cms manual system...document control numbers (dcn)s in the icor subsystem for each of the adjustment...

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CMS Manual System Department of Health & Human Services (DHHS) Pub 100-04 Medicare Claims Processing Centers for Medicare & Medicaid Services (CMS) Transmittal 3801 Date: June 28, 2017 Change Request 9968 Transmittal 3716, dated February 10, 2017, is being rescinded and replaced by Transmittal 3801, dated, June 28, 2017, to extend the implenentation date to the October 2017 release, add four new business requirements, and to revise requirements 9968.4.1 and 9968.4.2. All other information remains the same. SUBJECT: Extension of the Transition to the Fully Adjusted Durable Medical Equipment, Prosthetics, Orthotics and Supplies Payment Rates under Section 16007 of the 21st Century Cures Act I. SUMMARY OF CHANGES: This change request (CR) provides instructions regarding the implementation of revised 2016 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) fee schedule amounts based on changes mandated by section 16007 of the 21st Century Cures Act. EFFECTIVE DATE: July 1, 2016 *Unless otherwise specified, the effective date is the date of service. IMPLEMENTATION DATE: July 3, 2017 - For contractors to retrieve and test the fee schedule and begin the adjustment process; October 2, 2017 - For contractors to complete the adjustment process Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. Any other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents. II. CHANGES IN MANUAL INSTRUCTIONS: (N/A if manual is not updated) R=REVISED, N=NEW, D=DELETED-Only One Per Row. R/N/D CHAPTER / SECTION / SUBSECTION / TITLE N 20/20/20.6/ Phase-In for Competitive Bidding Rates in Areas Not in a Competitive Bid Area III. FUNDING: For Medicare Administrative Contractors (MACs): The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined in your contract. CMS does not construe this as a change to the MAC Statement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the Contracting Officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions regarding continued performance requirements.

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Page 1: CMS Manual System...Document Control Numbers (DCN)s in the ICOR subsystem for each of the adjustment claims with the ICOR values specified by the DME MACs. These values will allow

CMS Manual System Department of Health & Human Services (DHHS)

Pub 100-04 Medicare Claims Processing Centers for Medicare & Medicaid Services (CMS)

Transmittal 3801 Date: June 28, 2017

Change Request 9968 Transmittal 3716, dated February 10, 2017, is being rescinded and replaced by Transmittal 3801, dated, June 28, 2017, to extend the implenentation date to the October 2017 release, add four new business requirements, and to revise requirements 9968.4.1 and 9968.4.2. All other information remains the same. SUBJECT: Extension of the Transition to the Fully Adjusted Durable Medical Equipment, Prosthetics, Orthotics and Supplies Payment Rates under Section 16007 of the 21st Century Cures Act I. SUMMARY OF CHANGES: This change request (CR) provides instructions regarding the implementation of revised 2016 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) fee schedule amounts based on changes mandated by section 16007 of the 21st Century Cures Act. EFFECTIVE DATE: July 1, 2016 *Unless otherwise specified, the effective date is the date of service. IMPLEMENTATION DATE: July 3, 2017 - For contractors to retrieve and test the fee schedule and begin the adjustment process; October 2, 2017 - For contractors to complete the adjustment process Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. Any other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents. II. CHANGES IN MANUAL INSTRUCTIONS: (N/A if manual is not updated) R=REVISED, N=NEW, D=DELETED-Only One Per Row.

R/N/D CHAPTER / SECTION / SUBSECTION / TITLE

N 20/20/20.6/ Phase-In for Competitive Bidding Rates in Areas Not in a Competitive Bid Area

III. FUNDING: For Medicare Administrative Contractors (MACs): The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined in your contract. CMS does not construe this as a change to the MAC Statement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the Contracting Officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions regarding continued performance requirements.

