evekhm/cms_iom_500 huggingface dataset:
(Medicare Benefit Policy Manual)
The qualified home infusion therapy supplier must submit, in line -item detail on the claim, an appropriate G -code for each infusion drug administration calendar day. The claim should include the length of time, in 15- minute increments, for which professional services were furnished.  Billing instructions for home infusion therapy services are found in the Medicare Claims Processing Manual Chapter 32 Section 411.   320.8.3 - Initial Visits and Subsequent Visits for Home Infusion Therapy Services  (Rev. 10547, Issued: 12- 31-20, Effective: 01 -01-21, Implementation: 01- 04-21)  The first visit furnished by a qualified home infusion therapy supplier to furnish services in the patients home may be longer or more resource intensive than subsequent visits.  For each of the three payment categories listed in 320.8.1 of this chapter, the payment amounts are set higher for the first visit by the qualified home infusion therapy supplier to initiate the furnishing of home infusion therapy services in the patient's home and lower for subsequent visits in the patient's home.   If a patient receiving home infusion therapy services is discharged from such services, in order to bill a first visit again, the patients history must show a gap of more than 60 days between home infusion therapy service visits. This means that upon re -admission, there cannot be a G -code billed for this patient within the past 60 days, and the last G -code billed for this patient must show that the patient had been discharged. A qualified home infusion therapy supplier could bill the first visit payment am ount on day 61 for a patient who had previously been discharged from service.   The G -codes for the initial and subsequent home infusion therapy service visits, and instructions for billing for home infusion therapy services payments are found in the Medicare Claims Processing Manual Chapter 32 Section 411.   320.9 - Medical Review (Rev. 10547, Issued: 12- 31-20, Effective: 01 -01-21, Implementation: 01- 04-21)  All payments under this benefit may be subject to a medical review adjustment reflecting the following:  1. Beneficiary eligibility.  2. Plan of care requirements.  3. Medical necessity determinations.   330  Marriage and Family Therapist (MFT)  Services  (Rev.  12448; Issued:01- 11-24, Effective: 01- 01-24; Implementation: 02- 12-24)
(Medicare Benefit Policy Manual)
330  Marriage and Family Therapist (MFT)  Services  (Rev.  12448; Issued:01- 11-24, Effective: 01- 01-24; Implementation: 02- 12-24)   See the Medicare Claims  Processing  Manual  Chapter  12, Physician/Nonphysician Practitioners,  240, Marriage and Family Therapist  Services,  for payment  requirements.   A. Marriage and Family Therapist Defined    410.53 defines a  marriage and family therapist  as an individual  who:    Possesses a master's or doctor's degree which qualifies for licensure or certification as a marriage and family therapist pursuant to State law of the State in which such individual furnishes the services defined as marriage and family therapist services;    After obtaining such degree, has performed at least 2 years or 3,000 hours of post masters degree clinical supervised experience in marriage and family therapy in an appropriate setting such as a hospital, SNF, private practice, or clinic; and   Is licensed or certified as a marriage and family therapist by the State in which the services are performed.   B. Marriage and Family Therapist Services  Defined   Section  1861(lll)(1)  of the Act defines  marriage and family therapist services as services furnished by an MFT for the diagnosis and treatment of mental illnesses (other than services furnished to an inpatient of a hospital), which the MFT is legally authorized to perform under State law (or the State regulatory mechanism provided by State law) of the State in which such services are furnished, as would otherwise be covered if furnished by a physician or as an incident to a physicians professional service.   C. Covered  Services   Coverage is limited  to the services  a MFT is  legally  authorized to perform in accordance with State law (or State regulatory mechanism established by State law).  The services  of a MFT may be covered under Part B if they are:    The type of services for the diagnosis and treatment of mental illnesses that are otherwise covered if furnished by a physician, or as incident to a physicians service. (See 30 for a description of physicians services and 70 of Pub 100-1, the Medicare General  Information, Eligibility,  and Entitlement Manual, Chapter 5, for the definition of a physician.);   Performed  by a person who meets  the definition  of a MFT  (See subsection A.); and   Not otherwise excluded  from coverage.
