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2004 MLN Matters Articles

The Medicare Learning Network

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Transmittal # Subject Implementation Date CR # MM Article # MM Article Release Date
R7GI HIPAA Privacy Act N/A 2484 N/A N/A
R92OTN Additional Instructions Related to the "Redistribution of Unused Resident Positions," Section 422 of the Medicare Modernization Act of 2003 (MMA), P.L. 108-173, for Purposes of Graduate Medical Education (GME) Payments 07/16/2004 3353 N/A N/A
R223CP PET Scans and Related Claims Processing N/A 3304 N/A N/A
R222CP SNF CB Requirements for DMEPOS N/A 2453 N/A N/A
R56MCM Chapter 11 N/A N/A N/A N/A
R79PI Local Medical Review Policy/ Local Coverage Determination Medicare Summary Notice (MSN) Message Revision 08/09/2004 3222 N/A N/A
R48FM This transmittal is rescinded and replaced with Transmittal 50, dated July 30, 2004. N/A 3274 N/A N/A
R421CP Correction to January 2005 Annual Update of HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement 01/03/2005 3613 MM3613 01/06/2005
R422CP Update to FY 2005 Wage Index for Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS) Hospitals 01/31/2005 3672 MM3672 01/26/2005
R419CP January 2005 Update of the Hospital Outpatient Prospective Payment System (OPPS): Summary of Payment Policy Changes 01/03/2005 3632 N/A N/A
R423CP January 2005 Update of the Hospital Outpatient Prospective Payment System (OPPS): Summary of Payment Policy Changes 01/14/2005 3632 MM3632 01/12/2005
R211CP Elimination of Regulations for Written Statement of Intent (SOI) 07/19/2004 3310 MM3310 06/24/2004
R84OTN Reporting Medicare Secondary Payer (MSP) Information on the Health Insurance Portability and Accountability Act of 1996 (HIPAA) X12N 837 Created Via Free Billing Software 10/04/2004 3284 MM3284 06/07/2004
R417CP Initial Preventive Physical Examination (IPPE)-(Note: This is a full replacement of CR 3413, transmittal 294, dated September 3, 2004. CR 3413 is rescinded.) 01/03/2005 3638 MM3638 12/27/2004
R416CP Interest Payment on Clean Non-PIP Claims Not Paid Timely 01/25/2005 3557 N/A N/A
R14DEMO Chemotherapy Demonstration Project 01/17/2005 3670 MM3670 01/06/2005
R415CP Temporary Change in Carrier Jurisdictional Pricing Rules for Purchased Diagnostic Services 01/25/2005 3630 MM3630 04/01/2005
R5SSS Business Partners Systems Security Manual 02/28/2005 3605 N/A N/A
R402CP January Update to the Medicare Outpatient Code Editor (OCE) Version 20.1 for Bills From Hospitals That Are Not Paid Under The Outpatient Prospective Payment System (Non-OPPS) 01/03/2005 3621 MM3621 01/06/2005
R404CP January 2005 Update of the Hospital Outpatient Prospective Payment System (OPPS):Changes to Coding and Payment for Drug Administration 01/03/2005 3610 MM3610 12/21/2004
R403CP January 2005 Update of the Hospital Outpatient Prospective Payment System (OPPS): Billing for Devices that do not have Transitional Pass-Through Status, and that are not Classified as New Technology Ambulatory Payment Classification (APC) Groups 01/03/2005 3606 MM3606 12/23/2004
R396CP New Dispensing/Supply Fee Codes for Oral Anti-Cancer, Oral Ant-Emetic, Immunosuppressive, and Inhalation Drugs 01/17/2005 3620 MM3620 12/29/2004
R397CP DMERC/Local Carriers/SADMERC - Drug Pricing Limits as of January 1, 2005 01/03/2005 3232 MM3232 12/21/2004
R409CP Diabetes Screening Tests 01/03/2005 3637 N/A N/A
R406CP Update to Health Care Claims Status Category Codes and Health Care Claim Status Codes for Use with the Health Care Claim Status Request and Response ASC X12N 276/277 04/04/2005 3566 MM3566 12/23/2004
R133OTN Shared System Maintainer Hours for Resolution of Problems Detected as a Result of Implementation of Change Request 2525 and Change Request 2527 04/04/2005 3603 N/A N/A
R14GI Scheduled Release for January Updates to Software Programs and Pricing/Coding Files 01/10/2005 3550 N/A N/A
R11DEMO Medicare Coordinated Care Demonstration (MCCD)-Override of Certain Medicare Secondary Payer Edit Codes 04/04/2005 3594 N/A N/A
R400CP Incorrect Reporting of MTUS Indicator When Drugs are Billed Using an NDC Code 04/04/2005 3435 N/A N/A
R427PR1 Section 2231, Regional Medicare Swing-Bed Rates N/A N/A N/A N/A
R130OTN Development of a Coordination of Benefits Agreement (COBA) Auxiliary File and Modification of the Health Insurance Portability and Accountability Act (HIPAA) 837 Coordination of Benefits (COB) Flat File and National Council for Prescription Drug Programs (NCPDP) File 04/04/2005 3614 N/A N/A
R408CP Cardiovascular Disease Screening 01/03/2005 3411 MM3411 12/21/2004
R405CP Emergency Change to Carrier Instructions for the End Stage Renal Disease (ESRD) 50/50 Rule Implementation 01/03/2005 3609 MM3609 12/21/2004
R61FM New Location Code ICC, Status Code AR and Modified Intent Letter for Unfiled Cost Reports Only 01/10/2005 3563 N/A N/A
R22MSP Medicare Secondary Payer (MSP) Debt Referral Instructions and Debt Collection Improvement Act of 1996 (DCIA) Activities 01/10/2005 3293 N/A N/A
R386CP Hospice Pre-Election Evaluation and Counseling Services 01/03/2005 3585 MM3585 03/28/2005
R64MCM Surveys, Contracting Strategy, Grievances and Appeals N/A N/A N/A N/A
R385CP January 2005 Update of the Hospital Outpatient Prospective Payment System (OPPS): Summary of OPPS Outpatient Code Editor (OCE) Data Changes and OPPS PRICER Logic Changes; Changes to Payment for Diagnostic Mammography 01/03/2005 3586 MM3586 01/04/2005
R387CP This instruction is to inform the fiscal intermediaries that the January 2005 Outpatient Prospective Payment System Outpatient Code Editor (OPPS OCE) Specifications have been updated with new additions, changes, and deletions 01/03/2005 3583 MM3583 12/07/2004
R401CP 2005 Part B Deductible Update to the Back Page of Medicare Summary Notices 01/24/2005 3600 N/A N/A
R399CP Expansion of the Existing Interrupted Stay Policy Under Long Term Care Hospital (LTCH) Prospective Payment System 01/03/2005 3279 MM3279 12/29/2004
R395CP Ambulance Fee Schedule - Medical Conditions List 01/03/2005 3619 MM3619 01/10/2005
R394CP New Dispensing/Supply Fee Codes for Oral Anti-Cancer, Oral Ant-Emetic, Immunosuppressive, and Inhalation Drugs 01/17/2005 3620 N/A N/A
R393CP 2005 Part B Deductible Update to the Back Page of Medicare Summary Notices 01/24/2005 3600 N/A N/A
R12DEMO Chemotherapy Demonstration Project 01/17/2005 3634 N/A N/A
R91PI Revision of Program Integrity Manual (PIM), Section 3.11.1.4 01/03/2005 3560 N/A N/A
R90PI Prepayment Review of Claims for MR Purposes 01/10/2005 3569 N/A N/A
R384CP Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) 04/04/2005 3541 MM3541 12/07/2004
R127OTN Instructions Applicable to the Audit of Hospitals that are Part of an Affiliated Group in Relation to the "Redistribution of Unused Resident Positions," Section 422 of the Medicare Modernization Act of 2003 (MMA), P.L. 108-173, for Purposes of Graduate Medical Education (GME) Payments 12/06/2004 3558 N/A N/A
R360CP Annual Update of HCPCS Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) 01/03/2005 3542 MM3542 11/29/2004
R28BP Hospice Pre-Election Evaluation and Counseling Services 01/03/2005 3585 MM3585 03/28/2005
R363CP 2005 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment 01/03/2005 3526 MM3526 11/16/2004
R129OTN 2005 Drug Administration Coding Revisions 01/17/2005 3631 MM3631 01/06/2005
R128OTN Promoting Medicare's Preventive Benefits and Services on an Annual Basis 01/03/2005 3527 N/A N/A
R362CP Update to the Prospective Payment System (PPS) for Home Health Agencies for Calendar Year (CY) 2005 01/03/2005 3556 MM3556 11/19/2004
R372CP Payment for Referred Laboratory Automated Multi-Channel Chemistry (AMCC) Tests 04/04/2005 3483 MM3483 01/10/2005
R369CP Fee Schedule Update for 2005 for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) 01/03/2004 3574 N/A N/A
R371CP Updated Billing Instructions for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) 04/04/2005 3487 MM3487 12/10/2004
R374CP Clarification to IOM Chapter 17, Section 80.4 regarding claims for Blood Clotting Factors 11/22/2004 3370 N/A N/A
R27BP New ESRD Composite Payment Rates Effective January 1, 2005 01/03/2005 3554 MM3554 12/07/2004
R89PI Updating Financial Reporting Requirements for Medical Review and Local Provider Education and Training 12/27/2004 3446 N/A N/A
R60FM Revised instructions on contractor procedures for provider audit and the Provider Statistical & Reimbursement Report (PSRR) 01/24/2005 3492 N/A N/A
R88PI Timeframes for Processing 855 Enrollment Applications 12/27/2004 3528 N/A N/A
R382CP Independent Laboratory Billing for the Technical Component (TC) of Physician Pathology Services to Hospital Patients 01/03/2005 3467 MM3467 01/04/2005
R361CP MMA Drug Pricing Update - Payment Limit for J0207 (Amifostine) 12/06/2004 3552 MM3552 11/16/2004
R357CP Implementation of Coverage of Religious Nonmedical Health Care Institution Items and Services Furnished in the Home, MMA section 706. 04/04/2005 3529 MM3529 11/23/2004
R25BP Implementation of Coverage of Religious Nonmedical Health Care Institution (RNHCI) Items and Services Furnished in the Home, MMA section 706. 04/04/2005 3529 MM3529 11/23/2004
R63MCM Chapter 5 and Chapter 17B N/A N/A N/A N/A
R368CP Instructions for Completion of Form CMS-1450 04/04/2005 3543 MM3543 11/29/2004
R4SOM Guidance to Surveyors for Long Term Care Facilities 11/12/2004 N/A N/A N/A
R367CP Section 630 of the Medicare Modernization Act (MMA) allows for the reimbursement for ambulance services provided by IHS/Tribal Hospitals, including CAHs, which manage and operate hospital-based ambulances. 04/04/2005 3521 N/A N/A
R5SOM Revisions to Appendix P (Survey Protocols for Long Term Care Facilities) and Appendix PP (Guidance to Surveyors for Long Term Care Facilities) N/A N/A N/A N/A
R370CP New Case-Mix Adjusted End Stage Renal Disease (ESRD) Composite Payment Rates and New Composite Rates and New Composite Rate Exceptions Window for Pediatric ESRD Facilities 04/04/2005 3572 MM3572 01/06/2005
R373CP New ESRD Composite Payment Rates Effective January 1, 2005 01/03/2005 3554 N/A N/A
