Program_Memos / 2002 / AB-02-128

Why This Topic Matters

It helps readers determine whether the Medicare policy applies to a breast biopsy service and where to look for the billing and payment framework associated with the change. The memo also identifies the effective date and the administrative guidance needed for claims processing and provider notification.

Article Sections

1. Change Request 2232

   Introduces the CMS change request and the general subject of the memorandum. It frames the policy update and points readers to the referenced coverage manual section.

2. Background

   Provides a brief overview of the procedure and the image-guidance methods involved. It explains the broad clinical context for the coverage update.

3. Coverage

   Summarizes the Medicare coverage scope for the service and the types of breast lesions discussed. It also notes the date on which the policy becomes applicable.

4. Intermediary Billing Instructions

   Describes general intermediary billing references and the form or electronic equivalent used for submission. It also introduces the procedure-related code references that follow.

5. Intermediary - Applicable CPT Codes

   Lists the procedure code references associated with the service and notes related imaging guidance codes. This section is focused on code identification and billing context.

6. Intermediary - Applicable Revenue Codes

   Addresses revenue code reporting for different facility settings and payment environments. It distinguishes among hospital and critical access hospital billing contexts.

7. Intermediary Payment Requirements

   Summarizes how the service is paid under Medicare for the settings described in the memo. It also references the timing of related payment system updates.

8. Frequency

   Notes that contractors may develop reasonable limitations when national frequency limits are not established. This section addresses utilization management at a broad level.

9. Carrier Billing Instructions

   Provides carrier-side billing references for the same service and restates the related code context. It mirrors the intermediary guidance in a carrier claims setting.

10. Carrier Claims Requirements

    Identifies claim form and processing references for carrier-submitted claims. It points to standard Medicare claims handling materials.

11. Carrier Payment Requirements

    Summarizes payment and pricing references, including where pricing information will appear. It also notes general cost-sharing and claim handling considerations.

12. Remittance Advice Notice

    Describes how denied claims should be communicated using standard remittance and remark coding frameworks. It includes guidance for denials tied to the policy effective period.

13. Medicare Summary Notice (MSN) Messages

    Identifies the beneficiary notice language associated with claim denials and the related messaging reference. It also includes a Spanish-language version of the notice text.

14. Provider Notification

    Explains how contractors should communicate the new national coverage to providers. It references website notice and training as broad outreach methods.