evekhm/cms_iom_500 huggingface dataset:
Social Security Act §1861
[495]See Vol. II, P.L. 94-437, 403, with respect to an accountingof funds which must be included in the Secretarys annual report.See Vol. II, P.L. 105-33, 4105(c), with respect tothe establishment of outcome measures for beneficiaries with diabetes.See Vol. II, P.L. 108-173, 434, with respect to afrontier extended stay clinic demonstration project; 651, withrespect to demonstration project on coverage of chiropractic servicesunder Medicare; 702, with respect to a demonstration projectto clarify the definition of homebound; and 926(a), with respectto availability of information relating to Medicare skilled nursingfacilities.[496]P.L.114-113, 504(b)(2) inserted and applicable disposabledevices (as defined in section 1834(s)(2)) after durablemedical equipment. Effective for devices furnished on or afterJanuary 1, 2017.
Social Security Act §1861
[497]P.L.114-255, 5012(c)(3); inserted and homeinfusion therapy (as defined in subsection (iii)(i)) beforethe period in the first sentence, Effective for items and servicesfurnished on or after January 1, 2021.[498]P.L. 11440,2(a), inserted and eye tracking and gaze interactionaccessories for speech generating devices furnished to individualswith a demonstrated medical need for such accessories afterappropriate organizations. Effective for devices furnishedon or after January 1, 2016.[499]P.L. 114-10, 513; struckparagraph (7); Inserted replacement paragraph (7). Effective April16, 2015[500]See Vol. II, P.L. 11410,514, with respect to oversight of Medicare coverage of manualmanipulation of the spine to correct subluxation.[501]P.L. 114-27, 808(a);Inserted , including such renal dialysis services furnishedon or after January 1, 2017, by a renal dialysis facility or providerof services paid under section 1881(b)(14) to an individual with acutekidney injury (as defined in section 1834(r)(2)) . EffectiveApril 16, 2015[502]P.L.114-255, 5012(a)(1), (A) struck and at theend of subparagraph (EE); (B) inserted and at the endof subparagraph (FF); and (C) inserted new subparagraph (GG), Effectivewith respect to items and services furnished on or after January 1,2021.[503]P.L.115271, 2005, struck and at end of subparagraph(FF); inserted and at end of subparagraph (GG); andadded subparagraph (HH). Effective October 24, 2018.[504]See Vol. II, P.L. 78-410, 354.[505]SeeVol. II, P.L. 100-203 4071(b).
Social Security Act §1861
[504]See Vol. II, P.L. 78-410, 354.[505]SeeVol. II, P.L. 100-203 4071(b).[506]P.L. 100-203, 4072(e), provided for a final reportto be issued not later than April 1, 1993 and the amendments made4072(e) shall become effective on the first day of the firstmonth (May 1, 1993 to begin after such report is submitted to theCongress.The final report was issued Apr. 26,1993. See Cong. Rec., vol. 139, pt. 7, p. 10460, Ex. Comm. 1252.[507]See Vol. II, P.L. 78-410, 353.[508]P.L. 112-40, 261(a)(3)(B), struck out qualitycontrol and peer review and inserted quality improvement,applicable to contracts entered into or renewed on or after January1, 2012.[509]December 5,1980 [P.L. 96-499; 94 Stat. 2599].[510]December5, 1980 [P.L. 96-499; 94 Stat. 2599].[511]December 5, 1980 [P.L. 96-499; 94 Stat. 2599].[512]See Vol. II, P.L. 99-509, 9315(b) with respect toconsiderations in establishing limits and (c) with respect to theGAO report.[513]P.L. 78-410.[514]August 5, 1997 [P.L. 105-33;111 Stat. 251][515]P.L. 112-96,3201(a)(1), struck out and.[516]P.L. 112-96, 3201(a)(2)(A), struck out a subsequentfiscal year and inserted fiscal years 2001 through 2012,effective February 22, 2012.[517]P.L. 112-96,3201(a)(2)(B), struck out the period and inserted , and.
