Program_Memos / 2001 / AB-01-37

Why This Topic Matters

It clarifies how Medicare expected claims for verteporfin-associated services to be handled across physician, outpatient, and inpatient environments, and it identifies the diagnoses and claim-processing elements tied to payment and denial outcomes.

Article Sections

1. Transmittal AB-01-37

   Introduces the memorandum, dates, subject matter, and the general purpose of the guidance.

2. Background

   Summarizes the clinical and regulatory background for the therapy and drug referenced in the memorandum.

3. Medicare Coverage Policy

   Describes the Medicare coverage framework, including the settings and claim components addressed in the policy.

4. Carrier Claims Processing Instructions

   Outlines claims-processing guidance for carrier claims, including payment handling, edits, and pricing references.

5. Intermediary Claims Processing Instructions for Hospital Outpatient Services

   Provides hospital outpatient claims-processing guidance and notes related to transitional pass-through payment handling.

6. Intermediary Claims Processing Instructions for Hospital Inpatient Services

   Summarizes the inpatient reporting elements referenced for hospital claims.

7. Instructions for Both Carriers and Intermediaries

   Covers shared administrative instructions for documentation, audit support, and publication updates.

8. Medicare Summary Notice (MSN), and Remittance Advice Messages (RA)

   Lists beneficiary and provider denial messaging referenced for claim outcomes.