R377CP Long Act Implant, Bcg Live Intravesical Vac, and Gallium ga 67; Adjustments Due to Misclassification 12/28/2004 3540 MM3540 12/06/2004
R380CP Changes to the Laboratory National Coverage Determination (NCD) edit Software for January 2005 01/03/2005 3429 MM3429 12/06/2004
R379CP Low Osmolar Contrast Material/Laboratory Tests/Payment for Inpatient Services Furnished by a Critical Access Hospital (CAH) 04/04/2005 3439 MM3439 12/02/2004
R381CP Revisions and Corrections, Chapter 29 of the IOM, Claims Processing Manual - Appeals 01/10/2005 3127 N/A N/A
R86PI Payment for Emergency Medical Treatment and Labor Act (EMTALA) - Mandated Screening and Stabilization Services 11/22/2004 3437 N/A N/A
R353CP DMERC - Revision to CR 2631 Requirements for DMERC claims 04/04/2005 3261 N/A N/A
R352CP Three Places after the Decimal Point for ASP drug file 04/04/2005 3436 N/A N/A
R59FM Notice of New Interest Rate for Medicare Overpayments and Underpayments. 11/12/2004 3453 N/A N/A
R358CP Inclusion of Forteo as a Covered Osteoporosis Drug and Clarification of Manual Instructions Regarding Osteoporosis Drugs 04/04/2005 3524 MM3524 12/08/2004
R349CP Annual Type of Service (TOS) 01/03/2005 3519 N/A N/A
R346CP Three Places after the Decimal Point for ASP drug file 04/04/2005 3436 N/A N/A
R26BP Inclusion of Forteo as a Covered Osteoporosis Drug and Clarification of Manual Instructions Regarding Osteoporosis Drugs 04/04/2004 3524 MM3524 12/08/2004
R125OTN Instructions Applicable to the Audit of Hospitals that are Part of an Affiliated Group in Relation to the "Redistribution of Unused Resident Positions," Section 422 of the Medicare Modernization Act of 2003 (MMA), P.L. 108-173, for Purposes of Graduate Medical Education (GME) Payments 12/06/2004 3558 N/A N/A
R341CP Implementation of the Medicare Physician Fee Schedule (MPFS) National Abstract File for Purchased Diagnostic Tests and Interpretations 04/04/2005 3481 MM3481 03/21/2005
R11NCD Manualization NCD: Acupuncture for Fibromyalgia/Osteoarthritis 04/06/2004 3250 MM3250 04/28/2004
R340CP Annual Update of HCPCS Codes Used for Home Health Consolidated Billing Enforcement 01/03/2005 3525 MM3525 11/04/2004
R338CP Remonal of the Skilled Nursing Facility (SNF) No Pay File 01/03/2005 3534 N/A N/A
R337CP Change in Hospital Type of Bill for Billing Diagnostic and Screening Mammographics 04/04/2005 3469 MM3469 11/15/2004
R345CP DMERC - Revision to CR 2631 Requirements for DMERC claims 01/04/2005 3261 N/A N/A
R336CP Indian Health Service (IHS) or Tribal Hospitals including Critical Access Hospitals (CAH) Payment Methodology for Inpatient Social Admissions and Outpatient Services Occurring During Concurrent Stays 04/04/2005 3452 N/A N/A
R335CP Incorrect Reporting of Miles, Times, Units, Services (MTUS) Indicator When a Drug is Billed in the NCPDP Format Using an NDC Code 04/04/2005 3435 N/A N/A
R342CP Change to the Common Working File (CWF) Skilled Nursing Facility (SNF) Consolidated Billing (CB) Edits for Ambulance Transports to or from a Diagnostic or Therapeutic Site 04/04/2005 3427 MM3427 11/29/2004
R351CP Editing of Hospitals and Skilled Nursing Facilities Part B Inpatient Services (Full Replacement of Change Request 3366) 01/03/2005 3531 MM3531 11/16/2004
R347CP Inpatient Rehabilitation Facility (IRF) Classification Requirements 11/29/2004 3503 MM3503 11/08/2004
R348CP January 2005 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing File, Effective January 1, 2005 01/03/2005 3539 MM3539 11/08/2004
R350CP Editing for Part B Carriers and Durable Medical Equipment Regional Carriers (DMERCs) for Duplicate Claims in Process at the Same Time 04/04/2005 3347 N/A N/A
R343CP Clarification: Modifiers for Transportation of Portable X-rays (R0075) 04/04/2005 3280 MM3280 11/19/2004
R24BP Revision of Section 300.5.1, Chapter 15 of the Medicare Benefit Policy Manual to include 22x TOB as an applicable TOB for Diabetes Self-Management Training. 01/03/2005 3531 N/A N/A
R13GI Medicare Termination of Beneficiaries With End Stage Renal Disease (ESRD) 04/04/2005 2923 MM2923 11/04/2004
R21MSP Medicare Secondary Payer (MSP) Savings Report Redesign 04/04/2005 3407 N/A N/A
R20MSP Medicare Secondary Payer (MSP) Savings Report Redesign 04/06/2005 3181 N/A N/A
R71PI2 Rewrite of the Program Integrity Manual (except Chapter 10), Chapters 5 and 6 05/10/2004 3030 N/A N/A
R70PI New Requirements for Self-Administered Drug (SAD) Exclusion List Articles in the Medicare Coverage Database (MCD) 05/10/2004 3136 N/A N/A
R71PI Rewrite of the Program Integrity Manual (except Chapter 10), Transmittal Page, Business Requirements, Table of Contents, Chapters 1 and 2. 05/10/2004 3030 N/A N/A
R7NCD Electrical Stimulation and Electromagnetic Therapy for the Treatment of Woundsq 07/06/2004 3149 MM3149 04/28/2004
R110CP New Requirements for payment of drugs furnished in independent dialysis facilities and paid outside of the composite rate for dates of service (DOS) starting on January 1, 2004. Drugs furnished in this setting will be paid at the lower of billed charges or 95 percent Average Wholesale Price (AWP) for the calendar year 2004. These changes have been established with the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003, PL 108-173. 03/29/2004 3078 MM3078 03/05/2004
R108CP Type of Service (TOS) Corrections 03/29/2004 3018 N/A N/A
R4SSM Medicare Business Partners Systems Security (a.k.a. CMS Business Partners Systems Security Manual) 04/05/2004 3106 N/A N/A
R4COM Provider/Supplier Communications - Revisions and Additions to Existing Contractor Requirements 04/05/2004 3118 N/A N/A
R65OTN Implementation of Section 508(f) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173) 04/26/2004 3084 N/A N/A
R64OTN Implementation of Sections 401, 402, 504 and 508(a) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173 04/05/2004 3158 MM3158 04/05/2004
R12MSP Interim Non-Systems Solution: Converting Health Insurance Portability and Accountability Act (HIPAA) Individual Relationship Codes to Common Working File (CWF) Patient Relationship Codes 03/19/2004 3117 N/A N/A
R63OTN Durable Medical Equipment Regional Carriers (DMERCs) - DeWall Posture Protector Orthotic Body Jacket (L0430): Continuation of CMS' Policy Stated in CR 2711 (B-03-025) dated April 11, 2003. N/A 3224 N/A N/A
R69PI Streamlining Enrollment Requirements 04/26/2004 3159 N/A N/A
R131CP New Payment Allowance Percentages for DMERC Drugs 03/26/2004 3153 MM3153 04/05/2004
R118CP Frequency Limitations for Darbepoetin Alfa (trade name Aranesp) For Treatment Of Anemia In End Stage Renal Disease (ESRD) Patients On Dialysis. 04/05/2004 2984 N/A N/A
R130CP Chapter 32, Billing Instructions for Special Services N/A 2323 N/A N/A
R117CP Instructions for downloading the Medicare zip code file. 04/05/2004 3160 N/A N/A
R129CP Additional Information and Corrections to Previous Transmittals Regarding Healthcare Common Procedure Coding System (HCPCS) Codes and Modifiers for Low Osmolar Contrast Material, Orthotics, and Durable Medical Equipment 04/26/2004 3143 N/A N/A
R128CP Manualization of Deep Brain Stimulation N/A 2553 N/A N/A
R127CP 2004 Jurisdiction List 05/26/2004 3139 MM3139 03/31/2004
R126CP Manualization Clarification of ICD-9 Coding N/A 2857 N/A N/A
R125CP Manualization of the Sacral Nerve Stimulation N/A 2532 N/A N/A
R116CP ESRD- Miscellaneous Code Processing Clarification 04/05/2004 3019 N/A N/A
R11GI Manual Revision Regarding Waiver of Annual Deductible and Coinsurance for Both ASC Facility, and ASC/Hospital Outpatient Department Physician Services 11/22/2004 3471 MM3471 10/27/2004
R115CP DMERCs and VIPS, Processing NDC Numbers - Clarification to CR 3141 07/06/2004 3148 N/A N/A
R8BP Policy Changes to Reflect Billing for Darbepoetin Alfa and Epoetin 04/05/2004 2984 MM2984 03/25/2004
R61OTN Changes to the FY 2004 Graduate Medical Education (GME) Payments as Required by the Medicare Modernization Act of 2003 (MMA), P.L. 108-173 04/05/2004 3071 MM3071 03/19/2004
R334CP Payment of Beneficiary Submitted Flu Claims and Flu Claims Submitted by Non-Enrolled Providers 11/26/2004 3555 N/A N/A
R7ESRD Chapter 7, Sanctions and ESRD Complaints and Grievances 04/26/2004 N/A N/A N/A
R6ESRD Chapter 6, Community Information and Resources 04/26/2004 N/A N/A N/A
R339CP Calendar Year (CY) 2005 Participation Enrollment and Medicare Participating Physicians and Suppliers Directory (MEDPARD) Procedures 11/10/2004 3442 N/A N/A
R5ESRD Chapter 4, Information Management 04/26/2004 N/A N/A N/A
R124OTN Common Working File (CWF) Duplicate Claim Edit for Referred Clinical Diagnostic and Purchased Diagnostic Services 04/04/2005 3551 MM3551 12/10/2004
R36FM Contractor Reporting of Operations and Workload Data (CROWD) for EDI N/A 2249 N/A N/A
R3GI New Part B Annual Deductible 01/03/2005 3121 MM3121 03/16/2004
R119CP MMA Drug Pricing Update-Drug Exceptions 04/05/2004 3161 MM3161 03/24/2004
R5P238 Electronic Reporting Specifications for Form CMS-1984-99 N/A N/A N/A N/A
R123OTN Instructions For Pricing Trepostinil (Q4077) 11/29/2004 3533 MM3533 11/04/2004
R12P232 Home Health Agency Cost Report N/A N/A N/A N/A
R122OTN Shared System and CWF Renovation of Override Code Process and Recognition of Four 2-byte Modifier Fields on the Part B Query Record - For MCS Phased Implementation Approach Only 04/04/2005 3494 N/A N/A
R37FM Installation of Version 33 of the Provider Statistical and Reimbursement (PS&R) Reporting System. 07/05/2004 3131 N/A N/A
R62OTN Physician Self-Referral Prohibition; 18-Month Moratorium on Physician Investment in Specialty Hospitals 04/02/2004 3036 MM3036 04/07/2004
R121OTN Modification to Fiscal Intermediary Standard System (FISS) Regarding Common Working File Initiated Adjustments 04/04/2005 3330 N/A N/A
R13MSP Updates to the Electronic Correspondence Referral System (ECRS) User Guide v7.0 and Quick Reference Card v7.0 04/19/2004 3174 N/A N/A
R124CP Electrical Stimulation and Electromagnetic Therapy for the Treatment of Wounds 07/06/2004 3149 N/A N/A
R123CP April Outpatient Code Editor (OCE) Specifications Version 5.1 04/05/2004 3170 MM3170 03/30/2004
