Medicare_Claims_Processing_Manual / CMS 100-04, Change Request 7133

Why This Topic Matters

The guidance affects how Medicare claims for tobacco cessation counseling are reported, processed, and paid during the transition to permanent coding. It also identifies the administrative rules that impact claim acceptance, beneficiary cost-sharing, and denial messaging.

Article Sections

1. I. Summary of Changes

   Overview of the CMS update, including the service topic, effective date, and implementation date.

2. II. Changes in Manual Instructions

   List of manual chapters and sections revised or added in response to the change request.

3. III. Funding

   Administrative funding guidance for contractors and Medicare Administrative Contractors.

4. IV. Attachments

   Reference to the supporting business requirements and manual instruction materials.

5. I. General Information

   Background and policy context for the CMS coverage update, including the broader preventive service framework.

6. II. Business Requirements Table

   Placeholder section for implementation requirements and mandatory actions.

7. III. Provider Education Table

   Placeholder section related to provider outreach and education.

8. IV. Supporting Information

   Supporting notes and reference structure for the business requirements section.

9. V. Contacts

   CMS contact information for pre-implementation and post-implementation questions.

10. VI. Funding

    Repeated funding language for intermediary and contractor administration.

11. 150 Counseling to Prevent Tobacco Use

    Manual instructions describing coverage scope, service availability, and operational processing for the preventive counseling benefit.

12. 150.1 Healthcare Common Procedure Coding System (HCPCS) and Diagnosis Coding

    Coding-related instructions covering the HCPCS and diagnosis reporting framework for the service.

13. 150.2 Carrier Billing Requirements

    Billing guidance for carrier claims, including submission and payment administration.

14. 150.2.1 Fiscal Intermediary (FI) Billing Requirements

    Billing guidance for intermediary claims and facility payment pathways.

15. 150.3 Medicare Summary Notices (MSNs), Remittance Advice Remark Codes (RARCs), Claims Adjustment Reason Codes (CARCs), and Group Codes

    Claim denial and adjustment messaging guidance for notices, remark codes, reason codes, and group codes.

16. 150.4 Common Working File (CWF)

    Common Working File edits and inquiry functions related to service frequency tracking.