Medicare and Medicaid Programs; Quarterly Listing of Program Issuances-January 2003 Through March 2003

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-9017-N]

Medicare and Medicaid Programs; Quarterly Listing of Program Issuances—January 2003 Through March 2003

AGENCY:

Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION:

Notice.

SUMMARY:

This notice lists CMS manual instructions, substantive and interpretive regulations, and other

Federal Register

notices that were published from January 2003 through March 2003, relating to the Medicare and Medicaid programs. This notice provides information on national coverage determinations affecting specific medical and health care services under Medicare. Additionally, this notice identifies certain devices with investigational device exemption numbers approved by the Food and Drug Administration that potentially may be covered under Medicare. Finally, this notice also includes listings of all approval numbers from the Office of Management and Budget for collections of information in CMS regulations.

Section 1871(c) of the Social Security Act requires that we publish a list of Medicare issuances in the

Federal Register

at least every 3 months. Although we are not mandated to do so by statute, for the sake of completeness of the listing, we are also including all Medicaid issuances and Medicare and Medicaid substantive and interpretive regulations (proposed and final) published during this timeframe.

FOR FURTHER INFORMATION CONTACT:

It is possible that an interested party may have a specific information need and not be able to determine from the listed information whether the issuance or regulation would fulfill that need. Consequently, we are providing information contact persons to answer general questions concerning these items. Copies are not available through the contact persons. (See Section III of this notice for how to obtain listed material.)

Questions concerning items in Addendum III may be addressed to Karen Bowman, Office of Strategic Operations and Regulatory Affairs, Centers for Medicare & Medicaid Services, C5-16-03, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-5252.

Questions concerning national coverage determinations in Addendum V should be directed to Patricia Brocato-Simons, Office of Clinical Standards and Quality, Centers for Medicare & Medicaid Services, C1-09-06, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-0261.

Questions concerning Investigational Device Exemptions items in Addendum VI may be addressed to Sharon Hippler, Office of Clinical Standards and Quality, Centers for Medicare & Medicaid Services, C5-13-27, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-4633.

Questions concerning approval numbers for collections of information in Addendum VII may be addressed to Dawn Willingham, Office of Strategic Operations and Regulatory Affairs, Regulations Development and Issuances Group, Centers for Medicare & Medicaid Services, C5-09-26, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-6141.

Questions concerning all other information may be addressed to Margie Teeters, Office of Strategic Operations and Regulatory Affairs, Regulations Development and Issuances Group, Centers for Medicare & Medicaid Services, C5-13-18, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-4678.

SUPPLEMENTARY INFORMATION:

I. Program Issuances

The Centers for Medicare & Medicaid Services (CMS) is responsible for administering the Medicare and Medicaid programs. These programs pay for health care and related services for 39 million Medicare beneficiaries and 35 million Medicaid recipients. Administration of these programs involves (1) furnishing information to Medicare beneficiaries and Medicaid recipients, health care providers, and the public and (2) maintaining effective communications with regional offices, State governments, State Medicaid agencies, State survey agencies, various providers of health care, fiscal intermediaries and carriers that process claims and pay bills, and others. To implement the various statutes on which the programs are based, we issue regulations under the authority granted to the Secretary of the Department of Health and Human Services under sections 1102, 1871, 1902, and related provisions of the Social Security Act (the Act). We also issue various manuals, memoranda, and statements necessary to administer the programs efficiently.

Section 1871(c)(1) of the Act requires that we publish a list of all Medicare manual instructions, interpretive rules, statements of policy, and guidelines of general applicability not issued as regulations at least every 3 months in the

Federal Register

. We published our first notice June 9, 1988 (53 FR 21730). Although we are not mandated to do so by statute, for the sake of completeness of the listing of operational and policy statements, we are continuing our practice of including Medicare substantive and interpretive regulations (proposed and final) published during the 3-month time frame.

II. How To Use the Addenda

This notice is organized so that a reader may review the subjects of manual issuances, memoranda, substantive and interpretive regulations, national coverage determinations, and Food and Drug Administration-approved investigational device exemptions published during the timeframe to determine whether any are of particular interest. We expect this notice to be used in concert with previously published notices. Those unfamiliar with a description of our Medicare manuals may wish to review Table I of our first three notices (53 FR 21730, 53 FR 36891, and 53 FR 50577) published in 1988, and the notice published March 31, 1993 (58 FR 16837). Those desiring information on the Medicare Coverage Issues Manual (CIM) may wish to review the August 21, 1989 publication (54 FR 34555). Those interested in the procedures used in making national coverage determinations under the Medicare program may review the April 27, 1999 publication (64 FR 22619).

To aid the reader, we have organized and divided this current listing into six addenda:

• Addendum I lists the publication dates of the most recent quarterly listings of program issuances.

• Addendum II identifies previous

Federal Register

documents that contain a description of all previously published CMS Medicare and Medicaid manuals and memoranda.

• Addendum III lists a unique CMS transmittal number for each instruction in our manuals or Program Memoranda and its subject matter. A transmittal may consist of a single instruction or many. Often, it is necessary to use information in a transmittal in conjunction with information currently in the manuals.

• Addendum IV lists all substantive and interpretive Medicare and Medicaid regulations and general notices published in the

Federal Register

during the quarters covered by this notice. For each item we list the—

• Date published;

•

Federal Register

citation;

• Parts of the Code of Federal Regulations (CFR) that have changed (if applicable);

• Agency file code number; and

• Title of the regulation.

• Addendum V includes completed national coverage determinations (NCDs), or reconsiderations of completed NCDs, from the quarter covered by this notice. Completed decisions are identified by the section of the CIM in which the decision appears, the title, the date the publication was issued, and the effective date of the decision.