Page 2: CMS Manual System...Document Control Numbers (DCN)s in the ICOR subsystem for each of the adjustment claims with the ICOR values specified by the DME MACs. These values will allow

IV. ATTACHMENTS: Business Requirements Manual Instruction

Page 3: CMS Manual System...Document Control Numbers (DCN)s in the ICOR subsystem for each of the adjustment claims with the ICOR values specified by the DME MACs. These values will allow

Attachment - Business Requirements

Pub. 100-04 Transmittal: 3801 Date: June 28, 2017 Change Request: 9968 Transmittal 3716, dated February 10, 2017, is being rescinded and replaced by Transmittal 3801, dated, June 28, 2017, to extend the implenentation date to the October 2017 release, add four new business requirements, and to revise requirements 9968.4.1 and 9968.4.2. All other information remains the same. SUBJECT: Extension of the Transition to the Fully Adjusted Durable Medical Equipment, Prosthetics, Orthotics and Supplies Payment Rates under Section 16007 of the 21st Century Cures Act EFFECTIVE DATE: July 1, 2016 *Unless otherwise specified, the effective date is the date of service. IMPLEMENTATION DATE: July 3, 2017 - For contractors to retrieve and test the fee schedule and begin the adjustment process; October 2, 2017 - For contractors to complete the adjustment process I. GENERAL INFORMATION A. Background: Legislation effective January 1, 2017, requires changes to the July and October 2016 fee schedule amounts for certain items. This change request (CR) provides instructions regarding the implementation of revised 2016 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) fee schedule amounts based on changes mandated by section 16007 of the 21st Century Cures Act. Section 1834(a)(1)(F)(ii) of the Act mandates adjustments to the fee schedule amounts for certain DME items furnished on or after January 1, 2016, in areas that are not competitive bid areas, based on information from competitive bidding programs for DME. Regulations at section 414.210(g)(9) phased in these adjusted fees so that from January 1, 2016 through June 30, 2016, the fee schedule amount in non-bid areas was based on 50 percent of the adjusted payment amount established using competitive bidding information and 50 percent of the unadjusted fee schedule amount (i.e., the 2015 fee schedule amount updated by the 2016 covered item update). Beginning July 1, 2016, the fee schedule amounts for non-bid areas reverted to 100 percent of the adjusted payment amounts determined using competitive bidding information. B. Policy: Section 16007 of the 21st Century Cures Act changes the 2016 fee schedule transition period so that payment based on 50 percent of the adjusted payment amount established using competitive bidding information and 50 percent of the unadjusted fee schedule amount extends from June 30, 2016 to December 31, 2016. Section 16007 also changes from July 1, 2016 to January 1, 2017 the date that payment based on 100 percent of the adjusted payment amounts in non-bid areas is effective. To implement section 16007 for dates of service July 1, 2016 through December 31, 2016, the 50/50 blend fee schedules have been recalculated so that the adjusted portion of the payment blend utilizes July 1, 2016 adjusted fees. Also, the KE modifier fee schedules for items bid in the initial Round 1 Competitive Bidding Program have been added back to the fee schedule file for this extended phase-in period. The KE modifier was added to the DMEPOS fee schedule file as part of the January 2009 fee schedule update and described items that were bid under the initial Round 1 Competitive Bidding Program but were used with non-competitive bid base equipment. Suppliers should submit a request for reopening if their claim for dates of service between July 1, 2016 and December 31, 2016 should have been processed with the KE modifier. The revised July 1, 2016 through December 31, 2016 DMEPOS and PEN fee schedule files will be made available to contractors as part of this change request. The previously posted July 2016 and October 2016 DMEPOS and PEN public use files will be revised to reflect the new fee schedule amounts associated with the extension of the transition period. The contractor shall accept the KE modifier on the adjusted claims. In addition, for claims that the KE modifier would have been applicable to, the supplier may adjust the claim or notify the MACs to adjust the claims after the mass adjustments for the 50/50 fee blend have been

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completed. II. BUSINESS REQUIREMENTS TABLE "Shall" denotes a mandatory requirement, and "should" denotes an optional requirement. Number Requirement Responsibility A/B

MAC DME

MAC

Shared-System

Maintainers

Other

A B HHH

FISS

MCS

VMS

CWF

9968.1 The DME MACs and/or VDCs shall retrieve the revised July 2016 DMEPOS fee schedule file (filename: [email protected]). The revised file is available for download on or after May 01, 2017.

X VDC

9968.1.1 The DME MACs and/or VDCs shall retrieve the revised October 2016 DMEPOS fee schedule file (filename: [email protected]). The revised file is available for download on or after May 01, 2017.