R122CP Revision to Required Messages in Change Request (CR) 2944, Implementation of Skilled Nursing Facility (SNF) Consolidated Billing Edit for Therapy Codes Considered Separately Payable Physician Services 07/06/2004 3156 N/A N/A
R8NCD Current Perception Threshold/Sensory Nerve Conduction Threshold Test (sNCT) 04/01/2004 2988 MM2988 08/31/2004
R103CP Optional Method for Outpatient Services: Cost-Based Facility Services Plus 115 percent Fee Schedule Payment for Professional Services 07/01/2004 3114 MM3114 02/26/2004
R102P New Waived Tests--April 1, 2004 04/05/2004 3061 MM3571 02/03/2005
R101CP Restoring Composite Rate Exceptions for Pediatric Facilities Under the ESRD Composite Rate System 04/01/2004 3119 MM3119 03/05/2004
R7BP Restoring Composite Rate Exceptions for Pediatric Facilities Under the ESRD Composite Rate System 04/01/2004 3119 MM3119 03/04/2004
R107CP Health Insurance Portability and Accountability Act (HIPAA) X12N 837 Health Care Claim Implementation Guide (IG) Editing Additional Instruction 07/06/2004 3031 MM3031 08/31/2004
R112CP April 2004 Changes to the Hospital Outpatient Prospective Payment System (OPPS): Payment for Drugs, Biologicals and Radiopharmaceuticals, Generic Versus Brand Name 04/05/2004 3144 MM3144 03/19/2004
R67PI The Medicare Coverage Database 03/12/2004 2976 MM2976 06/23/2004
R11MSP General Policy 03/29/2004 3064 MM3064 03/05/2004
R114CP Modification of CMS' Medicare Contingency Plan for HIPPA Implementation 07/06/2004 2981 MM2981 03/01/2004
R113CP Claims Requiring Adjustment As a Result of April 2004 Changes to the Outpatient Prospective Payment System (OPPS) 04/05/2004 3145 MM3145 03/31/2004
R132CP April 2004 Update of the Hospital Outpatient Prospective Payment System 04/05/2004 3154 MM3154 04/05/2004
R111CP Payment For Services Provided Under a Contractual Agreement 03/12/2004 3083 MM3083 03/17/2004
R9NCD NCD - Ocular Photodynamic Therapy (OPT) With Verteporfin for Age-Related Macular Degeneration (AMD) 04/01/2004 3191 MM3191 12/16/2004
R68OTN Transmittal 49 Implementation Date Extension 07/06/2004 3197 MM3197 04/12/2004
R67OTN Requirement for Carriers, Durable Medical Equipment Regional Carriers (DMERCs), Fiscal Intermediaries (FIs), and Full Program Safeguard Contractors (PSCs) to Encourage Providers to Submit Medical Records to the Comprehensive Error Rate Testing (CERT) Contractor for Use in the November 2004 Improper Medicare Fee-For-Service (FFS) Payments Report 04/30/2004 3157 N/A N/A
R48MCM Grievances, Organization Determinations, and Appeals N/A N/A N/A N/A
R135CP Purchased Diagnostic Test - Carriers N/A 1658 N/A N/A
R133CP Billing NonCovered Charges to Fiscal Intermediaries - Summary and New Instructions - Clarification 04/16/2004 3115 N/A N/A
R134CP Instructions for Downloading the Medicare Zip Code File. 07/06/2004 3198 N/A N/A
R70OTN How Fiscal Intermediary's are to Record Coinsurance Amounts from The Provider Statistical and Reimbursement (PS&R) Report for Providers Who Elected to Accept Reduced Coinsurance for Outpatient Prospective Payment System (OPPS) Services 05/10/2004 3166 N/A N/A
R10NCD NCD is being released N/A N/A N/A N/A
R69OTN Carrier Only* Shared System Maintainer Hours for Resolution of Problems Detected As A Result of Implementation of CR 2525 and CR 2527 N/A 3146 N/A N/A
R50MCM Chapter 20, Managed Care and M+C Systems Business Requirements N/A N/A N/A N/A
R71PI4 Rewrite of the Program Integrity Manual (except Chapter 10), Chapters 13 and 11 05/10/2004 3030 N/A N/A
R71PI5 Rewrite of the Program Integrity Manual (except Chapter 10), Exhibits 05/10/2004 3030 N/A N/A
R71PI3 Rewrite of the Program Integrity Manual (except Chapter 10), Chapters 7, 8, 9 and 12 05/10/2004 3030 N/A N/A
R71PI1 Rewrite of the Program Integrity Manual (except Chapter 10), Chapters 3 and 4 05/10/2004 3030 N/A N/A
R121CP Manualization of Place of Service (POS) Code Set Program Memorandum; Revision to Group Home Code Description 04/01/2004 3087 MM3087 04/13/2004
R120CP April Update to the January Medicare Outpatient Code Editor (OCE) Specifications Version 19.1 R1 For Bills From Hospitals That Are Not Paid Under The Outpatient Prospective Payment System 04/05/2004 3155 MM3155 08/31/2004
R85P Processing of Claims for Referred Services for a Independent Clinical Diagnostic Laboratory 07/06/2004 3090 MM3090 04/05/2004
R87CP Expansion of Transfer Policy Under Inpatient Payment Prospective System 07/06/2004 2934 MM2934 03/01/2004
R84CP Additional Guidelines for Implementing the National Council for Prescription Drug Program 07/06/2004 3095 MM3095 02/13/2004
R86CP X12N 837 Professional Implementation Guide (IG) Edits 07/06/2004 3050 MM3050 02/10/2004
R35FM Unsolicited/Voluntary Refunds 10/04/2004 1444 N/A N/A
R2GI Scheduled Release for April Updates to Software Programs and Pricing/Coding Files 03/08/2004 3123 N/A N/A
R99CP Health Insurance Portability and Accountability Act (HIPAA) X12N 837 Coordination of Benefits (COB) Gap Fill Additional Instruction 07/06/2004 3100 N/A N/A
R330CP DMERC-Beneficiary Submitted Claims, Process First Claim 04/04/2005 3233 N/A N/A
R332CP New Policy and Refinements on Billing Noncovered Charges to Fiscal Intermediaries (FIs) 04/04/2005 3416 N/A N/A
R329CP DMERC Only - Payment to Providers/Suppliers Qualified to Bill Medicare for Prosthetics and Certain Custom-Fabricated Orthotics 07/05/2005 3373 N/A N/A
R328CP 2005 Annual Update for Skilled Nursing Facility (SNF) Consolidated Billing for the Common Working File (CWF) and Medicare Carriers 01/03/2005 3535 MM3535 12/29/2004
R325CP New Waived Tests-January 1, 2005 01/03/2005 3484 N/A N/A
R327CP This transmittal rescinded and replaced by R374CP 11/22/2005 3370 N/A N/A
R321CP Instructions for Downloading the Medicare Zip Code File 04/04/2005 3482 N/A N/A
R320CP Reminder Notice of the Implementation of the Ambulance Transition Schedule 01/03/2005 3473 N/A N/A
R319CP CORF/OPT Edit for Billing Inappropriate Supplies 04/04/2005 3468 MM3468 10/28/2004
R316CP Clarification of Messgaes in Chapter 1, Section 10.1.1.1 to Match Official Listing on the WPC-EDI Web Site N/A 3462 N/A N/A
R318CP Clarification of CR 3176 - Payment amounts for ESRD drug administration supplies: HCPCS A4657 and A4913 11/22/2004 3451 N/A N/A
R317CP Clarification to Chapter 26 of the Internet Only Manual (IOM) N/A 3431 N/A N/A
R315CP Temporary Change in Carrier Jurisdictional Pricing Rules for Purchased Diagnostic Services 11/22/2004 3464 N/A N/A
R12GI New Policy and Refinements on Billing Noncovered Charges to Fiscal Intermediaries (FIs) 04/04/2005 3416 MM3416 10/28/2004
R326CP Invalid Diagnosis Code Editing - Second Phase 04/04/2005 3260 MM3260 10/28/2004
R323CP Update Regarding the Use of American Dental Association's (ADA) Current Dental Terminology (CDT) Codes on Medicare Contractors' Web Sites and Other Electronic Media 11/22/2004 3499 N/A N/A
R324CP Quarterly Update to Correct Coding Initiative (CCI) edits, Version 11.0, Effective January 1, 2005 01/03/2005 3491 MM3491 10/28/2004
R322CP Release Medlearn Article for Change Request (CR) 2813 (End Stage Renal Disease Reimbursement for Automated Multi-channel Chemistry Test(s)). 10/29/2005 3501 N/A N/A
R57FM Revised Reporting Requirements for Contractor Reporting of Operational Workload Data (CROWD) Health Professional Shortage Area (HPSA) Quarterly Report (CMS Form 1565E, CROWD Form S) 04/04/2005 3472 N/A N/A
R85PI Informing Beneficiaries About Which Local Medical Review Policy (LMRP) and/or Local Coverage Determination (LCD) and/or National Coverage Determination (NCD) is Associated with Their Claim Denial 04/04/2005 3363 N/A N/A
R56FM Revision to Balancing Requirement on Form 5, Line 10, of the Contractor Reporting of Operational and Workload Data (Crowd) 11/22/2005 3486 N/A N/A
R308CP Two New Medicare Summary Notice (MSN) Messages for Parental Pumps - DMERC only 10/04/2004 3506 N/A N/A
R305CP Disabling the CWF 57x3 Consistency Error Code 01/03/2005 3470 N/A N/A
R114OTN Payment Allowances for the Influenza Virus Vaccine (CPT 90658) and the Pneumoccocal Vaccine (CPT 90732) 10/04/2004 3490 MM3490 11/19/2004
R304CP Nurse Practitioners As Attending Physicians in the Medicare Hospice Benefit 06/28/2004 3226 MM3226 10/15/2004
R22BP Nurse Practitioners As Attending Physicians in the Medicare Hospice Benefit 06/28/2004 3226 N/A N/A
R21BP Medicare Comprehensive Outpatient Rehabilitation Facility Coverage 10/25/2004 3315 MM3315 10/15/2004
R117OTN New Remark Code Message for Use with Claims for Parenteral Pumps - (DMERC) Only 10/04/2004 3405 N/A N/A
R310CP Billing Requirements for Positron Emission Tomography (PET) Scans for Dementia and Neurodegenerative Diseases 10/04/2004 3426 N/A N/A
R426PR1 For Assets Acquired On or After May 1, 2004 N/A N/A N/A N/A
R55FM Reporting Appeals Redetermination Information On Forms CMS-2591 and 2590 11/15/2004 3448 N/A N/A
R311CP Instructions for Completion of Form CMS-1450 01/05/2005 3417 MM3417 10/15/2004
R118OTN Shared Systems Maintainers Hours for Resolution of Problems Detected as a Result of Implementation of Change Request 2525 and Change Request 2527 01/03/2005 3536 N/A N/A
R314CP Percutaneous Transluminal Angioplasty (PTA) 10/12/2004 3489 MM3489 10/20/2004
R25NCD Percutaneous Transluminal Angioplasty (PTA) 10/12/2004 3489 MM3489 10/20/2004
R120OTN Override of Common Working File (CWF) Edit for Observation Services Exceeding 48 Hours 04/04/2005 3311 MM3311 10/13/2005
R302CP Nursing Facility Visits (Codes 99301 -99313) 10/25/2004 3096 N/A N/A
R303CP Instructions for Completion of Form CMS-1450 01/05/2004 3417 N/A N/A
R309CP Fiscal Year (FY) 2005 Inpatient Prospective Payment System (IPPS), Long Term Care Hospital (LTCH) and Other Bill Processing Changes Related to the IPPS Final Rule 10/04/2004 3459 MM3459 04/29/2005
R306CP Full Replacement of CR 3415, 3rd Update to the 2004 Medicare Physician Fee Schedule Database. 10/04/2004 3505 MM3505 10/05/2004
R62MCM Revisions to Chapter 13 - Medicare+Choice Beneficiary Grievances, Organization Determinations and Appeals N/A N/A N/A N/A
R299CP Use of Condition Code 44, "Inpatient Admission Changed to Outpatient" 10/12/2004 3444 N/A N/A