• Addendum VI includes listings of the Food and Drug Administration-approved investigational device exemption categorizations, using the investigational device exemption numbers the Food and Drug Administration assigns. The listings are organized according to the categories to which the device numbers are assigned (that is, Category A or Category B), and identified by the investigational device exemption number.

• Addendum VII includes listings of all approval numbers from the Office of Management and Budget (OMB) for collections of information in CMS regulations in title 42 of the Code of Federal Regulations (CFR) and in title 45 CFR, subchapter C. These collections of information, which OMB has approved, are being included for the first time in this quarterly listing of program issuances.

III. How To Obtain Listed Material

A. Manuals

Those wishing to subscribe to program manuals should contact either the Government Printing Office (GPO) or the National Technical Information Service (NTIS) at the following addresses:

Superintendent of Documents, Government Printing Office, Attn: New Orders, P.O. Box 371954, Pittsburgh, PA 15250-7954, Telephone (202) 512-1800, Fax number (202) 512-2250 (for credit card orders); or

National Technical Information Service, Department of Commerce, 5825 Port Royal Road, Springfield, VA 22161, Telephone (703) 487-4630.

In addition, individual manual transmittals and Program Memoranda listed in this notice can be purchased from NTIS. Interested parties should identify the transmittal(s) they want. GPO or NTIS can give complete details on how to obtain the publications they sell. Additionally, most manuals are available at the following Internet address:

http://cms.hhs.gov/manuals/default.asp.

B. Regulations and Notices

Regulations and notices are published in the daily

Federal Register

. Interested individuals may purchase individual copies or subscribe to the

Federal Register

by contacting the GPO at the address given above. When ordering individual copies, it is necessary to cite either the date of publication or the volume number and page number.

The

Federal Register

is also available on 24x microfiche and as an online database through

GPO Access.

The online database is updated by 6 a.m. each day the

Federal Register

is published. The database includes both text and graphics from Volume 59, Number 1 (January 2, 1994) forward. Free public access is available on a Wide Area Information Server (WAIS) through the Internet and via asynchronous dial-in. Internet users can access the database by using the World Wide Web; the Superintendent of Documents Home page address is

http://www.access.gpo.gov/nara/index.html,

by using local WAIS client software, or by telnet to

swais.access.gpo.gov,

then log in as guest (no password required). Dial-in users should use communications software and modem to call (202) 512-1661; type swais, then log in as guest (no password required).

C. Rulings

We publish rulings on an infrequent basis. Interested individuals can obtain copies from the nearest CMS Regional Office or review them at the nearest regional depository library. We have, on occasion, published rulings in the

Federal Register

. Rulings, beginning with those released in 1995, are available online, through the CMS Home Page. The Internet address is

http://cms.hhs.gov/rulings.

D. CMS's Compact Disk-Read Only Memory (CD-ROM)

Our laws, regulations, and manuals are also available on CD-ROM and may be purchased from GPO or NTIS on a subscription or single copy basis. The Superintendent of Documents list ID is HCLRM, and the stock number is 717-139-00000-3. The following material is on the CD-ROM disk:

• Titles XI, XVIII, and XIX of the Act.

• CMS-related regulations.

• CMS manuals and monthly revisions.

• CMS program memoranda.

The titles of the Compilation of the Social Security Laws are current as of January 1, 1999. (Updated titles of the Social Security Laws are available on the Internet at

http://www.ssa.gov/OP_Home/ssact/comp-toc.htm.

) The remaining portions of CD-ROM are updated on a monthly basis.

Because of complaints about the unreadability of the Appendices (Interpretive Guidelines) in the State Operations Manual (SOM), as of March 1995, we deleted these appendices from CD-ROM. We intend to re-visit this issue in the near future and, with the aid of newer technology, we may again be able to include the appendices on CD-ROM.

Any cost report forms incorporated in the manuals are included on the CD-ROM disk as LOTUS files. LOTUS software is needed to view the reports once the files have been copied to a personal computer disk.

IV. How To Review Listed Material

Transmittals or Program Memoranda can be reviewed at a local Federal Depository Library (FDL). Under the FDL program, government publications are sent to approximately 1,400 designated libraries throughout the United States. Some FDLs may have arrangements to transfer material to a local library not designated as an FDL. Contact any library to locate the nearest FDL.

In addition, individuals may contact regional depository libraries that receive and retain at least one copy of most Federal Government publications, either in printed or microfilm form, for use by the general public. These libraries provide reference services and interlibrary loans; however, they are not sales outlets. Individuals may obtain information about the location of the nearest regional depository library from any library.

Superintendent of Documents numbers for each CMS publication are shown in Addendum III, along with the CMS publication and transmittal numbers. To help FDLs locate the materials, use the Superintendent of Documents number, plus the transmittal number. For example, to find the Part 3—Claims Process, (CMS Pub. 13-3) transmittal entitled “Ambulance Services,” use the Superintendent of Documents No. HE 22.8/6 and the transmittal number 1877.

(Catalog of Federal Domestic Assistance Program No. 93.773, Medicare—Hospital Insurance, Program No. 93.774, Medicare—Supplementary Medical Insurance Program,

and Program No. 93.714, Medical Assistance Program)

Dated: June 19, 2003.

Jacquelyn Y. White,

Director, Office of Strategic Operations and Regulatory Affairs.

Addendum I

This addendum lists the publication dates of the most recent quarterly listings of program issuances.

August 11, 1998 (63 FR 42857)

September 16, 1998 (63 FR 49598)

December 9, 1998 (63 FR 67899)

May 11, 1999 (64 FR 25351)

November 2, 1999 (64 FR 59185)

December 7, 1999 (64 FR 68357)

January 10, 2000 (65 FR 1400)

May 30, 2000 (65 FR 34481)

June 28, 2002 (67 FR 43762)

September 27, 2002 (67 FR 61130)

December 27, 2002 (67 FR 79109)

March 28, 2003 (68 FR 15196)

Addendum II—Description of Manuals, Memoranda, and CMS Rulings

An extensive descriptive listing of Medicare manuals and memoranda was published on June 9, 1988, at 53 FR 21730 and supplemented on September 22, 1988, at 53 FR 36891 and December 16, 1988, at 53 FR 50577. Also, a complete description of the Medicare Coverage Issues Manual (CIM) was published on August 21, 1989, at 54 FR 34555. A brief description of the various Medicaid manuals and memoranda that we maintain was published on October 16, 1992 (57 FR 47468).

Addendum III.—Medicare and Medicaid Manual Instructions

[January 2003 through March 2003]

Transmittal No.

Manual/subject/publication No.

Intermediary Manual

Part 2—Audits, Reimbursement, Program

Administration

(CMS-Pub. 13-2)

(Superintendent of Documents No. HE 22.8/6-3)

421

•

Provider Communications—Provider Education and Training

422

•

Beneficiary Services

423

•

Provider Services, Inquiries

Intermediary Manual

Part 3—Claims Process

(CMS-Pub. 13-3)

(Superintendent of Documents No. HE 22.8/6)

1872

•

Prospective Payment for Outpatient Rehabilitation Services and the Financial Limitation

1873

•

Pneumococcal Pneumonia, Influenza Virus and Hepatitis B Vaccines

1874

•

Pneumococcal Pneumonia, Influenza Virus and Hepatitis B Vaccines

1875

•

Review of Form HCFA-1450 for Inpatient and Outpatient Bills

1876

•

Bill Review for Partial Hospitalization Services Provided in Community Mental Health Centers

Hospital Outpatient Partial Hospitalization Services

1877

•

Ambulance Services

1878

•

Intestinal and Multi-Visceral Transplants

Provider Education

Carriers Manual

Part 2—Program Administration

(Superintendent of Documents No. HE 22.8/7-3)

(CMS-Pub. 14-2)

146

•

Provider/Supplier Communications—Provider/Supplier Education and Training

147

•

Beneficiary Services

148

•

Provider Services, Inquiries

Carriers Manual

Part 3—Claims Process

(CMS-Pub. 14-3)

(Superintendent of Documents No. HE 22.8/7)

1785

•

Coding for Non-Covered Services and Services Not Reasonable and Necessary

1786

•

Carrier Use of Undeliverable Notices for Utilization, Fraud, and Quality Control

1787

•

Ordering Diagnostic Tests

Payment Conditions for Radiology Services

1788

•

HCPCS Coding

1789

•

Railroad Retirement Beneficiary Carrier

United Mine Workers of America

Title XIX Beneficiaries Residing in California

Disposition of Misdirected Claims

1790

•

Zip Code File on the Direct Connect

1791

•

Disposition of Misdirected Claims

Parenteral and Enteral Nutrition (PEN) Claims Jurisdiction

1792

•

Claims Processing Procedures for Physician/Supplier Services to HMO Members

Program Memorandum

Intermediaries (CMS-Pub. 60A)

(Superintendent of Documents No. HE 22.8/6-5)

A-02-128

•

Revision to 42 CFR 405.371 Suspension, Offset and Recoupment of Medicare Payments to Providers and Suppliers of Services

A-02-129

•

2003 Update of the Hospital Outpatient Prospective Payment System

A-03-001

•

January Medicare Outpatient Code Editor Specifications Version 18.1 For Bills From Hospitals That Are Not Paid Under the Outpatient Prospective Payment System

A-03-002

•

Installation of Version 28.0 Add-On of the Provider Statistical and Reimbursement Report

A-03-003

•

January Outpatient Code Editor Specifications Version (V4.0)

A-03-004

•

Calculating Provider-Specific Medicare Outpatient Cost-to-Charge Ratios and Instructions on Cost Report Treatment of Hospital Outpatient Services Paid on a Reasonable Cost Basis

A-03-005

•

Health Insurance Portability and Accountability Act Transaction 835v4010 Companion Document Update for Intermediaries

A-03-006

•

Update the Medicare Secondary Payment Module to Apportion Prospective Payment System (PPS) Outlier Amounts to all Service Lines With Medicare Reimbursement That Are PRICER Related and Potential Outlier Service Lines

A-03-007

•

Payment to Hospitals and Units Excluded from the Acute Inpatient Prospective Payment System for Direct Graduate Medical Education and Nursing and Allied Health Education for Medicare+Choice Enrollees

A-03-008

•

Clarification of 3-Day Payment Window vs. 1-Day Payment Window for Hospitals Excluded from Inpatient Prospective Payment System

A-03-009

•

Medical Nutrition Therapy Services for Beneficiaries with Diabetes or Renal Disease

A-03-010

•

Manual Medical Review Indicator for the Comprehensive Error Rate Testing Program

A-03-011

•

Changes in Payment for Certain Services Provided by Outpatient Physical Therapy Providers Under the Medicare Physician Fee Schedule

A-03-012

•

The Report of Benefit Savings

A-03-013

•

3-Day Payment Window Refinements Under the Short-Term Hospital Inpatient Prospective Payment System

A-03-014

•

Further Guidance Regarding Billing Under the Outpatient Prospective Payment System

A-03-015

•

Electromagnetic Stimulation

A-03-016

•

Continuous Home Care Under Medicare Hospice

A-03-017

•

Payment for Services To Be Paid on a Fee Schedule But for Which There Is No Price

A-03-018

•

Installation of Version 28.0 Second Add-On of the Provider Statistical and Reimbursement Report

A-03-019

•

Reactivation of Outpatient Prospective Payment System Outpatient Code Editor Edit 15, “Service Unit Out Of Range” and Guidance on Editing for Low Osmolar Contrast Media Procedures

A-03-020

•

April 2003 Update of the Hospital Outpatient Prospective Payment System

A-03-021

•

Announcement of Medicare Rural Health Clinics and Federally Qualified Health Centers Payment Rate Increases, Clarification on Coverage and Payment of Diabetes Self-Management Training Services and Medical Nutrition Therapy Services

A-03-022

•

Installation of Version 29.0 of the Provider Statistical and Reimbursement Reporting System—Modification

A-03-023

•

Implementation of the Temporary Equalization of Urban and Rural Standardized Payment Amounts Under the Medicare Inpatient Hospital Prospective Payment System as Required by Section 402(b) of Public Law 108-7

Program Memorandum

Carriers (CMS-Pub. 60B) (Superintendent of Documents No. HE 22.8/6-5)

B-03-001

•

Emergency Update to the 2003 Medicare Physician Fee Schedule Database

B-03-002

•

DMERCs-VIPS Medicare System Implementation To Process ICD-9 CM Codes Using Date of Service and Not Date of Receipt

B-03-003

•

Processing Initial Denials, of the DMEPOS Refund Requirements Implementation of Limits on Beneficiary Liability for Medical Equipment and Supplies—Change

B-03-004

•

CWF Change for Billing for Glucose Test Strips and Supplies—Follow-up to Change Request 2156

B-03-005

•

Reporting of Accident Date and Ambulance Certification Information on the X12N 837 (version 4010) Coordination of Benefits Transaction

B-03-006

•

Program Integrity Management Reporting System for Part B—Correction of Multiple Reports of Savings by VIPS Standard Systems (

i.e.

, VIPS Medicare System and Durable Medical Equipment Regional Contractor System)

B-03-007

•

Minimum Number of Pricing Files That Must Be Maintained Online for Medicare Physician Fee Schedule Services

B-03-008

•

Medical Review Progressive Corrective Action Continuation of Work Begun in Compliance with Change Request 2433

B-03-009

•

Durable Medical Equipment Regional Carriers—New Modifier Needed To Invoke Advanced Beneficiary Notice Logic for Hard Copy and Electronic Claims

B-03-010

•

Program Integrity Management Reporting System for Part B—Implementation of an Automated Edit Description Module

B-03-011

•

Correct Payment of January and February 2003 Physician Services

B-03-012

•

Use of the National Drug Code for Drug Claims at the Durable Medical Equipment Regional Carriers

B-03-013

•

Continuation of April 2003 Change Request 2424: Create Import/Export Functionality Between the Unique Provider Identification Number System and the Provider Enrollment Chain Ownership System

B-03-014

•

Continuation of April 2003 Change Request 2425: Create Import/Export Functionality Between the Medicare Claims System (MCS) and the Provider Enrollment Chain Ownership System

B-03-015

•

Continuation of April 2003 Change Request 2426: Process all Medicare Part B Provider Enrollments in the Provider Enrollment Chain Ownership System; Modify the Medicare Claims System To Incorporate All Claim Payment and Provider Correspondence Functionality That Is Included in the Provider Enrollment System But Will Not Be a Part of Provider Enrollment Chain Ownership System

B-03-016

•

Continuation of April 2003 Change Request 2427: Process all Medicare Part B Provider Enrollments in the Provider Enrollment Chain Ownership System; Create Import/Export Functionality Between the Viable Medicare System and the Provider Enrollment Chain Ownership System

B-03-017

•

Add-On-Codes for Anesthesia

B-03-018

•

Changes to Correct Coding Edits, Version 9.2, Effective July 1, 2003

B-03-019

•

Durable Medical Equipment Regional Carriers and Part B Carriers on the VMS Standard System—Short Descriptions of National Modifiers on the Healthcare Common Procedure Coding System Tape

B-03-020

•

2003 DMEPOS Jurisdiction List

B-03-021

•

Provider Education Regarding Home Health Consolidated Billing and Provider Liability

B-03-022

•

Use of Statistical Sampling for Overpayment Estimation When Performing Administrative Reviews of Part B Claims

Program Memorandum

Intermediaries/Carriers (CMS-Pub. 60A/B) (Superintendent of Documents No. HE 22.8/6-5)

AB-03-001

•

Medicare Coverage of Non-Invasive Vascular Studies for End-Stage Renal Disease Patients

AB-03-002

•

Quarterly Update of HCPCS Codes Used for Home Health Consolidated Billing Enforcement

B-03-003

•

Noncoverage of Multiple Electroconvulsive Therapy

B-03-004

•

Installation of a Security Firewall for Deceased Beneficiary Files (Options B & C)

AB-03-005

•

FY 2003 Systems Security Activities and Due Dates

AB-03-006

•

April Quarterly Update for 2003 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Fee Schedule

AB-03-007

•

Second Clarification of Medicare Policy Regarding the Implementation of the Ambulance Fee Schedule

AB-03-008

•

Clarification of Physician Certification Requirements for Medicare Hospice

AB-03-009

•

The Medicare Exclusion Database Replaces Publication 69

AB-03-010

•

Shared System Maintainer Hours for Resolution of Problems Detected During Health Insurance Portability and Accountability Act Transaction Release Testing

AB-03-011

•

Identifying the Primary Payer Amounts To Send to the Medicare Secondary Payer Pay Module and the Shared Systems When There Are Multiple Primary Payers on Electronic and Hardcopy Claims

AB-03-012

•

Remittance Advice Remark and Reason Code Update

AB-03-013

•

New Waived Tests—December 17, 2002

AB-03-014

÷

Single Drug Pricer

AB-03-015

•

Shared Systems Changes for Name Change from HCFA to CMS (MCS and CWF External Changes Only)

AB-03-016

•

CR 2240 Question and Answer Document

AB-03-017

•

Scheduled Release for April Updates to Software Programs and Pricing/Coding Files

AB-03-018

•

Implementation of the Financial Limitation for Outpatient Rehabilitation Services

AB-03-019

•

Notice of Interest Rate for Medicare Overpayments and Underpayments

AB-03-020

•

Clarification of Transmittal AB-00-107, Change Request 1163, and Transmittal AB-00-129, Change Request 1460, Regarding the Coordination of Benefits

Contractor and MSP Prepay Work Activities for Customer Service, MSP and Standard Systems Contractor Staff

AB-03-021

•

Additional Documentation Requests Requirements for Ordering Providers of Laboratory Services

AB-03-022

•

Use of the American Medical Association's

Physicians' Current Procedural Terminology, Fourth Edition

Codes on Contractors' Web Sites

AB-03-023

•

Deep Brain Stimulation for Essential Tremor and Parkinson's Disease

AB-03-024

•

Clarification of the Allocation of Initial Claim Entry Activities Where the Claim Is Paid Secondary by Medicare

AB-03-025

•

System Networking Electronic Correspondence Referral System 1.3 User and Installation Guides for Testing and Production

AB-03-026

•

Implementation of the Modifications (4010A1) to Transactions and Code Set Standards for Electronic Transactions Adopted Under the Health Insurance Portability and Accountability Act

AB-03-027

•

Payment Change for the 2003 Medicare Physician Fee Schedule and Further Extension of the 2003 Participation Enrollment Process

AB-03-028

•

Coverage and Billing of Sacral Nerve Stimulation

AB-03-029

•

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

AB-03-030

•

Changes to the Laboratory National Coverage Determination Edit Software for April 1, 2003

AB-03-031

•

Addition or Modification of Temporary “K” Codes and Change in Status for Code A4232

AB-03-032

•

File Names, Descriptions and Instructions for Retrieving the 2003 Ambulatory Surgical Center HCPCS Additions, Deletions, and Master Listing

AB-03-033

•

Promoting Colorectal Cancer Screening As a Part of National Colorectal Cancer Awareness Month

AB-03-034

•

Medicare Fee for Service Contractor Guidance on the HIPAA Privacy Rule

AB-03-035

•

Emergency Changes to the 2003 Medicare Physician Fee Schedule Database

AB-03-036

•

270/271 Implementation and Direct Date Entry Eligibility

AB-03-037

•

Provider Education Article: Medicare Payments for Part B Mental Health Services

AB-03-038

•

Reporting Benefit Integrity Workload in CROWD

AB-03-039

•

Procedure for Granting Extension to File Requests for Appeal Under the New 120-day Timeframe Created by section 521 of the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000

AB-03-040

•

Provider Education Article: “Hospice Care Enhances Dignity and Peace As Life Nears Its End”

Hospital Manual

(CMS-Pub. 10)

(Superintendent of Documents No. HE 22.8/2)

796

•

Pneumococcal Pneumonia, Influenza Virus, and Hepatitis B Vaccines

797

•

Pneumococcal Pneumonia, Influenza Virus, and Hepatitis B Vaccines

798

•

Billing for Hospital Outpatient Partial Hospitalization Services

799

•

Identifying Other Primary Players During the Admission Process

Hospice Manual

(CMS-Pub. 21)

(Superintendent of Documents No.)

66

•

Special Coverage Requirements

Coverage Issues Manual

(CMS-Pub. 6)

(Superintendent of Documents No. HE 22.8/14)

166

•

Multiple-Seizure Electroconvulsive Therapy

167

•

Treatment of Motor Function Disorders with Electric Nerve Stimulation—Not Covered

167

•

Deep Brain Stimulation for Essential Tremor and Parkinson's Disease

168

•

Ambulatory Blood Pressure Monitoring

Outpatient Physical Therapy

(CMS Pub. 9)

(Superintendent of Documents No. HE 2.8/9)

17

•

Billing Instructions for Partial Hospitalization Services Provided in Community Mental Health Centers

Provider Reimbursement Manual—Part 2

Provider Cost Reporting Forms and Instructions

Chapter 35/Form CMS-2540-96

(CMS-Pub. 15-2-35)

12

•

Skilled Nursing Facility Cost Report Form CMS-2540-96, and Is Effective for Cost Reporting Periods Ending on and After December 31, 2002

Financial Management

(CMS-Pub. 100-06)

13

•

Intermediary Claims Accounts Receivable

Physician/Supplier Overpayment Reporting System Summary Entry Debts Financial Reporting for Intermediary Claims Accounts Receivable

14

•

General

15

•

FMFIA and the CMS Medicare Contractor

Risk Assessment

Fiscal Year 2003 Medicare Control Objectives

Documentation and Work Papers

Requirements

Certification Statement

Executive Summary

CPIC—Report of Material Weaknesses

CPIC—Report of Reportable

Conditions

Definitions and Examples of Reportable Conditions and Material Weaknesses

Corrective Action Plans

Submission, Review, and Approval of Corrective Action Plans

Universal Corrective Action Plan Report

CMS Finding Numbers

Program Integrity Manual

(CMS-Pub. 100-08)

37

•

Written Orders

Written Orders Prior to Delivery

38

•

Articles

39

•

Overview of Prepayment and Postpayment Review for MR Purposes

Determinations Made During Prepayment and Postpayment MR

Documentation Specifications for Areas Selected for Prepayment or Postpayment MR

Additional Documentation Requests During Prepayment of Postpayment MR

Handling Late Documentation

Denials

Documenting That a Claim Should Be Denied

Spreading Workload Evenly

Review That Involves Utilization Parameters

Prepayment Review of Claims for MR Purposes

Documentation Specifications for Areas Selected for MR

Laboratory Claims

Documentation for Non-Physician Claims

Development of Claims for Additional Documentation

Postpayment Review Case Selection

Location of Postpayment Reviews

Re-adjudication of Claims

Calculation of the Correct Payment Amount and Subsequent

Over/Underpayment

Provider(s) Rebuttal(s) of Findings

Addendum IV.—Regulation Documents Published in the Federal Register

[January 2003 through March 2003]

Publication date

FR Vol. 68 page

CFR Part(s)

File code*

Regulation title

01/10/2003

1374

42 CFR 403, 416, 418, 460, 482, 483, 485

CMS-3047-F

Medicare and Medicaid Programs; Fire Safety Requirements for Certain Health Care Facilities.

01/24/2003

3586

42 CFR 433 and 438

CMS-2015-F

Medicaid Program; External Quality Review of Medicaid Managed Care Organizations.

01/24/2003

3534

CMS-3113-N

Medicare Program; Meeting of the Medicare Coverage Advisory Committee—March 12, 2003.

01/24/2003

3532

CMS-2177-PN

Medicare and Medicaid Programs; Application by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) for Hospices.

01/24/2003

3482

42 CFR Chapter IV

CMS-6012-N4

Medicare Program; Negotiated Rulemaking Committee on Special Payment Provisions and Requirements for Prosthetics and Certain Custom-Fabricated Orthotics.

01/24/2003

3435

42 CFR 482

CMS-3050-F

Medicare and Medicaid Programs; Hospital Conditions of Participation: Quality Assessment and Performance Improvement.

02/10/2003

6750

CMS-4051-N

Medicare Program; Renewal of the Advisory Panel on Medicare Education (APME) and Notice of Meeting of the Advisory Panel—February 27, 2003.

02/10/2003

6682

42 CFR 413

CMS-1126-P

Medicare Program; Provider Bad Debt Payment.

02/10/2003

6636

42 CFR 405 and 419

CMS-1206-CN2

Medicare Program; Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2003 Payment Rates; and Changes to Payment Suspension for Unfiled Cost Reports; Correction.

02/20/2003

8334

45 DCFR 160, 162, 164

CMS-0049-F

Health Insurance Reform: Security Standards.

02/28/2003

9681

CMS-1225-GNC

Medicare Program; Criteria and Standards for Evaluating Intermediary, Carrier, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Regional Carrier Performance During Fiscal Year 2003.

02/28/2003

9680

CMS-3099-N

Medicaid Program; Annual Review of the Appropriateness of Payment Amounts for New Technology Intraocular Lenses (NTIOLs) Furnished by Ambulatory Surgical Centers (ASCs).

02/28/2003

9673

CMS-5002-N

Medicare Program; Demonstration: Capitated Disease Management for Beneficiaries With Chronic Illnesses.

02/28/2003

9672

CMS-2165-N

Medicaid Program; Infrastructure Grant Program To Support the Competitive Employment of People With Disabilities.

02/28/2003

9671

CMS-1245-N

Medicare Program; Request for Nominations To the Advisory Panel on Ambulatory Payment Classifications Groups.

02/28/2003

9567

42 CFR 410, 414, 485

CMS-1204-F2

Medicare Program; Physician Fee Schedule Update for Calendar Year 2003.

03/05/2003

10420

42 CFR 412

CMS-1243-P

Medicare Program; Proposed Change in Methodology for Determining Payment for Extraordinarily High-Cost Cases (Cost Outliers) Under the Acute Care Hospital Inpatient Prospective Payment System.

03/07/2003

11234

42 CFR 412

CMS-1472-P

Medicare Program; Prospective Payment System for Long-Term Care Hospitals: Proposed Annual Payment Rate Updates and Policy Changes.

03/07/2003

10987

42 CFR 412

CMS-1177-F2

Medicare Program; Prospective Payment System for Long-Term Care Hospitals: Implementation and FY 2003 Rates; Correcting Amendment.

03/28/2003

15268

42 CFR 416

CMS-1885-FC

Medicare Program; Update of Ambulatory Surgical Center List of Covered Procedures Effective July 1, 2003.

03/28/2003

15207

CMS-1230—N

Medicare Program; Public Meetings in Calendar Year 2003 for New Durable Medical Equipment Coding and Payment Determinations.

03/28/2003

15206

CMS-1474-N

Medicare Program; Town Hall Meeting on the Inpatient Rehabilitation Facility Prospective Payment System.

03/28/2003

15196

CMS-9016-N

Medicare and Medicaid Programs; Quarterly Listing of Program Issuances—October 2002 Through December 2002.

03/28/2003

15139

42 CFR Chapter IV

CMS-6012-N5

Medicare Program; Negotiated Rulemaking Committee on Special Payment Provisions and Requirements for Prosthetics and Certain Custom-Fabricated Orthotics; Meeting Announcement

Addendum V—National Coverage Determinations [January 2003 Through March 2003]

A national coverage determination (NCD) is a determination by the Secretary with respect to whether or not a particular item or service is covered nationally under Title XVIII of the Social Security Act, but does not include a determination of what code, if any, is assigned to a particular item or service covered under this title, determination with respect to the amount of payment made for a particular item or service so covered. We include below all of the NCDs that became effective during the quarter covered by this notice. The entries below include information concerning completed decisions as well as sections on program and decision memoranda, which also announce impending decisions or, in some cases, explain why it was not appropriate to issue an NCD. We identify completed decisions by section of the CIM in which the decision appears, the title, the date the publication was issued, and the effective date of the decision. Information on completed decisions as well as pending decisions has also been posted on the CMS website at

http://cms.hhs.gov/coverage.

National Coverage Decisions for Quarterly Notices

Coverage Issues Manual (CIM) HCFA Pub. 06

CIM section

Title

Issue date

Effective date

50-42

Ambulatory Blood Pressure Monitoring

03/28/03

07/01/03

35-103

Multiple Monitored Electroconvulsive Therapy

01/10/03

04/01/03

65-19

Deep Brain Stimulation for Parkinson's

02/14/03

04/01/03

35-102

Electrical Stimulation for Wounds

01/15/03

04/01/03+

Program Memorandum (PM)

PM No.

Title

Issue date

Effective date

AB-03-030

Clinical Laboratory Edit Update

02/28/03

04/01/03

Addendum VI—Categorization of Food and Drug Administration-Allowed Investigational Device Exemptions

Under the Food, Drug, and Cosmetic Act (21 U.S.C. 360c), devices fall into one of three classes. Also, under the new categorization process to assist CMS, the Food and Drug Administration assigns each device with a Food and Drug Administration-approved investigational device exemption to one of two categories.) Category A refers to experimental/investigational device exemptions, and Category B refers to nonexperimental/investigational device exemptions. To obtain more information about the classes or categories, please refer to the

Federal Register

notice published on April 21, 1997 (62 FR 19328).

The following information presents the device number and category (A or B) for the first quarter, January through March 2003.

Investigational Device Exemption Numbers, 1st Quarter 2003

IDE/Category

G000247 B

G003004 B

G010216 B

G020225 B

G020231 B

G020240 A

G020244 B

G020247 B

G020248 B

G020262 B

G020279 B

G020299 B

G020301 B

G020308 B

G020310 B

G020311 B

G020314 B

G020315 B

G020317 B

G020318 B

G020319 B

G020320 B

G020324 B

G030003 A

G030004 B

G030006 B

G030012 B

G030013 B

G030014 B

G030016 B

G030018 B

G030019 B

G030020 B

G030021 B

G030023 B

G030024 B

G030025 B

G030028 B

G030030 B

G030033 B

G030035 B

G030036 B

G030037 B

G030041 B

G030043 A

G030048 B

G030049 B

G030052 B

G030053 B

Addendum VII—Approval Numbers for Collections of Information

Below we list all approval numbers for collections of information in the referenced sections of CMS regulations in title 42 and title 45, subchapter C, of the Code of Federal Regulations, which have been approved by the Office of Management and Budget:

OMB control nos.

Approved CFR sections in title 42 and title 45

0938-0008

414.40, 424.32, 424.44

0938-0022

413.20, 413.24, 413.106

0938-0023

424.103

0938-0025

406.28, 407.27

0938-0027

486.100-486.110

0938-0034

405.821

0938-0035

407.40

0938-0037

413.20, 413.24

0938-0041

408.6

0938-0042

410.40, 424.124

0938-0045

405.711

0938-0046

405.2133

0938-0050

413.20, 413.24

0938-0062

431.151, 435.1009, 440.250, 440.220, 442.1, 442.10-442.16, 442.30, 442.40, 442.42, 442.100-442.119, 483.400 -483.480, 488.332, 488.400, 498.3-498.5

0938-0065

485.701-485.729

0938-0074

491.1—491.11

0938-0080

406.13

0938-0086

420.200-420.206, 455.100-455.106

0938-0101

430.30

0938-0102

413.20, 413.24

0938-0107

413.20, 413.24

0938-0146

431.800-431.865

0938-0147

431.800-431.865

0938-0151

493.1-493.2001

0938-0155

405.2470

0938-0170

493.1269-493.1285

0938-0193

430.10-430.20, 440.167

0938-0202

413.17, 413.20

0938-0214

411.25, 489.2, 489.20

0938-0236

413.20, 413.24

0938-0242

416.44, 418.100, 482.41, 483.270, 483.470

0938-0245

407.10, 407.11

0938-0251

406.7

0938-0266

416.41, 416.83, 416.47, 416.48

0938-0267

485.56, 485.58, 485.60, 485.64, 485.66, 410.65

0938-0269

412.116, 412.632, 413.64, 413.350, 484.245

0938-0270

405.376

0938-0272

440.180, 441.300-441.305

0938-0273

485.701—85.729

0938-0279

424.5

0938-0287

447.31

0938-0296

413.170

0938-0300

431.800

0938-0301

413.20, 413.24

0938-0302

418.22, 418.24, 418.28, 418.56, 418.58, 418.70, 418.74, 418.83, 418.96, 418.100

0938-0313

418.1—418.405

0938-0328

482.12, 482.22, 482.27, 482.30, 482.41, 482.43, 482.53, 482.56, 482.57, 482.60, 482.61, 482.62, 482.66

0938-0334

491.9

0938-0338

486.104, 486.106, 486.110

0938-0354

441.60

0938-0355

484.10-484.52

0938-0357

409.40-409.50, 410.36, 410.170, 411.4-411.15, 421.100, 424.22, 484.18, 489.21

0938-0358

412.20-412.30

0938-0359

412.40-412.52

0938-0360

405.2100-405.2184

0938-0365

484.10, 484.11, 484.12, 484.14, 484.16, 484.18, 484.20, 484.36, 484.48, 484.52

0938-0372

414.330

0938-0378

482.60-482.62

0938-0379

418.1-418.405

0938-0380

482.1-482.66

0938-0386

405.2100-405.2171

0938-0391

488.18, 488.26, 488.28

0938-0426

476.104, 476.105, 476.116, 476.134

0938-0429

447.53

0938-0443

473.18, 473.34, 473.36, 473.42

0938-0444

1004.40, 1004.50, 1004.60, 1004.70

0938-0445

412.44, 412.46, 431.630, 456.654, 466.71, 466.73, 466.74, 466.78

0938-0447

405.2133

0938-0449

440.180, 441.300-441.310

0938-0454

424.20

0938-0456

412.105

0938-0463

413.20, 413.24

0938-0465

411.404, 411.406, 411.408

0938-0467

431.17, 431.306, 435.910, 435.920, 435.940-435.960

0938-0469

417.107, 417.478

0938-0470

417.143, 417.408

0938-0477

412.92

0938-0484

424.123

0938-0486

498.40-498.95

0938-0501

406.15

0938-0502

433.138

0938-0512

486.301-486.325

0938-0526

475.100 Subpart C, 475.106, 475.107, 462.102, 462.103

0938-0534

410.38, 424.5

0938-0544

493.1-493.2001

0938-0565

411.20-411.206

0938-0566

411.404, 411.406, 411.408

0938-0567

498 Subpart D, E, and H and 20 CFR 404.933

0938-0573

412.256, 412.230

0938-0581

493.1-493.2001

0938-0599

493.1-493.2001

0938-0600

405.371, 405.378, 413.20

0938-0610

417.436, 417.801, 417.436, 422.128, 430.12, 431.20, 431.107, 434.28, 483.10, 484.10, 489.102

0938-0612

493.1-493.2001

0938-0618

433.68, 433.74, 447.272

0938-0653

493

0938-0655

493.180

0938-0657

405.2110, 405.2112

0938-0658

405.2110, 405.2112

0938-0667

482.12, 488.18, 489.20, 489.24

0938-0673

430.10

0938-0679

410.38

0938-0685

410.32, 410.71, 413.17, 424.57, 424.73, 424.80, 440.30, 484.12

0938-0686

493.551-93.557

0938-0688

486.301-486.325

0938-0690

488.4-488.9, 488.201

0938-0691

412.106

0938-0692

466.78, 489.20, 489.27

0938-0700

417.479, 417.500; 422.208, 422.210; 434.44, 434.67, 434.70; 1003.100, 1003.101, 1003.103 & 1003.106

0938-0701

422.152

0938-0702

45 CFR

146

0938-0703

45 CFR

148

0938-0714

411.370-411.389

0938-0717

424.57

0938-0721

410.33

0938-0722

422.370-422.378

0938-0723

421.300-421.318

0938-0730

405.410, 405.430, 405.435, 405.440, 405.445, 405.455, 410.61, 415.110, 424.24

0938-0732

417.126, 417.470

0938-0734

45 CFR 5b

0938-0739

413.337, 413.343, 424.32, 483.20

0938-0742

422.300-422.312

0938-0749

424.57

0938-0753

422.000-422.700

0938-0754

441.152

0938-0758

413.20, 413.24

0938-0760

484 Subpart E, 484.55

0938-0761

484.11, 484.20

0938-0763

422.1-422.10, 422.50-422.80, 422.100-422.132, 422.300 -422.312, 422.400-422.404, 422.560-422.622

0938-0768

417.800-417.840

0938-0770

410.2

0938-0778

422.64, 422.111, 422.560-422.622

0938-0779

417.470, 417.126, 422.210, 422.64

0938-0781

411.404-411.406, 484.10

0938-0786

438.360, 438.362, 438.364

0938-0787

406.28, 407.27

0938-0790

460.12, 460.22, 460.26, 460.30, 460.32, 460.52, 460.60, 460.70, 460.71, 460.72, 460.74, 460.80, 460.82, 460.98, 460.100, 460.102, 460.104, 460.106, 460.110, 460.112, 460.116, 460.118, 460.120, 460.122, 460.124, 460.132, 460.152, 460.154, 460.156, 460.160, 460.164, 460.168, 460.172, 460.190, 460.196, 460.200, 460.202, 460.204, 460.208, 460.210

0938-0792

491.3, 491.8, 491.11

0938-0797

45 CFR

148

0938-0798

413.24, 413.65, 419.42

0938-0802

419.43

0938-0810

482.45

0938-0818

410.141-410.145, 414.63

0938-0819

45 CFR 146.121

0938-0823

420.410

0938-0824

482.13, 440.10

0938-0827

45 CFR 146.141

0938-0829

422.568

0938-0832

489

0938-0833

483.350-483.376

0938-0840

422.152

0938-0841

431.636, 457.50, 457.60, 457.70, 457.340, 457.350, 457.431, 457.440, 457.525, 457.560, 457.570, 457.740, 457.750, 457.810, 457.940, 457.945, 457.965, 457.985, 457.1005, 457.1015, 457.1180

0938-0842

412, 413

0938-0846

411.1, 411.350-411.357, 424.22

0938-0857

419

0938-0860

419

0938-0866

45 CFR

Part 162

0938-0872

483.20, 413.337

0938-0873

422.152

0938-0874

45 CFR

Parts 160 and 162

0938-0878

422 Subpart F & G

0938-0883

45 CFR parts 160 and 164

0938-0884

405.940

0938-0885

403.804, 403.806, 403.808, 403.810, 403.811, 403.820

Note:

Sections in title 45 are preceded by “45 CFR.”

[FR Doc. 03-16058 Filed 6-26-03; 8:45 am]

BILLING CODE 4120-01-P