evekhm/cms_iom_500 huggingface dataset:
(Medicare Claims Processing Manual)
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 Subject  Impl Date  CR#  R1530CP  06/06/2008  Critical Care Visits and Neonatal Intensive Care (Codes 99291-99292) - Rescinded and replaced by Transmittal 1548 07/07/2008  5993 R1490CP  04/11/2008  Prolonged Services (Codes 99354-99359) 07/07/2008  5972 R1489CP  04/11/2008  Nursing Facility Services (Codes 99304-99318) 07/07/2008  5968 R1473CP  03/07/2008  Payment for Inpatient Hospital Visits  General (Codes 99221-99239)  Rescinded and replaced by Transmittal 1545. 04/07/2008  5792 R1470CP  02/29/2008  Update to Audiology Policies 04/07/2008  5717 R1466CP  02/22/2008  Payment for Hospital Observation Services (Codes 99217 - 99220) and Observation or Inpatient Care Services (Including Admission and Discharge Services - Codes 99234 - 99236) 04/07/2008  5791 R1465CP  02/22/2008  Payment for Initial Hospital Care Services (Codes 99221 - 99233) and Observation or Inpatient Care Services (Including Admission and Discharge Services) (Codes 99234 - 99236) 04/07/2008  5793 R1460CP  02/22/2008  Subsequent Hospital Visits and Hospital Discharge Day Management Services (Codes 99231 - 99239) 04/07/2008  5794 R1458CP  02/22/2008  Teaching Physician Requirements for ESRD Monthly Capitation Payment (MCP) 03/24/2008  5932 R1434CP  02/05/2008  Extension of the Dates of Service for the Physician Scarcity Area (PSA) Bonus Payment  01/07/2008  5937 Rev #  Issue Date  Subject  Impl Date  CR#  R1324CP  08/27/2007  Anesthesia Services Furnished by the Same Physician Providing the Medical and Surgical Service 10/01/2007  5618 R1321CP  08/24/2007  Sunset of the Physician Scarcity Area
(Medicare Claims Processing Manual)
Date  CR#  R1324CP  08/27/2007  Anesthesia Services Furnished by the Same Physician Providing the Medical and Surgical Service 10/01/2007  5618 R1321CP  08/24/2007  Sunset of the Physician Scarcity Area (PSA) Bonus Payment 01/07/2008  5711 R1316CP  08/17/2007  Anesthesia Services Furnished by the Same Physician Providing the Medical and Surgical Service  Replaced by Transmittal 1324  10/01/2007  5618 R1277CP  06/29/2007  Medicare Telehealth Services  01/07/2008  5628 R1273CP  06/29/2007  Billing and Payment in a Health Professional Shortage Area (HPSA)  10/01/2007  5625 R1168CP  01/26/2007  Direct Billing and Payments for Non-Physician Practitioner Services Furnished to Hospital Inpatients and Outpatients  04/26/2007  5221 R1026CP  08/11/2006  Medicare Telehealth Services  01/02/2007  5201 R999CP  07/14/2006  Non-Physician Practitioner (NPP) Payment for Care Plan Oversight 10/02/2006  4374 R997CP  07/07/2006  Medicare Telehealth Services Update  08/07/2006  5122 R993CP  06/23/2006  Non-Physician Practitioner (NPP) Payment for Care Plan Oversight 10/02/2006  4374 R979CP  06/09/2006  Cardiovascular System (Codes 92950-93799 07/10/2006  5048 R968CP  05/26/2006  Drug Administration Coding and Payment Policy Update to Pub. 100-04 Med. Claims Processing  06/26/2006  5028 R954CP  05/19/2006  Payment for Evaluation and Management Services Provided During Global Period of Surgery  08/20/2006  5025 Rev #  Issue Date  Subject  Impl Date  CR#  R906CP  04/14/2006  Revision to Health Professional Shortage Area and Physician Scarcity Area Bonus Billing for Some Globally Billed Services  07/03/2006  5015 R834CP  02/03/2006  Revision to Health Professional Shortage Area and Physician Scarcity Area Bonus Billing for Some Globally Billed Services  07/03/2006  4266 R811CP  01/13/2006  Teaching Physician Services  02/13/2006  3928 R808CP  01/06/2006  Nursing Facility Services Codes
(Medicare Claims Processing Manual)
