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Medicare Compliance & Reimbursement

CMS MANUAL UPDATE

Published on Mon Dec 22, 2003

Thanks to the recently enacted Medicare prescription drug legislation, providers of therapy services no longer have to cope with the much-maligned therapy cap. In a Dec. 8 program transmittal (change request 3005), the Centers for Medicare & Medicaid Services confirms that Medicare contractors should not apply the cap to therapy claims submitted from Dec. 8, 2003 through Dec. 31, 2005.

That means the caps only apply claims submitted between Sept. 1, 2003, when CMS lifted a longstanding moratorium on the caps, and Dec. 7, 2003.

In other recent program transmittals, CMS:

  • corrects errors in the 2004 HCPCS file it released Oct. 15 (CR 3002);

  • updates the list of HCPCS codes that should not be paid to skilled nursing facilities (CR 2983);

  • lays out instruction on how hospitals should bill for Velcade under the outpatient prospective payment system (CR 2982);

  • outlines how Medicare contractors should monitor time between annual screening mammographies (CR 2932); and

  • updates the ANSI X12N transaction 835 companion document (CR 2947).

    To see the transmittals, go to http://cms.hhs.gov/manuals/transmittals/comm_date_dsc.asp.

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