evekhm/cms_iom_500 huggingface dataset:
(Medicare Claims Processing Manual)
As instructed in the CY 2014 OPPS/ASC final rule, CPT code 77371 is to be used  only for single session cranial SRS cases performed with a Cobalt -60 device, and CPT  code 77372 is to be used only for single session cranial SRS cases performed with a  linac - based device.  The term cranial means that the pathological lesion(s) that are the  target  of the radiation is located in the patients cranium or head.  The term single  session means that the entire intracranial lesion(s) that comprise the patients diagnosis  are treated in their entirety during a single treatment session on a single day.  CPT  code 77372 is never to be used for the first fraction or any other fraction of a fractionated SRS treatment.  CPT code 77372 is to be used only for single session cranial linac -based  SRS treatment.  Fractionated SRS treatment is any SRS delivery service requiring more than  a single session of SRS treatment for a cranial lesion, up to a total of no more than five fractions, and one to five sessions (but no more than five) for non -cranial lesions.   CPT code 77373 is to be used for any fraction (including the first fraction) in any series  of fractionated treatments, regardless of the anatomical location of the lesion or  lesions being radiated.  Fractionated cranial SRS is any cranial SRS that exceeds one treatment session and fractionated non- cranial SRS is any non -cranial SRS, regardless of  the number of fractions but never more than five.  Therefore, CPT code 77373 is  the exclusive code (and the use of no other SRS treatment delivery code is permitted) for  any and all fractionated SRS treatment services delivered anywhere in the body, including, but not limited to, the cranium or head.  77372 is not to be used for the first fraction of  a fractionated cranial SRS treatment series and must only be used in cranial SRS  when  there is a single treatment session to treat the patients entire  condition.
(Medicare Claims Processing Manual)
In addition, for the planning services, hospitals must report the specific CPT code  that accurately describes the service provided.  The planning services may include but are  not limited to CPT code 77290, 77295, 77300, 77334, or  77370.  CPT  Code  Long Descriptor  77290 Therapeutic radiology simulation- aided field setting; complex  77295 Therapeutic radiology simulation- aided field setting; 3-dimensional  77300 Basic radiation dosimetry calculation, central axis depth dose  calculation, tdf, nsd, gap calculation, off axis factor, tissue inhomogeneity factors, calculation of non- ionizing radiation surface and depth dose, as  required during course of treatment, only when prescribed by the  treating physician  77334 Treatment devices, design and construction; complex (irregular  blocks, special shields, compensators, wedges, molds or  casts)  77370 Special medical radiation physics  consultation   Effective for cranial single session stereotactic radiosurgery procedures (CPT code  77371 or 77372) furnished on or after January 1, 2016, costs  for certain adjunctive services (e.g., planning and preparation) are not factored into the  APC payment rate for APC 5627 (Level 7 Radiation Therapy).  Rather, the ten planning and preparation codes, will be paid according to their assigned status indicator when furnished 30 days prior or 30 days post SRS treatment  delivery. A list of the excluded planning and preparation CPT codes is provided in the C Y 2018 OPPS/ASC final rule with comment period.   200.4 - Billing for Amniotic Membrane  (Rev. 1445, Issued:  02- 08-08; Effective:  01 -01-08; Implementation:  03 -10-08)  Hospitals should report HCPCS code V2790 (Amniotic membrane for surgical reconstruction, per procedure) to report amniotic membrane tissue when the tissue is used.  A specific procedure code associated with use of amniotic membrane tissue is CPT code 65780 (Ocular surface reconstruction; amniotic membrane transplantation).  Payment for the amniotic membrane tissue is packaged into payment for CPT code 65780 or other procedures with which the amniotic membrane is used.