R297CP Reasonable Charge Update for 2005 for Splints, Casts, Dialysis Supplies, Dialysis Equipment, Therapeutic Shoes, and Certain Intraocular Lenses 01/03/2005 3430 MM3430 09/30/2004
R298CP MSN and ANSI Messages for Mammography Claims 09/25/2004 2617 MM2617 06/25/2004
R21NCD Magnetic Resonance Spectroscopy for Diagnosing Brain Tumors 09/10/2004 3425 MM3425 09/27/2004
R19BP Hospital Services Covered Under Part B 10/12/2004 3444 N/A N/A
R10GI Update to Medicare Deductible, Coinsurance and Premium Rates for Calendar Year 2005 01/03/2005 3463 MM3463 09/21/2004
R267CP Crossover Patients in New Long Term Care Hospitals (LTCH) 01/03/2005 3391 MM3391 09/27/2004
R301CP Editing Of Hospital And Skilled Nursing Facility Part B Inpatient Services 01/03/2005 3366 MM3366 09/27/2004
R116OTN Notification of Medlearn Matters (MM) Article for Confidential Change Request (CR) 3301 N/A 3465 N/A N/A
R54FM Notification to Providers of Intent to Complete a Post-Payment Audit 10/25/2004 3441 N/A N/A
R19MSP Clarification of MSP Rules in Relation to a Temporary Leave of Absence 10/25/2004 3447 MM3447 09/29/2004
R288CP Fiscal Year (FY) 2005 Payment for Services Furnished in Ambulatory Surgical Centers (ASCs) 10/01/2004 3394 MM3394 09/02/2004
R283CP 2005 Healthcare Common Procedure Coding System (HCPCS) Annual Update reminder 01/03/2005 3422 MM3422 09/02/2004
R285CP Addition of Physician Assistants, Nurse Practitioners and Clinical Nurse Specialists as Emergency On-Call Providers for Critical Access Hospitals (CAHs) 01/03/2005 3228 MM3228 09/02/2004
R6P229 For Cost Reporting Periods End On or After March 31, 2002 N/A N/A N/A N/A
R61MCM Emergency and Urgently Needed Services N/A N/A N/A N/A
R296CP Payment Denial for Medicare Services Furnished to Alien Beneficiaries Who Are Not Lawfully Present in the United States N/A 2825 N/A N/A
R295CP MSN Messages and Reason Codes for Mammography 09/25/2004 2617 MM2617 06/25/2004
R112OTN Billing Instructions for ADVATE rAHF-PFM on Medicare Claims 09/27/2004 3331 MM3331 10/04/2004
R113OTN Implementation of Section 921 of the Medicare Modernization Act (MMA) - Provider Customer Service Program 01/05/2005 3376 MM3376 12/23/2004
R286CP Medicare Physician Fee Schedule Database (MPFSDB) 2005 File Layout 01/03/2005 3421 N/A N/A
R287CP Schedule for Completing the Calendar Year (CY) 2005 Fee Schedule Updates and the Participating Physician Enrollment Procedures 08/27/2004 3409 N/A N/A
R284CP DMERCs Only-Appeals of Duplicate claims 09/27/2004 3371 N/A N/A
R58OTN Program Integrity Management Reporting (PIMR) System Program Integrity Management Reporting System (PIMR) FY 2004 F and T Codes 04/01/2004 3110 N/A N/A
R46MCM Chapter 19, Managed Care and M+C Systems Requirements N/A N/A N/A N/A
R45MCM Chapter 13, Grievances Organization Determinations and Appeals N/A N/A N/A N/A
R10MSP Update the Part B Shared Systems to Send the Appropriate Medicare Fee Schedule Amounts to the Medicare Secondary Payer Payment (MSPPAY) Software for Psychiatric MSP Claims 07/06/2004 2955 N/A N/A
R100CP Outpatient Clinical Laboratory Tests Furnished by Hospitals With Fewer Than 50 beds in Qualified Rural Areas 07/06/2004 3130 MM3130 03/31/2004
R32SOM Appendix C-Survey Procedures and Interpretive Guidelines for Laboratories and Laboratory Services 04/01/2004 N/A N/A N/A
R59OTN Temporary 5 Percent Payment Increase for Home Health Services Furnished in a Rural Area for One Year Under the Home Health Prospective Payment System (HH PPS), Change of HH PPS Annual Update from a Fiscal Year Update to a Calendar Year Update, and Adjustment of HH PPS Annual Update to the Home Health Market Basket Percentage Increase Minus 0.8 Percent 04/05/2004 3085 MM3085 03/16/2004
R425PR1 Regional Medicare Swing-Bed Rates N/A N/A N/A N/A
R47MCM Chapter 7--Medicare+Choice-Enrollment and Disenrollment N/A N/A N/A N/A
R66PI Progressive Corrective Action Program Memorandum and Providing Updated Instructions on How Contractors Must Identify, Verify, and Correct Billing Errors. 04/02/2004 3124 N/A N/A
R105CP 1st Update to the 2004 Medicare Physician Fee Schedule Database 04/05/2004 3128 N/A N/A
R104CP DMERCs and VIPS, Processing NDC Numbers 04/05/2004 3141 MM3141 05/06/2004
R77CP Change in Methodolgy for Determining Payment for Outliers 03/08/2004 2998 N/A N/A
R83CP New "K" Codes for Wheelchair Cushions 07/06/2004 3069 MM3069 02/28/2004
R76CP SNF Inpatient Part A Billing N/A 3133 N/A N/A
R82CP ESRD Data for Use in Adjusting Claims 07/06/2004 3066 N/A N/A
R81CP Update of UB-92 Codes 07/06/2004 3012 N/A N/A
R80CP Extend Medicare Coverage for Certain Colorectal Cancer Screenings at SNFs 07/06/2004 2874 MM2874 02/27/2004
R88CP Implementation of Changes to Payment for Ambulance Services Required by Section 414 of MMA 07/05/2004 3099 MM3099 07/14/2004
R89CP The Elimination of the 90-Day Grace Period for HCPCS Codes 07/06/2004 3093 MM3093 02/12/2004
R8MSP Common Working File MSP Modifications 07/06/2004 2775 N/A N/A
R7MSP Sending the Primary Payer Covered Charge Amount to the Medicare Secondary Payment (MSPPAY) Module for MSP Home Health Prospective Payment System (HH PPS) Claims 07/06/2004 2954 N/A N/A
R96CP Claims Status Codes in ASC X12N 276/277 Claims Status Health Insurance Portability and Accountability Act (HIPAA) Transactions N/A 3017 N/A N/A
R95CP Elimination of the 90-Day Grace Period for ICD-9-CM Codes 10/01/2004 3094 MM3094 02/10/2004
R97CP Implementation of New Medicare Redetermination Notice (MRN) 07/06/2004 2620 MM2620 10/04/2004
R98CP Consolidation of the Claims Crossover Process: Additional Common Working File (CWF) Functionality 07/06/2004 3109 MM3109 03/05/2004
R94CP Additional Information in Medicare Summary Notices (MSNs) to Beneficiaries about Skilled Nursing Facility (SNF) Benefits 07/06/2004 3098 MM3098 02/25/2004
R93CP Remittance Advice Remark Code and Claim Adjustment Reason Code Update 04/05/2004 3122 N/A N/A
R92CP Updates to the January 2004 Annual Update of HCPCS Codes Used for Skilled Nursing Facility Consolidated Billing Enforcement 04/05/2004 3070 N/A N/A
R91CP Revisions to Processing of Non-covered Charges on Certain Home Health Prospective Payment System Claims 07/06/2004 3077 N/A N/A
R90CP Implementation of Skilled Nursing Facility Consolidated Billing CWF Edit for Therapy Codes Considered Separately Payable Physician Services 07/06/2004 2944 N/A N/A
R79CP ESRD Reimbursement for AMCC Tests 07/06/2004 2813 N/A N/A
R58CP April Quarterly DMEPOS Fee Schedule Update 04/05/2004 3014 N/A N/A
R78CP Medicare Incentive Payments for Physician Care 07/06/2004 3108 MM3108 02/26/2004
R57CP Implementation Guide (IG) Edits 04/05/2004 3001 N/A N/A
R49OTN Announcement of Medicare Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Payment Rate Increases 03/02/2004 3075 N/A N/A
R63CP Special Rules for Critical Access Hospital (CAH) Outpatient Billing 04/05/2004 3051 MM3051 12/06/2004
R48OTN Transfer of "WW" Codes for Oral Anti-Cancer Drugs Billed Using National Drug Codes (NDCs) on Durable Medical Equipment Regional Carrier (DMERC) Claims 04/01/2004 2863 N/A N/A
R65PI Fiscal Intermediaries to Perform Medical Review on Long Term Care Hospitals 03/02/2004 2905 N/A N/A
R64PI Role Conditions of Participation (COPs) Requirements When Making a Payment Decision 03/02/2004 3042 N/A N/A
R31FM Installation of Version 31 of the Provider Statistical and Reimbursement (PS&R) Reporting System 02/16/2004 3073 N/A N/A
R75CP MMA Pricing File Clarifications 01/03/2004 3105 MM3105 03/10/2004
R56OTN Program Integrity Management Reporting (PIMR) System for Part A - Phase 4 07/06/2004 3113 N/A N/A
R55OTN Shared System Maintainer Hours for Resolution of Problems Detected During HIPAA Transaction Release Testing 07/06/2004 3067 N/A N/A
R53OTN Surgical Lines with No Charges 07/06/2004 3104 N/A N/A
R38OTN Provider Education Article: 2004 Medicare Physician Fee Schedule Increase and Extension of the Annual Participation Enrollment Period 01/05/2004 3040 N/A N/A
R37OTN Home Health Cost Reporting Processes 02/02/2004 2993 MM2993 02/03/2004
R61PI Clarification of Proof of Delivery Requirements 02/02/2004 2903 N/A N/A
R29FM Revisions to Chapter 3 & 4 02/06/2004 2911 N/A N/A
R59CP New HCPCS Code for Ambulance Night Differential Charges 01/05/2004 3035 N/A N/A
R40OTN Provider Education Article: Renewed Moratorium on Outpatient Rehabilitation Therapy Caps 01/20/2004 3045 N/A N/A
R4BP Dentists, podiatrists, and optometrists are added to the definition/list of physicians who may opt out of Medicare 02/02/2004 3016 MM3016 01/15/2004
R39OTN Change in Coding on Medicare Claims for Darbepoetin Alfa (trade name Aranesp) and Epoetin Alfa (trade name Epogen, EPO) For Treatment Of Anemia In End Stage Renal Disease (ESRD) Patients On Dialysis 01/05/2004 2963 MM2963 02/13/2004
R41OTN Provider Education Article: New Enrollee Rights, New Provider Responsibilities in M+C Program 01/09/2004 3044 N/A N/A
R44MCM Chapter 6, Relationships With Providers N/A N/A N/A N/A
R43MCM Chapter 4, Benefits and Beneficiary Protection N/A N/A N/A N/A
R42MCM Chapter 3, Marketing N/A N/A N/A N/A
R41MCM Chapter 2, Enrollment and Disenrollment N/A N/A N/A N/A
R60CP Chapter 18, Preventive and Screening Services N/A 2632 N/A N/A
R5BP Chapter 15, Covered Medical and Other Health Services N/A 2779 N/A N/A
R42OTN Payment to Ambulatory Surgical Centers (ASCs) for G0260 and to Physicians for 27096 When 27096 is Performed in an ASC 02/02/2004 2979 MM2979 02/13/2004
R6MSP Automatic Notice of Change to MSP Auxiliary File 01/11/2004 2608 N/A N/A
R67CP Revision to CR 2912: Coding, Testing, and Implementation Phases of CR 2631 for Jurisdiction 04/05/2004 3039 N/A N/A
R66CP Quarterly Update to Correct Coding Initiative (CCI) edits, Version 10.1, Effective April 1, 2004 04/05/2004 2997 N/A N/A
R65CP ANSI X12 Transaction 835 Companion Document Change for Carriers, Durable Medical Equipment Regional Carriers (DMERCs), and Fiscal Intermediaries (Fis) 02/16/2004 2948 N/A N/A
R64CP Coding Change for Ventricular Assist Devices (VADs) for Beneficiaries in an Medicare+Choice (M+C) Plan 02/16/2004 3068 MM3068 02/04/2004