(Medicare Benefit Policy Manual)
 Performed  by a person who meets  the definition  of a MFT  (See subsection A.); and   Not otherwise excluded  from coverage.   A/B MACs  (B) should become familiar  with the State law or regulatory mechanism governing a MFTs scope of practice in their service area.  D. Noncovered  Services   Services of a MFT are not covered when furnished to inpatients of a hospital. In addition, MFT services are not covered if they are otherwise excluded from Medicare coverage even though a MFT is authorized by State law to perform them. For example, the Medicare law excludes from coverage services  that are not reasonable  and necessary for  the diagnosis or  treatment  of an illness or injury or to improve the functioning of a malformed body member.   E. Assignment Requirement   Assignment  is required.    340 - Mental Health Counselor (MHC) Services  (Rev. 12448; Issued:01- 11-24, Effective: 01- 01-24; Implementation: 02- 12-24)   See the Medicare Claims  Processing  Manual  Chapter  12, Physician/Nonphysician Practitioners,  250, Mental Health Counselor  Services,  for payment  requirements.   A. Mental Health Counselor  Defined    410.54 defines a mental health counselor  as an individual  who:    Possesses a master's or doctor's degree which qualifies for licensure or certification as a mental health counselor, clinical professional counselor, professional counselor under the State law of the State in which such individual furnishes the services defined as mental health counselor services;    After obtaining such a degree, has performed at least 2 years or 3,000 hours of post masters degree clinical supervised experience in mental health counseling in an appropriate setting such as a hospital, SNF, private practice, or clinic; and    Is licensed or certified as a mental health counselor, clinical professional counselor, professional counselor by the State in which the services are performed.   B. Mental Health Counselor  Services  Defined
(Medicare Benefit Policy Manual)
 Is licensed or certified as a mental health counselor, clinical professional counselor, professional counselor by the State in which the services are performed.   B. Mental Health Counselor  Services  Defined   Section  1861(lll)(3)  of the Act defines  mental health counselor services as services furnished by a mental health counselor (MHC) for the diagnosis and treatment of mental illnesses (other than services furnished to an inpatient of a hospital), which the MHC is legally authorized to perform u nder State law (or the State regulatory mechanism provided by the State law) of the State in which such services are furnished, as would otherwise be covered if furnished by a physician or as incident to a physicians professional service.   Additionally, to the extent that addiction counselors and alcohol and drug counselors who furnish services for the diagnosis and treatment of mental illnesses, including substance use disorders,  meet all of the statutory and regulatory requirements regarding education, clinical supervised experience, and State licensure for MHCs, such counselors can enroll in Medicare as MHCs.   C. Covered  Services   Coverage  is limited  to the services  a MHC is  legally  authorized to perform in accordance with State  law (or State  regulatory  mechanism  established  by State  law).  