X VDC

9968.1.2 Notification of successful receipt of both July and October 2016 revised files shall be sent via email to [email protected] stating the name of the file received and the entity receiving the file (e.g., contractor name and number).

X VDC

9968.2 The HHH MACs and/or VDCs shall retrieve the revised July 2016 DMEPOS fee schedule file (filename: [email protected]). The revised file is available for download on or after May 01, 2017.

X VDC

9968.2.1 The HHH MACs and/or VDCs shall retrieve the revised October 2016 DMEPOS fee schedule file (filename: [email protected]). The revised file is available for download on or after May 01, 2017.

X VDC

9968.2.2 Notification of successful receipt of both July and October 2016 revised files shall be sent via email to [email protected] stating the name of the file received and the entity receiving the file (e.g., contractor name and number).

X VDC

Page 5: CMS Manual System...Document Control Numbers (DCN)s in the ICOR subsystem for each of the adjustment claims with the ICOR values specified by the DME MACs. These values will allow

Number Requirement Responsibility A/B

MAC DME

MAC

Shared-System

Maintainers

Other

A B HHH

FISS

MCS

VMS

CWF

9968.3 The DME MACs and/or VDCs shall retrieve the revised July 2016 PEN fee schedule file (filename: [email protected]). The revised file is available for download on or after May 01, 2017.

X VDC

9968.3.1 The DME MACs and/or VDCs shall retrieve the revised October 2016 PEN fee schedule file (filename: [email protected]). The revised file is available for download on or after May 01, 2017.

X VDC

9968.3.2 Notification of successful receipt of both July and October 2016 revised files shall be sent via email to [email protected] stating the name of the file received and the entity receiving the file (e.g., contractor name and number).

X VDC

9968.4 Contractors shall create a one-time process to validate and adjust claims using the new 2016 DMEPOS fee schedule file when the following is true:

• dates of service July 1, 2016 through December 31, 2016,

• a HCPCS/Modifier combination found on the list in Attachment A; and

• the beneficiary did NOT reside in a Round 1 (2014) or Round 2 (2016) Competitive Bidding Area; OR

• the beneficiary resided in a Round 1 (2014) or Round 2 (2016) Competitive Bidding Area, but the item was grandfathered and paid at the fee schedule price (Attachment B);

OR

• The beneficiary resided in a Round 1 (2014) or Round 2 (2016) Competitive Bidding Area, but the item was associated with the KY modifier and paid at the fee schedule price

X

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Number Requirement Responsibility A/B

MAC DME

MAC

Shared-System

Maintainers

Other

A B HHH

FISS

MCS

VMS

CWF

9968.4.1 The contractor shall have all adjustment claims associated with the Cures Act repricing released for processing no later than September 29, 2017.

X

9968.4.2 Contractors shall adjust claims that were previously paid no later than November 15, 2017.

X X

9968.4.3 Contractors shall begin the one-time claim adjustment process once the revised fee schedule files are available within the DME production regions rather than wait until the implementation date of this CR.

X X

9968.5 After the claim has been adjusted via the systematic process to reprice using the revised fee schedule prices, the Contractors shall re-adjust claims, with dates of service July 1, 2016 through December 31, 2016, submitted with the KE modifier when brought to their attention.

X X

9968.6 The contractor shall create a process to re-load the following DMEPOS fee schedule file:

• July 2016, and

• October 2016

X

9968.7 The contractor shall add the Remittance Advice Remark Code (RARC) on the Cures Act claim adjustments for the dates of service that are being repriced in order to identify these claims. The RARC value to add to each of these claims is N689 - Alert: This reversal is due to a retroactive rate change.

X

9968.8 The contractor shall generate correspondence Document Control Numbers (DCN)s in the ICOR subsystem for each of the adjustment claims with the ICOR values specified by the DME MACs. These values will allow the DCNs associated with these adjustments to be readily identifiable and to be closed without DME MAC intervention.

X

9968.9 The contractor shall ensure that the X12 837 crossover claims created for the VMS adjustments made for the Cures Act repricing process has the value of ‘C’ in the BHT03 segment to indicate that the claims are associated with a CMS mandated mass adjustment.

