physician Fee Schedule Abstract File  (Rev. 515, Issued: 04- 01-05, Effective: 01- 03-05, Implementation: 07- 05-05)  This file contains nonfacility  fee schedule payment amounts for the outpatient rehabilitation, and CORF HCPCS codes listed in 20.  These codes are identified in the abstract file by a value of R in the fee indicator field.  The file includes fee schedule payment amounts by locality and is available via the CMS Mainframe Telecommunications System (formerly referred to as the Network Data Mover).     Record Length:  Record Format:  Block size:  Character Code:  Sort Sequence:  60 FB 6000 EBCDIC  A/B MAC (B) , Locality HCPCS Code, Modifier   Data  Element Name  COBOL Location  Picture  Value  1  HCPCS  1-5 X(05)   2  Modifier  6-7 X(02)   3  Filler  8-9 X(02)   4 -- Non -Facility Fee  10-16 9(05)V99   5  Filler  17-23 X(07)   6  Filler  24-30 X(07)   7 -- A/B MAC (B)  Number  31-35 X(05)   8  Locality  36-37 X(02)  Identical to the radiology/diagnostic fees  9  Filler  38-40 X(03)   10 -- Fee Indicator  41-41 X(1)  R - Rehab/Audiology/CORF services  11 -- Outpatient Hospital  indicator  42-42 X(1)  0 - Fee applicable in hospital outpatient setting  1 - Fee not applicable in hospital outpatient setting  12  Filler  43-60 X(18)    Upon CMS notification, the contractor is responsible for retrieving this file and making payment based on 80 percent of the lower of the actual charge or fee schedule amount indicated on the file after the Part B deductible has been met.  The CMS will notify contractors of updates to the MPFS, file names and when the updated files will be available for retrieval.  Upon retrieval, contractors disseminate the fee schedules to their   providers.  The file is also available on the CMS Web site in the Public Use Files (PUF) area.
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providers.  The file is also available on the CMS Web site in the Public Use Files (PUF) area.   Addendum A  - Chapter 5, Section 20.4  Coding Guidance for Certain CPT Codes  All Claims  (Rev. 3220, Issued: 03- 16-15, Effective: ICD -10: Upon Implementation of ICD- 10, ASC- X12: 01- 01-12, Implementation: 10- 01-14, ICD -10: Upon Implementation of ICD- 10 ASC X12: 09 -16-14)
(Medicare Claims Processing Manual)
ICD-10-CM - Code and Description  A52.15 Late syphilitic neuropathy  E08.40 Diabetes mellitus due to underlying condition with diabetic neurop athy, unspecified  E08.41 Diabetes mellitus due to underlying condition with diabetic mononeuropathy  E08.42 Diabetes mellitus due to underlying condition with diabetic polyneuropathy  E09.40 Drug or chemical induced diabetes mellitus with neurological complications with diabetic neuropathy, unspecified  E09.41 Drug or chemical induced diabetes mellitus with neurological complications with diabetic mononeuropathy  E09.42 Drug or chemical induced diabetes mellitus with neurological complications with diab etic polyneuropathy  E10.40 Type 1 diabetes mellitus with diabetic neuropathy, unspecified  E10.41 Type 1 diabetes mellitus with diabetic mononeuropathy  E10.42 Type 1 diabetes mellitus with diabetic polyneuropathy  E10.43 Type 1 diabetes mellitus with dia betic autonomic (poly)neuropathy  E10.44 Type 1 diabetes mellitus with diabetic amyotrophy  E10.49 Type 1 diabetes mellitus with other diabetic neurological complication  E10.610 Type 1 diabetes mellitus with diabetic neuropathic arthropathy  E11.40 Type 2  diabetes mellitus with diabetic neuropathy, unspecified  E11.41 Type 2 diabetes mellitus with diabetic mononeuropathy  E11.42 Type 2 diabetes mellitus with diabetic polyneuropathy  E11.43 Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy  E11.44 Type 2 diabetes mellitus with diabetic amyotrophy  E11.49 Type 2 diabetes mellitus with other diabetic neurological complication  E11.610 Type 2 diabetes mellitus with diabetic neuropathic arthropathy  E13.40 Other specified diabetes mellitus with d iabetic neuropathy, unspecified  E13.41 Other specified diabetes mellitus with diabetic mononeuropathy  E13.42 Other specified diabetes mellitus with diabetic polyneuropathy
(Medicare Claims Processing Manual)
ICD-10-CM - Code and Description  E13.43 Other specified diabetes mellitus with diabetic autonomic (poly)neuropathy  E13.44 Other specified diabetes mellitus with diabetic amyotrophy  E13.49 Other specified diabetes mellitus with other diabetic neurological complication  E13.610 Other specified diabetes mellitus with diabetic neuropathic arthropathy  G13.0 Paraneoplast ic neuromyopathy and neuropathy  G13.1 Other systemic atrophy primarily affecting central nervous system in neoplastic disease  G56.40 Causalgia of unspecified upper limb  G56.41 Causalgia of right upper limb  G56.42 Causalgia of left upper limb  G56.90 Unspecified mononeuropathy of unspecified upper limb  G56.91 Unspecified mononeuropathy of right upper limb  G56.92 Unspecified mononeuropathy of left upper limb  G57.10 Meralgia paresthetica, unspecified lower limb  G57.11 Meralgia paresthetica, right low er limb  G57.12 Meralgia paresthetica, left lower limb  G57.20 Lesion of femoral nerve, unspecified lower limb  G57.21 Lesion of femoral nerve, right lower limb  G57.22 Lesion of femoral nerve, left lower limb  G57.30 Lesion of lateral popliteal nerve, unspecified lower limb  G57.31 Lesion of lateral popliteal nerve, right lower limb  G57.32 Lesion of lateral popliteal nerve, left lower limb  G57.40 Lesion of medial popliteal nerve, unspecified lower limb  G57.41 Lesion of medial popliteal nerve, right l ower limb  G57.42 Lesion of medial popliteal nerve, left lower limb  G57.60 Lesion of plantar nerve, unspecified lower limb  G57.61 Lesion of plantar nerve, right lower limb  G57.62 Lesion of plantar nerve, left lower limb  G57.70 Causalgia of unspecified lower limb  G57.71 Causalgia of right lower limb  G57.72 Causalgia of left lower limb  G57.80 Other specified mononeuropathies of unspecified lower limb  G57.81 Other specified mononeuropathies of right lower limb  G57.82 Other specified mononeuropathies of left lower limb