The services  of a MHC may be covered under Part B if they are:  a. The type of services for the diagnosis and treatment of mental illnesses that are otherwise covered if furnished by a physician, or as incident to a physicians service. (See 30 for a description of physicians services and 70 of Pub 100-1, the Medicare General  Information, Eligibility,  and Entitlement Manual, Chapter 5, for the definition of a physician.);  b. Performed  by a person who meets  the definition  of a MHC  (See subsection A.); and   c. Not otherwise excluded  from coverage.   A/B MACs  (B) should become familiar  with the State law or regulatory mechanism governing a MHCs scope of practice in their service area.  D. Noncovered  Services
(Medicare Benefit Policy Manual)
c. Not otherwise excluded  from coverage.   A/B MACs  (B) should become familiar  with the State law or regulatory mechanism governing a MHCs scope of practice in their service area.  D. Noncovered  Services   Services of a MHC are not covered when furnished to inpatients of a hospital. In addition, MHC services are not covered if they are otherwise excluded from Medicare coverage even though a MHC is authorized by State law to perform them. For example, the Medicare law excludes from coverage services  that are not reasonable and necessary for the diagnosis or treatment  of an illness or injury or to improve the functioning of a malformed body member.  E. Assignment Requirement   Assignment is  required.      Transmittals Issued for this Chapter  Rev #  Issue Date  Subject  Impl Date  CR#  R12448BP  01/11/2024 Updates to Medicare Benefit Policy Manual and Medicare Claims Processing Manual for Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs)  02/12/2024 13469  R12425BP  12/21/2023 Enforcing Billing Requirements for Intensive Outpatient Program (IOP) Services with New Condition Code 92 - Additional Publication Update  01/02/2024 13496 R12352BP  11/08/2023 Manual Updates for Coverage of Intravenous Immune Globulin (IVIG) For Treatment of Primary Immune Deficiency Diseases in the Home  01/02/2024 13414 R12299BP  10/12/2023 An Omnibus CR to Implement Policy Updates in the CY 2023 PFS Final Rule, Including (1) Removal of Selected NCDs (NCD 160.22 Ambulatory EEG Monitoring), and, (2) Expanding Coverage of Colorectal Cancer Screening - Full Agile Pilot CR   11/13/2023 13017 R12171BP  08/03/2023 Update to Pub. 100 -02 Medicare Benefit Policy, Chapter 15, Section 110.8 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Benefit Category Determinations   09/04/2023 13228 R11901BP  03/16/2023 Update to the Manual to Clarify Supervision Requirements for Diagnostic Tests  05/17/2023 13094 R11995BP
(Medicare Benefit Policy Manual)
09/04/2023 13228 R11901BP  03/16/2023 Update to the Manual to Clarify Supervision Requirements for Diagnostic Tests  05/17/2023 13094 R11995BP   04/21/2023 Medicare Policy Updates for Dental Services as Finalized in the Calendar Year (CY) 2023 Physician Fee Schedule (MPFS) Final Rule 05/12/2023 13181 Rev #  Issue Date  Subject  Impl Date  CR#   R11905BP  03/16/2023 Revisions to Medicare Part B Coverage of Pneumococcal Vaccinations for the Medicare Policy Manual Chapter 15, Section 50.4.4.2  04/17/2023 13118 R11865BP  02/16/2023 An Omnibus CR to Implement Policy Updates in the CY 2023 PFS Final Rule, Including (1) Removal of Selected NCDs (NCD 160.22 Ambulatory EEG Monitoring), and, (2) Expanding Coverage of Colorectal Cancer Screening - Full Agile Pilot CR  - Rescinded and Replaced by Transmittal 1 2299   02/27/2023 13017 R11824BP  01/27/2023 An Omnibus CR to Implement Policy Updates in the CY 2023 PFS Final Rule, Including (1) Removal of Selected NCDs (NCD 160.22 Ambulatory EEG Monitoring), and, (2) Expanding Coverage of Colorectal Cancer Screening - Full Agile Pilot CR - Rescinded and Replaced by Transmittal 11865  02/27/2023 13017 R11769BP  12/30/2022 Manual Update Pub. 100 -02 Medicare Benefit Policy, Chapter 15, Section 110.8 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Benefit Category Determinations  01/31/2023 13029 R11771BP  12/30/2022 Internet-Only Manual (IOM) Updates for Nurse Practitioners (NPs) and Clinical Nurse Specialists (CNSs)  01/31/2023 13029 R11764BP  12/22/2022 New Medicare Part B 01/03/2023 12804 Rev #  Issue Date  Subject  Impl Date  CR#  Immunosuppressant Drug Benefit (PBID)  Implementation  R11646BP
(Medicare Benefit Policy Manual)
10/19/2022 New Medicare Part B Immunosuppressant Drug Benefit (PBID)  Implementation - Rescinded and Replaced by Transmittal 11764 01/03/2023 12804  07/28/2022 New Medicare Part B Immunosuppressant Drug Benefit (PBID)  Implementation  SENSITIVE/CONTROVERSIAL  DO NOT POST   Rescinded and Replaced by Transmittal 11646 01/03/2023 12804 R11426BP 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), Cardiac Rehabilitation (CR), and Intensive Cardiac Rehabilit ation (ICR) Conditions of Coverage 07/05/2022 12613 R11399BP 05/04/2022 Revisions to Medicare Part B Coverage of Pneumococcal Vaccinations for the Medicare Benefit Policy Manual Chapter 15, Section 50.4.4.2  06/06/2022 12723 R11355BP  04/14/2022  Update to Publication 100-04, Chapter 18 and Publication 100-02, Chapter 15, Section to Add Data Regarding Novel Coronavirus (COVID -19) and its Administration to Current Claims Processing Requirements and Other General Updates  05/06/2022 12634 Rev #  Issue Date  Subject  Impl Date  CR#  R11288BP  03/04/2022 Internet-Only Manual Updates (IOM) for Critical Care, Split/Shared Evaluation and Management Services, Teaching Physicians, and Physician Assistants  02/15/2022 12543 R11272BP  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
(Medicare Benefit Policy Manual)
07/05/2022 12613 R11181BP  01/14/2022 Internet-Only Manual Updates (IOM) for Critical Care, Split/Shared Evaluation and Management Services, Teaching Physicians, and Physician Assistants  Rescinded and replaced by transmittal 11288  02/15/2022 12543 R10880BP  08/06/2021 Internet Only Manual Updates to Pub. 100-01, 100-02, and 100-04 to Implement Consolidated Appropriations Act Changes and Correct Errors and Omissions (SNF)  11/08/2021 12009 R10573BP  03/24/2021 Update to Pulmonary Rehabilitation (PR), Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Program Manual Sections  04/26/2021 12115      Rev #  Issue Date  Subject  Impl Date  CR#  R10639BP  03/12/2021 Update to the Manual for Telephone Services, Physician Assistant (PA) Supervision, and Medical Record Documentation for Part B Services  04/12/2021 11862 R10547BP 12/31/2020 Billing for Home Infusion Therapy Services On or After January 1, 2021 01/04/2021     11880   R10463BP  11/13/2020 Billing for Home Infusion Therapy Services On or After January 1, 2021  Rescinded and replaced by transmittal 10574  01/04/2021 11880 R10269BP 08/07/2020 Billing for Home Infusion Therapy Services On or After January 1, 2021- Rescinded and replaced by transmittal 10463  01/04/2021 11880 R259BP 07/12/2019 Update to Coverage of Intravenous Immune Globulin for Treatment of Primary Immune Deficiency Diseases in the Home  08/13/2019 11295 R256BP 02/01/2019 Update to Intensive Cardiac Rehabilitation (ICR) Programs  03/19/2019 11117 R255BP  01/25/2019 Updates to Reflect Removal of Functional Reporting Requirements and Therapy Provisions of the Bipartisan Budget Act of 2018 02/26/2019 11120 R251BP 11/30/2018 Revision of Definition of the Physician Supervision of Diagnostic Procedures, Clarification of DSMT Telehealth Services, and Establishing a Modifier for Expanding the Use of Telehealth for Individuals with Stroke 01/02/2019 11043
(Medicare Benefit Policy Manual)
R241BP 02/02/2018 New K Code for Therapeutic Shoe Inserts 04/02/2018 10436 Rev #  Issue Date  Subject  Impl Date  CR#  R235BP  06/09/2017 Removal of Contractor Requirement to Submit Opt Out Data into the Contractor Reporting of Operational and Workload Data (CROWD) System (Form 8)  07/11/2017 10121 R228BP  10/13/2016 Internet Only Manual Updates to Pub. 100-01, 100-02 and 100-04 to Correct Errors and Omissions (SNF)  10/18/2016 9748  R227BP 09/16/2016 Internet Only Manual Updates to Pub. 100-01, 100-02 and 100-04 to Correct Errors and Omissions (SNF) - Rescinded and replaced by Transmittal 228  10/18/2016 9748 R222BP 05/13/2016 Revisions to Private Contracting/Opt-Out Manual Sections Due to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) 08/15/2016 9616 R221BP 03/11/2016 Telehealth Services  04/11/2016 9428 R216BP  12/22/2015 Advance Care Planning (ACP) as an Optional Element of an Annual Wellness Visit (AWV)  01/04/2016 9271 R212BP 11/06/2015 Update to the List of Compendia as Authoritative Sources for Use in the Determination of a Medically -Accepted Indication of Drugs and Biologicals Used Off- label in an Anti-Cancer Chemotherapeutic Regimen  02/10/2016 9386 R210BP 08/07/2015 Advance Care Planning (ACP) as an Optional Element of an Annual Wellness Visit (AWV)  Rescinded and replaced by Transmittal 216 01/04/2016 9271 Rev #  Issue Date  Subject  Impl Date  CR#  R206BP  04/10/2015 Private Contracting: Definition of Emergency Care Services and Appeals of Opt Out Determinations 07/13/2015 9116 R203BP 02/13/2015 Payment Repairs to Capped Rental Equipment Prior to the End of the 13-Month Cap 07/06/2015 9062 R202BP
(Medicare Benefit Policy Manual)
02/13/2015 Payment Repairs to Capped Rental Equipment Prior to the End of the 13-Month Cap 07/06/2015 9062 R202BP 12/31/2014 Modifications to Medicare Part B Coverage of Pneumococcal Vaccinations  02/02/2015 9051 R196BP 10/17/2014 Medicare Coverage of Ultrasound Screening for Abdominal Aortic Aneurysms (AAA) and Screening Fecal -Occult Blood Tests (FOBT) 11/18/2014 8881 R194BP 09/03/2014 Pub. 100-02 Language-Only Update for ICD-10 Upon Implementation of ICD -10 8605 R193BP 08/29/2014 Cardiac Rehabilitation Programs for Chronic Heart Failure  08/18/2014 8758 R192BP 08/01/2014 Clarification of the Confined to the Home Definition in Chapter 15, Covered Medical and Other Health Services, of the Medicare Benefit Policy Manual 09/02/2014 8818 R191BP 07/18/2014 Cardiac Rehabilitation Programs for Chronic Heart Failure  Rescinded and replaced by Transmittal 193  08/18/2014 8758 R186BP 04/16/2014 Clarification to Pub. 100-02, Medicare Benefit Policy Manual Regarding Antigens and Deletion of Section 13.14 from Chapter 13 of Pub. 100-08, Medicare Program Integrity Manual 05/12/2014 8665 R185BP 04/15/2014 Aprepitant for Chemotherapy Induced Emesis  07/07/2014 8418 Rev #  Issue Date  Subject  Impl Date  CR#  R184BP  04/11/2014 Clarification to Pub. 100-02, Medicare Benefit Policy Manual Regarding Antigens and Deletion of Section 13.14 from Chapter 13 of Pub. 100-08, Medicare Program Integrity Manual  Rescinded and replaced by Transmittal 186 05/12/2014 8665 R182BP 03/21/1014 Implementing the Part B Inpatient Payment Policies from CMS -1599-F 04/21/2014 8666 R181BP 03/14/2014 Pub. 100-02 Language-Only Update for ICD-10  Rescinded and replaced by Transmittal 194