Physician Scarcity Area Bonus Billing for Some Globally Billed Services  07/03/2006  4266 R811CP  01/13/2006  Teaching Physician Services  02/13/2006  3928 R808CP  01/06/2006  Nursing Facility Services Codes (99304  99318 01/23/2006  4246 R807CP  01/06/2006  Revision to IOM 100-04, Chapter 12, Sections 90.4.1.1 and 90.4.2 02/06/2006  4182 R792CP  12/23/2005  Nursing Facility Services Codes (99304  99318) - Rescinded and replaced by Transmittal 808  01/23/2006  4246 R790CP  12/23/2005  List of Medicare Telehealth Services  04/03/2006  4204 R788CP  12/20/2005  Consultation Services (Codes 99241  99255) 01/17/2006  4215 R782CP  12/16/2005  Consultation Services (Codes 99241  99255) Rescinded and replaced by Transmittal 788  01/17/2005  4215 R775CP  12/02/2005  Home Care and Domiciliary Care Visits (99324  99350) 01/03/2006  4212 R748CP  11/04/2005  New G Code for Power Mobility Devices (PMDs)  10/25/2005  4121 R731CP  10/28/2005  Payment for Office or Other Outpatient Evaluation and Management (E/M) Visits (Codes 99201 - 99215) 01/03/2006  4032 R713CP  10/18/2005  New G Code for Power Mobility Devices (PMDs)  10/25/2005  4121 Rev #  Issue Date  Subject  Impl Date  CR#  R667CP  09/02/2005  Home Care and Domiciliary Care Visits (Codes 99321 - 99350) 12/05/2005  3922 R608CP  07/22/2005  New Health Professional Shortage Area (HPSA) Modifier  01/03/2006  3935 R556CP  05/06/2005  Revision to the Health Professional Shortage Area (HPSA) and Physician Scarcity Area (PSA) Payment Rules  10/03/2005  3822 R547CP  04/29/2005  Revision to the Health Professional Shortage Area (HPSA)
(Medicare Claims Processing Manual)
Revision to the Health Professional Shortage Area (HPSA) and Physician Scarcity Area (PSA) Payment Rules  10/03/2005  3822 R547CP  04/29/2005  Revision to the Health Professional Shortage Area (HPSA) and Physician Scarcity Area (PSA) Payment Rules  10/03/2005  3822 R524CP  04/15/2005  Clarification to the Health Professional Shortage Area Language in the Medicare Claims Processing Manual  05/16/2005  3736 R517CP  04/01/2005  List of Medicare Telehealth Services  05/02/2005  3747 R504CP  03/11/2005  Update to Pub 100-04, Chapter 12, Section 200 of the Internet Only Manual N/A 3732 R417CP  12/22/2004  Initial Preventive Physical Examination  01/03/2005  3638 R382CP  11/26/2004  Independent Laboratory Billing for the Technical Component (TC) of Physician Pathology Services to Hospital Patients 01/03/2005  3467 R302CP  09/24/2004  Nursing Facility Visits (Codes 99301 -99313)  10/25/2004  3096 R280CP  08/13/2004  Billing and Payment in a Health Professional Shortage Area 10/04/2004  3401 R277CP  08/13/2004  Instructions to Establish Carrier Web Pages for Health Professional Shortage Area and for Provider Education for the HPSA and Physician Scarcity Area Bonus Payment  09/13/2004  3388 Rev #  Issue Date  Subject  Impl Date  CR#  R218CP  06/25/2004  Implementation of the Analysis and Design Phases of The Revisions to the Health Professional Shortage Area Bonus Payment  10/04/2004  3317 R217CP  06/25/2004  Implementation of the Analysis and Design Phases of the Physician Scarcity Bonus 10/04/2004  3318 R203CP  06/10/2004  Billing Payment in a Health Professional Shortage Area 07/06/2004  3336 R178CP  05/14/2004  Evaluation and Management Service Codes N/A 2321 R168CP  05/07/2004  Chapter 12, Physician/Practitioner Billing0  N/A 1756 R157CP  04/30/2004  Implementation of the Analysis and Design Phase of the Physician Scarcity Bonus 10/04/2004  3223 R155CP  04/30/2004  Implementation of the Analysis and Design Phases of the Revision to the Health Professional Shortage Area Bonus Payment
(Medicare Claims Processing Manual)
Implementation of the Analysis and Design Phase of the Physician Scarcity Bonus 10/04/2004  3223 R155CP  04/30/2004  Implementation of the Analysis and Design Phases of the Revision to the Health Professional Shortage Area Bonus Payment  10/04/2004  3215 R147CP  04/23/2004  Payment for Chemotherapy Administration Services, Nonchemotherapy Drug Infusion Services, and Drug Injection Services 05/24/2004  3192 R137CP  04/09/2004  Manualization of Section 4118 of the Medicare Carriers Manual, Part 3  N/A 3234 R078CP  02/06/2004  Medicare Incentive Payments for Physician Care  07/06/2004  3108 R001CP  10/01/2003  Initial Publication of Manual NA NA Back to top of Chapter
