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  • NOTE: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material that is copyrighted by the American Medical Association. You are forbidden to download the files unless you read, agree to, and abide by the provisions of the copyright statement. Read the copyright statement now and you will be linked back to here.

    http://www.palmettogba.com/viewamalicense http://www.palmettogba.com/viewamalicense

  • JJ Part a Medicare advisory Latest Medicare News for JJ Part A

    palmettogba.com/jja

    April 2018 Volume 2018, Issue 02

    The JJ Part A Medicare Advisory contains coverage, billing and other information for Jurisdiction J Part A. This information is not intended to constitute legal advice. It is our official notice to those we serve concerning their responsibilities and obligations as mandated by Medicare regulations and guidelines. This information is readily available at no cost on the Palmetto GBA website. It is the responsibility of each facility to obtain this information and to follow the guidelines. The JJ Part A Medicare Advisory includes information provided by the Centers for Medicare & Medicaid Services (CMS) and is current at the time of publication. The information is subject to change at any time. This bulletin should be shared with all health care practitioners and managerial members of the provider staff. Bulletins are available at no-cost from our website at http://www.PalmettoGBA.com/Medicare.

    CPT only copyright 2017 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS\DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT®, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. The Code on Dental Procedures and Nomenclature is published in Current Dental Terminology (CDT), Copyright © 2012 American Dental Association (ADA). All rights reserved.

    What’s Inside... MLN Connects ..............................................................................................................3

    Weekly Articles .......................................................................................................3 Special Edition Articles ..........................................................................................3 Medicare Expired Legislative Provisions Extended and Other Bipartisan Budget Act of 2018 Provisions ...............................................................3

    Multiple Provider Information ....................................................................................4 Diagnosis Code Update for Add-on Payments for Blood Clotting Factor Administered to Hemophilia Inpatients ...................................................................4 Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - April 2018 Update ...............................................5 Adjustments to Qualified Medicare Beneficiary (QMB) Claims Processed Under CR 9911 .........................................................................................................7 Reinstating the Qualified Medicare Beneficiary Indicator in the Medicare Fee-For-Service Claims Processing System from CR9911 ......................................9 April 2018 Integrated Outpatient Code Editor (I/OCE) Specifications Version 19.1 ....................................................................................12 Prohibition Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) Program ............................................15 Appropriate Use Criteria for Advanced Diagnostic Imaging – Voluntary Participation and Reporting Period - Claims Processing Requirements – HCPCS Modifier QQ .....................................19 Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) .............................................................................................22 We’d Love Your Feedback! ....................................................................................27 Get Your Medicare News Electronically ................................................................28 Medicare Learning Network® (MLN) ...................................................................29

    Fee Schedule Information ..........................................................................................30 Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment ..................................................30 April Quarterly Update for 2018 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule .................................................33

    Federally Qualified Health Centers (FQHCs) Information ....................................36 Update to the Federally Qualified Health Center (FQHC) Prospective Payment System (PPS) for Calendar Year (CY) 2018 - Recurring File Update ...................36

  • 2 04/2018

    CPT codes, descriptors and other data only are copyright 2017 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data con- tained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

    Hospital Information ..................................................................................................39 The Supplemental Security Income (SSI)/Medicare Beneficiary Data for Fiscal Year 2016 for Inpatient Prospective Payment System (IPPS) Hospitals, Inpatient Rehabilitation Facilities (IRFs), and Long Term Care Hospitals (LTCH) .............39 Billing Requirements for OPPS Providers with Multiple Service Locations ........40 April 2018 Update of the Hospital Outpatient Prospective Payment System (OPPS) ........................................................................................45

    Learning and Education Information .......................................................................52 JJ Part A Website Navigation Basics Webcast – April 12, 2018 ............................52 April 25, 2018, Part A Skilled Nursing Facility (SNF) Consolidated Billing Webcast ...................................................................................................................53 June 13, 2018, Part A Quarterly Updates Webcast .................................................53 Educational Events Where You Can Ask Questions and Get Answers from Palmetto GBA .........................................................................................................54

    Medical Policy Information .......................................................................................55 NCD Coding Review - CR 10318-ICD-10 and Other Coding Revisions to NCDs ..................................................................................................................55 ICD-10 and Other Coding Revisions to National Coverage Determinations (NCDs) MLN Matters ............................................................................................56 Part A Local Coverage Determinations (LCDs) Updates .......................................59 Part A Local Coverage Determinations (LCDs) Article Updates ...........................61 Part A/B Medicare Administrative Contractor (MAC) Local Coverage Determinations (LCDs) Updates ............................................................................64 Part A/B Local Coverage Determinations (LCDs) Article Updates .......................66 MolDX Local Coverage Determinations (LCDs) Updates ....................................67 Infectious Disease Molecular Diagnostic Testing Local Coverage Determination (LCD Number: L33433) - Retired .......................67

    Skilled Nursing Facility (SNF) Information .............................................................68 Internet Only Manual Updates to Pub. 100-01, 100-02 and 100-04 to Correct Errors and Omissions (SNF) (2018) ......................................................68

    Tools You Can Use .......................................................................................................73 Basics of Provider Level Balance (PLB) Reason Codes ........................................73 New Medicare Card Information ...........................................................................74

    Helpful Information ....................................................................................................75 Contact Information for Palmetto GBA Part A ......................................................75

    April and June 2018 Part A Educational Events

    JJ Part A Website Navigation Basics Webcast – April 12, 2018 Palmetto GBA will host a Jurisdiction J Part A Website Navigation Basics Webcast on Thursday, April 12, 2018 at 10 a.m. ET.

    April 25, 2018, Part A Skilled Nursing Facility (SNF) Consolidated Billing Webcast Please join Palmetto GBA for an informative Part A Skilled Nursing Facility (SNF) Consolidated Billing (CB) webcast on April 25, 2018, at 10 a.m. ET!

    June 13, 2018, Part A Quarterly Updates Webcast Palmetto GBA will host the Med

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