evekhm/cms_iom_500 huggingface dataset:
(Medicare Claims Processing Manual)
The provider shall bill this code for group visits, initial and subsequent. This code can also be used when there is a change in a patients condition that affects the nutritional status of the patient and the patient is attending in a group.   NOTE: The above codes can be paid if submitted by a registered dietitian or nutrition professional who meet the specified requirements; or a hospital that has received reassigned benefits from a registered dietitian or nutritionist. These services cannot be paid incident to physician services.   B. Healthcare Common Procedure Coding System (HCPCS) Codes for MNT When There is a Change in the Beneficiaries Condition (for services effective on or after January 1, 2003)   The following HCPCS codes shall be used when there is a change in the beneficiary's condition:    G0270 -  Medical Nutrition Therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes.    G0271 -  Medical Nutrition Therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease) group (2 or more individuals), each 30 minutes.   NOTE: These G codes should be used when additional hours of MNT services are performed beyond the number of hours typically covered, (3 hours in the initial calendar year, and 2 follow -up hours in subsequent years with a physician referral) when the physician de termines there is a change of diagnosis or medical condition that makes a change in diet necessary. Appropriate medical review for this provision should only be done on a post payment basis. Outliers may be judged against nationally accepted dietary or nut ritional protocols in accordance with 42 CFR 410.132(a).   300.5 - General Claims Processing Information  (Rev.11504, Issued 07- 21-22; Effective:01 -10-23; Implementation: 01 -03-23)
(Medicare Claims Processing Manual)
300.5 - General Claims Processing Information  (Rev.11504, Issued 07- 21-22; Effective:01 -10-23; Implementation: 01 -03-23)  This benefit is payable for beneficiaries who have diabetes or renal disease.  Contractors are urged to perform data analysis of these services in your jurisdiction.  If you determine that a potential problem exists, you should verify the cause of the pote ntial error by conducting an error validation review as described in the Program Integrity Manual (PIM), Chapter 3, Section 2A.  Where errors are verified, initiate appropriate corrective actions found in the PIM, Chapter 3, Sections 3 through 6.  If no di agnosis is on the claim, return the claim as unprocessable.  If the claim does not contain a diagnosis of diabetes or renal disease, then deny the claim under Section 1862(a)(1)(A) of the Act.   A. Special Requirements for A/B MACs (B)    Registered dietitians and nutrition professionals can be part of a group practice in which case the provider identification number of the registered dietitian or nutrition professional that performed the service must be entered in on the claim form.    The specialty code for dietitians/nutritionists is 71.   B. Medicare Summary Notices (MSNs)    Use the following MNT messages where appropriate.  If you locate a more appropriate message, then you should use it.   If a claim for MNT is submitted with dates of service before January 1, 2002, use MSN 21.11 (This service was not covered by Medicare at the time you received it).  The Spanish version is Este servicio no estaba cubierto por Medicare cuando usted lo recibio.    If a claim for MNT is submitted by a provider that does not meet the criteria use MSN 21.18 (This item or service is not covered when performed or ordered by this provider).  The Spanish version is Este servicio no esta cubierto cuando es ordenado o rendido por este proveedor.   C. A/B MAC (A)  Special Billing Instructions
(Medicare Claims Processing Manual)