X

Page 7: CMS Manual System...Document Control Numbers (DCN)s in the ICOR subsystem for each of the adjustment claims with the ICOR values specified by the DME MACs. These values will allow

Number Requirement Responsibility A/B

MAC DME

MAC

Shared-System

Maintainers

Other

A B HHH

FISS

MCS

VMS

CWF

9968.10 The contractor shall ensure that the value of ‘M’ is sent to CWF in the HUDC query field for mass adjustments to note that these Cures Act adjustments are due to a CMS mandated fee schedule change.

X

III. PROVIDER EDUCATION TABLE Number Requirement Responsibility

A/B

MAC DME

MAC

CEDI A B H

HH

9968.11 MLN Article: A provider education article related to this instruction will be available at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/ shortly after the CR is released. You will receive notification of the article release via the established "MLN Matters" listserv. Contractors shall post this article, or a direct link to this article, on their Web sites and include information about it in a listserv message within 5 business days after receipt of the notification from CMS announcing the availability of the article. In addition, the provider education article shall be included in the contractor's next regularly scheduled bulletin. Contractors are free to supplement MLN Matters articles with localized information that would benefit their provider community in billing and administering the Medicare program correctly.

X X

IV. SUPPORTING INFORMATION Section A: Recommendations and supporting information associated with listed requirements: N/A "Should" denotes a recommendation.

X-Ref Requirement Number

Recommendations or other supporting information:

Section B: All other recommendations and supporting information: N/A V. CONTACTS

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Pre-Implementation Contact(s): Bobbett Plummer, 410-786-3321 or [email protected] (For claims processing instructions) , Karen Jacobs, 410-786-2173 or [email protected] (For policy questions) Post-Implementation Contact(s): Contact your Contracting Officer's Representative (COR). VI. FUNDING Section A: For Medicare Administrative Contractors (MACs): The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined in your contract. CMS does not construe this as a change to the MAC Statement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the Contracting Officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions regarding continued performance requirements. ATTACHMENTS: 1

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Medicare Claims Processing Manual Chapter 20 – Durable Medical Equipment, Prosthetics, Orthotics,

and Supplies (DMEPOS)

Table of Contents

(Rev.3801, Issued: 06-28- 17)

Transmittals for Chapter 20 20.6 Phase-in For Competitive Bid Rates in Areas Not in a Competitive Bid Area (Rev.3801, Issued: 06-28- 17, Effective: 07- 01-16, Implementation: 07- 03 – 17, - For contractors to retrieve and test the fee schedule and begin the adjustment process; October 2, 2017 - For contractors to complete the adjustment process) Section 1834(a)(1)(F)(ii) of the Act mandates adjustments to the fee schedule amounts for certain DME items furnished on or after January 1, 2016, in areas that are not competitive bid areas, based on information from competitive bidding programs for DME. Regulations at section 414.210(g)(9) phased in these adjusted fees so that from January 1, 2016 through June 30, 2016, the fee schedule amount in non-bid areas was based on 50 percent of the adjusted payment amount established using competitive bidding information and 50 percent of the unadjusted fee schedule amount (i.e., the 2015 fee schedule amount updated by the 2016 covered item update). Beginning July 1, 2016, the fee schedule amounts for non-bid areas reverted to 100 percent of the adjusted payment amounts determined using competitive bidding information. Section 16007 of the 21st Century Cures Act changes the 2016 fee schedule transition period so that payment based on 50 percent of the adjusted payment amount established using competitive bidding information and 50 percent of the unadjusted fee schedule amount extends from June 30, 2016 to December 31, 2016. Section 16007 also changes from July 1, 2016 to January 1, 2017 the date that payment based on 100 percent of the adjusted payment amounts in non-bid areas is effective. Repriced Cures Act claim adjustments for the above mentioned dates of service shall use the following RARC code: N689 - Alert: This reversal is due to a retroactive rate change.

