Medicare_Claims_Processing_Manual / 426

Why This Topic Matters

The article explains a Medicare policy change that affects how mammography claims are reported and processed, making it important for accurate claim submission and contractor administration.

Article Sections

1. Transmittal Information and Summary of Changes

   Provides the transmittal identification, effective and implementation dates, and a high-level summary of the manual update. It also identifies the affected manual chapter and section.

2. Attachment - Business Requirements

   Outlines the general business requirement framework and supporting implementation notes for the claims processing update. It includes background, policy, and provider education references.

3. HCPCS and Diagnosis Codes for Mammography Services

   Lists mammography-related HCPCS and associated billing guidance used in Medicare claims processing. The section also addresses timing notes and service categories for the reported codes.

4. New Modifier -GG

   Introduces a modifier associated with same-day mammography service reporting and notes its tracking-related role. The section discusses the circumstances and dates to which the modifier applies.

5. Diagnosis for Services On or After January 1, 1998

   Explains diagnosis reporting guidance for later mammography claims and how claims without diagnosis information are handled. It also references the forms and fields used for submission.

6. Diagnoses for Services October 1, 1997 Through December 31, 1997

   Summarizes earlier mammography diagnosis reporting guidance for a prior date range. The section includes high-risk and other diagnosis reporting categories.