evekhm/cms_iom_500 huggingface dataset:
(Medicare Claims Processing Manual)
Acquisition Program (CAP) - Claim Processing for Not Otherwise Classified ("NOC") Drugs  01/02/2007 5259 R953CP  05/19/2006 CAP -Creation of Automated tables for Providers Information, Expansion of CAP Fee Schedule  10/02/2006 5079 R882CP  03/03/2006 Hospital Billing for Take -Home Drugs  07/03/2006 4301 R867CP  02/17/2006 Elimination of the Durable Medical Equipment Regional Carriers (DMERC) Information Form (DIF)  04/03/2006 4241 R866CP  02/17/2006 Additional Requirements for the Competitive Acquisition Program (CAP) for Part B Drugs  07/03/2006 4309 R840CP  02/06/2006 Hospital Billing for Take -Home Drugs  07/03/2006 4301 R839CP  02/06/2006 Additional Requirements for the Competitive Acquisition Program (CAP) for Part B Drugs  07/03/2006 4309 R754CP  11/10/2005 Fees for Supplying Inhalation Drugs Fee Dispensing Fee Revisions and Clarifications  01/03/2006 3990 R745CP  11/4/2005 Elimination of the Durable Medical Equipment Regional Carriers (DMERC) Information Form (DIF)  04/03/2006 4040 R736CP  10/31/2005 Clarification and Update to Hospital Billing Instructions and Payment for Epoetin Alfa (EPO) and Darbepoetin Alfa (Aranesp) for Beneficiaries with End Stage Renal Disease (ESRD)  04/03/2006 4103 R719CP  10/21/2005 Clarification and Update to Hospital Billing Instructions and Payment for Epoetin Alfa (EPO) and Darbepoetin Alfa (Aranesp) for Beneficiaries with End Stage Renal Disease (ESRD)  04/03/2006 4103  Rev #  Issue Date  Subject  Impl Date  CR#  R684CP  09/23/2005 Correction to Chapter 17, Section 80.2.3, MSN/ANSIX12 Denial Messages for Anti-Emetic Drugs  12/23/2005 4001 R590CP  06/24/2005 Aprepitant for Chemotherapy- Induced Emesis  07/05/2005 3831 R576CP  06/03/2005 Correction to Chapter 17, Section 80.2.3,
(Medicare Claims Processing Manual)
4001 R590CP  06/24/2005 Aprepitant for Chemotherapy- Induced Emesis  07/05/2005 3831 R576CP  06/03/2005 Correction to Chapter 17, Section 80.2.3, MSN/ANSIX12N Denial Messages for Anti-Emetic Drugs  Not Applicable  3918 R551CP  04/29/2005 Dispensing/Supply Fee Code, Payment, and Common Working File (CWF) Editing for Immunosuppressive Drugs  10/03/2005 3830 R521CP  04/08/2005 Hemophilia Blood Clotting Factors  05/09/2005 3755 R509CP  03/18/2005 Number of Drug Pricing Files That Must Be Maintained Online by DMERCs  07/05/2005 3584 R496CP  03/04/2005 Billing for Blood and Blood Products Under the Hospital Outpatient Prospective Payment System (OPPS)  07/05/2005 3681 R455CP  01/28/2005 Number of Drug Pricing Files That Must Be Maintained Online by DMERCs  07/05/2005 3584 R397CP  12/16/2004 Drug Pricing Limits as of January 1, 2005  01/03/2005 3232 R396CP  12/16/2004 New Dispensing/Supply Fee Codes for Oral Anti -Cancer, Oral Ant -Emetic, Immunosuppressive, and Inhalation Drugs  01/17/2005 3620 R394CP  12/10/2004 New Dispensing/Supply Fee Codes for Oral Anti -Cancer, Oral Ant -Emetic, Immunosuppressive, and Inhalation Drugs  01/17/2005 3620 R374CP  11/22/2004 Carrier Processing of Claims for Blood Clotting Factors  11/22/2004 3370 R352CP  11/03/2004 Use of Three Places after the Decimal Point for ASP Drug File  04/04/2005 3436  Rev #  Issue Date  Subject  Impl Date  CR#  R346CP  10/29/2004 Use of Three Places after the Decimal Point for ASP Drug File  04/05/2005 3436 R327CP  10/22/2004 Carrier Processing of Claims for Blood Clotting Factors  11/22/2004 3370 R269CP  08/03/2004 Required Number Of Online Pricing Files to Be Maintained By Carriers  01/03/2005
