AHA Coding Clinic® for HCPCS - 2006 Issue 3
Reporting of C-codes by Medicare non-OPPS providers
Effective October 1, 2006, C-codes may be used to bill services payable under Medicare payment systems other than Medicare’s Hospital Outpatient Prospective Payment System (OPPS). HCPCS C-codes are unique, temporary codes used to describe certain implantable medical devices, radiopharmaceuticals, drugs and biologicals, certain drug administration services, certain magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) procedures and new technology services. C-codes were initially created by the Centers for Medicare & Medicaid Services (CMS) to permit implementation of the Balanced Budget Refinement Act of 1999 (BBRA). These codes were initially created to identify services qualifying for “pass-through&rdquo...
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Article Overview
This article covers CMS guidance on when certain Medicare non-OPPS providers may report HCPCS C-codes, along with the provider categories and billing contexts addressed in the instruction. It is relevant to hospital billing and revenue cycle staff, compliance teams, and coders who work with Medicare claims, provider-based billing, and CMS manual updates. The article also points readers to the related CMS transmittal, MLN Matters reference, and a Medicare Claims Processing Manual revision.
Why This Topic Matters
It helps readers understand a Medicare policy change affecting how certain providers may report HCPCS C-codes and where the official guidance is documented.
Article Sections
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Guidance on C-code reporting for Medicare non-OPPS providers
Overview of the Medicare policy change and the provider types addressed in the CMS instruction. The section summarizes the general billing contexts covered by the guidance.
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CMS references and manual update
References to the CMS transmittal, MLN Matters item, and the manual chapter update associated with the policy change. This section identifies where the official instruction is documented.
What You Will Learn
- Which Medicare non-OPPS provider groups are addressed in the guidance
- What general types of services and billing settings are discussed
- Where to find the related CMS instruction and manual update
- How the article situates the guidance within Medicare claims processing
Who Should Read This
- Hospital coders
- Billing staff
- Revenue cycle teams
- Compliance professionals
- Medicare claims administrators
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