Social Security Act §1861
[518]P.L. 112-96,3201(a)(3), added clause (v), effective February 22, 2012.[519]P.L. 112-96, 3201(b)(1), struck out with respect tocost reporting periods beginning on or after October 1, 2005and inserted and (beginning with respect to cost reportingperiods beginning during fiscal year 2013) for covered skilled nursingservices described in section 1888(e)(2)(A) furnished by hospitalproviders of extended care services (as described in section 1883),effective February 22, 2012.[520]P.L. 112-96,3201(b)(2), struck out reduced by 30 percent of suchamount otherwise allowable; and and inserted reducedby and new subclauses (I) and (II), effective February22, 2012.[521]P.L. 112-96, 3201(b)(3), struck out such sectionshall not be reduced. and inserted such sectionand new subclauses (I)-(IV), effective February 22, 2012.[522]P.L.112-96, 3201(c), added new subparagraph (W), effective February22, 2012.[523]See Vol. II, P.L. 97-248, 111,with respect to elimination of private room subsidy.[524]P.L. 112-40, 261(a)(3)(B), struck out qualitycontrol and peer review and inserted quality improvement,applicable to contracts entered into or renewed on or after January1, 2012.[525]See Vol. II, P.L. 78-410, 329, 330, 332 and1302(7).[526]SeeVol. II, P.L. 78-410, 330.[527]See Vol. II, P.L. 94-437, title V.
Social Security Act §1861
[528]P.L. 115123, 51006(a)(1), struck ornurse and inserted , the nurse; inserted or the physician assistant (as defined in such subsection)after subsection(aa)(5)). Effective January 1, 2019.[529]P.L.113185, 3(a), added subparagraph (C) and required $70million transferred between 2015 and 2025 from the HI trust fund tocarry out. Effective October 6, 2014.[530]See Vol.II, P.L. 110-275, 143(d), with respect to a rule of constructionregarding existing regulations and policies.[531]See Vol. II, P.L. 105-33, 4104(a)(2),with respect to the deadline for publication of determination on coverageof screening barium enema.[532]See Vol. II, P.L. 83-591, 501(c)(3).
Social Security Act §1861
[533]P.L. 115271, 2002, inserted and thefurnishing of a review of any current opioid prescriptions (as definedin paragraph (4)),. Effective for examinations and visits furnishedon or after January 1, 2020. See Vol. II, P.L. 115271, 2002(c)for further applicability.[534]P.L. 115271,2002, redesignated subparagraph (N) as (O) and inserted newsubparagraph (N). Effective for examinations and visits furnishedon or after January 1, 2020. See Vol. II, P.L. 115271, 2002(c)for further applicability.[535]P.L. 115271,2002, inserted paragraph (4). Effective for examinations andvisits furnished on or after January 1, 2020. See Vol. II, P.L. 115271,2002(c) for further applicability.[536]P.L. 115123, 51008(a)(1),struck physician-supervised before program (asdescribed and inserted under the supervision of a physician(as defined in subsection (r)(1)) or a physician assistant, nursepractitioner, or clinical nurse specialist (as those terms are definedin subsection (aa)(5)) before the period. Effective for itemsand services furnished on or after January 1, 2024.[537]P.L. 115123, 51008(a)(2)(A), struck the period at theend of clause (iii) and inserted a semicolon. Effective for itemsand services furnished on or after January 1, 2024.
