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Source: medicare.gov

Medicare Coverage Database – Centers for Medicare & Medicaid Services

Contextual Help & Page Help – Contextual Help is a new feature that provides users with the ability to receive onscreen help for specific elements on the page. To use the feature, click the "Contextual Help" link and move the mouse to the onscreen location of the associated page element. The user can turn the feature off when help is no longer required. Users who are unable to use this feature, or who prefer to have a link to a single page of help for the entire page, may continue to use the "Page Help" link to get assistance.
Source: cms.gov

Healthcare business news, research, data and events from Modern Healthcare

Genesis Healthcare, one of the nation’s largest investor-owned skilled nursing, senior living and rehabilitation therapy providers, will settle six lawsuits alleging that its acquired companies billed Medicare for unnecessary treatment and delivered grossly substandard nursing care.
Source: modernhealthcare.com

Medicare Fee, Payment, Procedure code, ICD, Denial

All In-Office Laboratory Testing and Procedures:    Marked with *, **, ***, ****, and ***** will be limited to one procedure within the same family of asterisks, per visit. Example: All laboratory testing/procedure codes that are marked with one * will only be allowed to have one laboratory test/procedure performed, per visit, out of all of the codes designated with the single *.   Marked with the # symbol will only be considered for reimbursement if the member has an infertility benefit and the provider has the appropriate specialty. Refer to the policy titled Infertility Diagnosis and Treatment for additional information related to infertility coverage. CPT Code Description Primary Care Physicians and Specialists 80305 Drug test(s), presumptive, any number of drug classes, any number of devices or procedures (e.g., immunoassay); capable of being read by direct optical observation only (e.g., dipsticks, cups, cards, cartridges) includes sample validation when performed, per date of service 80306 Drug test(s), presumptive, any number of drug classes, any number of devices or procedures (e.g., immunoassay); read by instrument assisted direct optical observation (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service 81000* Urinalysis, non-automated, with microscopy 81001* Urinalysis, automated, with microscopy 81002* Urinalysis, non-automated, without microscopy 81003* Urinalysis, automated, without microscopy 81025 Urine pregnancy test, by visual color comparison methods  82270***** Blood, occult, by peroxidase activity (e.g., guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (i.e., patient was provided three cards or single triple card for consecutive collection) CPT Code Description Hematologists/Oncologists/Pediatric Hematologists 85097 Bone marrow; smear interpretation only, with or without differential cell count 86077 Blood bank physician services; difficult cross-match and/or evaluation of irregular antibody(s), interpretation and written report 86078 Blood bank physician services; investigation of transfusion reaction, including suspicion of transmissible disease, interpretation and written report 86079 Blood bank physician services; authorization for deviation from standard bloodbanking procedures, with written report 86927-86999 Transfusion medicine Ophthalmologists and Connecticut CLIA Certified Optometrists Note: Connecticut optometrists may be reimbursed for CPT code 83861 in the office if they are CLIA Certified (Clinical Laboratory Improvement Amendments of 1988 (CLIA)). If no CLIA certification is on file, the service is not eligible for reimbursement. 83861 Microfluidic analysis utilizing an integrated collection and analysis device, tear osmolarity Ophthalmologists and Optometrists 83516 Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method 87809 Infectious agent antigen detection by immunoassay with direct optical observation; adenovirus Pulmonologists 82803 Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation) Rheumatologists 89060 Crystal Identification by light microscopy with or without polarizing lens analysis; tissue or any body fluid (except urine) Urologists  89264# Sperm identification from testis tissue, fresh or cryopreserved 89300 Semen analysis; presence and/or motility of sperm including Huhner test (post coital) 89310 Semen analysis; motility and count (not including Huhner test) 89320 Semen analysis; volume, count, motility and differential 89321 Semen analysis; sperm presence and motility of sperm, if performed 89322 Semen analysis; volume, count, motility, and differential using strict morphologic criteria (e.g., Kruger) REIMBURSEMENT GUIDELINES In-Office Laboratory Testing and Procedures Reimbursement of network physicians for the performance of in-office laboratory testing/procedures is limited to those codes listed on the in-office laboratory testing and procedures list. Reimbursement for some of the Laboratory testing/procedures is limited to certain physician specialties. Refer to the Applicable Codes section below for a list of specific CPT codes.   Marked with a # symbol, will only be considered for reimbursement if the member has an infertility benefit and the provider has the appropriate specialty. Refer to the policy titled Infertility Diagnosis and Treatment for additional information related to infertility coverage. Specimen Handling and Venipuncture CODE 36415 When specimen handling and venipuncture codes are billed; With a laboratory/procedure code on the in-office laboratory testing and procedures list, only the laboratory testing/procedure and venipuncture codes will be considered for reimbursement. Note: The laboratory testing/procedure code will only be considered for reimbursement if the code is listed in the Applicable Codes section of the policy and the provider has the appropriate specialty, if required.   Without a laboratory testing/procedure code on the in-office laboratory testing and procedures list or with other non-laboratory testing/procedure services, the specimen handling and venipuncture codes will be considered for reimbursement.
Source: medicarepaymentandreimbursement.com

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