(Medicare Claims Processing Manual)
200.5 - Reserved  (Rev. 1882, Issued:  12- 21-09; Effective Date:  01 -01-10; Implementation Date:  01-04-10)  200.6 - Billing and Payment for Alcohol and/or Substance Abuse Assessment and Intervention Services  (Rev. 1445, Issued:  02- 08-08; Effective:  01 -01-08; Implementation:  03 -10-08)  For CY 2008, the CPT Editorial Panel has created two new Category I CPT codes for reporting alcohol and/or substance abuse screening and intervention services.  They are CPT code 99408 ( Alcohol and/or substance (other than tobacco) abuse structured screening (e.g., AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes); and CPT code 99409 ( Alcohol and/or substance (other than tobacco) abuse structured screening (e.g., AUDIT, DAST), and brief intervention (SBI) services; greater than 30 minut es).  However, screening services are not covered by Medicare without specific statutory authority, such as has been provided for mammography, diabetes, and colorectal cancer screening.  Therefore, beginning January 1, 2008, the OPPS recognizes two parallel G -codes (HCPCS codes G0396 and G0397) to allow for appropriate reporting and payment of alcohol and substance abuse structured assessment and intervention services that are not provided as screening services, but that are performed in the context of the diagnosis or treatment of illness or injury.  Contractors shall make payment under the OPPS for HCPCS code G0396 (Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., AUDIT, DAST) and brief intervention, 15 to 30 minutes) and HCPCS code G0397, (Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., AUDIT, DAST) and intervention greater than 30 minutes), only when reasonable and necessary (i.e., when the service is provided to evaluate patients with signs/symptoms of illness or injury) as per section  1862(a)(1)(A) of the Act.
(Medicare Claims Processing Manual)
HCPCS codes G0396 and G0397 are to be used for structured alcohol and/or substance (other than tobacco) abuse assessment and intervention services that are distinct from other clinic and emergency department visit services performed during the same encount er.  Hospital resources expended performing services described by HCPCS codes G0396 and G0397 may not be counted as resources for determining the level of a visit service and vice versa (i.e., hospitals may not double count the same facility resources in order to reach a higher level clinic or emergency department visit).  However, alcohol and/or substance structured assessment or intervention services lasting less than 15 minutes should not be reported using these HCPCS codes, but the hospital resources expended should be included in determining the level of the visit service reported.  200.7 - Billing for Cardiac Echocardiography Services (Rev. 1445, Issued:  02- 08-08; Effective:  01 -01-08; Implementation:  03 -10-08)  200.7.1 - Cardiac Echocardiography Without Contrast  (Rev. 1445, Issued:  02- 08-08; Effective:  01 -01-08; Implementation:  03 -10-08)  Hospitals are instructed to bill for echocardiograms without contrast in accordance with the CPT code descriptors and guidelines associated with the applicable Level I CPT code(s) (93303- 93350).   200.7.2 - Cardiac Echocardiography With Contrast  (Rev. 1657, Issued: 12- 31-08, Effective: 01 -01-09, Implementation: 01- 05-09)  Hospitals are instructed to bill for echocardiograms with contrast using the applicable HCPCS code(s) included in Table 200.7.2 below.  Hospitals should also report the appropriate units of the HCPCS codes for the contrast agents used in the performance of  the echocardiograms.  Table 200.7.2 -  HCPCS Codes For  Echocardiograms With Contrast
(Medicare Claims Processing Manual)
HCPCS  Long Descriptor  C8921 Transthoracic echocardiography with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; complete  C8922 Transthoracic echocardiography with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; follow -up or limited study C8923 Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real -time with image documentation (2D), includes M -mode recording, when performed, complete, without spectral or color Doppler echocardiography C8924 Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real -time with image documentation (2D), includes M -mode recording, when performed, follow -up or limited study  C8925 Transesophageal echocardiography (TEE) with contrast, or without contrast followed by with contrast, real time with image documentation (2D) (with or without M -mode recording); including probe placement, image acquisition, interpretation and report   HCPCS  Long Descriptor  C8926 Transesophageal echocardiography (TEE) with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report  C8927 Transesophageal echocardiography (TEE) with contrast, or without contrast followed by with contrast, for monitoring purposes, including probe placement, real time 2- dimensional image acquisition and interpretation leading to ongoing (continuous) assessment  of (dynamically changing) cardiac pumping function and to therapeutic measures on an immediate time basis  C8928 Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real -time with image documentation (2D), includes M -mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report  C8929 Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real -time with image documentation (2D), includes M -mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler e chocardiography C8930 Transthoracic echocardiography, with contrast, or without contrast followed by with
(Medicare Claims Processing Manual)
200.8 - Billing for Nuclear Medicine Procedures  (Rev. 1657, Issued: 12- 31-08, Effective: 01 -01-09, Implementation: 01 -05-09)  Beginning January 1, 2008, the I/OCE began editing for the presence of a radiolabeled product when a separately payable nuclear medicine procedure is present on a claim.  Hospitals should include radiolabeled product HCPCS codes on the same claim as a nuclear medicine procedure beginning on January 1, 2008.  Hospitals are required to submit the HCPCS code for the radiolabeled product on the same claim as the HCPCS code for the nuclear medicine procedure.  Hospitals are also instructed to submit the claim so that the services on the claim each reflect the date the particular service was provided.  Therefore, if the nuclear medicine procedure is provided on a different date of service from the radiolabeled product, the claim will contain more than one date of service.  More information regarding these edits is availa ble on the OPPS Web site at http://www.cms.hhs.gov/HospitalOutpatientPPS/ .