Social Security Act §1861
[538]P.L.115123, 51008(a)(2)(B), struck a physicianand inserted a physician (as defined in subsection (r)(1))or a physician assistant, nurse practitioner, or clinical nurse specialist(as those terms are defined in subsection (aa)(5)) before theperiod. Effective for items and services furnished on or after January1, 2024.[539]P.L. 115123, 51008(a)(3),struck physician-supervised before program (asdescribed and inserted under the supervision of a physician(as defined in subsection (r)(1)) or a physician assistant, nursepractitioner, or clinical nurse specialist (as those terms are definedin subsection (aa)(5)) after paragraph (3). Effectivefor items and services furnished on or after January 1, 2024.[540]P.L.115123, 51004, struck or at the end ofclause (v); struck the period and inserted a semicolon at the endof clause (vi); inserted new clauses (vii) and (viii). Effective February9, 2018.[541]P.L. 115123 51008(b)(12) struck physician-supervisedbefore program (as described and inserted underthe supervision of a physician (as defined in subsection (r)(1)) ora physician assistant, nurse practitioner, or clinical nurse specialist(as those terms are defined in subsection (aa)(5)) before theperiod. Effective for items and services furnished on or after January1, 2024.[542]P.L. 115271, 2002(b), redesignated subparagraph(G) as subparagraph (I), and inserted subparagraphs (G) and (H). Effectivefor examinations and visits furnished on or after January 1, 2020.See Vol. II, P.L. 115271, 2002(c) for further applicability.
Social Security Act §1861
[543]P.L.114-255, 5012(a)(2), inserted new subsection1861(iii), Effective with respect to items and services furnishedon or after January 1, 2021.[544]P.L.115271, 2005(b), added subsection (jjj). Effective October24, 2018.[545]21 U.S.C. 355.[546]See Vol. II,42 C.F.R. 8.2.END CONTENTPAGE FOOTERFooter menuSSA INTERNET BODY SCRIPTS
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Article - Billing and Coding: Sclerosing of Varicose Veins (A53079)
CMS National Coverage PolicyN/AArticle TextImportant Coding AlertNoridian is revising this article to further clarify that CPT37241 is not an acceptable choice of procedure codes for treatment of symptoms of varicose veins of the lower extremity regardless of the method used.Noridians Local Coverage Determination, Treatment of Varicose Veins of the Lower Extremities; L34209 (JEA and JEB)/L34010 (JFA and JFB) provides coverage criteria for the treatment of varicose veins and the CPTcodes that are expected to be utilized for billing this service.As previously noted, a product for the treatment of varicose veins has appeared on the market for which the products information states that it utilizes both a sclerosing agent and a rotating wire which allegedly mixes the agent and possibly macerates any clots in the area.Noridian has been informed that some providers may have been recommended to use CPT37241 when using this device for the treatment of varicose veins. This advice is incorrect. CPT37241 must not be used to bill for the treatment of varicose veins of the lower extremities with this or similar devices.When using the ClariVein device in the treatment of varicose veins before January 1, 2017, Noridian recommends billing with CPTcode 36299. The sclerosing agent is bundled into the procedure code and is not separately reimbursable. ClariVein must be entered in Item 19 of the CMS-1500 form or the electronic notepad equivalent. For dates of service on and after January 1, 2017 providers should use CPT36473 for first vein (Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; first vein treated) and 36474 (Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) If billing for both extremities it is appropriate to append modifier RT or LT to the respective claim line.
Article - Billing and Coding: Sclerosing of Varicose Veins (A53079)
Based on the intensity of service for CPTcode 37241, Noridian no longer allows payment for claims using this CPTin Place of Service 11  Office effective June 6, 2016.
Article - Billing and Coding: Sclerosing of Varicose Veins (A53084)
CMS National Coverage PolicyN/AArticle TextImportant Coding AlertNoridian is revising this article to further clarify that CPT37241 is not an acceptable choice of procedure codes for treatment of symptoms of varicose veins of the lower extremity regardless of the method used.Noridians Local Coverage Determination, Treatment of Varicose Veins of the Lower Extremities; L34209 (JEA and JEB)/L34010 (JFA and JFB) provides coverage criteria for the treatment of varicose veins and the CPTcodes that are expected to be utilized for billing this service.As previously noted, a product for the treatment of varicose veins has appeared on the market for which the products information states that it utilizes both a sclerosing agent and a rotating wire which allegedly mixes the agent and possibly macerates any clots in the area.Noridian has been informed that some providers may have been recommended to use CPT37241 when using this device for the treatment of varicose veins. This advice is incorrect. CPT37241 must not be used to bill for the treatment of varicose veins of the lower extremities with this or similar devices.When using the ClariVein device in the treatment of varicose veins before January 1, 2017, Noridian recommends billing with CPTcode 36299. The sclerosing agent is bundled into the procedure code and is not separately reimbursable. ClariVein must be entered in Item 19 of the CMS-1500 form or the electronic notepad equivalent. For dates of service on and after January 1, 2017 providers should use CPT36473 for first vein (Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; first vein treated) and 36474 (Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) If billing for both extremities it is appropriate to append modifier RT or LT to the respective claim line.