R62CP January 2004 annual update of HCPCS codes used for Home Health Consolidated Billing Enforcement 02/16/2004 3024 N/A N/A
R61CP Diagnosis coding instructions for anticipated payment and claims to conform with HIPAA requirements 02/16/2004 2992 N/A N/A
R47OTN Implementation of the Occupational Mix Survey 02/23/2004 3043 N/A N/A
R290CP October 2004 Update of the Hospital Outpatient Prospective Payment System (OPPS) 10/04/2004 3420 MM3420 09/08/2004
R46OTN Railroad Medicare Carrier Collection of Data 02/23/2004 3041 N/A N/A
R45OTN Emergency Correction to Healthcare Common Procedure Coding System (HCPCS) Codes for Low Osmolar Contrast Material 04/05/2004 3053 MM3053 03/20/2004
R44OTN Correction-CWF Edits for Inserts for Therapeutic Shoes 04/01/2004 3029 N/A N/A
R289CP File Descriptions and Instructions for Retrieving the 2005 Pricing Files through CMS's Mainframe Telecommunications System 01/03/2005 3428 N/A N/A
R43OTN Correction To The Effective Date On 9 Code Pairs in Correct Coding Initiative (CCI) Version 9.3 (Cardiology edits) 02/23/2004 3008 N/A N/A
R63PI Benefit Improvement Protection Act (BIPA) 02/23/2004 3010 N/A N/A
R240CP Expansion of the Existing Interrupted Stay Policy Under Long Term Care Hospital (LTCH) Prospective Payment System 01/03/2005 3279 N/A N/A
R62PI The Focused Medical Review Report 04/05/2004 3062 N/A N/A
R74CP Intravenous Immune Globulin 04/05/2004 3060 MM3060 02/10/2004
R73CP MCE and IPPS Transfers Between Hospitals N/A 2176 N/A N/A
R71CP Changes to the Laboratory National Coverage Determination (NCD) Edit Software 04/05/2004 3032 N/A N/A
R72CP Update of Address for the Railroad Retirement Board (RRB) 02/23/2004 3034 N/A N/A
R69CP Criteria for Using the CB Modifier 02/23/2004 2906 N/A N/A
R6NCD Cardiac Output Monitoring by Thoracic Electrical Bioimpedance 02/23/2004 2689 N/A N/A
R6BP Intravenous Immune Globulin 04/05/2004 3059 MM3060 02/10/2004
R30FM Notice of New Interest Rates for Medicare Overpayments and Underpayments 02/04/2004 2829 N/A N/A
R68CP New Requirements for Critical Access Hospitals. These changes have been established with the "Medicare Prescription Drug, Improvement, and Modernization Act" (MPDIMA) of 2003, Pub.L. 108-173 04/05/2004 3052 MM3052 02/06/2004
R52OTN Provider Data on Outbound Coordination of Benefit (COB) Files 07/06/2004 3101 N/A N/A
R50OTN ANSI X12 Transaction 270/271 Changes 04/05/2004 3065 N/A N/A
R51OTN Changes in Payment for Services Furnished in Ambulatory Surgical Centers for Fiscal Year 2004 04/05/2004 3082 MM3082 05/06/2004
R33FM Coordination of Medicare and Complementary Insurance Programs 07/06/2004 3109 MM3109 02/29/2004
R32FM Expanded Identification and Workload Reporting for CMS Medicare Systems 07/06/2004 3023 N/A N/A
R34FM Chapter 7 - Internal Control Requirements Update 03/08/2004 3006 N/A N/A
R51FM Notice of New Interest Rate for Medicare Overpatments and Underpatyments 08/09/2004 2831 N/A N/A
R52FM Notice of New Insterest Rate for Medicare Overpayments and Underpayments 08/09/2004 2831 N/A N/A
R9MSP Converting Health Insurance Portability and Accountability ct (HIPAA) Individual Relationship Codes to Common Working File (CWF) Patient Relationship Codes 07/06/2004 3116 N/A N/A
R270CP Update to the Frequency of Billing 01/03/2005 3382 N/A N/A
R269CP Number of Drug Pricing Files That Must Be Maintained Online for Medicare 01/03/2005 3231 MM3231 12/16/2004
R271CP Medicare Program-Update to the Hospice Payment Rates, Hospice Cap, Hospice Wage Index and the Hospice Pricer for FY 2005 10/04/2004 3386 N/A N/A
R272CP October Quarterly Update For 2004 10/04/2004 3377 MM3377 08/18/2004
R5DEMO Use of Group Health Plan Payment System to Pay Capitated Payments to Non-Health Plan Demonstration/Program Sites Serving Medicare Fee For Service Beneficiaries- Updated List of Plan Numbers 01/03/2005 3423 N/A N/A
R58MCM Chapter 5 Revisions N/A N/A N/A N/A
R57MCM Chapter 7 Revisions N/A N/A N/A N/A
R278CP 3rd Update to the 2004 Medicare Physician Fee Schedule Database 10/04/2004 3415 MM3415 08/21/2004
R276CP Further Information Related to CR 3175, Distinct Part Units of Critical Access Hospitals (CAHs) 01/03/2005 3399 MM3399 08/23/2004
R275CP The Supplemental Security Income (SSI)/Medicare Beneficiary Data for Fiscal Year 2003 for Inpatient Prospective Payment System (IPPS) Hospitals 10/04/2004 3403 N/A N/A
R274CP Good Cause Waiver of Late Claim Filing Payment Reduction Penalty 09/14/2004 3042 N/A N/A
R282CP Good Cause Waiver of Late Claim Filing Payment Reduction Penalty 09/14/2004 3402 N/A N/A
R106OTN MMA Drug Pricing Update-Payment Limits for J9045 (Carboplatin injection) and J9310 (Rituximab cancer treatment) 09/24/2004 3419 MM3419 09/02/2004
R111OTN Creation of CWF Auxilliary Files and Associated Logic to Properly Calculate Medicare-Equivalent Deductibles for VA Claims 01/03/2005 3450 N/A N/A
R110OTN MMA Drug Pricing Update-Payment Limits for J1000 (Depo-estradiol cypionate inj) 09/27/2004 3418 MM3418 09/02/2004
R109OTN CWF Analysis to Process Claims Per the Renovated Override Code Billing Instructions for ADVATE rAHF-PFM on Medicare Claims 09/27/2004 3331 N/A N/A
R108OTN New Remark Code Message for Use with Claims for Parenteral Pumps - Durable Medical Equipment Regional Carrier (DMERC) Only 09/27/2004 3405 N/A N/A
R107OTN CWF Analysis to Process Claims Per the Renovated Override Code Processing (re: CR3190) and CWF Analysis to Review System Edits for Additional 2-byte Modifiers Added in CR3190. (Phase 2) 01/03/2005 3320 N/A N/A
R6DEMO Revision of CR 3269 for the Demonstration Project to Clarify the Definition of Homebound (Homebound Demonstration) 01/03/2005 3432 N/A N/A
R83PI PIM Revisions for Chapter 4 09/27/2004 3379 N/A N/A
R53FM Change Request 3367, Debt Collection System (DCS), replaces Change Request 2952, Debt Collection System (DCS) 09/27/2004 3367 N/A N/A
R18MSP Application of the Medicare Secondary Payer for the Working Aged Provision and the Medicare Secondary for the Disabled Provision to Former Spouses and Certain Family Members with Coverage Under the Federal Employees Health Benefits (FEHB) Program 11/29/2004 3120 MM3120 09/02/2004
R229CP Additional Clarification of Bill Types 22x and 23x Submitted by Skilled Nursing Facilities (SNFs) With Instructions for Involuntarily Moving a Beneficiary Out of the SNF and Ending a Benefit Period 08/19/2004 3323 MM3323 08/02/2004
R291CP Use of Transmission Date in the Service Date/Assessment Date Field for Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) Claims 01/03/2005 3433 N/A N/A
R100OTN This transmittal is rescinded and replaced with Transmittal 103, dated July 30, 2004 N/A 3236 N/A N/A
R99OTN This One-Time Notification is a Full Replacement for Transmittal 86 (CR 3142) Interface File from Recovery Management and Accounting System (ReMAS 01/03/2005 3383 N/A N/A
R98OTN Change to Previous Transmittal Regarding the Discontinued Use of Revenue Code 0910 10/04/2004 3343 MM3343 08/03/2004
R96OTN Annual Changes to the Amount in Controversy (AIC) Thresholds for the Administrative Law Judge (ALJ) and Judicial Review Levels of the Claim Appeals Process as Required by Section 940 of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 10/01/2004 3354 N/A N/A
R94OTN Shared System Maintainer Hours for Resolution of Problems Detected During Health Insurance Portability and Accountability Act (HIPAA) Transaction Release Testing 01/03/2005 3316 N/A N/A
R97OTN Implementation of the Business Segment Identifier (BSI) in the Healthcare Integrated General Ledger Accounting System (HIGLAS) 01/03/2005 3362 N/A N/A
R17MSP Clarification of CR 3064 08/16/2004 3267 MM3267 07/28/2004
R49FM Procedures For Re-Issuance and Stale Dating of Medicare Checks 08/16/2004 2951 MM2951 07/21/2004
R2SOM Provider Identification Numbers N/A 3245 N/A N/A
R59MCM Chapter 2 N/A N/A N/A N/A
R60MCM Chapter 3 N/A N/A N/A N/A
R188CP 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 MM3287 07/09/2004
R273CP Modification of CMS's Medicare Contingency Plan for HIPAA Implementation 07/06/2004 2981 N/A N/A
R230CP Update to the Claims Status Codes 01/03/2005 3361 MM3361 07/28/2004
R187CP Billing Requirements for Hyperbaric Oxygen (HBO) Therapy for the Treatment of Diabetic Wounds of the Lower Extremities 06/28/2004 3172 MM3172 06/04/2004
R234CP Standardized Responses to Provider Inquiries Regarding the Negotiated Laboratory National Coverage Determinations (NCDs) Edit Software 10/04/2004 3374 MM3374 08/05/2004
R185CP Change to the Common Working File (CWF) Skilled Nursing Facility (SNF) Consolidated Billing (CB) Edits for Drugs and Electrocardiogram (EKG) Testing Provided During an Ambulance Transport 10/04/2004 3212 N/A N/A
R236CP 2005 DMEPOS Pricing File Record Layout Expansion and New Pricing Procedures for Certain DMEPOS Items Based on Modifiers 01/03/2005 3300 MM3300 04/29/2005
R237CP Implementation of Patient Status Code 65, Discharged/Transferred to a Psychiatric Hospital or Psychiatric Distinct Part Unit of a Hospital 01/03/2005 3364 MM3364 08/23/2004
R47FM Expanded Identification and Workload Reporting for CMS Medicare Systems 10/04/2004 3256 N/A N/A
R238CP Health Insurance Portability and Accountability Act (HIPAA) X12N 837 Institutional Health Care Claim Implementation Guide (IG) Additional Updates 01/03/2005 3321 MM3321 07/28/2004
R215CP Implementation of Skilled Nursing Facility Consolidated Billing CWF Edit for Therapy Codes Considered Separately Payable Physician Services 07/06/2004 2944 N/A N/A
R220CP Implementation of Section 414 of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 07/06/2004 3099 N/A N/A
R239CP Update to the Frequency of Billing 01/03/2005 3382 MM3382 08/16/2005
R213CP Payment to Bank 07/25/2004 3079 MM3079 07/26/2004
R242CP Quarterly Update to Correct Coding Initiative (CCI) edits, Version 10.3, Effective October 1, 2004. 10/04/2004 3349 MM3349 09/08/2004
R16NCD Cardiac Pacemaker 04/30/2004 3369 N/A N/A
R243CP Patient Status Code and Reason for Patient Visit for the Hospital Outpatient Prospective Payment System (OPPS) 01/03/2005 2800 N/A N/A
R93OTN Temporary SNF Extension 07/09/2004 3352 N/A N/A
