Program_Memos / 2001 / B-01-30

Why This Topic Matters

It helps readers understand a Medicare policy update affecting how coverage-related situations are reported on claims and what accompanying information may be required. Accurate awareness of these changes supports cleaner claim submission and proper handling of non-covered or excluded services.

Article Sections

1. Program Memorandum

   Introductory memorandum details, including issuing agency, transmittal information, date, and the change request being addressed.

2. Coding changes effective January 01, 2002

   Summary of the coding updates announced in the memorandum, including retired items, new items, and a status update to an existing HCPCS entry.

3. Explanatory information to be included

   General narrative and reporting guidance for claims that require additional explanation when the new codes or modifiers are used.

4. Items and services considered not reasonable and necessary

   Discussion of claim handling for services or items viewed as not reasonable and necessary under Medicare policies and regulations.

5. Statutorily non-covered items or services

   Guidance addressing statutorily excluded items or services and the associated claim processing approach.

6. Use of the GA modifier with the new codes and modifiers

   General instructions regarding beneficiary notice, waiver of liability, and the relationship between the GA modifier and the newly added reporting options.

7. Provider notification

   Instructions to carriers and related entities about informing providers and suppliers of the changes and the implementation timeline.