(Medicare Claims Processing Manual)
Hospitals are instructed to use HCPCS code C9898 (Radiolabeled product provided during a hospital inpatient stay) on outpatient claims for nuclear medicine procedures to indicate that a radiolabeled product that provides the radioactivity necessary for the  reported diagnostic nuclear medicine procedure was provided during a hospital inpatient stay.  This HCPCS code is assigned status indicator N because no separate payment is made for the code under the OPPS.  The effective date of the code is January 1, 2008, the date the nuclear medicine procedure- to-radiolabeled product edits were initially implemented.  Because the Medicare claims processing system requires that there be a charge for each HCPCS code reported on the claim, hospitals should always report  a token charge of less than $1.01 for HCPCS code C9898.  The date of service reported on the claim for HCPCS code C9898 should be the same as the date of service for the nuclear medicine procedure HCPCS code, which should always accompany the reporting of HCPCS code C9898.  HCPCS code C9898 should never be reported on a claim without a diagnostic nuclear medicine procedure that is subject to the nuclear medicine procedure -to-radiolabeled product edits.  More information regarding these edits is available on the OPPS Web site at http://www.cms.hhs.gov/HospitalOutpatientPPS   Future updates to this section will be communicated in a Recurring Update Notification.   200.9 - Billing for Sometimes Therapy Services that May be Paid as Non-Therapy Services for Hospital Outpatients  (Rev. 3156, Issued: 12 -22-14, Effective: 01 -01-15, Implementation: 01- 05-15)  Section 1834(k) of the Act, as added by Section 4541 of the BBA, allows payment at 80 percent of the lesser of the actual charge for the services or the applicable fee schedule amount for all outpatient therapy services; that is, physical therapy services, speech -language pathology services, and occupational therapy services.  As provided under Section 1834(k)(5) of the Act, a therapy code list was created based on a uniform coding system (that is, the HCPCS) to identify and track these outpatient therapy s ervices paid under the Medicare Physician Fee Schedule (MPFS).
(Medicare Claims Processing Manual)
The list of therapy codes, along with their respective designation, can be found on the CMS Website, specifically at http://www.cms.hhs.gov/TherapyServices/05_Annual_Therapy_Update.asp#TopOfPage .  Two of the designations that are used for therapy services are: always therapy and sometimes therapy.  An always therapy service must be performed by a qualified therapist under a certified therapy plan of care, and a sometimes therapy service m ay be performed by physician or a non- physician practitioner outside of a certified therapy plan of care.   Under the OPPS, separate payment is provided for certain services designated as sometimes therapy services if these services are furnished to hospital outpatients as a non-therapy service, that is, without a certified therapy plan of care. Specifically, to be paid under the OPPS for a non- therapy service, hospitals SHOULD NOT append the therapy modifier GP (physical therapy), GO (occupational therapy), or GN (speech language pathology), or report a therapy revenue code 042x, 043x, or 044x in association with the sometimes therapy codes listed in the table below.   To receive payment under the MPFS, when sometimes therapy services are performed by a qualified therapist under a certified therapy plan of care, providers should append the appropriate therapy modifier GP, GO, or GN, and report the charges under an appropriate therapy revenue code, specifically 042x, 043x, or 044x. This instruction does not apply to claims for sometimes therapy codes furnished as non- therapy services in the hospital outpatient department and paid under the OPPS.
(Medicare Claims Processing Manual)
Effective January 1, 2015, two HCPCS codes designated as Sometimes Therapy services, G0456 (Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) using a mechanically -powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area less than or equal to 50 square centimeters) and G0457 (Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) using a mechanically -powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area greater than 50 square centimeters) would be terminated and replaced with two new CPT codes 97607 (Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non- durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session;  total wounds(s) surface area less than or equal to 50 square centimeters) and 97608 (Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non- durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session;  total wounds(s) surface area greater than 50 squa re centimeters).