Article - Billing and Coding: Sclerosing of Varicose Veins (A53084)
Based on the intensity of service for CPTcode 37241, Noridian no longer allows payment for claims using this CPTin place of Service 11  Office, effective June 6, 2016.
Article - Billing and Coding: Lab: Bladder/Urothelial Tumor Markers (A53095)
CMS National Coverage PolicyTitle XVIII of the Social Security Act, 1833(e) prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.CMS 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 TextThe information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Lab: Bladder/Urothelial Tumor Markers L33420.This A/B MAC will only cover bladder tumor marker fluorescence in situ hybridization (FISH) testing services when performed using validated assays. To date, UroVysion Bladder Cancer Kit is the only Federal Drug Administration (FDA) approved assay that is designed to detect aneuploidy for chromosomes 3, 7, 17 and loss of the 9p21 locus via FISH. The assay is performed on urine specimens from persons with hematuria suspected of having bladder cancer as an aid for initial diagnosis of bladder carcinoma and subsequent monitoring for tumor recurrence in patients previously diagnosed with bladder cancer. UroVysion Bladder Kit services may only be billed by a CLIA certified lab.To bill UroVysion Bladder Kit services, submit the following claim information:Select CPTcode 88120 or 88121 as appropriateLaboratories reporting only the technical component for a UroVysion service should append the appropriate code 88120 or 88121 with the TC modifier.All other services that meet the code 88120 or 88121 definition performed by any provider type MUST bill the following claim information.Select CPTcode 88120 or 88121 as appropriate
Article - Billing and Coding: Lab: Bladder/Urothelial Tumor Markers (A53095)
All other services that meet the code 88120 or 88121 definition performed by any provider type MUST bill the following claim information.Select CPTcode 88120 or 88121 as appropriateNote:Physicians may NOT submit claims for a code 88120 and 88121 professional component when the interpretive information is provided by a lab technician or scientist. Per Chapter 10 in the NCCI Policy Manual for Medicare Services, Version 16.3, the physician work component requires a physician to read, quantitate and interpret the tissues/cells stained with the probes(s). Physicians who knowingly report and provide interpretation based on the documented results of another professional may be subject to additional corrective action including Recovery Audit Contractor (RAC) or fraud referrals.To report a Bladder/Urothelial Tumor Marker service, please submit the following claim information:Select the appropriate CPTcodeEnter 1 unit of service (UOS)Select the appropriate ICD-10 code
Article - Billing and Coding: MolDX: Afirma™ Assay by Veracyte Update (A53098)
CMS National Coverage PolicyN/AArticle TextThe MolDX Team has completed the Afirma assessment and determined that the test meets criteria for analytical and clinical validity, and clinical utility as a reasonable and necessary Medicare benefit. Effective 10/01/2015, MolDX will reimburse Afirma services for patients with the following conditions (patient must have 1 and 2):Patients with one or more thyroid nodules with a history or characteristics suggesting malignancy such as:Nodule growth over timeFamily history of thyroid cancerHoarseness, difficulty swallowing or breathingHistory of exposure to ionizing radiationHard nodule compared with rest of gland consistencyPresence of cervical adenopathyHave an indeterminate follicular pathology on fine needle aspirationMolDX expects this test will be performed once per patient lifetime. Should the unlikely situation of a second, unrelated thyroid nodule with indeterminate pathology occur, coverage may be considered upon appeal with support documentation.To report an Afirma service, please submit the following claim information:Select the appropriate CPTcodeSelect the appropriate ICD-10-CM diagnosis.Enter DEX Z-Code identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types:Loop 2400 or SV101-7 for the 5010A1 837PBox 19 for paper claimEnter DEX Z-Code identifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types:Line SV202-7 for 837I electronic claimBlock 80 for the UB04 claim form
Article - Billing and Coding: MolDX: bioTheranostics Cancer TYPE ID® Update (A53101)
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 TextEffective November 19, 2012, Cancer TYPE ID, an RT-PCR 92-gene assay, has been assigned a DEX Z-Codeidentifier. To bill for Cancer TYPE ID, please provide the following claim information:CPT code: 81540- Oncology (tumor of unknown origin) mRNA gene expression of 92 genesEnter 1 in the Days/Unit fieldEnter DEX Z-Codeidentifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types:Loop 2400 or SV101-7 for the 5010A1 837PBox 19 for paper claimEnter DEX Z-Codeidentifier adjacent to the CPT code in the comment/narrative field for the following Part A claim field/types:Line SV202-7 for 837I electronic claimBlock 80 for the UB04 claim formSelect the appropriate ICD-10-CM code.Note: MolDX expects this test to ONLY be ordered by the treating physician.
