decisionhealth Newsletters, Answer Books - 2006 Issue 3 (March)
Program_Memos / 2001 / B-01-58
Subscribe or sign in to view the full article.
Article Overview
This article explains a CMS program memorandum for carriers and DMERCs that updates Medicare billing guidance for non-covered items and services, including the use of certain HCPCS modifiers and related claims-processing instructions. It is relevant to providers, suppliers, and coders who need to understand the policy change, affected code set references, effective dates, and claim documentation requirements.
Why This Topic Matters
The memorandum describes a Medicare payment-policy update that affects how certain claims are reported and processed. It also identifies discontinued items, newly introduced modifiers, and documentation expectations that can affect claim handling and administrative compliance.
Article Sections
-
Program Memorandum Header and Change Request
Administrative information identifying the issuing organizations, transmittal details, date, and the subject of the change request.
-
Overview of the Coding Update
A summary of the policy update and the general categories of services and items addressed by the memorandum. This section also notes the timing of the update and the relationship to prior guidance.
-
Discontinued Codes and Modifier
A list of previously used HCPCS items and a modifier that are being replaced or discontinued under the memorandum.
-
New Modifiers
The new HCPCS modifiers introduced by the memorandum and their role in the updated billing framework.
-
Clarification on Use of A9270
Guidance on the status of a specific HCPCS code and its role in Medicare billing under the updated policy.
-
Use of the GA, GY, and GZ Modifiers for Services Billed to Carriers
General carrier-facing instructions for applying the updated modifiers when reporting services to Medicare carriers.
-
Use of the GA, GY, and GZ Modifiers for Items and Supplies Billed to DMERCs
General DMERC-facing instructions for applying the updated modifiers when reporting items and supplies under Medicare.
-
Carriers and DMERCs
Claims-processing notes describing how submitted claims may be handled when the updated modifiers are present.
-
Explanatory Information To Be Included on Claims
Documentation and narrative requirements when specific coding situations require additional claim-level explanation.
-
Provider Notification
Instructions for communicating the policy change to affected providers and suppliers, along with implementation timing and retention guidance.
What You Will Learn
- What policy area the memorandum addresses
- Which HCPCS-related items and modifiers are affected by the update
- How the article distinguishes carrier and DMERC billing contexts
- What claim documentation topics are covered
- What dates govern implementation and effectiveness
Who Should Read This
- Medical coders
- Billing staff
- Compliance teams
- Durable medical equipment suppliers
- Providers submitting Medicare claims
- Revenue cycle professionals
Codes Discussed
Modifiers Discussed
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com