(Medicare Claims Processing Manual)
10/22/2004 Carrier Processing of Claims for Blood Clotting Factors  11/22/2004 3370 R269CP  08/03/2004 Required Number Of Online Pricing Files to Be Maintained By Carriers  01/03/2005 3231 R248CP  07/23/2004 Replaced by Revision 397CP  01/01/2005 3232 R244CP  07/23/2004 Replaced by Revision 269CP  01/03/2005 3231 R188CP  05/28/2004 Hospital Outpatient Billing and Payment under OPPS for New, Unclassified Drugs or Biologicals Approved by the FDA After January 1, 2004, But Before Assignment of a Product -Specific Drug/Biological HCPCS Code  07/06/2004 3287 R136CP  04/09/2004 New "WW" codes to identify Xeloda.  07/06/2004 3169 R131CP  03/26/2004 Payment Allowance Limit for Drugs and Biologicals Not Paid on a Cost or Prospective Payment Basis  03/26/2004 3153 R104CP  02/20/2004 Instructions for Processing NDC Codes for DMERCs and VMS  04/05/2004 3141 R074CP  01/23/2004 Payment for intravenous immune globulin in the home for the treatment of primary immune deficiency diseases  04/05/2004 3060 R055CP  12/24/2003 Implementation of drug payment under the "Medicare Prescription Drug, Improvement, and Modernization Act" (MPDIMA) of 2003  01/05/2004 3025 R054CP  12/24/2003 Implementation of drug payment under the "Medicare Prescription Drug, Improvement, and Modernization Act" (MPDIMA) of 2003  01/05/2004 3022 R035CP  11/28/2003 Number of Required Carrier Pricing Files for the Single Drug Pricer  01/01/2004 2755  Rev #  Issue Date  Subject  Impl Date  CR#  R001CP  10/01/2003 Initial Publication of Manual  NA NA Back to top of chapter
Article - Billing and Coding: Frequency of Hemodialysis (A55672)
CMS National Coverage PolicyN/AArticle TextRefer to theNational Government ServicesLocal Coverage Determination (LCD) L37475, Frequency of Hemodialysis, for reasonable and necessary requirements and frequency limitations.The Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) code(s) may be subject to National Correct Coding Initiative (NCCI) edits. This information does not take precedence over NCCI edits. Please refer to NCCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.This article outlines how to line item bill dialysis sessions for End Stage Renal Disease (ESRD) patients. This does not address line item billing for sessions associated with training or other modalities such as peritoneal dialysis. This article does not change any other billing requirements for dialysis claims. Note: This article uses the terms dialysis session and treatment interchangeably.CMS IOM Publication 100-04,Medicare Claims Processing Manual, Chapter 8 requires line item billing for all ESRD claims with dates of service (DOS) on or after April 1, 2007. Each dialysis session performed should be reported on a separate line.CMS IOM Publication 100-02,Medicare Benefit Policy Manual, Chapter 11 discusses that ESRD facilities furnishing dialysis treatments in facility or in the beneficiarys home are paid for up to 3 treatments per week. Payment for additional treatments, defined as any treatments in excess of 3 treatments per week, may be considered in addition to the ESRD PPS per treatment payment amount paid for up to 3 treatments per week.For monthly claims submitted with Bill Type 72X and Revenue Codes 0821 and 0881, three approaches of billingper lineare available. Based on the Patients Plan of Care (POC), or other available medical documents, the following scheme should be followed when billing sessions. Note: Dialysis sessions in the patients POC that are not furnished should not be billed.
