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Medicare Compliance & Reimbursement

Program Memo Roundup

Published on Mon Feb 02, 2004

Physicians hassled by carriers who bungle claims for sacroiliac joint injection of anesthetic agents or steroids should get some relief in the wake of a Jan. 16 program transmittal from the Centers for Medicare & Medicaid Services (change request 2979).
 
In the transmittal, classified as a one-time notification, CMS explains that HCPCS code G0260 is on the list of Medicare-approved procedures for ambulatory surgical centers, so carriers should pay the ASC facility fee for those claims.
 
The transmittal also orders carriers to add CPT code 27096 to the list of approved ASC procedures, which means that physicians that perform 27096 in an ASC would receive the lower "facility rate" under the physician fee schedule.

In other recent program transmittals, CMS:

 

  • makes corrections to the list of HPCPS codes used for home health consolidated billing enforcement (CR 3024);

     

  • updates billing policies for ventricular assist devices provided to beneficiaries enrolled in a Medicare+Choice plan (CR 3068); and

     

  • corrects language in the ANSI X12N transaction 835 companion documents for carriers, fiscal intermediaries and durable medical equipment regional carriers (CR 2948).

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

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