evekhm/cms_iom_500 huggingface dataset:
(Medicare Claims Processing Manual)
QM  MIPS adjustment amount   QN  First APC pass- through device offset   QO  Second APC pass -through device offset   QP  Third APC pass -through device offset   QQ  Terminated procedure with device offset   QR  First APC pass- through drug or biological offset   QS  Second APC pass -through drug or biological offset    QT  Third APC pass -through drug or biological offset   QU Device credit with device offset   QV  Value -based purchasing adjustment amount   QW  Placeholder reserved for future use   QX-QZ  Not used by Medicare   200 - Special Services for OPPS Billing  (Rev. 1445, Issued:  02- 08-08; Effective:  01- 01-08; Implementation:  03 -10-08)  200.1 - Billing for Corneal Tissue  (Rev. 3425, Issued: 12- 18-15, Effective: 01- 01-16, Implementation: 01- 04-16)  Corneal tissue will be paid on a cost basis, not under OPPS, only when it is used in a corneal transplant procedure described by one of the following CPT codes: 65710, 65730, 65750, 65755, 65756, 65765, 65767, and any successor code or new code describing a new type of corneal transplant procedure that uses eye banked corneal tissue.  In all other procedures cornea tissue is packaged.  To receive cost based reimbursement hospitals must bill charges for corneal tissue using HCPCS code V2785.   200.2 - Hospital Dialysis Services For Patients With and Without End Stage Renal Disease (ESRD)  (Rev.  2455, Issued: 04- 26-12, Effective: 10- 01-12, Implementation; 10- 01-12)
(Medicare Claims Processing Manual)
Effective with claims with dates of service on or after August 1, 2000, hospital -based End Stage Renal Disease (ESRD) facilities must submit services covered under the ESRD benefit in 42 CFR 413.174 (maintenance dialysis and those items and services directly related to dialysis such as drugs, supplies) on a separate claim from services not covered under the ESRD benefit.  Items and services not covered under the ESRD benefit must be billed by the hospital using the hospital bill type and be paid under the Outpatient Prospective Payment System  (OPPS) (or to a CAH at reasonable cost).  Services covered under the ESRD benefit in 42 CFR 413.174 must be billed on the ESRD bill type and must be paid under the ESRD PPS.  This requirement is necessary to properly pay only unrelated ESRD services (those not covered under the ESRD benefit) under OPPS (or to a CAH  at reasonable cost).   Medicare does not allow payment for routine or related dialysis treatments, which are covered and paid under the ESRD PPS, when furnished to ESRD patients in the outpatient department of a hospital. However, in certain medical situat ions in which the ESRD outpatient cannot obtain her or his regularly scheduled dialysis treatment at a certified ESRD facility, the OPPS rule for 2003 allows payment for non- routine dialysis treatments (which are not covered under the ESRD benefit) furnished to ESRD  outpatients in the outpatient department of a hospital.  Payment for unscheduled dialysis furnished to ESRD outpatients and paid under the OPPS is limited to the following circumstances:    Dialysis performed following or in connection with a di alysis -related procedure such as vascular access procedure or blood transfusions;    Dialysis performed following treatment for an unrelated medical emergency; e.g., if a patient goes to the emergency room for chest pains and misses a regularly scheduled dialysis treatment that cannot be rescheduled, CMS allows the hospital to provide and bill Medicare for the dialysis treatment; or    Emergency dialysis for ESRD patients who would otherwise have to be admitted as inpatients in order for the hospital to recei ve payment.
(Medicare Claims Processing Manual)
 Emergency dialysis for ESRD patients who would otherwise have to be admitted as inpatients in order for the hospital to recei ve payment.    In these situations, non- ESRD certified hospital outpatient facilities are to bill Medicare using the Healthcare Common Procedure Coding System (HCPCS) code G0257 (Unscheduled or emergency dialysis treatment for an ESRD patient in a hospital outpatient department that is not certified as an ESRD facility).    HCPCS code G0257 may only be reported on type of bill 13X (hospital outpatient service) or type of bill 85X ( critical access hospital) because HCPCS code G0257 only reports services for hospital outpatients with ESRD and only these bill types are used to report services to hospital outpatients.  Effective for services on and after October 1, 2012, claims containi ng HCPCS code G0257 will be returned to the provider for correction if G0257 is reported with a type of bill other than 13X or 85X (such as a 12x inpatient claim).   HCPCS code 90935 (Hemodialysis procedure with single physician evaluation) may be reported  and paid only if one of the following two conditions is met:   1) The patient is a hospital inpatient with or without ESRD and has no coverage under Part A, but has Part B coverage.  The charge for hemodialysis is a charge for the use of a prosthetic device.  See Benefits Policy Manual 100 -02 Chapter 15 section 120.  A.  The service must be reported on a type of bill 12X or type of bill 85X.  See the Benefits Policy Manual 100- 02 Chapter 6 section 10 ( Medical and Other Health Services Furnished to Inpatients of Participating Hospitals)  for the criteria that must be met for services to be paid when a hospital inpatient has Part B coverage but does not have coverage under Part A; or   2) A hospital outpatient does not have ESRD and is receiving hemodialysis in the hospital outpatient department.  The service is reported on a type of bill 13X or type of bill 85X.
(Medicare Claims Processing Manual)
2) A hospital outpatient does not have ESRD and is receiving hemodialysis in the hospital outpatient department.  The service is reported on a type of bill 13X or type of bill 85X.     CPT code 90945 (Dialysis procedure other than hemodialysis (e.g. peritoneal dialysis, hemofiltration, or other continuous replacement therapies)), with single physician evaluation, may be reported by a hospital paid under the OPPS or CAH method I or method II on type of bill 12X, 13X or 85X.   200.3 - Billing Codes for Intensity Modulated Radiation Therapy (IMRT) and Stereotactic Radiosurgery (SRS)  (Rev. 1445, Issued:  02- 08-08; Effective:  01- 01-08; Implementation:  03 -10-08)  200.3.1 - Billing Instructions for IMRT Planning and Delivery  (Rev. 3685, Issued: 12- 22-16, Effective: 01- 01-17, Implementation: 01- 03-17)  Payment for the services identified by CPT codes 77014, 77280, 77285, 77290, 77295, 77306 through 77321, 77331, and 77370 are included in the APC payment for CPT  code 77301 (IMRT planning). These codes should not be reported in addition to CPT  code 77301 when provided prior to or as part of the  development of the IMRT  plan.  In addition, CPT codes 77280- 77290 (simulation- aided field settings) should not be reported for verification of the treatment field during a course of IMRT.     200.3.2 - Billing for Multi- Source Photon (Cobalt 60 -Based) Ster eotactic Radiosurgery (SRS) Planning and Delivery (Rev. 3941; Issued: 12- 22-17; Effective: 01-  01-18; Implementation: 01 -02-18)  Effective for services furnished on or after January 1, 2014, hospitals must report  SRS planning and delivery services using only the CPT codes that accurately describe the service furnished.  For the delivery services, hospitals must report CPT code  77371, 77372, or  77373.
(Medicare Claims Processing Manual)
CPT  Code  Long  Descriptor  77371 Radiation treatment delivery, stereotactic radiosurgery (srs),  complete course of treatment of cranial lesion(s) consisting of 1 session;  multi-  source cobalt 60  based  77372 Radiation treatment delivery, stereotactic radiosurgery (srs),  complete course of treatment of cranial lesion(s) consisting of 1 session;  linear accelerator  based  77373 Stereotactic body radiation therapy, treatment delivery, per fraction to  1 or more lesions, including image guidance, entire course not to exceed 5 fractions    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 f raction (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
(Medicare Claims Processing Manual)
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 tr eatment 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 co de 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 physi cian 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 planni ng 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 CY 2018 OPPS/ASC final rul e 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 tis sue 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 minutes).  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 encounter.  H ospital 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 t o 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 C ontrast  (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  HCPCS  Long Descriptor  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   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) w ith 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 pumpi ng 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 echocardiography  HCPCS  Long Descriptor  C8930 Transthoracic echocardiography,
(Medicare Claims Processing Manual)
includes M -mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography  HCPCS  Long Descriptor  C8930 Transthoracic echocardiography, with contrast, or without contrast followed by wit h 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; including performance of continuous electrocardiographic monitoring, with physician supervision
(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 refle ct 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 available 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 H CPCS 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 fo r 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 H CPCS) to identify and track these outpatient therapy services 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 may 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 assoc iation with the sometimes therapy codes listed in the table below.