Article - Billing and Coding: Frequency of Hemodialysis (A55672)
For dialysis sessions that have been furnished 3 times (3X) per week, each line should be 90999 without any modifiers appended. That is, when the hemodialysis-prescription is 3 times (3X) per week and each session is furnished, all of these sessions be billed as 90999 (no modifier appended) and they will be paid as routine conventional dialysis up to 13/14 per month.For each dialysis sessions furnished in addition to the 3 sessions per week that do not include medical documentation supporting a reasonable and necessary determination for payment, each line for these sessions should be billed as 90999 CG. Examples of when this could occur include short, more frequent treatments furnished for the convenience of the patient or staff, etc. Additional sessions need to be billed as 90999 CG when medical documentation has not been submitted to support the extra sessions as reasonable and necessary. The CG modifier indicates that the facility attests the additional treatment is not reasonable and necessary and should not receive additional payment. Each line billed as 90999 CG will be denied. However, the use of the modifier is used for data analysis. Please refer to CR 9989, Implementation of Modifier CG for Type of Bill 72X, dated May 12, 2017.For each dialysis session furnished in addition to 3 sessions per week that includes medical documentation supporting a reasonable and necessary determination for payment, each line for these services should be billed as 90999 KX. These include medical conditions for acute and occasionally chronic conditions that have supporting documentation that the extra sessions are reasonable and necessary (e.g. through documents from recent hospital care, office visits, dialysis progress notes or MCP visits). These sessions must be reasonable and necessary for additional payment based on clinical conditions. On these claims, the 90999 lines without a modifier will be paid as 3X per week and those lines with 90999 KX will be considered for additional payments. Omission of the KX modifier will result in no additional payment for the line item. For diagnoses not listed in this article but felt to be reasonable and necessary, the KX modifier should be appended as well. A denial will occur on these lines, but the redetermination process (an appeal) will be available to submit supportive documentation for review.
Article - Billing and Coding: Frequency of Hemodialysis (A55672)
The expectation is that these three scenarios will be seen on monthly claims, i.e., claims with 90999 lines only, or those with lines of 90999 mixed with 90999 CG or KX modifier appended. Ongoing data analysis may trigger provider specific requests for documentation should unusual patterns occur, i.e., claims with only lines of 90999 KX submitted.Please note that the POC and other supporting medical documentation to justify any of the line item sessions will be most important and may be requested.Please see L37475 for instructions when clinical conditions outside those listed in the available diagnoses should occur.Please see L37475 for Documentation Requirements and Utilization Guidelines.
Article - Billing and Coding: Frequency of Hemodialysis (A55675)
CMS National Coverage PolicyPlease refer to the Noridian Local Coverage Determination (LCD) L37502, Frequency of Hemodialysis.Article Text
Article - Billing and Coding: Frequency of Hemodialysis (A55675)
Refer to the Noridian Healthcare SolutionsLocal Coverage Determination (LCD) L37502, Frequency of Hemodialysis, for reasonable and necessary requirements and frequency limitations.The Current Procedural Terminology (CPT/Healthcare Common Procedure Coding System (HCPCS) code(s) may be subject to National Correct Coding Initiative (NCCI) edits. This information does not take precedence over NCCI edits. Please refer to NCCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.This article outlines how to line bill dialysis sessions of End Stage Renal Disease (ESRD) patients. This does not address line item billing for sessions associated with training or other modalities such as peritoneal dialysis. This article does not change any other billing requirements for dialysis claims. Note: This article uses the terms dialysis 'session' and 'treatment' interchangeably.CMS IOM Publication 100-04,Medicare Claims Processing Manual, Chapter 8 requires line item billing for all ESRD claims with dates of service (DOS) on or after April 1, 2007. Each dialysis session performed should be reported on a separate line.CMS IOM Publication 100-02,Medicare Benefit Policy Manual, Chapter 11 discusses that ESRD facilities furnishing dialysis treatments in facility or in the beneficiary's home are paid for up to 3 treatments per week. Payment for additional treatments, defined as any treatments in excess of 3 treatments per week, may be considered in addition to the ESRD PPS per treatment payment amount paid for up to 3 treatments per week.For monthly claims submitted with Bill Type 72X and Revenue Codes 0821 and 0881, three approaches of billingper lineare available. Based on the Patients Plan of Care (POC) or other available medical documents, the following scheme should be followed when billing sessions. Note: Dialysis sessions in the patient's POC that are not furnished should not be billed.