R186CP July Update to the Medicare Outpatient Code Editor (OCE) Version 19.2 For Bills From Hospitals That Are Not Paid Under The Outpatient Prospective Payment System 07/06/2004 3319 MM3319 06/09/2004
R184CP Change to the Common Working File (CWF) Skilled Nursing Facility (SNF) Consolidated Billing (CB) Edits for Drugs and Electrocardiogram (EKG) Testing Provided During an Ambulance Transport 07/06/2004 3314 MM3314 06/09/2004
R248CP DMERC/Local Carriers/SADMERC - Drug Pricing Limits as of January 1, 2005 01/05/2005 3232 MM3232 12/21/2004
R221CP Medicare IRF Classification Requirements 07/01/2004 3334 MM3334 07/26/2004
R244CP Number of Drug Pricing Files That Must Be Maintained Online for Medicare 01/03/2005 3231 N/A N/A
R214CP MSN Messages 09/25/2004 2617 MM2617 06/25/2004
R227CP Local Medical Review Policy/ Local Coverage Determination Medicare Summary Notice (MSN) Message Revision 08/09/2004 3222 N/A N/A
R249CP New Medicare Summary Notice Message 31.18 01/03/2005 2989 N/A N/A
R250CP Coordination of Benefits Agreement (COBA) Claims Selection Options 01/03/2005 3404 N/A N/A
R226CP Quarterly Update of HCPCS Codes Used for Home Health Consolidated Billing Enforcement 10/04/2004 3350 MM3350 08/16/2004
R224CP October Quarterly Update to 2004 Annual Update of HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing Enforcement 10/04/2004 3348 N/A N/A
R252CP Paper Remittance Advice format change to accommodate the forced balancing amount to balance at the claim level as well as the provider level, a flat file change, and a change in the companion document for fiscal intermediaries (FIs). 01/03/2005 3344 MM3344 09/02/2004
R225CP Changes to the Laboratory National Coverage Determination (NCD)Edit Software for October 2004 10/04/2004 3358 MM3358 07/14/2004
R251CP Editing Of Hospital And Skilled Nursing Facility Part B Inpatient Services 01/03/2005 3366 N/A N/A
R253CP Fiscal Intermediary Shared System (FISS) Changes to Allow for Provider Liability Days on Skilled Nursing Facility (SNF) and Swing Bed Facility Inpatient Bills 01/03/2005 3308 N/A N/A
R83OTN Additional Health Insurance Health Insurance Portability and Accountability Act (HIPAA) Coordination of Benefits (COB) Information for Trading Partners 06/14/2004 3255 N/A N/A
R4DEMO Use of Group Health Plan Payment System to Pay Capitated Payments to Non Health Plan Demonstrations Serving Medicare Fee For Service Beneficiaries 10/04/2004 3283 MM3283 05/21/2004
R81PI Implementation of the Quarterly Strategy Analysis 08/23/2004 3294 N/A N/A
R82PI Home Health Demand Bills 08/23/2004 3266 N/A N/A
R13NCD Removal of Coding from National Coverage Determination on Stem Cell Transplantation 07/06/2004 3265 N/A N/A
R14BP Changes in the Medicare Benefit Policy Manual-Chapter 10 07/01/2004 3225 N/A N/A
R13BP Diabetes Self Management Training Services 06/28/2004 3185 MM3185 06/04/2004
R12BP Chiropractic Billing 10/04/2004 3063 N/A N/A
R6GI CMS policy for testing quarterly release of the Medicare shared systems and the CWF 08/01/2004 3011 N/A N/A
R198CP End Stage Renal Disease (ESRD) Reimbursement for Automated Multi-Channel Chemistry Test(s) 01/03/2005 2813 MM2813 12/23/2004
R197CP Emergency Hospital Outpatient billing of Epotein Alfa (EPO) and Darbepoetin Alfa (Aranesp) 10/04/2004 3184 MM3184 06/10/2004
R196CP Payment Denial for Medicare Services Furnished to Alien Beneficiaries Who Are Not Lawfully Present in the U. S. N/A 2825 N/A N/A
R88OTN Clarification and Revision of Change Request (CR) 3084, Implementation of Section 508(f) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173) 07/06/2004 3342 N/A N/A
R254CP October 2004 Outpatient Prospective Payment System Code Editor (OPPS OCE) Specifications Version 5.3 10/04/2004 3395 MM3395 08/05/2004
R195CP July 2004 Update of the Hospital Outpatient Prospective Payment System (OPPS) 07/06/2004 3324 MM3324 06/30/2004
R78PI Medical Review (MR) Progressive Corrective Action (PCA) for Part A 10/04/2004 3111 N/A N/A
R255CP October Update to the Medicare Outpatient Code Editor (OCE) Version 20.0 for Bills From Hospitals that are not Paid Under the Outpatient Prospective Payment System (OPPS) 10/04/2004 3396 MM3396 08/05/2004
R204CP Medicare HIPAA Electronic Claims Compliance Report N/A 3306 N/A N/A
R256CP Use of Group Health Plan Payment System/MMCS to Pay Capitated Payments to Chronic Care Improvement Organizations Serving Medicare Fee-For-Service Beneficiaries under Section 721 of the MMA 01/03/2005 3410 MM3410 09/01/2004
R258CP New Waived Tests - October 1, 2004 10/04/2004 3372 N/A N/A
R257CP Shared Systems Changes for Medicare Part B Drugs for ESRD Independent Dialysis Facilities 01/03/2005 3332 MM3332 08/03/2004
R259CP Scheduled Release for October Updates to Software Programs and Pricing/Coding Files 01/03/2005 3397 N/A N/A
R260CP Cryosurgery of the Prostate 01/03/2005 3168 MM3168 08/03/2004
R261CP Billing and Requirements for Islet Cell Transplantation for Beneficiaries in a National Institutes of Health (NIH) Clinical Trial 10/04/2004 3385 MM3385 08/13/2004
R263CP Inpatient Rehabilitation Facility (IRF) Annual Update: Prospective Payment System (PPS) Pricer Changes for FY 2005 10/04/2004 3378 N/A N/A
R203CP Billing Payment in a Health Professional Shortage Area 07/06/2004 3336 MM3336 06/28/2004
R264CP Medicare Program-Update to the Hospice Payment Rates, Hospice Cap, Hospice Wage Index and the Hospice Pricer for FY 2005 10/04/2004 3386 N/A N/A
R268CP Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Pricer Update FY 2005 10/04/2004 3368 N/A N/A
R266CP Revision of Common Working File (CWF) Editing for Same-Day, Same- Provider Acute Care Readmissions 01/03/2005 3389 MM3389 10/20/2004
R202CP Revised Updated SNF NO PAY File for July 2004 07/06/2004 3338 MM3338 06/21/2004
R50FM Unsolicited/Voluntary Refunds 10/04/2004 3274 MM3274 12/10/2004
R201CP IOM Manualization of Indian Health Services N/A 3302 N/A N/A
R95OTN Modification to Post-payment Adjustment Process for Home Health Prospective Payment System Claims Failing to Report Prior Inpatient Discharges 01/03/2005 3400 MM3400 08/05/2004
R200CP Update to the Common Working File Edits for Skilled Nursing Facility (SNF) Consolidated Billing (CB) to Expand the Bypass for Pharmacy Services. 10/04/2004 3277 MM3277 07/21/2004
R199CP Medicare Need for a Specific Line Item Date of Service (LIDOS) for Each Revenue Code on ALL Outpatient and Inpatient Part B Claims 10/04/2004 3337 MM3337 06/18/2004
R101OTN Change of the Premera Blue Cross Medicare Part A Plan Under Contract to BCBSA to a Part A Fiscal Intermediary Contract with Noridian Mutual Insurance Company in the States of Washington and Alaska 10/04/2004 3380 N/A N/A
R14NCD Arthroscopic Lavage and Arthroscopic Debridement for the Osteoarthritic Knee 07/11/2004 3281 MM3281 06/28/2004
R205CP Nurse Practitioners As Attending Physicians in the Medicare Hospice Benefit N/A 3226 N/A N/A
R15BP Nurse Practitioners As Attending Physicians in the Medicare Hospice Benefit N/A 3226 N/A N/A
R46FM Installation of Version 33.0 of the Provider Statistical and Reimbursement (PS&R) Reporting System-Modification of CR 3131 08/31/2004 3313 N/A N/A
R12P236 Chapter 36, Hospital and Hospital Healthcare Complex Cost Report, Form CMS 2552-96 N/A N/A N/A N/A
R210CP Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) 10/04/2004 3303 MM3303 06/24/2004
R209CP Correction to CR 2944, Transmittal 90, Issued on February 6, 2004 07/06/2004 3333 MM3333 06/24/2004
R208CP Long Term Care Hospital Prospective Payment System (LTCH PPS) Fiscal Year 2005-Update 07/06/2004 3335 MM3335 07/15/2004
R207CP Expansion of Policy Where Patient is a Member of a Medicare Advantage (MA) Organization For Only a Portion of the Billing Period to Include Inpatient Rehabilitation Facilities (IRF) and Long Term Care Hospitals (LTCH) 07/19/2004 3309 MM3309 06/24/2004
R15NCD NCD: Sensory Nerve Conduction Threshold Test (sNCTs) (NOTE THAT Change Request (CR) 3339 CONSTITUTES A TECHNICAL CORRECTION TO PREVIOUSLY ISSUED CR 2988 dated 03/19/04. CR 2988 ORIGINALLY COMMUNICATED ON MARCH 19, 2004 VIA RO-2541, SHOULD BE DISCARDED AND REPLACED WITH CR 3339. 04/01/2004 3339 MM3339 06/24/2004
R90OTN MMA Drug Pricing Update-Payment Limits for J7308 (Levulan Kerastick) and J9395 (Faslodex) 07/25/2004 3312 MM3312 07/07/2004
R49MCM Chapter 4, Benefits and Beneficiary Protection N/A N/A N/A N/A
R17BP Incident-To Services on Form CMS-1500 10/04/2004 3242 N/A N/A
R3SOM Medicare Systems Acceptance of New Provider Numbers for Federally Qualified Health Centers (FQHC) 04/04/2005 3537 N/A N/A
R89OTN Shared System Maintainer Hours for Resolution of Problems Detected As A Result of Implementation of CR 2525 and CR 2527 10/04/2004 3305 N/A N/A
R75PI Informing Beneficiaries About Which Local Medical Review Policy (LMRP) and/or Local Coverage Determination (LCD) and/or National Coverage Determination (NCD) is Associated with Their Claim Denial 10/04/2004 3089 N/A N/A
R144CP Distinct Part Units for Critical Access Hospitals 10/04/2004 3175 MM3175 04/30/2004
R180CP Hospital Partial Hospitalization Services Billing Requirements N/A 3297 N/A N/A
R145CP Data Element Requirements Matrix - Carrier 05/24/2004 3164 N/A N/A
R178CP Evaluation and Management Service Codes N/A 2321 N/A N/A
R147CP Payment for Chemotherapy Administration Services, Nonchemotherapy Drug Infusion Services, and Drug Injection Services 05/24/2004 3192 MM3192 05/06/2004
R176CP Instructions for Downloading the Medicare Zip Code File 10/04/2004 3270 N/A N/A
R149CP General Instructions for Completion of Form CMS-1450 for Billing 10/04/2004 3183 MM3183 04/30/2004
R177CP Updated SNF NO PAY File for July 2004 07/06/2004 3275 N/A N/A
R182CP Updated SNF NO PAY File for July 2004 07/06/2004 3275 N/A N/A
R73OTN Revised American National Standards Institute X12N 837 Professional Health Care Claim Companion Document 05/24/2004 3177 MM3177 05/12/2004
R74OTN Emergency Correction Regarding Correction to Healthcare Common Procedure Coding System (HCPCS) Codes for Low Osmolar Contrast Material 05/24/2004 3187 MM3187 05/01/2004
R16HMO Retirement of Manual N/A N/A N/A N/A