(Medicare Claims Processing Manual)
of left lower limb  G57.80 Other specified mononeuropathies of unspecified lower limb  G57.81 Other specified mononeuropathies of right lower limb  G57.82 Other specified mononeuropathies of left lower limb  G57.90 Unspecified mononeuropathy of unspecified lower limb
(Medicare Claims Processing Manual)
ICD-10-CM - Code and Description  G57.91 Unspecified mononeuropathy of right lower limb  G57.92 Unspecified mononeuropathy of left lower limb  G58.7 Mononeuritis multiplex  G58.8 Other specified mononeuropathi es G58.9 Mononeuropathy, unspecified  G59 Mononeuropathy in diseases classified elsewhere  G60.0 Hereditary motor and sensory neuropathy  G60.1 Refsum's disease  G60.2 Neuropathy in association with hereditary ataxia  G60.3 Idiopathic progressive neuropathy  G60.8 Other hereditary and idiopathic neuropathies  G60.9 Hereditary and idiopathic neuropathy, unspecified  G61.0 Guillain -Barre syndrome  G61.1 Serum neuropathy  G62.0 Drug -induced polyneuropathy  G62.1 Alcoholic polyneuropathy  G62.2 Polyneuropathy due to other toxic agents  G62.82 Radiation -induced polyneuropathy  G63 Polyneuropathy in diseases classified elsewhere  G65.0 Sequelae of Guillain -Barr syndrome  G65.1 Sequelae of other inflammatory polyneuropathy  G65.2 Sequelae of toxic polyneuropathy  I70.231 Atherosclerosis of native arteries of right leg with ulceration of thigh  I70.232 Atherosclerosis of native arteries of right leg with ulceration of calf  I70.233 Atherosclerosis of native arteries of right leg with ulceration of ankle  I70.234 Atherosclerosis of native arteries of right leg with ulceration of heel and midfoot  I70.235 Atherosclerosis of native arteries of right leg with ulceration of other part of foot  I70.238 Atherosclerosis of native arteries of right leg with ulceration of other part of lower right leg  I70.239 Atherosclerosis of native arteries of right leg with ulceration of unspecified site  I70.241 Atherosclerosis of native arteries of left leg with ulceration of thigh  I70.242 Atherosclerosis of native art eries of left leg with ulceration of calf  I70.243 Atherosclerosis of native arteries of left leg with ulceration of ankle  I70.244 Atherosclerosis
(Medicare Claims Processing Manual)
Atherosclerosis of native art eries of left leg with ulceration of calf  I70.243 Atherosclerosis of native arteries of left leg with ulceration of ankle  I70.244 Atherosclerosis of native arteries of left leg with ulceration of heel and midfoot  I70.245 Atherosclerosis of native arteri es of left leg with ulceration of other part of foot
(Medicare Claims Processing Manual)
ICD-10-CM - Code and Description  I70.248 Atherosclerosis of native arteries of left leg with ulceration of other part of lower left leg  I70.249 Atherosclerosis of native arteries of left leg with ulceration of unspecified site  I70.331 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of thigh  I70.332 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of calf  I70.333 Atherosclerosis of unspecified type o f bypass graft(s) of the right leg with ulceration of ankle  I70.334 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of heel and midfoot  I70.335 Atherosclerosis of unspecified type of bypass graft(s) of the right le g with ulceration of other part of foot  I70.338 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of other part of lower leg  I70.339 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulcera tion of unspecified site  I70.341 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of thigh  I70.342 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of calf  I70.343 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of ankle  I70.344 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of heel and midfoot  I70.345 Atherosclerosis of unspecified type  of bypass graft(s) of the left leg with ulceration of other part of foot  I70.348 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of other part of lower leg  I70.349 Atherosclerosis of unspecified type of bypass graf t(s) of the left leg with ulceration of unspecified site  I70.431
(Medicare Claims Processing Manual)
of the left leg with ulceration of other part of lower leg  I70.349 Atherosclerosis of unspecified type of bypass graf t(s) of the left leg with ulceration of unspecified site  I70.431 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of thigh  I70.432 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of c alf I70.433 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of ankle  I70.434 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of heel and midfoot
(Medicare Claims Processing Manual)