(Medicare Claims Processing Manual)
The list of HCPCS codes designated as sometimes therapy services that may be paid as non-therapy services when furnished to hospital outpatients is displayed in the table below.  Services Designated as Sometimes Therapy that May be Paid as Non -Therapy Services for Hospital Outpatients  HCPCS Code  Long Descriptor  92520  Laryngeal function studies (i.e., aerodynamic testing and acoustic testing)  HCPCS Code  Long Descriptor  97597  Removal of devitalized tissue from wound(s), selective debridement, without anesthesia (eg., high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), with or without topical application(s), wound assessment, and instruction(s) for ongoing care, may include use of a whirlpool, pe r session; total wound(s) surface area less than or equal to 20 square centimeters  97598  Removal of devitalized tissue from wound(s), selective debridement, without anesthesia (e.g., high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), with or without topical application(s), wound assess ment, and instruction(s) for ongoing care, may include use of a whirlpool, per session; total wound(s) surface area greater than 20 square centimeters  97602  Removal of devitalized tissue from wound(s), non -selective debridement, without anesthesia (e.g., wet -to-moist dressings, enzymatic, abrasion), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session  97605  Negative pressure wound therapy (e.g., vacuum assisted drainage collection), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters  97606  Negative pressure wound therapy (e.g., vacuum assisted drainage collection), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters  97607  Negative pressure wound therapy, (eg, vacuum assisted drainage
(Medicare Claims Processing Manual)
including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters  97607  Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non- durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session;  total wounds(s) surface area less than or equal to 50 square centimeters  97608  Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non- durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session;  total wounds(s) surface area greater than 50 square centimeters  97610  Low frequency, non -contact, non -thermal ultrasound, including topical application(s), when performed, wound assessment, and instruction(s) for ongoing care, per day
(Medicare Claims Processing Manual)
200.11  Billing Advance Care Planning (ACP) as an Optional Element of an Annual Wellness Visit (AWV)   (Rev. 3739, Issued: 03- 17-17, Effective: 01 -01-16, Implementation: 06- 19-17)   Effective January 1, 2016 payment for the service described by CPT code 99497 (Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face -to-face with the patient, family member(s), and/or surrogate) is conditionally packaged under the OPPS and is consequently assigned to a conditionally packaged payment status indicator of Q1. When this service is furnished with another service paid under the OPPS, payment is packaged; when it is the only service furnished, payment is made separately. CPT code 99498 (Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when perform ed), by the physician or other qualified health care professional; each additional 30 minutes (List separately in addition to code for primary procedure)) is an add- on code and therefore payment for the service described by this code is unconditionally pac kaged (assigned status indicator N) in the OPPS in accordance with 42 CFR 419.2(b)(18).   In addition, for services furnished on or after January 1, 2016, Advance Care Planning (ACP) is treated as a preventive service when furnished with an AWV. The Medicare coinsurance and Part B deductible are waived for ACP when furnished as an optional elem ent of an AWV.
(Medicare Claims Processing Manual)
The codes for the optional ACP services furnished as part of an AWV are 99497 (Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health professional; first 30 minutes, face -to-face with the patient, family member(s) and/or surrogate;) and an add- on code 99498 (each additional 30 minutes (List separately in addition to code for primary procedure)). When ACP services a re provided as a part of an AWV, practitioners would report CPT code 99497 (and add- on CPT code 99498 when applicable) for the ACP services in addition to either of the AWV codes (G0438 or G0439).   The deductible and coinsurance for ACP will only be waived when billed on the same day and on the same claim as an AWV (code G0438 or G0439), and must also be furnished by the same provider. Waiver of the deductible and coinsurance for ACP is limited to on ce per year. Payment for an AWV is limited to once per year. If the AWV billed with ACP is denied for exceeding the once per year limit, the deductible and coinsurance will be applied to the ACP.   Also see Pub. 100- 02, Medicare Benefit Policy Manual, chapter 15, section 280.5.1 for more information.   230 - Billing and Payment for Drugs and Drug Administration  (Rev. 573, Issued: 06- 03-05, Effective: 01 -01-05, Implementation: 06- 01-05)  This section provides billing guidance and payment instructions for hospitals when providing drugs and drug administration services in the hospital outpatient department.   230.1 - Coding and Payment for Drugs and Biologicals, and Radiopharmaceuticals (Rev. 1445, Issued:  02- 08-08; Effective:  01 -01-08; Implementation:  03 -10-08)  This section provides hospitals with coding instructions and payment information for drugs paid under OPPS.  For additional information on coding and payment for drugs and biologicals under the OPPS, see the Medicare Claims Processing Manual, Chapter 17 Drugs and Biologicals.