tci Medicare Compliance & Reimbursement - 2005 Issue 13

COVERAGE: CMS Expands Defibrillator Coverage

Transmittal states Medicare HMO patients can get fee-for-service devices.Patients should be able to receive an implantable defibrillator on a fee-for-service basis even if they're enrolled in a Medicare Advantage Plan, according to Transmittal 488, issued March 4. Defibrillators won't be part of the capitated rates the plans receive. Also, Medicare will require that all patients receiving defibrillators to prevent cardiac arrest must be enrolled in a data-collection program. For these patients, you should append the -QR modifier starting April 4. As of Jan. 25, Medicare has expanded coverage for implantable defibrillators to include four new indications (coverage...

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