Article - Billing and Coding: Thermal Capsulorrhaphy (A53435)
CMS National Coverage PolicyN/AArticle TextThermal capsulorrhaphy, also known as thermal coagulation of joints, radiofrequency thermal shrinkage, electrothermal assisted capsulorrhaphy (ETAC) and laser-assisted capsular shrinkage (LACS) is proposed as a minimally invasive arthroscopic procedure to tighten the capsule and ligaments of joints.Due to the lack of clinical evidence to demonstrate improved health outcomes, Palmetto GBA has determined that this service as a treatment of joint instability, for the shoulder, knee, elbow, etc. is considered not medically necessary. Therefore, claims submitted for this service will be denied.To report this non-covered service, submit CPT code 29999 (unlisted procedure, arthroscopy).
Article - Billing and Coding: Amniotic Membrane Billing Guidelines for HCPCS Code V2790 (A53441)
CMS National Coverage PolicyN/AArticle TextHCPCS code V2790 (amniotic membrane for surgical reconstruction, per procedure) is included in the allowance for CPT Codes 65778 and 65779. In an inpatient facility reimbursement for HCPCS code V2790 is included in the Outpatient Prospective Payment System (OPPS) allowance. In an Ambulatory Surgical Center (ASC) reimbursement for V2790 is included in the facility allowance.HCPCS code V2790 (amniotic membrane for surgical reconstruction, per procedure) should not be billed to Part B separately except as noted below:HCPCS code V2790 can be reimbursed separately in an office setting when billed with CPT Code 65780. A copy of the invoice must be submitted when billing for V2790 and 65780 on the same claim.HCPCS code V2790 should not be billed with CPT Code 65775. However, if amniotic membrane application is required in the course of that procedure, then either CPT Codes 65778 or 65779, depending on the method of application of the membrane must be billed with 65775 when a membrane is applied. As indicated above, CPT Codes 65778 and 65779 both include payment for the membrane itself (V2790) and therefore V2790 should not be billed separately when those codes are billed.Documentation That Must Be Submitted with ClaimFor electronic claims, submit an invoice via fax.For paper claims, please submit the actual invoice with the claim.This instruction is effective for dates of service on or after September 4, 2012.
Article - Billing and Coding: Periodic Adjustment of Gastric Restrictive Device after the Global Period (A53444)
CMS National Coverage PolicyTitle XVIII of the Social Security Act, 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations Manuel, Chapter 1, Part 2, 100.1 Bariatric Surgery for Treatment of Co-Morbid Conditions Related to Morbid ObesityArticle Text**Only payable in an office setting **The laparoscopic gastric band is an adjustable and reversible bariatric surgery procedure. The band is an inflatable doughnut-shaped ring. The diameter, which can be adjusted in the office setting by adding or removing saline via a port, is positioned beneath the skin. The number and frequency of adjustments to the band depends on individual consideration(s). Most patients have between 5 and 8 adjustments within the first year after surgery. Claims for an adjustment of a gastric restrictive device after the global period (90 days after surgery) may be reimbursable in the office setting.An adjustment of the gastric band (CPTcode 43999) and an evaluation and management service (E/M) service are not payable on the same day of service. An E/M and the adjustment of a gastric band (CPTcode 43999) will only be allowed on the same day if there was a significantly separate service provided. The CPTmodifier 25 should be appended to the E/M code to indicate the E/M service was a significantly separate service.To submit a claim for adjustment of Gastric Restrictive Device:Submit CPTCode 43999Narrative field put the words 'adjustment of lap-band'NOTE:Only reimbursable in the office setting.Imaging to locate the port would be included in the service of CPTcode 43999.