Page 10: CMS Manual System...Document Control Numbers (DCN)s in the ICOR subsystem for each of the adjustment claims with the ICOR values specified by the DME MACs. These values will allow

Attachment A Attachment BGrandfathered Codes Paid at Fee Schedule

HCPCS Modifier 1 Modifier 2 HCPCS Code

HCPCS Description Round CBA

A4221E0165

Commode chair with detacharm Round 1

A4222E0170

Commode chair electric Round 1

A4557E0171

Commode chair non-electric Round 1

A4595E0181

Press pad alternating w/ pum Round 1

A4604 NUE0182

Replace pump, alt press pad Round 1

A4619 NUE0186

Air pressure mattress Round 1

A4636 NUE0187

Water pressure mattress Round 1

A4636 RRE0193

Powered air flotation bed Round 1

A4636 UEE0196

Gel pressure mattress Round 1

A4637 NUE0197

Air pressure pad for mattres Round 1

A4637 RRE0277

Powered pres-redu air mattrs Round 1

A4637 UEE0371

Nonpower mattress overlay Round 1

A4640 NUE0372

Powered air mattress overlay Round 1

A4640 RRE0373

Nonpowered pressure mattress Round 1

A4640 UEE0565

Compressor air power source Round 1

Page 11: CMS Manual System...Document Control Numbers (DCN)s in the ICOR subsystem for each of the adjustment claims with the ICOR values specified by the DME MACs. These values will allow

A6550E0570

Nebulizer with compression Round 1

A7000 NUE0572

Aerosol compressor adjust pr Round 1

A7003 NUE0585

Nebulizer w/ compressor & he Round 1

A7004 NU E0630Patient lift hydraulic Round 1

A7005 NU E0635Patient lift electric Round 1

A7006 NUE0636

Pt support & positioning sys Round 1

A7007 NUE0779

Amb infusion pump mechanical Round 1

A7010 NUE0781

External ambulatory infus pu Round 1

A7012 NUE0784

Ext amb infusn pump insulin Round 1

A7013 NUE0791

Parenteral infusion pump sta Round 1

A7014 NUE0958

Whlchr att- conv 1 arm drive Round 1

A7015 NUE0985

W/c seat lift mechanism Round 1

A7017 NUE1031

Rollabout chair with casters Round 1

A7017 RRE1035

Patient transfer system <300 Round 1

A7017 UEE1036

Patient transfer system >300 Round 1

A7018E1037

Transport chair, ped size Round 1

Page 12: CMS Manual System...Document Control Numbers (DCN)s in the ICOR subsystem for each of the adjustment claims with the ICOR values specified by the DME MACs. These values will allow

A7027 NUE1038

Transport chair pt wt<=300lb Round 1

A7028 NUE1039

Transport chair pt wt >300lb Round 1

A7029 NUE1225

Manual semi-reclining back Round 1

A7030 NUE2228

Mwc acc, wheelchair brake Round 1

A7031 NUE2402

Neg press wound therapy pump Round 1

A7032 NU K0001Standard wheelchair Round 1

A7033 NUK0002

Stnd hemi (low seat) whlchr Round 1

A7034 NU K0003Lightweight wheelchair Round 1

A7035 NUK0004

High strength ltwt whlchr Round 1

A7036 NU K0006Heavy duty wheelchair Round 1

A7037 NUK0007

Extra heavy duty wheelchair Round 1

A7038 NUK0070

Rr whl compl pne tire rep ea Round 1

A7039 NUK0195

Elevating whlchair leg rests Round 1

A7044 NUE0165

Commode chair with detacharm Round 2

A7045 NUE0170

Commode chair electric Round 2

A7045 RRE0171

Commode chair non-electric Round 2

A7045 UEE0181

Press pad alternating w/ pum Round 2

A7046 NUE0182

Replace pump, alt press pad Round 2

Page 13: CMS Manual System...Document Control Numbers (DCN)s in the ICOR subsystem for each of the adjustment claims with the ICOR values specified by the DME MACs. These values will allow

B4035E0186

Air pressure mattress Round 2

B4036E0187

Water pressure mattress Round 2

B4034E0196

Gel pressure mattress Round 2

B4081E0197

Air pressure pad for mattres Round 2

B4082E0565

Compressor air power source Round 2

B4083E0570

Nebulizer with compression Round 2

B4087E0572

Aerosol compressor adjust pr Round 2

B4088E0585

Nebulizer w/ compressor & he Round 2

B4149 E0630Patient lift hydraulic Round 2

B4150 E0635Patient lift electric Round 2

B4152E0636

Pt support & positioning sys Round 2

B4153E0958

Whlchr att- conv 1 arm drive Round 2

B4154E0985

W/c seat lift mechanism Round 2

B4155E1035

Patient transfer system <300 Round 2

B9000 MSE1036

Patient transfer system >300 Round 2

B9000 NUE1037

Transport chair, ped size Round 2

Page 14: CMS Manual System...Document Control Numbers (DCN)s in the ICOR subsystem for each of the adjustment claims with the ICOR values specified by the DME MACs. These values will allow

