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QPU April 2007

The Quarterly Provider Update provides a listing of Agency regulations and meeting notices. Non-regulatory changes to the Medicare and Medicaid programs, consisting of manual instructions, are also included in this listing.

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File Name Subject Publication/Implementation Date Quarterly Release Date
R432PR1 Inflation factors to update previous years reasonable compensation ranges. 05/04/2007 04/02/2007
R432PR1 Inflation factors to update previous years reasonable compensation ranges. 05/04/2007 04/02/2007
R432PR1 Inflation factors to update previous years reasonable compensation ranges. 05/04/2007 04/02/2007
CMS-6040-N2 Medicare Program; Approval of Deeming Authority for National Accreditation Organizations to Accredit Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers 05/25/2007 04/02/2007
CMS-1546-N Public Meeting for Payment for New Clinical Laboratory Tests--July 16, 2007 05/25/2007 04/02/2007
CMS-3172-N Meeting of the Medicare Coverage Advisory Committee--July 18, 2007 05/25/2007 04/02/2007
CMS-3188-NC Evaluation Criteria and Standards for Quality Improvement Program Contracts N/A 04/02/2007
CMS-2257-F Citizenship Documentation Requirements N/A 04/02/2007
CMS-0029-P Exemption of Privacy Act Disclosure of Certain Investigative Materials N/A 04/02/2007
CMS-1727-F Provider Reimbursement Determinations and Appeals N/A 04/02/2007
CMS-3173-N Medicare Evidence Development Coverage Advisory Committee Executive Committee for August 2007 N/A 04/02/2007
R1158CP Guidelines for Payment of Diabetes Self-Management Training 07/02/2007 04/02/2007
R1158CP Guidelines for Payment of Diabetes Self-Management Training 07/02/2007 04/02/2007
R1158CP Guidelines for Payment of Diabetes Self-Management Training 07/02/2007 04/02/2007
R1158CP Guidelines for Payment of Diabetes Self-Management Training 07/02/2007 04/02/2007
R1158CP Guidelines for Payment of Diabetes Self-Management Training 07/02/2007 04/02/2007
R1158CP Guidelines for Payment of Diabetes Self-Management Training 07/02/2007 04/02/2007
R1158CP Guidelines for Payment of Diabetes Self-Management Training 07/02/2007 04/02/2007
R1158CP Guidelines for Payment of Diabetes Self-Management Training 07/02/2007 04/02/2007
R1157CP Guidelines for Payment of Diabetes Self-Management Training 07/02/2007 04/02/2007
R1157CP Guidelines for Payment of Diabetes Self-Management Training 07/02/2007 04/02/2007
R1160CP Colorectal Cancer Screening Flexible Sigmoidoscopy & Colonoscopy Coinsurance Payment Change 07/02/2007 04/02/2007
R1160CP Colorectal Cancer Screening Flexible Sigmoidoscopy & Colonoscopy Coinsurance Payment Change 07/02/2007 04/02/2007
R1172CP Payment of Same Day Transfer Claims Under the LTCH PPS 07/02/2007 04/02/2007
R1173CP TIMELINESS STANDARDS FOR PROCESSING OTHER-THAN-CLEAN CLAIMS 07/02/2007 04/02/2007
R1173CP TIMELINESS STANDARDS FOR PROCESSING OTHER-THAN-CLEAN CLAIMS 07/02/2007 04/02/2007
R1173CP TIMELINESS STANDARDS FOR PROCESSING OTHER-THAN-CLEAN CLAIMS 07/02/2007 04/02/2007
R1177CP DME-Changes in Maintenance & Servicing Due to DRA Legislation for Capped Rentals & Oxygen Equipment 07/02/2007 04/02/2007
R1180CP Outpatient Clinical Laboratory Tests Furnished by Hospitals With Fewer Than 50 Beds in Qualified Areas 07/02/2007 04/02/2007
R1170CP Inpatient Psychiatric Facility PPS for Oncology Treatment Payment Adjustment 07/02/2007 04/02/2007
R1173CP TIMELINESS STANDARDS FOR PROCESSING OTHER-THAN-CLEAN CLAIMS 07/02/2007 04/02/2007
R1173CP TIMELINESS STANDARDS FOR PROCESSING OTHER-THAN-CLEAN CLAIMS 07/02/2007 04/02/2007
R1173CP TIMELINESS STANDARDS FOR PROCESSING OTHER-THAN-CLEAN CLAIMS 07/02/2007 04/02/2007
R1173CP TIMELINESS STANDARDS FOR PROCESSING OTHER-THAN-CLEAN CLAIMS 07/02/2007 04/02/2007
R1173CP TIMELINESS STANDARDS FOR PROCESSING OTHER-THAN-CLEAN CLAIMS 07/02/2007 04/02/2007
R1173CP TIMELINESS STANDARDS FOR PROCESSING OTHER-THAN-CLEAN CLAIMS 07/02/2007 04/02/2007
R1179CP DIFFERENTIATING MASS ADJUSTMENTS FROM OTHER TYPES OF ADJUSTMENTS AND CLAIMS FOR CROSSOVER PURPOSES AND REVISING THE DETAILED ERROR REPORT SPECIAL PRO 07/02/2007 04/02/2007
R1189CP DIFFERENTIATING MASS ADJUSTMENTS FROM OTHER TYPES OF ADJUSTMENTS AND CLAIMS FOR CROSSOVER PURPOSES AND REVISING THE DETAILED ERROR REPORT SPECIAL PRO 07/02/2007 04/02/2007
R1210CP New "K" Codes for Oral/Mask for Use with Continious Positive Airway Pressure Device 07/02/2007 04/02/2007
R261OTN Institutional Value Code Changes 07/02/2007 04/02/2007
R261OTN Institutional Value Code Changes 07/02/2007 04/02/2007
R261OTN Institutional Value Code Changes 07/02/2007 04/02/2007
R261OTN Institutional Value Code Changes 07/02/2007 04/02/2007
R261OTN Institutional Value Code Changes 07/02/2007 04/02/2007
R1210CP New "K" Codes for Oral/Mask for Use with Continious Positive Airway Pressure Device 07/02/2007 04/02/2007
R1210CP New "K" Codes for Oral/Mask for Use with Continious Positive Airway Pressure Device 07/02/2007 04/02/2007
R261OTN Institutional Value Code Changes 07/02/2007 04/02/2007
R261OTN Institutional Value Code Changes 07/02/2007 04/02/2007
R261OTN Institutional Value Code Changes 07/02/2007 04/02/2007
R64BP Guidelines for Payment of Diabetes Self-Management Training 07/02/2007 04/02/2007
R64BP Guidelines for Payment of Diabetes Self-Management Training 07/02/2007 04/02/2007
R64BP Guidelines for Payment of Diabetes Self-Management Training 07/02/2007 04/02/2007
R64BP Guidelines for Payment of Diabetes Self-Management Training 07/02/2007 04/02/2007
R64BP Guidelines for Payment of Diabetes Self-Management Training 07/02/2007 04/02/2007
R64BP Guidelines for Payment of Diabetes Self-Management Training 07/02/2007 04/02/2007
R64BP Guidelines for Payment of Diabetes Self-Management Training 07/02/2007 04/02/2007
R64BP Guidelines for Payment of Diabetes Self-Management Training 07/02/2007 04/02/2007
R222PI Discontinuance of the Unique Physician Identification Number (UPIN) Registry 06/29/2007 04/02/2007
R222PI Discontinuance of the Unique Physician Identification Number (UPIN) Registry 06/29/2007 04/02/2007
R222PI Discontinuance of the Unique Physician Identification Number (UPIN) Registry 06/29/2007 04/02/2007
R222PI Discontinuance of the Unique Physician Identification Number (UPIN) Registry 06/29/2007 04/02/2007
R222PI Discontinuance of the Unique Physician Identification Number (UPIN) Registry 06/29/2007 04/02/2007
R222PI Discontinuance of the Unique Physician Identification Number (UPIN) Registry 06/29/2007 04/02/2007
R222PI Discontinuance of the Unique Physician Identification Number (UPIN) Registry 06/29/2007 04/02/2007
R222PI Discontinuance of the Unique Physician Identification Number (UPIN) Registry 06/29/2007 04/02/2007
R222PI Discontinuance of the Unique Physician Identification Number (UPIN) Registry 06/29/2007 04/02/2007
R222PI Discontinuance of the Unique Physician Identification Number (UPIN) Registry 06/29/2007 04/02/2007
R222PI Discontinuance of the Unique Physician Identification Number (UPIN) Registry 06/29/2007 04/02/2007
R222PI Discontinuance of the Unique Physician Identification Number (UPIN) Registry 06/29/2007 04/02/2007
R222PI Discontinuance of the Unique Physician Identification Number (UPIN) Registry 06/29/2007 04/02/2007
R222PI Discontinuance of the Unique Physician Identification Number (UPIN) Registry 06/29/2007 04/02/2007
CMS-1270-RCN Competitive Acquisition for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies; Extension of Timeline for Publication of Final Rule 04/05/2007 04/02/2007
R1218CP Program Instructions Designating the Competitive Bidding Areas and Product Categories Included in the CY 2007 DMEPOS Competitive Bid Program 04/02/2007 04/02/2007
CMS-1274-NC Announcement of Applications From Two Hospitals Requesting Waivers for Organ Procurement Service Areas 05/25/2007 04/02/2007
CMS-1529-F Prospective Payment System for Long-Term Care Hospitals RY 2008: Annual Payment Rate Updates, Policy Changes, Clarifications, and Hospital Direct and Indirect Graduate Medical Education Payments 05/11/2007 04/02/2007
R1255CP Guidelines for Payment of Diabetes Self-Management Training (DSMT) 07/02/2007 04/02/2007
R1247CP New Deadline for Required Submission of the Form CMS-1500 (08-05) 07/01/2007 04/02/2007
CMS-1541-P Home Health Prospective Payment System Refinement and Rate Update for Calendar Year 2008 05/11/2007 04/02/2007
CMS-1539-P Hospice Wage Index for FY 2008 05/01/2007 04/02/2007
CMS-1551-P Prospective Payment System for Inpatient Rehabilitation Facilities for FY 2008 05/08/2007 04/02/2007
R207PI Discontinuance of the Unique Physician Identification Number Registry 06/29/2007 04/02/2007
R1247CP New Deadline for Required Submission of the Form CMS-1500 (08-05) 07/01/2007 04/02/2007
R1248CP Revisions, in the Medicare Claims Processing Manual, to Section 40, titled, "Discarded Drugs and Biologicals," and Section 100.2.9, titled, "Submission of Claims With the Modifier JW, 'Drug Amount Discarded/Not Administered to Any Patient.'" 07/02/2007 04/02/2007
R1247CP New Deadline for Required Submission of the Form CMS-1500 (08-05) 07/01/2007 04/02/2007
CMS-2258-FC Cost Limit for Providers Operated by Units of Government and Provisions To Ensure the Integrity of Federal-State Financial Partnership 05/29/2007 04/02/2007
CMS-2241-N State Children's Health Insurance Program (SCHIP); Redistribution of Unexpended SCHIP Funds From the Appropriations for Fiscal Year 2004 and Fiscal Year 2005 To Eliminate SCHIP Fiscal Year 2007 Funding Shortfalls; and Provisions for Continued Authority for Qualifying States To Use a Portion of Certain SCHIP Funds for Medicaid Expenditures 05/29/2007 04/02/2007
R1251CP Clarification of the National Provider Identifier (NPI) Reporting Requirements for Ambulance Service Claims 07/02/2007 04/02/2007
R1252CP Clarification of Skilled Nursing Facility (SNF) No Pay Billing 08/27/2007 04/02/2007
R1261CP Revised HCPCs Codes Relating to Immune Globulin 07/02/2007 04/02/2007
R1263CP July Quarterly Update for 2007 Durable Medicare Equipment, Prosthetics, Orthotice, and Supplies Fee Schedule 07/02/2007 04/02/2007
R17P236 HOSPITAL & HOSPITAL HEALTH CARE COMPLEX COST REPORT N/A 04/02/2007
R206PI Discontinuance of the UPIN Registry 06/29/2007 04/02/2007
R274OTN Invalid Skilled Nursing Facility (SNF) Informational Unsolicited Responses (IURs) from CWF. 07/02/2007 04/02/2007
R1227CP Medicare Fee for Service (FFS) National Provider Identifier (NPI) Implementation Contingency Plan 05/23/2007 04/02/2007
R1233CP Clarification of Bariatric Surgery Billing Requirements Issued in CR 5013 05/29/2007 04/02/2007
R1253CP Quarterly Update to MUEs 07/02/2007 04/02/2007
R72BP Guidelines for Payment of Diabetes Self-Management Training (DSMT) 07/02/2007 04/02/2007
R1255CP Guidelines for Payment of Diabetes Self-Management Training (DSMT) 07/02/2007 04/02/2007
R1260CP July 2007 Quarterly Update to the HCPCS Codes for Albuterol, Levalbuterol, and Reclast 07/02/2007 04/02/2007
R1260CP July 2007 Quarterly Update to the HCPCS Codes for Albuterol, Levalbuterol, and Reclast 07/02/2007 04/02/2007
R1260CP July 2007 Quarterly Update to the HCPCS Codes for Albuterol, Levalbuterol, and Reclast 07/02/2007 04/02/2007
R1260CP July 2007 Quarterly Update to the HCPCS Codes for Albuterol, Levalbuterol, and Reclast 07/02/2007 04/02/2007
CMS-6060-N HIPAA Administrative Simplification: National Plan and Provider Enumeration System (NPPES) Data Dissemination 05/30/2007 04/02/2007
R72BP Guidelines for Payment of Diabetes Self-Management Training (DSMT) 07/02/2007 04/02/2007
R72BP Guidelines for Payment of Diabetes Self-Management Training (DSMT) 07/02/2007 04/02/2007
R72BP Guidelines for Payment of Diabetes Self-Management Training (DSMT) 07/02/2007 04/02/2007
R72BP Guidelines for Payment of Diabetes Self-Management Training (DSMT) 07/02/2007 04/02/2007
R72BP Guidelines for Payment of Diabetes Self-Management Training (DSMT) 07/02/2007 04/02/2007
R72BP Guidelines for Payment of Diabetes Self-Management Training (DSMT) 07/02/2007 04/02/2007
R72BP Guidelines for Payment of Diabetes Self-Management Training (DSMT) 07/02/2007 04/02/2007
R1255CP Guidelines for Payment of Diabetes Self-Management Training (DSMT) 07/02/2007 04/02/2007
R1256CP Update--Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) for Rate Year (RY) 2008 07/02/2007 04/02/2007
R1259CP July 2007 Update of the Hospital Outpatient Prospective Payment System (--- Summary of Payment Policy Changes 07/02/2007 04/02/2007
R1258CP July Update to the 2007 Medicare Physician Fee Schedule Database 07/02/2007 04/02/2007
R71BP Clarification of Manual Instruction Regarding the Scope of Portable X-Ray Benefit 07/02/2007 04/02/2007
R1270CP July 2007 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing File, Effective July 1, 2007, and Revisions to the January 2007 and April 2007 Quarterly ASP Medicare Part B Drug Pricing Files 07/02/2007 04/02/2007
R283OTN Notifying Affected Parties Regarding Changes to the Mandatory Medigap ("Claims-Based") Crossover Process 07/16/2007 04/02/2007
R1264CP July 2007 Integrated Outpatient Code Editor (I/OCE) Specifications Version 8.2 07/02/2007 04/02/2007
R1270CP July 2007 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing File, Effective July 1, 2007, and Revisions to the January 2007 and April 2007 Quarterly ASP Medicare Part B Drug Pricing Files 07/02/2007 04/02/2007
R1270CP July 2007 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing File, Effective July 1, 2007, and Revisions to the January 2007 and April 2007 Quarterly ASP Medicare Part B Drug Pricing Files 07/02/2007 04/02/2007
CMS-9040-N Quarterly Issuances Notice - January -- March 2007 06/22/2007 04/02/2007
R1264CP July 2007 Integrated Outpatient Code Editor (I/OCE) Specifications Version 8.2 07/02/2007 04/02/2007
R1264CP July 2007 Integrated Outpatient Code Editor (I/OCE) Specifications Version 8.2 07/02/2007 04/02/2007
R1264CP July 2007 Integrated Outpatient Code Editor (I/OCE) Specifications Version 8.2 07/02/2007 04/02/2007
R71BP Clarification of Manual Instruction Regarding the Scope of Portable X-Ray Benefit 07/02/2007 04/02/2007
R1264CP July 2007 Integrated Outpatient Code Editor (I/OCE) Specifications Version 8.2 07/02/2007 04/02/2007
R1264CP July 2007 Integrated Outpatient Code Editor (I/OCE) Specifications Version 8.2 07/02/2007 04/02/2007
R1264CP July 2007 Integrated Outpatient Code Editor (I/OCE) Specifications Version 8.2 07/02/2007 04/02/2007
R1264CP July 2007 Integrated Outpatient Code Editor (I/OCE) Specifications Version 8.2 07/02/2007 04/02/2007
R87MCM Update of Chapter 4, Benefits and Beneficiary Protections 07/02/2007 04/02/2007
CMS-1541-CN Home Health Prospective Payment System Refinement and Rate Update for Calendar Year 2008; Correction 06/18/2007 04/02/2007
R1267CP Remittance Advice Remark Code (RARC) and Claim Adjustment Reason Code (CARC) Update and MREP Enhancement 07/02/2007 04/02/2007
R1268CP Update Long-Term Care Hospital Prospective Payment System (LTCH PPS) Rate Year 2008 07/02/2007 04/02/2007
R1265CP Quarterly Update to MUEs 07/02/2007 04/02/2007
R283OTN Notifying Affected Parties Regarding Changes to the Mandatory Medigap ("Claims-Based") Crossover Process 07/16/2007 04/02/2007
R283OTN Notifying Affected Parties Regarding Changes to the Mandatory Medigap ("Claims-Based") Crossover Process 07/16/2007 04/02/2007
R283OTN Notifying Affected Parties Regarding Changes to the Mandatory Medigap ("Claims-Based") Crossover Process 07/16/2007 04/02/2007
R283OTN Notifying Affected Parties Regarding Changes to the Mandatory Medigap ("Claims-Based") Crossover Process 07/16/2007 04/02/2007
R283OTN Notifying Affected Parties Regarding Changes to the Mandatory Medigap ("Claims-Based") Crossover Process 07/16/2007 04/02/2007
R1271CP Vagus Nerve Stimulation (VNS) for Resistant Depression 07/23/2007 04/02/2007
R1278CP Update to Chapter 18, Section 10-Clarification of Existing Instructions and New Reporting Requirements for Form CMS-1500... 07/01/2007 04/02/2007
CMS-1727-RCN Provider Reimbursement Determinations and Appeals; Extension of Timeline for Publication of Final Rule 06/22/2007 04/02/2007
R70NCD Vagus Nerve Stimulation (VNS) for Resistant Depression 07/23/2007 04/02/2007
R1270CP July 2007 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing File, Effective July 1, 2007, and Revisions to the January 2007 and April 2007 Quarterly ASP Medicare Part B Drug Pricing Files 07/02/2007 04/02/2007
R1270CP July 2007 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing File, Effective July 1, 2007, and Revisions to the January 2007 and April 2007 Quarterly ASP Medicare Part B Drug Pricing Files 07/02/2007 04/02/2007
R1271CP Vagus Nerve Stimulation (VNS) for Resistant Depression 07/23/2007 04/02/2007
R70NCD Vagus Nerve Stimulation (VNS) for Resistant Depression 07/23/2007 04/02/2007
CMS-2268-P Establishment of Quality-Based Revisit User Fee Program for Medicare Survey and Certification Activities 06/29/2007 04/02/2007
R71NCD Percutaneous Transluminal Angioplasty 07/30/2007 04/02/2007
R71NCD Percutaneous Transluminal Angioplasty 07/30/2007 04/02/2007
CMS-1270-F Competitive Acquisition for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies 04/10/2007 04/02/2007
CMS-1321-F2 Revisions to Payment Policies, Five-Year Review of Work Relative Value Units, and Changes to the Practice Expense Methodology Under the Physician Fee Schedule, and Other Changes to Payment Under Part B; Correcting Amendment 04/16/2007 04/02/2007
R69NCD Bone Mass Measurements (BMMs) 07/02/2007 04/02/2007
R69NCD Bone Mass Measurements (BMMs) 07/02/2007 04/02/2007
R1236CP Bone Mass Measurements (BMMs) 07/02/2007 04/02/2007
R207PI Discontinuance of the Unique Physician Identification Number Registry 06/29/2007 04/02/2007
R207PI Discontinuance of the Unique Physician Identification Number Registry 06/29/2007 04/02/2007
R277OTN Physician Quality Reporting Initiative Coding Reporting Principles 05/18/2007 04/02/2007
CMS-2279-P Graduate Medical Education 05/23/2007 04/02/2007
R1243CP Quarterly Update to Correct Coding Initiative Edits, Version 13.2, Effective July 1, 2007 07/02/2007 04/02/2007
R13P232 To reflect further clarification to existing instructions and incorporates 05/18/2007 04/02/2007
R1244CP New Waived Test 07/02/2007 04/02/2007
R277OTN Physician Quality Reporting Initiative Coding Reporting Principles 05/18/2007 04/02/2007
CMS-4130-P Policy and Technical Changes to the Medicare Prescription Drug Benefit 05/25/2007 04/02/2007
R70BP Bone Mass Measurements (BMMs) 07/02/2007 04/02/2007
CMS-3181-PN Application by the American Diabetes Association for Continued Recognition as a National Accreditation Program for Accrediting Entities To Furnish Outpatient Diabetes Self-Management Training 05/25/2007 04/02/2007
CMS-4124-P Medicare Advantage and Part D Prescription Drug Contract Determinations, Appeals, and Intermediate Sanctions Processes 05/25/2007 04/02/2007
R70BP Bone Mass Measurements (BMMs) 07/02/2007 04/02/2007
R1236CP Bone Mass Measurements (BMMs) 07/02/2007 04/02/2007
R1255CP Guidelines for Payment of Diabetes Self-Management Training (DSMT) 07/02/2007 04/02/2007
R207PI Discontinuance of the Unique Physician Identification Number Registry 06/29/2007 04/02/2007
R207PI Discontinuance of the Unique Physician Identification Number Registry 06/29/2007 04/02/2007
R207PI Discontinuance of the Unique Physician Identification Number Registry 06/29/2007 04/02/2007
R207PI Discontinuance of the Unique Physician Identification Number Registry 06/29/2007 04/02/2007
R207PI Discontinuance of the Unique Physician Identification Number Registry 06/29/2007 04/02/2007
R207PI Discontinuance of the Unique Physician Identification Number Registry 06/29/2007 04/02/2007
R207PI Discontinuance of the Unique Physician Identification Number Registry 06/29/2007 04/02/2007
R432PR1 Inflation factors to update previous years reasonable compensation ranges. 05/04/2007 04/02/2007
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