(Medicare National Coverage Determinations Manual)
Medicare National Coverage Determinations Manual  Chapter 1, Part 2 (Sections 90  160.26) Coverage Determinations   Table of Contents  (Rev. 1 2299, 10-12-23)  Transmittals for Chapter 1, Part 2   90 - Genetics  90.1  Pharmacogenomic Testing to Predict Warfarin Responsiveness (Effective August 3, 2009)           90.2 Next-Generation Sequencing for Patients with Advanced Cancer  100 - Gastrointestinal System 100.1 - Bariatric Surgery for Treatment of Co -morbid Conditions Related to Morbid Obesity (Effective September 24, 2013) 100.2 - Endoscopy  100.3 - 24-Hour Ambulatory Esophegeal pH Monitoring 100.4 - Esophageal Manometry 100.5 - Diagnostic Breath Analyses  100.6 - Gastric Freezing  100.7 - Colonic Irrigation  100.8  Intestinal Bypass Surgery (RETIRED)  100.9 - Implantation of Anti- Gastroesophageal Reflux Device (RETIRED)  100.10 - Injection Sclerotherapy for Esophageal Variceal Bleeding  100.11  Gastric Balloon for Treatment of Obesity  (RETIRED)  100.12 - Gastrophotography 100.13 - Laproscopic Cholecystectomy  100.14  Surgery for Diabetes (RETIRED ) 110 - Hematology/Immunology/Oncology 110.1 - Hyperthermia for Treatment of Cancer  110.2 - Certain Drugs Distributed by the National Cancer Institute  110.3 - Anti -Inhibitor Coagulant Complex (AICC)  110.4 - Extracorporeal Photopheresis  110.5 - Granulocyte Transfusions  110.6 - Scalp Hypothermia During Chemotherapy to Prevent Hair Loss  110.7 - Blood Transfusions  110.8 - Blood Platelet Transfusions
(Medicare National Coverage Determinations Manual)
110.8.1 - Stem Cell Transplantation (RETIRED) 110.9 - Antigens Prepared for Sublingual Administration 110.10 - Intravenous Iron Therapy  110.11 - Food Allergy Testing and Treatment  110.12 - Challenge Ingestion Food Testing 110.13 - Cytotoxic Food Tests  110.14 - Apheresis (Therapeutic Pheresis)  110.15 - Ultrafiltration, Hemoperfusion and Hemofiltration  110.16 -  Nonselective (Random) Transfusions and Living Related Donor Specific Transfusions (DST) in Kidney Transplantation 110.17 -  Anti -cancer Chemotherapy for Colorectal Cancer (Effective January 28, 2005)  110.18 -  Aprepitant  for Chemotherapy- Induced Emesis  110.19  Abarelix for the Treatment of Prostate Cancer (Effective March 15, 2005)  (RETIRED)  110.20 -  Blood Brain Barrier Osmotic Disruption for Treatment of Brain Tumors (Effective March 20, 2007)  110.21 -  Erythropoiesis Stimulating Agents (ESAs) in Cancer and Related Neoplastic Conditions  110.22  Autologous Cellular Immunotherapy Treatment (Effective June 30, 2011)  110.23 -  Stem Cell Transplantation (Formerly 110.8.1) (Various Effective Dates Below)  110.24 -  Chimeric Antigen Receptor (CAR) T -cell therapy  120 -  Infectious Diseases  130 -  Mental Health  130.1 -  Inpatient Hospital Stays for the Treatment of Alcoholism 130.2 -  Outpatient Hospital Services for Treatment of Alcoholism 130.3 -  Chemical Aversion Therapy for Treatment of Alcoholism  130.4 -  Electrical Aversion Therapy for Treatment of Alcoholism  130.5 -  Treatment of Alcoholism and Drug Abuse in a Freestanding Clinic  130.6 -  Treatment of Drug Abuse (Chemical Dependency)  130.7 -  Withdrawal Treatments for Narcotic Addictions  130.8 -  Hemodialysis for Treatment of Schizophrenia  140 -  Miscellaneous Surgical Procedures  140.1 -  Abortion 140.2 -  Breast Reconstruction Following Mastectomy 140.4 -  Plastic Surgery to Correct Moon Face"  140.5 -  Laser Procedures  140.6  Wrong Surgical or Other Invasive Procedure Performed on a Patient (Effective January 15, 2009)  140.7  Surgical or Other Invasive Procedure Performed on the Wrong Body Part (Effective January 15, 2009)  140.8  Surgical or Other Invasive Procedure Performed on the Wrong Patient (Effective January 15, 2009)