R55MCM Chapter 10, Organization Compliance With State Law and Pre-emption by Federal Law 12/08/2003 N/A N/A N/A
R75OTN One time instructions for audit intermediary cost reporting processes to accommodate claims processing error that prevented some supply charges from being reported on home health prospective payment system claims 05/24/2004 3147 N/A N/A
R54MCM Chapter 19, Managed Care and M+C Systems Requirements N/A N/A N/A N/A
R143CP Updated SNF NO PAY File for April 2004 04/19/2004 3238 N/A N/A
R53MCM Chapter 11, Contracts With Medicare+Choice Organizations N/A N/A N/A N/A
R87PI Informing Beneficiaries About Which Local Medical Review Policy (LMRP) and/or Local Coverage Determination (LCD) and/or National Coverage Determination (NCD) is Associated with Their Claim Denial 04/04/2005 3363 N/A N/A
R6COM Provider/Supplier Communications - Revisions and Additions to Existing Contractor Requirements 06/21/2004 3179 N/A N/A
R140CP Hospital Concerns Regarding Changing of Patient Status Code Due to Common Working File Edit 7272 05/23/2004 3240 MM3240 04/28/2004
R1SOM Release of Basic Manual N/A N/A N/A N/A
R183CP Skilled Nursing Facility (SNF) Consolidated Billing: Services Furnished Under an "Arrangement" With an Outside Entity 07/01/2004 3248 MM3248 04/01/2004
R39FM Installation of Version 34.0 of the Provider Statistical and Reimbursement (PS&R) Reporting System 10/04/2004 3182 N/A N/A
R72PI Automated Prepayment 05/01/2004 3088 N/A N/A
R17HMO Rescission of Transmittal 16 N/A N/A N/A N/A
R51MCM Chapter 2, End Stage Renal Disease N/A N/A N/A N/A
R71OTN Update to the Healthcare Provider taxonomy Codes (HPTC) Version 4.0 05/17/2004 3188 MM3188 04/28/2004
R87OTN Instructions Related to "Redistribution of Unused Resident Positions," Section 422 of the Medicare Modernization Act of 2003 (MMA), P.L. 108-173, for Purposes of Graduate Medical Education (GME) Payments 06/14/2004 3247 N/A N/A
R72OTN Changes in Determining Rural Status of Hospitals for Transitional Outpatient Payments (TOPs) for 2004 06/01/2004 3214 MM3214 05/06/2004
R86OTN Interface File from Recovery Management and Accounting System (ReMAS) N/A 3142 N/A N/A
R136CP Addition of Two "WW" Codes to Identify Xeloda (Capecitabine) 07/06/2004 3169 N/A N/A
R85OTN CD-ROM Initiative for Distribution of the Annual Disclosure, Dear Doctor Letter and Participation Enrollment Material 06/28/2004 3292 N/A N/A
R77PI Instructions for Carriers, DMERCs, FIs, and full PSCs when interacting with the Comprehensive Error Rate Testing (CERT) Contractor (i.e., handling appeals of CERT-initiated denials, contacting non-responders, tracking over/underpayments 06/28/2004 3229 N/A N/A
R137CP Manualization of Section 4118 of the Medicare Carriers Manual, Part 3 N/A 3134 MM3134 04/29/2004
R45FM Addition of Instructions for Form CMS-2591 to Chapter 6 N/A N/A N/A N/A
R76PI Clarification of Complex Medical Review 06/28/2004 3211 N/A N/A
R138CP The Consolidation of the Claims Crossover Process: Smaller-Scale Initial Implementation 07/06/2004 3218 MM3218 04/20/2004
R38FM Chapter 1, Budget Preparation 07/06/2004 3218 N/A N/A
R191CP Skilled Nursing Facility Consolidated Billing L Codes - DMERCs and Fis 06/28/2004 3295 MM3295 06/04/2004
R76OTN Shared System Maintainer Hours for Resolution of Problems Detected During Health Insurance Portability and Accountability Act (HIPAA) Transaction Release Testing 10/04/2004 3178 N/A N/A
R192CP Healthcare Common Procedure Coding System (HCPCS) Correction 07/06/2004 3282 N/A N/A
R2DEMO Virginia Cardiac Surgery Initiative Demonstration - Modifications & Corrections to Change Request 2382 10/04/2004 3199 N/A N/A
R77OTN Instructions Related to "Redistribution of Unused Resident Positions," Section 422 of the Medicare Modernization Act of 2003 (MMA), P.L. 108-173, for Purposes of Graduate Medical Education (GME) Payments 06/04/2004 3247 N/A N/A
R78OTN Renovate Override Code Processing In Common Working File 10/04/2004 3190 N/A N/A
R190CP End Stage Renal Disease (ESRD) Reimbursement for Automated Multi-Channel Chemistry (AMCC) Tests 10/04/2004 3239 MM3239 11/26/2004
R42FM Unsolicited/Voluntary Refunds 10/04/2004 3274 N/A N/A
R43FM Expanded Identification and Workload Reporting for CMS Medicare Systems 10/04/2004 3256 N/A N/A
R161CP Informing Beneficiaries about whicl local Medical Review Policy (LMRP) and /or Local Coverage Determinatin (LCD) and o/or National Coverage Determination (NCD) is associated with their claim denia 10/04/2004 3089 N/A N/A
R81OTN Requirement for Carriers, Durable Medical Equipment Regional Carriers (DMERCs), Fiscal Intermediaries (FIs), and Full Program Safeguard Contractors (PSCs) to Encourage Providers to Submit Medical Records to the Comprehensive Error Rate Testing (CERT) Contractor for Use in the November 2004 Improper Medicare Fee-For-Service (FFS) Payments Report 04/30/2004 3157 N/A N/A
R5GI Chapter 7 - Contract Administrative Requirements N/A 2765 N/A N/A
R82OTN Changes in Determining Rural Status of Hospitals for Transitional Outpatient Payments (TOPs) for 2004 06/01/2004 3214 N/A N/A
R163CP Change to the Common Working File (CWF) Skilled Nursing Facility (SNF) Consolidated Billing (CB) Edits for Ambulance Transports to or from a Diagnostic or Therapeutic Site Other than a Physician's Office or Hospital 10/04/2004 3196 MM3196 06/06/2004
R10BP Chapter 6, Hospital Services Covered Under Part B N/A 3298 N/A N/A
R169CP Chapter 1, General Billing Requirements N/A 2631 SE0429 07/09/2004
R162CP Key Shop and Optical Character Recognition (OCR)/Image Character Recognition (ICR) Output Mapping 10/04/2004 3180 N/A N/A
R168CP Chapter 12, Physician/Practitioner Billing N/A 1756 N/A N/A
R164CP End Stage Renal Disease (ESRD) Reimbursement for Automated Multi-Channel Chemistry Test(s) 07/06/2004 2813 N/A N/A
R174CP Healthcare Common Procedure Coding System (HCPCS) Corrections Involving 0040T and A9603 07/06/2004 3258 N/A N/A
R73PI Program Integrity Management Reporting System (PIMR) Section 7.2 of the Program Integrity Manual (PIM) 06/10/2004 2646 N/A N/A
R173CP 2nd Update to the 2004 Medicare Physician Fee Schedule Database 07/06/2004 3286 MM3286 05/20/2004
R172CP New Waived Tests - July 1, 2004 07/06/2004 3254 N/A N/A
R41FM Change in Interest Calculation for Medicare Overpayments and Underpayments and Medicare Secondary Payer (MSP) Recoveries 10/04/2004 3163 N/A N/A
R171CP July Quarterly Update for 2004 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule 07/06/2004 3253 MM3253 05/12/2004
R170CP Chapter 1, General Billing Requirements N/A 2815 N/A N/A
R390CP Announcement of Medicare Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Payment Rate Increases - Skilled Nursing Facility (SNF) Consolidated Billing (CB) as it Applies to RHC and FQHC Service 01/03/2005 3575 MM3575 12/17/2004
R3DEMO Demonstration Project to Clarify the Definition of Homebound - Section 702 of MMA 10/04/2004 3269 MM3269 07/23/2004
R52MCM Chapter 17, Subchapter A, TEFRA Cost-Based Payment Process and Principles 05/07/2004 N/A N/A N/A
R392CP The Supplemental Security Income (SSI) Medicare Beneficiary Data for Fiscal Year 2003 for Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) 01/10/2005 3567 N/A N/A
R79OTN 18-Month Moratorium on Physician Self-Referrals to Specialty Hospitals; Processing of Form CMS-855A Applications to Become a Medicare Certified Hospital 06/07/2004 3193 N/A N/A
R158CP Consolidation of the Claims Crossover Process: Full-scale Implementation of the Coordination of Benefits Agreement (COBA) Initiative 10/04/2004 3273 N/A N/A
R156CP Clarification of payments and billing procedures for hospitals subject to the Maryland waiver. 10/04/2004 3200 MM3200 05/07/2004
R165CP Enhancement to Home Health Consolidated Billing Edits 10/04/2004 3186 N/A N/A
R152CP Inclusion of Core-Based Statistical Area (CBSA) Data Elements to the Provider Specific Files 10/04/2004 3272 N/A N/A
R150CP Quarterly Update to Correct Coding Initiative (CCI) edits, Version 10.2, Effective July, 1, 2004. 07/06/2004 3244 MM3244 06/30/2004
R12NCD Cardiac Pacemakers 04/30/2004 3290 N/A N/A
R4GI Scheduled Release for July Updates to Software Programs and Pricing/Coding Files 06/01/2004 3278 N/A N/A
R80OTN Medicare Systems Acceptance of New Provider Numbers for Home Health Agencies 10/04/2004 3245 N/A N/A
R153CP Type of Service Corrections 10/04/2004 3189 N/A N/A
SE0459 Clarification of Medicare's Transfer Policy Under the Inpatient Prospective Payment System (IPPS) N/A N/A SE0459 12/27/2004
SE0452 Use Condition Code 59 When an ESRD Beneficiary Receives Non-Scheduled or Emergency Dialysis Services at a Non-Primary ESRD Dialysis Facility N/A N/A SE0452 09/02/2004
SE0462 MMA - Drug Administration Coding Changes and Reimbursement N/A N/A SE0462 11/04/2004
SE0451 Guidance Regarding Elimination of Standard Paper Remittance (SPR) Advice Notices in the Old Format N/A N/A SE0451 12/06/2004
SE0454 Information and Education Resources for Medicare Providers, Suppliers, and Physicians N/A N/A SE0454 09/13/2004
SE0461 Inappropriate Access to or Use of Electronic Data Interchange (EDI) Transaction Data by Third Party Entities N/A N/A SE0461 11/08/2004
SE0441 "Incident to" Services N/A N/A SE0441 11/03/2004
SE0450 MMA - Medicare Prescription Drug, Improvement and Modernization Act of 2003 Information for Medicare Rural Health Providers, Suppliers, and Physicians N/A N/A SE0450 12/14/2004
SE0447 Guidance for Part A Providers Switching to Electronic Remittance Advices (ERAs) N/A N/A SE0447 09/27/2004
SE0401 Announcing the New Medlearn MattersInformation for Medicare Providers Educational Resource for Medicare Providers N/A N/A SE0401 02/05/2004
SE0417 Centers for Medicare & Medicaid Services (CMS) Working to Improve Provider Enrollment Process N/A N/A SE0417 05/04/2004
SE0431 Skilled Nursing Facility Consolidated Billing N/A N/A SE0431 02/18/2005
SE0405 Reminder: Hospital Discounts Permitted for Indigent, Uninsured, and Underinsured Patients N/A N/A SE0405 03/24/2004
SE0413 Temporary Hold of Outpatient Claims Subject to the Outpatient Prospective Payment System (OPPS) in April 2004 N/A N/A SE0413 04/01/2004
SE0418 Non-Physician Practitioner Questions and Answers N/A N/A SE0418 08/16/2005
SE0403 Reminder of the Required Three-day Hospital Stay for SNF Admissions N/A N/A SE0403 02/03/2004
SE0435 Skilled Nursing Facility Consolidated Billing as It Relates to Dialysis Coverage N/A N/A SE0435 02/02/2004
SE0440 Skilled Nursing Facility Consolidated Billing as It Relates to Certain Diagnostic Tests N/A N/A SE0440 02/18/2004
SE0408 Modification of Requirements in CR2716, CWF Edits to Ensure Accurate Coding and Payments for Discharge and/or Transfer Policies N/A N/A SE0408 03/11/2004
SE0415 Reminder to Stop Duplicate Billings N/A N/A SE0415 04/29/2004
SE0420 MMA - Section 937 - Correction of Minor Errors and Omissions Without Appeals N/A N/A SE0420 04/30/2004
SE0425 Use of Group Health Plan Payment System for Medicare Disease Management Demonstration Serving Medicare Fee For Service Beneficiaries N/A N/A SE0425 03/10/2005
SE0406 Clarification of Epoetin Alfa (EPO) Billing Procedures and Codes in ESRD N/A N/A SE0406 08/23/2004
SE0414 Medicare Providers: Their Vendors, Clearinghouses, or Other Third-Party Billers and the HIPAA/Medicare Contingency Plan N/A N/A SE0414 04/16/2004
SE0419 MMA - CMS to Increase Payments to Hospitals Reclassified Under Medicare Reform Law N/A N/A SE0419 05/01/2004
SE0424 Clarification for Billing Left Ventricular Assist Devices N/A N/A SE0424 07/07/2004
SE0410 Medicare Resources for Researching Inpatient Discharges within 14 Days of a Home Health Admission N/A N/A SE0410 04/20/2004
SE0421 OIG Alert About Charging Extra for Covered Services N/A N/A SE0421 07/30/2004
SE0429 Clarification of Change Request 2631 N/A N/A SE0429 07/09/2004
SE0402 Treatment of Certain Dental Claims as a Result of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 N/A N/A SE0402 02/03/2004
SE0434 Skilled Nursing Facility Consolidated Billing and Erythropoietin (EPO, Epoetin Alfa) and Darbepoetin Alfa (Aranesp) N/A N/A SE0434 03/01/2005
SE0439 Skilled Nursing Facility Consolidated Billing as It Relates to Clinical Social Workers N/A N/A SE0439 02/18/2004
SE0411 Temporary Hold of Inpatient Claims in April 2004 N/A N/A SE0411 03/31/2004
SE0438 MMA - Medicare Prescription Drug, Improvement, and Modernization Act - Skilled Nursing Facility Consolidated Billing and Services of Rural Health Clinics and Federally Qualified Health Centers N/A N/A SE0438 02/18/2004
R15MSP Change in Interest Calculation for Medicare Overpayments and Underpayments and Medicare Secondary Payer (MSP) Recoveries 10/04/2004 3163 N/A N/A
R241CP Processing Part B Claims for Indian Health Services (HIS) 01/03/2005 3288 N/A N/A
R167CP Discontinued Use of Revenue Code 0910 10/04/2004 3194 N/A N/A
R103OTN ANSI X12 Transaction 835 Flat File and Companion Document Correction for Carriers and DMERCs, and Deletion of a Hard Coded Reason Code A2 that Has Been Deactivated 01/03/2005 3236 N/A N/A
R80PI PIM Fraud and Abuse Complaint Screening Revisions 08/16/2004 3341 N/A N/A
R231CP Indian Health Service (IHS) or Tribal Critical Access Hospital (CAH) Payment Methodology for Inpatient and Outpatient Services 01/03/2005 3235 N/A N/A
R160CP Section 511 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 Special Adjustment for Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Rates for Acquired Immune Deficiency Syndrome (AIDS) 10/04/2004 3291 MM3291 05/10/2004
R148CP Incident-To Services on Form CMS-1500 05/24/2004 3138 N/A N/A
R7P218 Cost Reporting Forms, Chapter 18 N/A N/A N/A N/A
R420CP Good Cause Waiver of Late Claim Filing Payment Reduction Penalty and Monitoring of Late Claims Submissions. Full Replacement of CR 3402, Which Was Rescinded 01/31/2005 3549 N/A N/A
R40FM Modification of CROWD Form 5 10/04/2004 3257 N/A N/A
R194CP July 2004 Update of the Hospital Outpatient Prospective Payment System (OPPS): Payment for Drugs, Biologicals and Radiopharmaceuticals 07/06/2004 3322 N/A N/A
R142CP Manualization for 2502 N/A 2502 N/A N/A
R19NCD Blood-Derived Products for Chronic Non-Healing Wounds 07/23/2004 3384 MM3384 08/11/2004
R16MSP Update Medicare Secondary Payer (MSP) Group Health Plan Recovery Demand Letters to Employers and Insurers for Data Match and Non-Data Match Debts 07/06/2004 3216 N/A N/A
R74PI SNF Certification and Recertification 05/24/2004 3150 N/A N/A
R216CP Manualization of INR Monitoring N/A 2323 N/A N/A
R159CP National 1-800-MEDICARE (1-800-633-4227) Implementation (section 923(d) of MMA) 06/01/2004 3195 N/A N/A
R359CP Annual Type of Service (TOS) 01/05/2005 3519 N/A N/A
R228CP General Policy 08/16/2004 3267 N/A N/A
R181CP Instructions for Downloading the Medicare Zip Code File 07/06/2004 3198 N/A N/A
R130aCP Chapter 32, Billing Instructions for Special Services N/A 2323 N/A N/A
R9BP Arrangements for Physical, Occupational, and Speech Language Pathology Services (PT, OT, SLP) 05/24/2004 3134 MM3134 04/29/2004
R8GI Standard Terminology for Claims Processing Systems 01/03/2005 3086 N/A N/A
R54OTN Introduction of "Medlearn Matters - Information for Medicare Providers" and Instructions for Carrier/Intermediary Use of This New Provider Education Vehicle 03/08/2004 3129 N/A N/A
R413CP Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Pricer Update FY 2005 for 9 Metropolitan Statistical Areas (MSAs) with New Wage Index Values Effective January 1, 2005 01/17/2005 3651 N/A N/A
R410CP Medicare HIPAA Electronic Claims Compliance Report - Reporting Timeframe Extension 02/07/2005 3611 N/A N/A
R235CP Instructions for Downloading the Medicare Zip Code File 01/03/2005 3340 N/A N/A
R166CP New DMERC/VIPS Systems Requirement 10/04/2004 2761 N/A N/A
R102OTN Update to the Healthcare Provider Taxonomy Codes (HPTC)/Medicare Specialty Code Crosswalk 01/03/2005 3259 N/A N/A
R412CP Skilled Nursing Facility (SNF) Consolidated Billing Service Furnished under an Arrangement with an Outside Entity 01/24/2005 3592 N/A N/A
R17NCD Manualization of the Negotiated Clinical Diagnostic Laboratory National Coverage Determinations N/A 2130 N/A N/A
R44FM Notice of New Interest Rate for Medicare Overpayments and Underpayments 05/07/2004 2830 N/A N/A
R5COM Introduction of "Medlearn Matters - Information for Medicare Providers" and Instructions for Carrier/Intermediary Use of This New Provider Education Vehicle 05/24/2004 3097 N/A N/A
R179CP Clarification to CR 3069 - New "K" Codes for Wheelchair Cushions 07/06/2004 3289 N/A N/A
R14MSP Chapter 5, Contractor Prepayment Processing Requirements N/A 2074 N/A N/A
R109CP Updated Policy and Claims Processing Instructions for Ambulatory Blood Pressure Monitoring (ABPM) 04/05/2004 2726 MM2726 03/31/2004
R26NCD Electrocardiographic Services 10/10/2004 3590 MM3590 12/27/2004
R411CP Ambulance Inflation Factor (AIF) 01/03/2005 3599 N/A N/A
R119OTN Shared System Maintainer Hours for Resolution of Problems Detected During Health Insurance Portability and Accountability Act (HIPAA) Transaction Release Testing 04/04/2005 3495 N/A N/A
R154CP Remittance Advice Remark Code and Claim Adjustment Reason Code Update 07/06/2004 3227 MM3227 05/12/2004
R313CP Remittance Advice Remark Code and Claim Adjustment Reason Code Update 01/03/2005 3466 MM3466 10/20/2004
R414CP Emergency Update to the 2005 Medicare Physician Fee Schedule Database 01/03/2005 3595 MM3595 01/12/2006
R24NCD Update to Chapter 1, Section 220.6 - Dementia and Neurodegenerative Diseases 10/04/2004 3426 MM3426 04/22/2005
R84PI Payment for Emergency Medical Treatment and Labor Act (EMTALA) - Mandated Screening and Stabilization Services 11/22/2004 3437 MM3437 10/28/2004
R131OTN Coverage of Routine Costs of Clinical Trials Involving Investigational Device Exemption (IDE) Category A Devices 04/04/2005 3548 MM3548 12/21/2004
R189CP Updated SNF Help File Available for Calendar Year 2004 06/28/2004 3252 MM3252 06/04/2004
R175CP Additional Health Insurance Portability and Accountability Act (HIPAA) X12N 837 Institutional Health Care Claim Implementation Guide (IG) Instruction and Clarification of Transmittal 107/100-04 (CR 3031) 10/04/2004 3264 MM3264 06/03/2004
R378CP Liability Days on Skilled Nursing Facility (SNF) and Swing Bed Facility Inpatient Bills 01/03/2005 3568 MM3568 01/04/2005
SE0443 MMA - Medicare Replacement Drug Demonstration N/A N/A SE0443 08/18/2004
SE0437 Skilled Nursing Facility Consolidated Billing as It Relates to Prosthetics and Orthotics N/A N/A SE0437 02/18/2004
SE0416 Referral of Patients for X-rays by Chiropractors N/A N/A SE0416 08/31/2005
SE0436 Skilled Nursing Facility Consolidated Billing and Preventive/Screening Services N/A N/A SE0436 02/18/2004
SE0422 MMA - New Medicare-Approved Drug Discount Cards and Transitional Assistance Program: A Summary for Physicians and Other Health Care Professionals N/A N/A SE0422 11/08/2004
SE0423 MMA - New Medicare-Approved Drug Discount Cards and Transitional Assistance Program: A Summary for Pharmacists and Other Pharmacy Professionals N/A N/A SE0423 10/28/2004
SE0458 MMA - Medicare-Approved Drug Discount Cards and Transitional Assistance Program: A Summary of New Initiative of Interest to Pharmacists and Pharmacy Professionals N/A N/A SE0458 10/22/2004
SE0457 MMA - Medicare-Approved Drug Discount Cards and Transitional Assistance Program: A Summary of New Initiative of Interest to Physicians and Other Health Care Professionals N/A N/A SE0457 10/22/2004
R23NCD Treatment of Obesity 10/01/2004 3502 MM3502 10/12/2004
SE0432 Skilled Nursing Facility Consolidated Billing as It Relates to Certain Types of Exceptionally Intensive Outpatient Hospital Services N/A N/A SE0432 02/22/2005
R300CP Payment For Outpatient End Stage Renal Disease (ESRD)-Related Services 10/18/2004 3414 MM3414 09/27/2004
R146CP Clarification of Billing for Separately Billable ESRD Drugs 10/04/2004 3176 MM3176 05/12/2004
SE0433 Skilled Nursing Facility Consolidated Billing as It Relates to Ambulance Services N/A N/A SE0433 02/18/2005
R407CP Hospital Billing for Repetitive Services 01/03/2005 3633 MM3633 12/27/2004
R23BP Revised Requirements for Chiropractic Billing of Active/Corrective Treatment and Maintenance Therapy. Full Replacement of CR 3063 10/04/2004 3449 MM3449 11/19/2004