ICD-10-CM - Code and Description  I70.435 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of other part of foot  I70.438 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of other part of lower leg  I70.439 Atherosclerosis of autologous vein bypas s graft(s) of the right leg with ulceration of unspecified site  I70.441 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of thigh  I70.442 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration  of calf  I70.443 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of ankle  I70.444 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of heel and midfoot  I70.445 Atherosclerosis of autolo gous vein bypass graft(s) of the left leg with ulceration of other part of foot  I70.448 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of other part of lower leg  I70.449 Atherosclerosis of autologous vein bypass graft( s) of the left leg with ulceration of unspecified site  I70.531 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of thigh  I70.532 Atherosclerosis of nonautologous  biological bypass graft(s) of the right leg with ulceration of calf  I70.533 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of ankle  I70.534 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of heel and midfoot  I70.535 Atherosclerosis of nonautologous biological bypass graft(s) of the
(Medicare Claims Processing Manual)
nonautologous biological bypass graft(s) of the right leg with ulceration of heel and midfoot  I70.535 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of other part of foot  I70.538 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of other part of lower leg  I70.539 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of unspecified site  I70.541 Atherosclerosis of nonautologous  biological bypass graft(s) of the left leg with ulceration of thigh  I70.542 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of calf
(Medicare Claims Processing Manual)
ICD-10-CM - Code and Description  I70.543 Atherosclerosis of nonautologous biological bypass graft(s) of the le ft leg with ulceration of ankle  I70.544 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of heel and midfoot  I70.545 Atherosclerosis of nonautologous  biological bypass graft(s) of the left leg with ulceration of other part of foot  I70.548 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of other part of lower leg  I70.549 Atherosclerosis of nonautologous biol ogical bypass graft(s) of the left leg with ulceration of unspecified site  I70.631 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of thigh  I70.632 Atherosclerosis of nonbiological bypass graft(s) of the right leg with u lceration of calf  I70.633 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of ankle  I70.634 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of heel and midfoot  I70.635 Atherosclerosis of  nonbiological bypass graft(s) of the right leg with ulceration of other part of foot  I70.638 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of other part of lower leg  I70.639 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of unspecified site  I70.641 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of thigh  I70.642 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of calf I70.643 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of
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of nonbiological bypass graft(s) of the left leg with ulceration of calf I70.643 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of ankle  I70.644 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of heel and midfoot  I70.645 Atherosclerosis of nonbiological by pass graft(s) of the left leg with ulceration of other part of foot  I70.648 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of other part of lower leg  I70.649 Atherosclerosis of nonbiological bypass graft(s) of the left l eg with ulceration of unspecified site
(Medicare Claims Processing Manual)
ICD-10-CM - Code and Description  I70.731 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of thigh  I70.732 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of calf  I70.733 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of ankle  I70.734 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of heel and midfoot  I70.735 Atherosclerosis of other type of bypass graft (s) of the right leg with ulceration of other part of foot  I70.738 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of other part of lower leg  I70.739 Atherosclerosis of other type of bypass graft(s) of the right leg with  ulceration of unspecified site  I70.741 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of thigh  I70.742 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of calf I70.743 Atherosclerosis of  other type of bypass graft(s) of the left leg with ulceration of ankle  I70.744 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of heel and midfoot  I70.745 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of other part of foot  I70.748 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of other part of lower leg  I70.749 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of unspecified site  L89.000 Pressure ulcer of unspecified elbow, unstageable  L89.001 Pressure ulcer of unspecified elbow, stage 1  L89.002 Pressure ulcer of unspecified elbow, stage 2
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of unspecified site  L89.000 Pressure ulcer of unspecified elbow, unstageable  L89.001 Pressure ulcer of unspecified elbow, stage 1  L89.002 Pressure ulcer of unspecified elbow, stage 2  L89.003 Pressure ulcer of unspecified elbow, stage 3  L89.004 Pressure u lcer of unspecified elbow, stage 4  L89.009 Pressure ulcer of unspecified elbow, unspecified stage  L89.010 Pressure ulcer of right elbow, unstageable  L89.011 Pressure ulcer of right elbow, stage 1  L89.012 Pressure ulcer of right elbow, stage 2  L89.013 Pressure ulcer of right elbow, stage 3