B9000 RRE1039

Transport chair pt wt >300lb Round 2

B9000 UEE2228

Mwc acc, wheelchair brake Round 2

B9002 MSE2375

Non-expandable controller Round 2

B9002 NUE2378

Pw actuator replacement Round 2

B9002 RRB9002 UEE0130 NUE0130 RRE0130 UEE0135 NUE0135 RRE0135 UEE0140 RRE0141 NUE0141 RRE0141 UEE0143 NUE0143 RRE0143 UEE0144 RRE0147 NUE0147 RRE0147 UEE0148 NUE0148 RRE0148 UEE0149 RRE0154 NUE0154 RRE0154 UEE0155 NUE0155 RRE0155 UEE0156 NUE0156 RRE0156 UEE0157 NUE0157 RRE0157 UE

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E0158 NUE0158 RRE0158 UEE0159 NUE0159 RRE0159 UEE0160 NUE0160 RRE0160 UEE0161 NUE0161 RRE0161 UEE0163 NUE0163 RRE0163 UEE0165 RRE0167 NUE0167 RRE0167 UEE0168 NUE0168 RRE0168 UEE0170 RRE0171 RRE0181 RRE0182 RRE0184 NUE0184 RRE0184 UEE0185 NUE0185 RRE0185 UEE0186 RRE0187 RRE0188 NUE0188 RRE0188 UEE0189 NUE0189 RRE0189 UEE0193 RRE0196 RRE0197 RRE0199 NUE0199 RRE0199 UEE0250 RR

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E0251 RRE0255 RRE0256 RRE0260 RRE0261 RRE0265 RRE0266 RRE0271 NUE0271 RRE0271 UEE0272 NUE0272 RRE0272 UEE0275 NUE0275 RRE0275 UEE0276 NUE0276 RRE0276 UEE0277 RRE0280 NUE0280 RRE0280 UEE0290 RRE0291 RRE0292 RRE0293 RRE0294 RRE0295 RRE0296 RRE0297 RRE0300 RRE0301 RRE0302 RRE0303 RRE0304 RRE0305 RRE0310 NUE0310 RRE0310 UEE0316 RRE0325 NUE0325 RRE0325 UEE0326 NUE0326 RRE0326 UE

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E0371 RRE0372 RRE0373 RRE0424 RRE0431 RRE0433 RRE0434 RRE0439 RRE0441E0442E0443E0444E0470 RRE0471 RRE0472 RRE0561 NUE0561 RRE0561 UEE0562 NUE0562 RRE0562 UEE0565 RRE0570 RRE0572 RRE0580 NUE0580 RRE0580 UEE0585 RRE0601 RRE0621 NUE0621 RRE0621 UEE0627 NUE0627 RRE0627 UEE0628 NUE0628 RRE0628 UEE0629 NUE0629 RRE0629 UEE0630 RRE0635 RRE0636 RRE0705 NUE0705 RRE0705 UE

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E0720 NUE0730 NUE0731 NUE0776 NU BAE0776 RR BAE0776 UE BAE0776 NUE0776 RRE0776 UEE0779 RRE0780 NUE0781 RRE0784 RRE0791 RRE0910 RRE0911 RRE0912 RRE0940 RRE0950 NUE0950 RRE0950 UEE0951 NUE0951 RRE0951 UEE0952 NUE0952 RRE0952 UEE0955 RRE0956 NUE0956 RRE0956 UEE0957 NUE0957 RRE0957 UEE0958 RRE0959 NUE0959 RRE0959 UEE0960 NUE0960 RRE0960 UEE0961 NUE0961 RRE0961 UEE0966 NUE0966 RRE0966 UE

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E0967 NUE0967 RRE0967 UEE0971 NUE0971 RRE0971 UEE0973 NUE0973 RRE0973 UEE0974 NUE0974 RRE0974 UEE0978 NUE0978 RRE0978 UEE0981 NUE0981 RRE0981 UEE0982 NUE0982 RRE0982 UEE0985 RRE0990 NUE0990 RRE0990 UEE0992 NUE0992 RRE0992 UEE0995 NUE0995 RRE0995 UEE1002 RRE1003 RRE1004 RRE1005 RRE1006 RRE1007 RRE1008 RRE1010 RRE1015 NUE1015 RRE1015 UEE1016 NUE1016 RRE1016 UEE1020 RRE1028 RR

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E1029 RRE1030 RRE1031 RRE1035 RRE1036 RRE1037 RRE1038 RRE1039 RRE1225 RRE1226 NUE1226 RRE1226 UEE1372 NUE1372 RRE1372 UEE1390 RRE1391 RRE1392 RRE2201 NUE2201 RRE2201 UEE2202 NUE2202 RRE2202 UEE2203 NUE2203 RRE2203 UEE2204 NUE2204 RRE2204 UEE2205 NUE2205 RRE2205 UEE2206 NUE2206 RRE2206 UEE2207 NUE2207 RRE2207 UEE2208 NUE2208 RRE2208 UEE2209 NUE2209 RRE2209 UEE2210 NUE2210 RR

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E2210 UEE2211 NUE2211 RRE2211 UEE2212 NUE2212 RRE2212 UEE2213 NUE2213 RRE2213 UEE2214 NUE2214 RRE2214 UEE2215 NUE2215 RRE2215 UEE2219 NUE2219 RRE2219 UEE2220 NUE2220 RRE2220 UEE2221 NUE2221 RRE2221 UEE2222 NUE2222 RRE2222 UEE2224 NUE2224 RRE2224 UEE2225 NUE2225 RRE2225 UEE2226 NUE2226 RRE2226 UEE2228 RRE2231 NUE2231 RRE2231 UEE2310 RRE2311 RRE2321 RR KCE2321 RRE2322 RR KCE2322 RR

Page 22: CMS Manual System...Document Control Numbers (DCN)s in the ICOR subsystem for each of the adjustment claims with the ICOR values specified by the DME MACs. These values will allow

E2323 NUE2323 RRE2323 UEE2324 NUE2324 RRE2324 UEE2325 RRE2326 RRE2327 RRE2328 RRE2329 RRE2330 RRE2351 NUE2351 RRE2351 UEE2359 NUE2359 RRE2359 UEE2360 NUE2360 RRE2360 UEE2361 NUE2361 RRE2361 UEE2362 NUE2362 RRE2362 UEE2363 NUE2363 RRE2363 UEE2364 NUE2364 RRE2364 UEE2365 NUE2365 RRE2365 UEE2366 NUE2366 RRE2366 UEE2367 NUE2367 RRE2367 UEE2368 RRE2369 RRE2370 RRE2371 NUE2371 RR

Page 23: CMS Manual System...Document Control Numbers (DCN)s in the ICOR subsystem for each of the adjustment claims with the ICOR values specified by the DME MACs. These values will allow

E2371 UEE2373 RR KCE2374 RRE2375 RRE2376 RRE2377 RRE2378 RRE2381 NUE2381 RRE2381 UEE2382 NUE2382 RRE2382 UEE2383 NUE2383 RRE2383 UEE2384 NUE2384 RRE2384 UEE2385 NUE2385 RRE2385 UEE2386 NUE2386 RRE2386 UEE2387 NUE2387 RRE2387 UEE2388 NUE2388 RRE2388 UEE2389 NUE2389 RRE2389 UEE2390 NUE2390 RRE2390 UEE2391 NUE2391 RRE2391 UEE2392 NUE2392 RRE2392 UEE2394 NUE2394 RRE2394 UEE2395 NU

Page 24: CMS Manual System...Document Control Numbers (DCN)s in the ICOR subsystem for each of the adjustment claims with the ICOR values specified by the DME MACs. These values will allow

E2395 RRE2395 UEE2396 NUE2396 RRE2396 UEE2397 NUE2397 RRE2397 UEE2402 RRE2601 NUE2601 RRE2601 UEE2602 NUE2602 RRE2602 UEE2603 NUE2603 RRE2603 UEE2604 NUE2604 RRE2604 UEE2605 NUE2605 RRE2605 UEE2606 NUE2606 RRE2606 UEE2607 NUE2607 RRE2607 UEE2608 NUE2608 RRE2608 UEE2611 NUE2611 RRE2611 UEE2612 NUE2612 RRE2612 UEE2613 NUE2613 RRE2613 UEE2614 NUE2614 RRE2614 UEE2615 NUE2615 RR

Page 25: CMS Manual System...Document Control Numbers (DCN)s in the ICOR subsystem for each of the adjustment claims with the ICOR values specified by the DME MACs. These values will allow

E2615 UEE2616 NUE2616 RRE2616 UEE2619 NUE2619 RRE2619 UEE2620 NUE2620 RRE2620 UEE2621 NUE2621 RRE2621 UEE2622 NUE2622 RRE2622 UEE2623 NUE2623 RRE2623 UEE2624 NUE2624 RRE2624 UEE2625 NUE2625 RRE2625 UEE2626 NUE2626 RRE2626 UEE2627 NUE2627 RRE2627 UEE2628 NUE2628 RRE2628 UEE2629 NUE2629 RRE2629 UEE2630 NUE2630 RRE2630 UEE2631 NUE2631 RRE2631 UEE2632 NUE2632 RRE2632 UEE2633 NU

Page 26: CMS Manual System...Document Control Numbers (DCN)s in the ICOR subsystem for each of the adjustment claims with the ICOR values specified by the DME MACs. These values will allow

E2633 RRE2633 UEK0001 RRK0002 RRK0003 RRK0004 RRK0006 RRK0007 RRK0015 RRK0017 NUK0017 RRK0017 UEK0018 NUK0018 RRK0018 UEK0019 NUK0019 RRK0019 UEK0020 NUK0020 RRK0020 UEK0037 NUK0037 RRK0037 UEK0038 NUK0038 RRK0038 UEK0039 NUK0039 RRK0039 UEK0040 NUK0040 RRK0040 UEK0041 NUK0041 RRK0041 UEK0042 NUK0042 RRK0042 UEK0043 NUK0043 RRK0043 UEK0044 NUK0044 RRK0044 UEK0045 NUK0045 RR

Page 27: CMS Manual System...Document Control Numbers (DCN)s in the ICOR subsystem for each of the adjustment claims with the ICOR values specified by the DME MACs. These values will allow

K0045 UEK0046 NUK0046 RRK0046 UEK0047 NUK0047 RRK0047 UEK0050 NUK0050 RRK0050 UEK0051 NUK0051 RRK0051 UEK0052 NUK0052 RRK0052 UEK0053 NUK0053 RRK0053 UEK0056 NUK0056 RRK0056 UEK0065 NUK0065 RRK0065 UEK0069 NUK0069 RRK0069 UEK0070 RRK0071 NUK0071 RRK0071 UEK0072 NUK0072 RRK0072 UEK0073 NUK0073 RRK0073 UEK0077 NUK0077 RRK0077 UEK0098 NUK0098 RRK0098 UEK0105 NUK0105 RRK0105 UE

Page 28: CMS Manual System...Document Control Numbers (DCN)s in the ICOR subsystem for each of the adjustment claims with the ICOR values specified by the DME MACs. These values will allow

K0195 RRK0552K0601 NUK0602 NUK0603 NUK0604 NUK0605 NUK0733 NUK0733 RRK0733 UEK0738 RRK0800 NUK0800 RRK0800 UEK0801 NUK0801 RRK0801 UEK0802 NUK0802 RRK0802 UEK0806 NUK0806 RRK0806 UEK0807 NUK0807 RRK0807 UEK0808 NUK0808 RRK0808 UEK0813 RRK0814 RRK0815 RRK0816 RRK0820 RRK0821 RRK0822 RRK0823 RRK0824 RRK0825 RRK0826 RRK0827 RRK0828 RRK0829 RRK0835 RRK0836 RRK0837 RRK0838 RR

Page 29: CMS Manual System...Document Control Numbers (DCN)s in the ICOR subsystem for each of the adjustment claims with the ICOR values specified by the DME MACs. These values will allow

K0839 RRK0840 RRK0841 RRK0842 RRK0843 RR