Article - Billing and Coding: Frequency of Hemodialysis (A55675)
1.For dialysis sessions that have been furnished 3 times (3X) per week, each line should be billed with 90999 without any modifiers appended. That is, when the hemodialysis-prescription is 3 times (3X) per week and each session is furnished, all of these sessions be billed as 90999 (no modifier appended) and they will be paid as routine conventional dialysis up to 13/14 per month.2.For each dialysis session furnished in addition to the 3 sessions per week that do not include medical documentation supporting a reasonable and necessary determination for payment,each line for these sessions should be billed as 90999 CG. Examples of when this could occur include short, more frequent treatments furnished for the convenience of the patient or staff, etc. Additional sessions need to be billed as 90999 CG when medical documentation has not been submitted to support the extra sessions as reasonable and necessary. The CG modifier indicates that the facility attests the additional treatment is not reasonable and necessary and should not receive additional payment. Each line billed as 90999 CG will be denied. However, the use of the modifier is used for data analysis. Please refer to CR 9989, Implementation of Modifier CG for Type of Bill 72X, dated May 12, 2017.
Article - Billing and Coding: Frequency of Hemodialysis (A55675)
3.For each dialysis session furnished in addition to 3 sessions per week that includes medical documentation supporting a reasonable and necessary determination for payment, each line for these services should be billed as 90999 KX. These include medical conditions for acute and occasionally chronic conditions that have supporting documentation that the extra sessions are reasonable and necessary (e.g. through documents from recent hospital care, office visits, dialysis progress notes or MCP visits). These sessions must be reasonable and necessary for additional payment based on clinical conditions. On these claims, the 90999 lines without a modifier will be paid as 3X per week and those lines with 90999 KX will be considered for additional payments. Omission of the KX modifier will result in no additional payment for the line item. For diagnoses not listed in this article but felt to be reasonable and necessary, the KX modifier should be appended as well. A denial will occur on these lines, but the redetermination process (an appeal) will be available to submit supportive documentation for review.The expectation is that these three scenarios will be seen on monthly claims, i.e., claims with 90999 lines only, or those with lines of 90999 mixed with 90999 CG or KX modifier appended. Ongoing data analysis may trigger provider specific requests for documentation should unusual patterns occur, i.e., claims with only lines of 90999 KX submitted.Please note that the POC and other supporting medical documentation to justify any of the line item sessions will be most important and may be requested.Please see L37502 for instructions when clinical conditions outside those listed in the available diagnoses should occur.Please see L37502 for Documentation Requirements and Utilization Guidelines.
Article - Billing and Coding: Frequency of Hemodialysis (A55676)
CMS National Coverage PolicyPlease refer to the Noridian Local Coverage Determination (LCD) L37504, Frequency of Hemodialysis.Article Text
Article - Billing and Coding: Frequency of Hemodialysis (A55676)
Refer to the Noridian Healthcare Solutions Local Coverage Determination (LCD) L37504, Frequency of Hemodialysis, for reasonable and necessary requirements and frequency limitations.The Current Procedural Terminology CPT/Healthcare Common Procedure Coding System (HCPCS) code(s) may be subject to National Correct Coding Initiative (NCCI) edits. This information does not take precedence over NCCI edits. Please refer to NCCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.This article outlines how to line bill dialysis sessions of End Stage Renal Disease (ESRD) patients. This does not address line item billing for sessions associated with training or other modalities such as peritoneal dialysis. This article does not change any other billing requirements for dialysis claims. Note: This article uses the terms dialysis 'session' and 'treatment' interchangeably.CMS IOM Publication 100-04,Medicare Claims Processing Manual, Chapter 8 requires line item billing for all ESRD claims with dates of service (DOS) on or after April 1, 2007. Each dialysis session performed should be reported on a separate line.CMS IOM Publication 100-02,Medicare Benefit Policy Manual, Chapter 11 discusses that ESRD facilities furnishing dialysis treatments in facility or in the beneficiary's home are paid for up to 3 treatments per week. Payment for additional treatments, defined as any treatments in excess of 3 treatments per week, may be considered in addition to the ESRD PPS per treatment payment amount paid for up to 3 treatments per week.For monthly claims submitted with Bill Type 72X and Revenue Codes 0821 and 0881, three approaches of billingper lineare available.Based on the Patients Plan of Care (POC) or other available medical documents, the following scheme should be followed when billing sessions. Note: Dialysis sessions in the patient's POC that are not furnished should not be billed.