Article - Billing and Coding: MolDX: MammaPrint (A53104)
CMS National Coverage PolicyN/AArticle TextMammaPrint is a diagnostic test that analyzes the gene expression profile of FFPE breast cancer tissue samples to assess a patients' risk for distant metastasis.The test can be performed using either a FDA-cleared in vitro microarray assay or a next generation sequencing (NGS)-based assay. Each assay has been assigned a unique Z-code identifier in the DEX Registry.MammaPrintwas prospectively validated as a microarray assay in the 6,693 patient MINDACT trial in early stage breast cancer, <5cm up to 3 positive lymph nodes and independent of receptor status. The MammaprintNGS test has demonstrated technically equivalent performance to the predicate microarray test.To bill for MammaPrintservices, submit the following claim information:Enter 1 in the Days/Unit fieldFor CPTnon-NOC codes, Labs may either use the SV101-7 or SV202-7 (preferred) or the NTE field to submit this required information. For dates of service on or after 1/1/2022, use CPT code 81523 for the test if performed by NGS.Enter the appropriate DEX Z-Code identifier adjacent to the CPTcode in the comment/narrative field for the following Part B claim field/types:Loop 2400 or SV101-7 for the 5010A1 837PBox 19 for paper claimEnter the appropriate DEX Z-Code identifier adjacent to the CPTcode in the comment/narrative field for the following Part A claim field/types:Line SV202-7 for 837I electronic claimBlock 80 for the UB04 claim formOnly one test- NGS or microarray may be performed on a given date of service for a given patient.Note:MolDX expects this test may be performed upon occasion twice per patient lifetime for bilateral disease. Should a patient experience an additional occurrence, coverage may be considered with supporting documentation through the appeal process.
Article - Billing and Coding: MolDX: Oncotype DX® Breast Cancer Assay (A53105)
CMS National Coverage PolicyN/AArticle TextNOTE:The Oncotype DX Breast Cancer Assay and the Oncotype DX DCIS Score are different tests and should NOT be submitted with the same Z-Code Identifier. Because this article ONLY addresses Oncotype DX Breast, the diagnosis codes for breast carcinoma in situ have been removed.Oncotype DX & reg Breast was developed for patients with the following findings:estrogen-receptor positive, node-negative carcinoma of the breastestrogen-receptor positive micrometastases of carcinoma of the breast, andestrogen-receptor positive breast carcinoma with 1-3 positive nodesTo bill an Oncotype Breast service, please provide the following claim information:CPTcode 81519  Oncology (breast)Enter 1 in the Days/Unit fieldSelect the appropriate ICD-10-CM code.Enter DEX Z-Code identifier adjacent to the CPTcode in the comment/narrative field for the following Part B claim field/types:Loop 2400 or SV101-7 for the 5010A1 837PBox 19 for paper claimEnter DEX Z-Code identifier adjacent to the CPTcode in the comment/narrative field for the following Part A claim field/types:Line SV202-7 for 837I electronic claimBlock 80 for the UB04 claim form