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2008 Carrier/A/B MAC Update

NOTE:  CR 6180, Transmittal 1580, issued August 22, 2008, revised the Professional Component/Technical Component designation for codes 92557 and 92567 from “0” to “9.”  This change is effective retroactively back to January 1, 2008.  As of January 5, 2009, File 1 will be updated to reflect that change.  Separate payment will no longer be allowed for these codes when submitted after this date, with dates of service on or after January 1, 2008. 

2008 Fourth Quarterly Update (Note: There were no First and Second updates)

The following coding change was implemented for claims with dates of service on or after January 1, 2008.  L5670 was inadvertently left off the Skilled Nursing Facility (SNF) coding files as a separately payable code outside of consolidated billing.

Coding File 1

ADD – L5670

If you have claims incorrectly denied, contact your Medicare carrier to have the claims reopened and reprocessed.

2008 Third Quarterly Update (Note: There were no First and Second updates):

The following coding change was implemented for claims with dates of service on or after January 1, 2008.

Coding File 1

ADD – J9303

When brought to their attention, Carriers shall reopen and reprocess claims for any of these services incorrectly denied.

2008 Annual Carrier Update

The SNF consolidated billing files reflect new codes that have been developed for 2008 and codes that have been discontinued for 2008. In addition, the files reflect any additions and deletions to categories of services excluded from consolidated billing. These files are effective for claims with dates of service on or after 1/01/2008 unless otherwise noted.

File 1 - Part A Stay - Physician Services (see file below)

Note: Services represented by these codes are not subject to skilled nursing facility (SNF) consolidated billing for Medicare beneficiaries in a SNF Part A covered stay. They should be submitted to the Part B Medicare carrier or Durable Medical Equipment Regional Carrier, as appropriate, for payment consideration.

File 2 - Part A Stay - Professional Components of Services to be Submitted with a 26 Modifier (see file below)

Note: The professional component of the services represented by these codes are not subject to skilled nursing facility (SNF) consolidated billing and will be considered for payment by the Part B Medicare carrier for Medicare beneficiaries in a SNF Part A stay. These codes must be submitted with a modifier of 26 to indicate "professional component".

File 3 - Part A Stay - Ambulance (see file below)

Note: These are ambulance codes that will always be denied by the Part B Medicare carrier for Medicare beneficiaries in a skilled nursing facility Part A covered stay when submitted with an NN modifier. Effective 10/4/04, per Transmittal 163, these ambulance codes will also be denied when submitted with modifiers ND or DN.

In addition, when not subject to SNF CB, certain codes for drugs and EKG testing provided during an ambulance transport to or from a SNF may be separately payable during the transition to the Ambulance Fee Schedule. (This policy applies only to Method 3 and 4 ambulance suppliers, and only in those areas where suppliers are eligible to bill separately for these services.) Contact your local carrier for additional information.

File 4 - Part B Stay Only - Therapy Services (see file below)

Note: Services represented by these codes are the only services subject to skilled nursing facility (SNF) consolidated billing for Medicare beneficiaries in a SNF Part B stay. The file includes codes for physical, occupational and speech therapy. The Part B Medicare carrier will always deny these codes for Medicare beneficiaries in a SNF Part B stay. Therapy services must be provided and billed under arrangement with the SNF.