Physician Medicare Update Items

Correction to CR 5404: New Waived Tests, CMS CR 5482 - CMS has released an article regarding an incorrect procedure code. CR 5404, which informed carriers and A/B MACS about new waived tests approved by the FDA under CLIA, contained an incorrect CPT code for the Gryphus Diagnostics BVBlue test. The correct code for this test is 87999QW (Unlisted microbiology procedure). The complete article is available on the CMS MLN Matters Web page.

New Waived Tests, CMS CR 5484 - CMS has released an article regarding the new waived tests, effective April 1, 2007. The complete article is available on the CMS MLN Matters Web page.

Quarterly Update to Correct Coding Initiative (CCI) Edits, CMS CR 5492 - CMS has released an article regarding the CCI. CR 5492 gives carriers and A/B MACs the latest package of CCI edits. These edits (Version 13.1), include all previous versions and updates from January 1, 1996, and will be effective on April 1, 2007. The complete article is available on the CMS MLN Matters Web page.

CMS Breaking News!! RE: Form CMS-1500 , CMS Contractor Provider Education Resources Listserv, dated March 9, 2007 - The Form CMS-1500 is the standard claim form used by a non-institutional providers or suppliers to bill Medicare carriers and Durable Medical Equipment Regional Carriers (DMERCs), when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of claims. It is also used for billing of some Medicaid state agencies. The National Uniform Claim Committee (NUCC) is responsible for the maintenance of the Form CMS-1500. CMS does not provide the form to providers for claim submission.

It has come to CMS’ attention that there are incorrectly formatted versions of the revised form. Given, the circumstances, CMS has decided to extend the acceptance period of the Form CMS-1500-(12-90) version beyond the original April 1, 2007, deadline while this situation is resolved. Contractors will be directed to continue to accept the Form CMS-1500 (12-90) until notified by CMS to cease.

• The following link to the CMS Web site will help you to properly identify which form is which and to read more about the implementation of the Form CMS-1500:
  www.cms.hhs.gov/ElectronicBillingEDITrans/16_1500.asp
• Select the following link to access an important CMS PDF document regarding this issue:
  www.cms.hhs.gov/ElectronicBillingEDITrans/Downloads/1500%20problems.pdf