Article - Billing and Coding: Frequency of Hemodialysis (A55676)
1.For dialysis sessions that have been furnished 3 times (3X) per week, each line should be billed with 90999 without any modifiers appended. That is, when the hemodialysis-prescription is 3 times (3X) per week and each session is furnished, all of these sessions be billed as 90999 (no modifier appended) and they will be paid as routine conventional dialysis up to 13/14 per month.2. For each dialysis session furnished in addition to the 3 sessions per week that do not include medical documentation supporting a reasonable and necessary determination for payment, each line for these sessions should be billed as 90999 CG. Examples of when this could occur include short, more frequent treatments furnished for the convenience of the patient or staff, etc. Additional sessions need to be billed as 90999 CG when medical documentation has not been submitted to support the extra sessions as reasonable and necessary. The CG modifier indicates that the facility attests the additional treatment is not reasonable and necessary and should not receive additional payment. Each line billed as 90999 CG will be denied. However, the use of the modifier is used for data analysis. Please refer to CR 9989, Implementation of Modifier CG for Type of Bill 72X, dated May 12, 2017.
Article - Billing and Coding: Frequency of Hemodialysis (A55676)
3. For each dialysis session furnished in addition to 3 sessions per week that includes medical documentation supporting a reasonable and necessary determination for payment, each line for these services should be billed as 90999 KX. These include medical conditions for acute and occasionally chronic conditions that have supporting documentation that the extra sessions are reasonable and necessary (e.g. through documents from recent hospital care, office visits, dialysis progress notes or MCP visits). These sessions must be reasonable and necessary for additional payment based on clinical conditions. On these claims, the 90999 lines without a modifier will be paid as 3X per week and those lines with 90999 KX will be considered for additional payments. Omission of the KX modifier will result in no additional payment for the line item. For diagnoses not listed in this article but felt to be reasonable and necessary, the KX modifier should be appended as well. A denial will occur on these lines, but the redetermination process (an appeal) will be available to submit supportive documentation for review.The expectation is that these three scenarios will be seen on monthly claims, i.e., claims with 90999 lines only, or those with lines of 90999 mixed with 90999 CG or KX modifier appended. Ongoing data analysis may trigger provider specific requests for documentation should unusual patterns occur, i.e., claims with only lines of 90999 KX submitted.Please note that the POC and other supporting medical documentation to justify any of the line item sessions will be most important and may be requested.
Article - Billing and Coding: Frequency of Hemodialysis (A55676)
Please see L37504 for instructions when clinical conditions outside those listed in the available diagnosis should occur.Please see L37504 for Documentation Requirements and Utilization Guidelines.
Article - Billing and Coding: MolDX: Abbott RealTime IDH1 and IDH2 testing for Acute Myeloid Leukemia (AML) (A55695)
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. 100-02, Medicare Benefit Policy Manual, Chapter 15, 80.1.2 A/B MAC (B) Contacts With Independent Clinical LaboratoriesCMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 16, 50.5 Jurisdiction of Laboratory Claims, 60.1.1 Independent Laboratory Specimen Drawing, 60.2 Travel AllowanceCMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 23, 10 Reporting ICD Diagnosis and Procedure CodesArticle TextTheAbbott RealTime IDH1by Abbott Molecular is the only test that has received FDA approval to be usedas an aid in identifying acute myeloid leukemia (AML) patients with an isocitrate dehydrogenase-1(IDH1) mutation for treatment with TIBSOVO(ivosidenib).TIBSOVO(ivosidenib) is an isocitrate dehydrogenase-1 (IDH1) inhibitor indicated for the treatment of adult patients with relapsed or refractory acute myeloid leukemia (AML) with a susceptible IDH1 mutation as detected by an FDA-approved test.Abbott RealTime IDH1byAbbott Molecular meets the reasonable and necessary criteria for Medicare reimbursement, effective 7/20/2018.TheAbbott RealTimeIDH2by Abbott Molecular is the only test that has received FDA approval to be usedas an aid in identifying acute myeloid leukemia (AML) patients with an isocitrate dehydrogenase-2 mutation for treatment with enasidenib (IDHIFA).IDHIFA isan isocitrate dehydrogenase-2 inhibitor indicated for the treatment of adult patients with relapsed or refractory acute myeloid leukemia (AML) with an isocitrate dehydrogenase-2 (IDH2) mutation as detected by an FDA-approved test.Abbott RealTime IDH2by Abbott Molecular meets the reasonable and necessary criteria for Medicare reimbursement, effective 8/1/2017.To report anAbbott RealTime IDH1service, please submit the following claim information: