TRANSMITTALS ~ 3 Pump Codes No Longer Covered In SNFs

Why This Topic Matters

These transmittals can change how claims are processed, whether certain services are separately payable in specific settings, and how claim records are annotated or adjusted. Staying current helps billing and coding staff avoid avoidable denials, billing errors, and workflow delays.

Article Sections

1. Claims processing timelines for other-than-clean claims

   Discusses CMS guidance on the processing window for claims requiring additional development and how the timing is affected by carrier communication. The section also distinguishes these claims from delays related to system issues.

2. Coverage update for infrared therapy

   Summarizes a Medicare coverage update affecting a therapy used for neuropathy. The section identifies the transmittal tied to the change and its general coverage context.

3. Skilled nursing facility consolidated billing update

   Covers changes to the list of services included in SNF consolidated billing. The section references chemotherapy administration-related pump and maintenance procedures.

4. Imaging service denotation mark for TC cap

   Describes a claims-processing notation used for imaging services subject to a payment cap tied to outpatient payment levels. The section explains the general purpose of the marker in the claim record.

5. Mass adjustments and claims adjustment processing

   Addresses CMS guidance on distinguishing mass adjustments from other claim adjustments. The section mentions processing tools used for large-scale monetary changes.