C. A/B MAC (A)  Special Billing Instructions   MNT Services can be billed to A/B MACs (A) when performed in an outpatient hospital setting.  The Hospital outpatient departments can bill for the MNT services through the A/B MAC (A) if the nutritionists or registered dietitians reassign their benefits to the hospital.  If the hospitals do not get the reassignments the nutritionists and the registered dietitians will have to bill the Medicare A/B MAC (B) under their own provider number  or the hospital will have to bill the Medicare A/B MAC (B).   NOTE:   Nutritionists and registered dietitians must obtain a Medicare provider number before they can reassign their benefits.   The only applicable bill types are 13X, 23X, 32X, and 85X.      300.5.1 - Rural Health Centers (RHCs)/Federally Qualified Health Centers (FQHCs) Special Billing Instructions  (Rev. 11426; Issued: 05- 20-22; Effective: 01 -01-22; Implementation: 07 -05-22)  Detailed billing instructions for MNT services provided in Rural Health Clinics and Federally Qualified Health Centers can be found in Chapter 9, section 182 of this manual.   300.6 - Common Working File (CWF) Edits  (Rev. 11426; Issued: 05- 20-22; Effective: 01 -01-22; Implementation: 07 -05-22)  The Common Working File (CWF) edit will allow 3 hours of therapy for MNT in the initial calendar year. The edit will allow more than 3 hours of therapy if there is a change in the beneficiarys medical condition, diagnosis, or treatment regimen and this change must be documented in the beneficiarys medical record. Two new G codes have been created for use when a beneficiary receives a second referral in a calendar year that allows the beneficiary to receive more than 3 hours of therapy. Another edit will a llow 2 hours of follow up MNT with another referral in subsequent years.   Advance Beneficiary Notice (ABN)
(Medicare Claims Processing Manual)
Advance Beneficiary Notice (ABN)   The beneficiary is liable for services denied over the limited number of hours with referrals for MNT. An Advance Beneficiary Notice (ABN) should be issued in these situations. In absence of evidence of a valid ABN, the provider will be held liable.   An ABN should not be issued for Medicare -covered services such as those provided by hospital dietitians or nutrition professionals who are qualified to render the service in their state but who have not obtained Medicare provider numbers.   Duplicate Edits   Although beneficiaries are allowed to receive training and therapy during the same time period DSMT and MNT services may not be provided on the same day to the same beneficiary. Effective April 1, 2010 CWF shall implement a new duplicate crossover edit to identify and prevent claims for DSMT/MNT services from being billed with the same dates of services for the same beneficiaries submitted from institutional providers and from a professional provider.   310 - Lung Volume Reduction Surgery  (Rev. 768, Issued:  12- 01-05; Effective:  11 -17-05; Implementation:  03 -02 06)   Lung Volume Reduction Surgery (LVRS) (also known as reduction pneumoplasty, lung shaving, or lung contouring) is an invasive surgical procedure to reduce the volume of a hyperinflated lung in order to allow the underlying compressed lung to expand, and thus, establish improved respiratory function.   Effective for 'from' dates of service on or after January 1, 2004, Medicare will cover LVRS under certain conditions as described in 240 of the Pub. 100- 03, National Coverage Determinations.   LVRS can only be performed in the facilities listed on the following website:  http://www.cms.gov/Medicare/Medicare -General -Information/MedicareApprovedFacilitie/Lung -Volume -Reduction- Surgery -LVRS.html .   LVRS is an inpatient procedure.  However pre - and post - operative services are performed on an outpatient basis and must be performed at one of the facilities certified to do so.  These procedures are paid under the Outpatient Prospective Payment System (OPPS), except for hospitals located in Maryland.
(Medicare Claims Processing Manual)
Medicare previously only covered LVRS as part of the National Emphysema Treatment Trial (NETT).  The study was limited to 18 hospitals, and patients were randomized into two arms, either medical management and LVRS or medical management.  The study was con ducted by The National Heart, Lung, and Blood Institute of the National Institutes of Health and coordinated by Johns Hopkins University (JHU).  Hospital claims for patients in the NETT were identified by the presence of Condition Code EY.  The JHU instruc ted hospitals of the correct billing procedures for billing claims under the NETT.   320 - Outpatient Intravenous Insulin Treatment (OIVIT)  (Rev. 1930, Issued:  03- 09-10, Effective Date:  12- 23-09; Implementation Date:  04-05-10)  Effective for claims with dates of service on and after December 23, 2009, the Centers for Medicare and Medicaid Services (CMS) determines that the evidence does not support a conclusion that OIVIT improves health outcomes in Medicare beneficiaries.  Therefore, CMS has determined that OIVIT is not reasonable and necessary for any indication under section 1862(a)(1)(A) of the Social Security Act.  Services comprising an OIVIT regimen are nationally non- covered under Medicare when furnished pursuant to an OIV IT regimen.   See Pub. 100- 03, Medicare National Coverage Determinations Manual, Section 40.7, Outpatient Intravenous Insulin Treatment (Effective December 23, 2009), for general information and coverage indications.  320.1 - HCPCS Coding for OIVIT  (Rev. 1930, Issued:  03- 09-10, Effective Date:  12- 23-09; Implementation Date:  04-05-10)
(Medicare Claims Processing Manual)
HCPCS code G9147, effective with the April IOCE and MPFSDB updates, is to be used on claims with dates of service on and after December 23, 2009, billing for non- covered OIVIT and any services comprising an OIVIT regimen.  NOTE:  HCPCS codes 99199 or 94681(with or without diabetes related conditions 250.00- 250.93) are not to be used on claims billing for non- covered OIVIT and any services comprising an OIVIT regimen when furnished pursuant to an OIVIT regimen. Claims billing for H CPCS codes 99199 and 94681 for non- covered OIVIT are to be returned to provider/returned as unprocessable.   320.2 - Medicare Summary Notices (MSN), Reason Codes, and Remark Codes (Rev. 3475, Issued: 03- 04-16, Effective: 06 -06-16, Implementation: 06- 06-16)  Contractors shall return non- covered OIVIT claims billed with HCPCS 99199 to provider/return as unprocessable.   The contractor shall use the following remittance advice messages and associated codes when rejecting/denying claims under this policy.  This CARC/RARC combination is compliant with CAQH CORE Business Scenario Two.  Group Code: CO  CARC: 16  RARC: MA66, N56 MSN: N/A  Contractors shall return non- covered OIVIT claims billed with HCPCS 94681 with or without diabetes -related conditions 250- 00-250.93 to provider/return as unprocessable.   The contractor shall use the following remittance advice messages and associated codes when rejecting/denying claims under this policy.  This CARC/RARC combination is compliant with CAQH CORE Business Scenario Three.   Group Code: CO  CARC: 16  RARC: MA66, N56 MSN: N/A  Contractors shall deny claims for non- covered OIVIT and any services comprising an OIVIT regimen billed with HCPCS code G9147.  The contractor shall use the following remittance advice messages and associated codes when rejecting/denying claims under this policy.  This CARC/RARC combination is compliant with CAQH CORE Business Scenario Three.
(Medicare Claims Processing Manual)
Group Code: CO  CARC: 96  RARC: N386  MSN: 16.10Transmittals Issued for this Chapter  Rev #  Issue Date  Subject  Impl Date  CR#  R12552CP  03/21/2024 April 2024 Update of the Hospital Outpatient Prospective Payment System (OPPS)   04/01/2024 13568  R12421CP  12/21/2023 January 2024 Update of the Hospital Outpatient Prospective Payment System (OPPS)  01/02/2024 13488  R12423CP   12/20/2023 Enforcing Billing Requirements for Intensive Outpatient Program (IOP) Services with New Condition Code 92  01/02/2024 13222  R12369CP  11/17/2023 Implementation of Rural Emergency Hospital (REH) Provider Type   01/03/2023    12820  R12321CP  10/18/2023 Implementation of Rural Emergency Hospital (REH) Provider Type - Rescinded and replaced by Transmittal 12369  01/03/2023 12820   07/13/2023 Enforcing Billing Requirements for Intensive Outpatient Program (IOP) Services with New Condition Code 92-  SENSITIVE/CONTROVERSIAL  Rescinded and replaced by Transmittal 12423 01/02/2024 13222  R11941CP  04/05/2023 Correction to Manual for Outlier Calculations 05/05/2023 13142  R11937CP  03/31/2023 April 2023 Update of the Hospital Outpatient Prospective Payment System (OPPS)   04/03/2023 13136  R11900CP  03/13/2023 Implementation of Rural Emergency Hospital (REH) Provider Type -- Rescinded and replaced by Transmittal 12321  01/03/2023 12820  R11897CP  03/10/2023 April 2023 Update of the Hospital Outpatient Prospective Payment System (OPPS) - Rescinded and replaced by Transmittal 11 937 04/03/2023 13136  Rev #  Issue Date  Subject  Impl Date  CR#  R11801CP  01/20/203 January 2023 Update of the Hospital Outpatient Prospective  Payment System (OPPS)
(Medicare Claims Processing Manual)
01/03/2023 13031  R11737CP  12/08/2022 January 2023 Update of the Hospital Outpatient Prospective Payment System (OPPS)  - Rescinded and replaced by transmittal 11801 01/03/2023 13031  R11729CP  12/06/2022 Implementation of Rural Emergency Hospital (REH) Provider Type - Rescinded and replaced by transmittal  11900 01/03/2023 12820       R11685CP  11/09/2022 Billing for Hospital Part B Inpatient Services  12/12/2022 11685   07/28/2022 Implementation of Rural Emergency Hospital (REH) Provider Type SENSITIVE/CONTROVERSIAL   Rescinded and replaced by transmittal 11729 01/03/2023 12820  R11504CP   07/21/2022 Modification of Existing Common Working File (CWF) Editing for Preventive Services   01/03/2023 12792  R11457CP  06/15/2022 July 2022 Update of the Hospital Outpatient Prospective Payment System (OPPS)  07/05/2022 12761  R11435CP  05/26/2022 July 2022 Update of the Hospital Outpatient Prospective Payment System (OPPS)  -Rescinded and Replaced by Transmittal #11457 07/05/2022 12761  R11426CP
(Medicare Claims Processing Manual)
05/20/2022 An Omnibus CR Covering: (1) Removal of Two National Coverage Determination (NCDs), (2) Updates to the Medical Nutrition Therapy (MNT) Policy, and (3) Updates to the Pulmonary Rehabilitation (PR), 07/05/2022 12613  Rev #  Issue Date  Subject  Impl Date  CR#  Cardiac Rehabilitation (CR), and Intensive Cardiac Rehabilitation (ICR) Conditions of Coverage  R11396CP  05/04/2022 Update to Chapters 3, 4, 27 and 37 of Publication (Pub.) 100- 04 Medicare Claims Processing Manual to Remove Reference to the Term "OSCAR"  10/03/2022 12715  R11272CP  02/18/2022 An Omnibus CR Covering: (1) Removal of Two National Coverage Determination (NCDs), (2) Updates to the Medical Nutrition Therapy (MNT) Policy, and (3) Updates to the Pulmonary Rehabilitation (PR), Cardiac Rehabilitation (CR), and Intensive Cardiac Rehabilit ation (ICR) Conditions of Coverage  -Rescinded and Replaced by Transmittal #11426  07/05/2022 12613  R11305CP  03/24/2022 April 2022 Update of the Hospital Outpatient Prospective Payment System (OPPS)  04/04/2022 12666  R11150CP  12/10/2021 January 2022 Update of the Hospital Outpatient Prospective Payment System (OPPS)  01/03/2021 12552  R10869CP  07/14/2021 Updates to Chapter 4, Section 10.11.9 -  Methodology for Calculation of the Cost-to-Charge Ratio [CCR] for Community Mental Health Centers [CMHCs] in the Medicare Claims Processing Manual  08/13/2021 12332 R10541CP  12/31/2020 January 2021 Update of the Hospital Outpatient Prospective Payment System (OPPS)  01/04/2021 12120 R4513CP  02/04/2020 January 2020 Update of the Hospital Outpatient Prospective Payment System (OPPS)   01/06/2020 11605 R4494CP  01/15/2020 January 2020 Update of the Hospital Outpatient Prospective Payment 01/06/2020 11605 Rev #  Issue Date  Subject  Impl Date  CR#  System (OPPS) - No Longer Sensitive Rescinded and Replaced by Transmittal #4513
(Medicare Claims Processing Manual)
12/20/2019 January 2020 Update of the Hospital Outpatient Prospective Payment System (OPPS) - Sensitive/Controversial  Rescinded and Replaced by Transmittal # 4494  01/06/2020 11605 R4394CP  09/13/2019 Billing for Hospital Part B Inpatient Services  10/15/2019 11413 R4390CP   09/06/2019 Fiscal Year (FY) 2020 Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) PPS Changes   10/07/2019 11361 R4391CP  09/06/2019 Implementation of the Medicare Performance Adjustment (MPA) for the Maryland Total Cost of Care (MD TCOC) Model  07/01/2019 10971 R4337CP    07/18/2019 Implementation of the Medicare Performance Adjustment (MPA) for the Maryland Total Cost of Care (MD TCOC) Model - Rescinded and Replaced by Transmittal 4391  07/01/2019 10971 R4308CP  05/16/2019 Implementation of the Medicare Performance Adjustment (MPA) for the Maryland Total Cost of Care (MD TCOC) Model - Rescinded and Replaced by Transmittal 4337  07/01/2019 10971 R4295CP  05/03/2019 Update to the Internet Only Manual (IOM) Publication (Pub.) 100- 04, Chapter 4  08/27/2019 11274 R4308CP  05/16/2019 Implementation of the Medicare Performance Adjustment (MPA) for the Maryland Total Cost of Care (MD TCOC) Model  07/01/2019 10971
(Medicare Claims Processing Manual)
Rev #  Issue Date  Subject  Impl Date  CR#  R4259CP  03/22/2019 Billing for Hospital Part B Inpatient Services  06/21/2019    11181 R4257CP  03/14/2019 Implementation of the Medicare Performance Adjustment (MPA) for the Maryland Total Cost of Care (MD TCOC) Model - Rescinded and replaced by Transmittal 4308 07/01/2019 10971 R4255CP  03/15/2019 April 2019 Update of the Hospital Outpatient Prospective Payment System (OPPS)  04/01/2019 11216 R4233CP  02/08/2019 Update to Publication (Pub.) 100- 04 Chapters 4 and 17 to Provide Language -Only Changes for the New Medicare Card Project  03/12/2019 11084 R4230CP  02/01/2019 Implementation of the Medicare Performance Adjustment (MPA) for the Maryland Total Cost of Care (MD TCOC) Model - Rescinded and replaced by Transmittal 4257 07/01/2019 10971 R4204CP  01/17/2019 January 2019 Update of the Hospital Outpatient Prospective Payment System (OPPS)  01/07/2019 11099 R4186CP  12/31/2018 January 2019 Update of the Hospital Outpatient Prospective Payment System (OPPS) - Rescinded and replaced by Transmittal 4204 01/07/2019 11099 R4157CP  11/02/2018 Hospital and Critical Access Hospital (CAH) Swing -Bed Manual Revisions and Shared Systems Changes  04/01/2019 10962 R3941CP  12/22/2017 January 2018 Update of the Hospital Outpatient Prospective Payment System (OPPS)  01/02/2018 10417 R3795CP  06/17/2017 Updates in the Fiscal Intermediary Shared System (FISS) Inpatient and Outpatient Provider Specific Files (PSF)  10/02/2017 10165 Rev #  Issue Date  Subject  Impl Date  CR#  R3750CP  04/17/2017 New Fields in the Fiscal Intermediary Shared System (FISS) Inpatient and Outpatient Provider Specific Files (PSF)  07/03/2017 9926 R3739CP  03/17/2017 Billing for Advance Care Planning (ACP) Claims  06/19/2017 10000 R3685CP  12/22/2016 January 2017 Update of the Hospital Outpatient Prospective Payment System (OPPS)
(Medicare Claims Processing Manual)
R3739CP  03/17/2017 Billing for Advance Care Planning (ACP) Claims  06/19/2017 10000 R3685CP  12/22/2016 January 2017 Update of the Hospital Outpatient Prospective Payment System (OPPS)  01/03/2017 9930 R3680CP  12/19/2016 Update to the Fiscal Intermediary Shared Systems (FISS) Outpatient Provider Specific File (OPSF) for Outpatient Prospective Payment System (OPPS) Hospitals  01/03/2017 9675 R3622CP  10/13/2016 Update to the Fiscal Intermediary Shared Systems (FISS) Outpatient Provider Specific File (OPSF) for Outpatient Prospective Payment System (OPPS) Hospitals  Rescinded and replaced by Transmittal 3680 01/03/2017 9675 R3582CP  08/05/2016 Update to the Fiscal Intermediary Shared Systems (FISS) Outpatient Provider Specific File (OPSF) for Outpatient Prospective Payment System (OPPS) Hospitals  01/03/2017 9675 R3578CP  08/05/2016 Multiple Procedure Payment Reduction (MPPR) on the Professional Component (PC) of Certain Diagnostic Imaging Procedures  01/03/2017 9647 R3571CP  07/29/2016 New Revenue Code 0815 for Allogeneic Stem Cell Acquisition Services  01/03/2017 9674 R3557CP  07/01/2016 July 2016 Update of the Hospital Outpatient Prospective Payment System (OPPS)  07/05/2016 9658 Rev #  Issue Date  Subject  Impl Date  CR#  R3556CP  07/01/2016 Stem Cell Transplantation for Multiple Myeloma, Myelofibrosis, Sickle Cell Disease, and Myelodysplastic Syndromes  10/03/2016 9620 R3552CP  06/28/2016 July 2016 Update of the Hospital Outpatient Prospective Payment System (OPPS)  Rescinded and replaced by Transmittal 3557 07/05/2016 9658 R3523CP  05/13/2016 July 2016 Update of the Hospital Outpatient Prospective Payment System (OPPS) -  Rescinded and replaced by Transmittal 3552 07/05/2016 9658 R3509CP  04/29/2016 Stem Cell Transplantation for Multiple Myeloma, Myelofibrosis, Sickle Cell Disease, and Myelodysplastic Syndromes -  Rescinded and replaced
(Medicare Claims Processing Manual)
9658 R3509CP  04/29/2016 Stem Cell Transplantation for Multiple Myeloma, Myelofibrosis, Sickle Cell Disease, and Myelodysplastic Syndromes -  Rescinded and replaced by Transmittal 3556 10/03/2016 9620 R3475CP  03/04/2016 Updates to Pub. 100- 04, Chapters 4 and 5 to Correct Remittance Advice Messages  06/06/2016 9424 R3471CP  02/26/2016 April 2016 Update of the Hospital Outpatient Prospective Payment System (OPPS)  04/04/2016 9549 R3425CP  12/18/2015 January 2016 Update of the Hospital Outpatient Prospective Payment System (OPPS)  01/04/2016 9486 R3280CP  06/05/2015 July 2015 Update of the Hospital Outpatient Prospective Payment System (OPPS)  07/06/2015 9205 R3238CP  04/22/2015 April 2015 Update of the Hospital Outpatient Prospective Payment System (OPPS)  04/06/2015 9097 R3235CP  04/14/2015 April 2015 Update of the Hospital Outpatient Prospective Payment System (OPPS)  Rescinded and replaced by Transmittal 3238 04/06/2015 9097 Rev #  Issue Date  Subject  Impl Date  CR#  R3217CP  03/13/2015 April 2015 Update of the Hospital Outpatient Prospective Payment System (OPPS)  Rescinded and replaced by Transmittal 3235 04/06/2015 9097 R3181CP  01/30/2015 Implementation of New NUBC Condition Code 53 Initial placement of a medical device provided as part of a clinical trial or a free sample  07/06/2015 8961 R3156CP  12/22/2014 January 2015 Update of the Hospital Outpatient Prospective Payment System (OPPS)  01/05/2015 9014 R3150CP  12/12/2014 January 2015 Update of the Hospital Outpatient Prospective Payment System (OPPS)  Rescinded and replaced by Transmittal 3156 01/05/2015 9014 R3106CP  11/06/2014 Implementing The Payment Policies Related To Patient Status From The CMS -1599- F 02/10/2015 8959 R3065CP  09/12/2014 Billing for Cost Based Payment for Certified Registered Nurse Anesthetists (CRNA) Services Furnished by