(Medicare Benefit Policy Manual)
03/14/2014 Pub. 100-02 Language-Only Update for ICD-10  Rescinded and replaced by Transmittal 194 10/01/2014 8605 R180BP  02/21/2014 Aprepitant for Chemotherapy Induced Emesis  Rescinded and replaced by Transmittal 185 07/07/2014 8418 R179BP 01/14/2014 Manual Updates to Clarify Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF), Home Health (HH), and Outpatient (OPT) Coverage Pursuant to Jimmo vs. Sebelius  01/07/2014 8458 R178BP 12/30/2013 Expansion of Medicare Telehealth Services for CY 2014 01/06/2014 8553 R176BP 12/13/2013 Manual Updates to Clarify Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF), Home Health (HH), and Outpatient (OPT) Coverage Pursuant to Jimmo vs. Sebelius  Rescinded and replaced by Transmittal 179 01/07/2014 8458 R170BP 05/10/2013 Updates to Medicare Coverage of Hepatitis B Vaccine and its Administration and Medicare Coverage of the Annual Wellness Visit (AWV) Providing Personalized Prevention Plan Services (PPPS)  06/10/2013 8275 Rev #  Issue Date  Subject  Impl Date  CR#  R167BP  02/06/2013 Expansion of Medicare Telehealth Services for CY 2012 01/25/2013 7900 R165BP  12/21/2012 Implementing the Claims -Based Data Collection Requirement for Outpatient Therapy Services -- Section 3005(g) of the Middle Class Tax Relief and Jobs Creation Act (MCTRJCA) of 2012  01/07/2013 8005 R164BP 11/30/2012 Expansion of Medicare Telehealth Services for CY 2012 - Rescinded and replaced by Transmittal 167 01/07/2013 7900 R163BP 11/30/2012 Implementing the Claims -Based Data Collection Requirement for Outpatient Therapy Services -- Section 3005(g) of the Middle Class Tax Relief and Jobs Creation Act (MCTRJCA) of 2012  Rescinded and replaced by Transmittal 165  01/07/2013 8005 R161BP
(Medicare Benefit Policy Manual)
10/26/2012 Manual Updates to Clarify SNF Claims Processing  04/01/2013 8044 R160BP 10/26/2012 Effect of Beneficiary Agreements Not to Use Medicare Coverage and When Payment May be Made to a Beneficiary for Service of an Opt -Out Physician/Practitioner  01/28/2013 8100 R159BP 08/31/2012 Expansion of Medicare Telehealth Services for CY 2012 Rescinded and replaced by Transmittal 164 01/07/2013 7900 R158BP 08/24/2012 Implementing the Claims -Based Data Collection Requirement for Outpatient Therapy Services -- Section 3005(g) of the Middle Class Tax Relief and Jobs Creation Act (MCTRJCA) of 2012  Rescinded and replaced by Transmittal 163 01/07/2013 8005 Rev #  Issue Date  Subject  Impl Date  CR#  R157BP  06/08/2012 July 2012 Update of the Hospital Outpatient Prospective Payment System (OPPS)  07/02/2012 7847 R151BP 11/18/2011 Expansion of Medicare Telehealth Services for CY 2012 01/03/2012 7504 R147BP 08/26/2011 Clarification of Evaluation and Management Payment Policy  11/28/2011 7405 R146BP 08/12/2011 Expansion of Medicare Telehealth Services for CY 2012  Rescinded and replaced by Transmittal 151 01/03/2012 7504 R145BP 07/08/2011 Influenza Virus Vaccine  08/08/2011 7453 R140BP  02/28/2011 Expansion of Medicare Telehealth Services for CY 2011 01/03/2011 & 04/04/2011 7049 R138BP 02/15/2011 Annual Wellness Visit (AWV), Including Personalized Prevention Plan Services (PPPS)  04/04/2011 7079 R134BP 12/03/2010 Annual Wellness Visit (AWV), Including Personalized Prevention Plan Services (PPPS)  Rescinded and replaced by Transmittal 138 04/04/2011 7079 R132BP