Program_Memos / 2002 / AB-02-042

Why This Topic Matters

The memorandum addresses a covered diabetes-related service area with specific billing and administrative requirements that affect claims processing, reimbursement, and provider notification. It helps billing and coding staff identify the scope of the benefit and the operational details tied to Medicare payment.

Article Sections

1. Coverage

   Describes the Medicare coverage topic, the clinical context, and the effective date for the service benefit. It also discusses the general diagnostic approach and the organizations referenced in connection with the guidance.

2. Applicable HCPCS Codes

   Lists the HCPCS codes associated with the service family and presents the related reporting framework. It also includes a note about reimbursement treatment for one of the listed codes.

3. Short Descriptors

   Provides abbreviated labels associated with the HCPCS codes referenced in the memorandum.

4. Diagnosis Codes

   Identifies the diagnosis codes to report in conjunction with the benefit described in the memorandum.

5. Intermediary Payment Requirements

   Summarizes payment categories, deductible and coinsurance treatment, and examples of how payment is calculated. It also addresses bill types and claim-related administrative considerations.

6. Intermediary - Applicable Revenue Codes

   Identifies the revenue code guidance associated with the service and notes where the service may be reported in hospital settings.

7. Carrier - Payment Requirements

   Addresses carrier billing and payment administration for the listed HCPCS codes.

8. Claims Editing Instructions for Carriers and FIs

   Discusses claims processing edits and the possibility of local edits under national policy.

9. Provider Notification

   Explains how contractors should notify providers about the coverage change and implementation timeline.