(Medicare National Coverage Determinations Manual)
(Effective January 15, 2009)  140.7  Surgical or Other Invasive Procedure Performed on the Wrong Body Part (Effective January 15, 2009)  140.8  Surgical or Other Invasive Procedure Performed on the Wrong Patient (Effective January 15, 2009)  140.9 -  Gender Reassignment Surgery for Gender Dysphoria  150 -  Musculoskeletal  System  150.1 -  Manipulation 150.2 -  Osteogenic Stimulator  150.3 -  Bone (Mineral) Density Studies  (Effective January 1, 2007)  150.5 -  Diathermy Treatment  150.6 -  Vitamin B12 Injections to Strengthen Tendons, Ligaments, etc., of the Foot  150.7 -  Prolotherapy, Joint Sclerotherapy, and Ligamentous Injections with Sclerosing Agents  150.8 -  Fluidized Therapy Dry Heat for Certain Musculoskeletal Disorders  150.9 -  Arthroscopic Lavage and Arthroscopic Debridement for the Osteoarthritic Knee (Effective June 11, 2004)  150.10 -  Lumbar Artificial Disc Replacement (LADR) (Effective August 14, 2007)  150.11  Thermal Intradiscal Procedures (Effective September 29, 2008)  150.12  Collagen Meniscus Implant (Effective May 25, 2010)  150.13 -  Percutaneous Image- guided Lumbar Decompression (PILD) for Lumbar Spinal Stenosis (LSS) (Various Effective Dates Below)  150.20  Reserved for Future Use  160 -  Nervous System  160.1 -  Induced Lesions of Nerve Tracts  160.2 -  Treatment of Motor Function Disorders with Electric Nerve Stimulation  160.4 -  Stereotactic Cingulotomy as a Means of Psychosurgery (RETIRED)  160.5 -  Stereotaxic Depth Electrode Implantation 160.6 -  Carotid Sinus Nerve Stimulator  (RETIRED)  160.7 -  Electrical Nerve Stimulators  160.7.1 -  Assessing Patients Suitability for Electrical Nerve Stimulation Therapy  160.8 -  Electroencephalographic Monitoring During Surgical Procedures Involving the Cerebral Vasculature  160.9  Electroencephalographic (EEG) Monitoring During Open- Heart Surgery  (RETIRED)  160.10 -  Evoked Response Tests  160.12 -  Neuromuscular Electrical Stimulator (NMES)  160.13 -  Supplies Used in the Delivery of Transcutaneous Electrical
(Medicare National Coverage Determinations Manual)
Monitoring During Open- Heart Surgery  (RETIRED)  160.10 -  Evoked Response Tests  160.12 -  Neuromuscular Electrical Stimulator (NMES)  160.13 -  Supplies Used in the Delivery of Transcutaneous Electrical Nerve Stimulation (TENS) and Neuromuscular Electrical Stimulation (NMES)  160.14 -  Invasive Intracranial Pressure Monitoring 160.15 -  Electrotherapy for Treatment of Facial Nerve Palsy (Bells Palsy)  160.16 -  Vertebral Axial Decompression (VAX -D) 160.17 -  L-Dopa  160.18 -  Vagus Nerve Stimulation  (VNS)  160.19 -  Phrenic Nerve Stimulator  160.20 -  Transfer Factor for Treatment of Multiple Sclerosis  160.21 -  Telephone Transmission of EEGs  160.22 -  Ambulatory EEG Monitoring (RETIRED)  160.23 -  Sensory Nerve Conduction Threshold Tests (sNCTs)  160.24  Deep Brain Stimulation for Essential Tremor and Parkinsons Disease  160.25 -  Multiple Electroconvulsive Therapy (MECT)  160.26 -  Cavernous Nerves Electrical Stimulation With Penile Plethysmography -  Effective August 24, 2006 160.27  Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Low Back Pain (CLBP)
(Medicare National Coverage Determinations Manual)
90 - Genetics  (Rev. 1, 10- 03-03)  No coverage determinations   90.1 - Pharmacogenomic Testing to Predict Warfarin Responsiveness  (Effective August 3, 2009)  (Rev. 111, Issued: 12- 18-09, Effective: 08 -03-09, Implementation: 04- 05-10)  A. General   Warfarin sodium is an orally administered anticoagulant drug that is marketed most commonly as Coumadin. (The Food and Drug Administration (FDA) approved labeling for Coumadin includes a Black Box Warning dating back to 2007.)  Anticoagulant drugs are sometimes referred to as blood thinners by the lay public.  Warfarin affects the vitamin K -dependent clotting factors II, VII, IX, and X.  Warfarin is thought to interfere with clotting factor synthesis by inhibition of the C1 subunit of the vitamin K epoxide reductase (VKORC1) enzyme complex, thereby reducing the regeneration of vitamin K1 epoxide.  The elimination of warfarin is almost entirely by metabolic conversion to inactive metabolites by cytochrome P450 (CYP) enzymes in liver cells.  CYP2C9 is the pr incipal cytochrome P450 enzyme that modulates the anticoagulant activity of warfarin.  From results of clinical studies, genetic variation in the CYP2C9  and/or VKORC1  genes can, in concert with clinical factors, predict how each individual responds to warf arin.
(Medicare National Coverage Determinations Manual)
Pharmacogenomics denotes the study of how an individual's genetic makeup, or genotype, affects the body's response to drugs.  Pharmacogenomics as a science examines associations among variations in genes with individual responses to a drug or medication.  In application, pharmacogenomic results (i.e., information on the patients genetic variations) can contribute to predicting a patients response to a given drug: good, bad, or none at all.  Pharmacogenomic testing of CYP2C9  or VKORC1  alleles to predict a patients response to warfarin occurs ideally prior to initiation of the drug.  This would be an once -in-a-lifetime test, absent any reason to believe that the patients personal genetic characteristics would change over time.  Although such pharmacogenomi c testing would be used to attempt to better approximate the best starting dose of warfarin, it would not eliminate the need for periodic PT/INR testing, a standard diagnostic test for coagulation activity and for assessing how a patient is reacting to a w arfarin dose.   Nationally Covered Indications   Effective August 3, 2009, the Centers for Medicare & Medicaid Services (CMS) believes that the available evidence supports that coverage with evidence development (CED) under 1862(a)(1)(E) of the Social Security Act (the Act) is appropriate for pharmacoge nomic testing of CYP2C9 or VKORC1 alleles to predict warfarin responsiveness by any method, and is therefore covered only when provided to Medicare beneficiaries who are candidates for anticoagulation therapy with warfarin who:   1. Have not been previously tested for CYP2C9 or VKORC1 alleles; and   2. Have received fewer than five days of warfarin in the anticoagulation regimen for which the testing is ordered; and   3. Are enrolled in a prospective, randomized, controlled clinical study when that study meets the following standards.   A clinical study seeking Medicare payment for pharmacogenomic testing of CYP2C9 or VKORC1 alleles to predict warfarin responsiveness provided to the Medicare beneficiary who is a candidate for anticoagulation therapy with warfarin pursuant to CED must addr ess one or more aspects of the following question: