Medicare and Medicaid Programs; Quarterly Listing of Program Issuances-January Through March 2005, 36620-36640 [05-12525]

Agencies

• Centers for Medicare & Medicaid Services
• DEPARTMENT OF HEALTH AND HUMAN SERVICES

[Federal Register Volume 70, Number 121 (Friday, June 24, 2005)]
[Notices]
[Pages 36620-36640]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 05-12525]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-9028-N]


Medicare and Medicaid Programs; Quarterly Listing of Program 
Issuances--January Through March 2005

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Notice.

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SUMMARY: This notice lists CMS manual instructions, substantive and 
interpretive regulations, and other Federal Register notices that were 
published from January 2005 through March 2005, relating to the 
Medicare and Medicaid programs. This notice provides information on 
national coverage determinations (NCDs) affecting specific medical and 
health care services under Medicare. Additionally, this notice 
identifies certain devices with investigational device exemption (IDE) 
numbers approved by the Food and Drug Administration (FDA) that 
potentially may be covered under Medicare. This notice also includes 
listings of all approval numbers from the Office of Management and 
Budget for collections of information in CMS regulations. Finally, for 
the first time, this notice includes a list of Medicare-approved 
carotid stent facilities.
    Section 1871(c) of the Social Security Act requires that we publish 
a list of Medicare issuances in the Federal Register at least every 3 
months. Although we are not mandated to do so by statute, for the sake 
of completeness of the listing, and to foster more open and transparent 
collaboration efforts, we are also including all Medicaid issuances and 
Medicare and Medicaid substantive and interpretive regulations 
(proposed and final) published during this 3-month time frame.

FOR FURTHER INFORMATION CONTACT: It is possible that an interested 
party may have a specific information need and not be able to determine 
from the listed information whether the issuance or regulation would 
fulfill that need. Consequently, we are providing information contact 
persons to answer general questions concerning these items. Copies are 
not available through the contact persons. (See Section III of this 
notice for how to obtain listed material.)
    Questions concerning items in Addendum III may be addressed to 
Timothy Jennings, Office of Strategic Operations and Regulatory 
Affairs, Centers for Medicare & Medicaid Services, C4-26-05, 7500 
Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 
786-2134.
    Questions concerning Medicare NCDs in Addendum V may be addressed 
to Patricia Brocato-Simons, Office of Clinical Standards and Quality, 
Centers for Medicare & Medicaid Services, C1-09-06, 7500 Security 
Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-0261.
    Questions concerning FDA-approved Category B IDE numbers listed in 
Addendum VI may be addressed to John Manlove, Office of Clinical 
Standards and Quality, Centers for Medicare & Medicaid Services, S3-26-
10, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call 
(410) 786-6877.
    Questions concerning approval numbers for collections of 
information in Addendum VII may be addressed to Jim Wickliffe, Office 
of Strategic Operations and Regulatory Affairs, Regulations Development 
and Issuances Group, Centers for Medicare & Medicaid Services, C5-14-
03, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call 
(410) 786-4596.
    Questions concerning Medicare-approved carotid stent facilities may 
be addressed to Rana A. Hogarth, Office of Clinical Standards and 
Quality, Centers for Medicare & Medicaid Services, C1-

[[Page 36621]]

09-06, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can 
call (410) 786-2112; or to Sarah J. McClain, Office of Clinical 
Standards and Quality, Centers for Medicare & Medicaid Services, C1-09-
06, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call 
(410) 786-2994.
    Questions concerning all other information may be addressed to 
Gwendolyn Johnson, Office of Strategic Operations and Regulatory 
Affairs, Regulations Development Group, Centers for Medicare & Medicaid 
Services, C5-14-03, 7500 Security Boulevard, Baltimore, MD 21244-1850, 
or you can call (410) 786-6954.

SUPPLEMENTARY INFORMATION: 

I. Program Issuances

    The Centers for Medicare & Medicaid Services (CMS) is responsible 
for administering the Medicare and Medicaid programs. These programs 
pay for health care and related services for 39 million Medicare 
beneficiaries and 35 million Medicaid recipients. Administration of the 
two programs involves (1) furnishing information to Medicare 
beneficiaries and Medicaid recipients, health care providers, and the 
public and (2) maintaining effective communications with regional 
offices, State governments, State Medicaid agencies, State survey 
agencies, various providers of health care, all Medicare contractors 
that process claims and pay bills, and others. To implement the various 
statutes on which the programs are based, we issue regulations under 
the authority granted to the Secretary of the Department of Health and 
Human Services under sections 1102, 1871, 1902, and related provisions 
of the Social Security Act (the Act). We also issue various manuals, 
memoranda, and statements necessary to administer the programs 
efficiently.
    Section 1871(c)(1) of the Act requires that we publish a list of 
all Medicare manual instructions, interpretive rules, statements of 
policy, and guidelines of general applicability not issued as 
regulations at least every 3 months in the Federal Register. We 
published our first notice June 9, 1988 (53 FR 21730). Although we are 
not mandated to do so by statute, for the sake of completeness of the 
listing of operational and policy statements, and to foster more open 
and transparent collaboration, we are continuing our practice of 
including Medicare substantive and interpretive regulations (proposed 
and final) published during the respective 3-month time frame.

II. How To Use the Addenda

    This notice is organized so that a reader may review the subjects 
of manual issuances, memoranda, substantive and interpretive 
regulations, NCDs, and FDA-approved IDEs published during the subject 
quarter to determine whether any are of particular interest. We expect 
this notice to be used in concert with previously published notices. 
Those unfamiliar with a description of our Medicare manuals may wish to 
review Table I of our first three notices (53 FR 21730, 53 FR 36891, 
and 53 FR 50577) published in 1988, and the notice published March 31, 
1993 (58 FR 16837). Those desiring information on the Medicare NCD 
Manual (NCDM, formerly the Medicare Coverage Issues Manual (CIM)) may 
wish to review the August 21, 1989, publication (54 FR 34555). Those 
interested in the revised process used in making NCDs under the 
Medicare program may review the September 26, 2003, publication (68 FR 
55634).
    To aid the reader, we have organized and divided this current 
listing into eight addenda:
     Addendum I lists the publication dates of the most recent 
quarterly listings of program issuances.
     Addendum II identifies previous Federal Register documents 
that contain a description of all previously published CMS Medicare and 
Medicaid manuals and memoranda.
     Addendum III lists a unique CMS transmittal number for 
each instruction in our manuals or Program Memoranda and its subject 
matter. A transmittal may consist of a single or multiple 
instruction(s). Often, it is necessary to use information in a 
transmittal in conjunction with information currently in the manuals.
     Addendum IV lists all substantive and interpretive 
Medicare and Medicaid regulations and general notices published in the 
Federal Register during the quarter covered by this notice. For each 
item, we list the--
    [cir] Date published;
    [cir] Federal Register citation;
    [cir] Parts of the Code of Federal Regulations (CFR) that have 
changed (if applicable);
    [cir] Agency file code number; and
    [cir] Title of the regulation.
     Addendum V includes completed NCDs, or reconsiderations of 
completed NCDs, from the quarter covered by this notice. Completed 
decisions are identified by the section of the NCDM in which the 
decision appears, the title, the date the publication was issued, and 
the effective date of the decision.
     Addendum VI includes listings of the FDA-approved IDE 
categorizations, using the IDE numbers the FDA assigns. The listings 
are organized according to the categories to which the device numbers 
are assigned (that is, Category A or Category B), and identified by the 
IDE number.
     Addendum VII includes listings of all approval numbers 
from the Office of Management and Budget (OMB) for collections of 
information in CMS regulations in title 42; title 45, subchapter C; and 
title 20 of the CFR.
     Addendum VIII includes listings of Medicare-approved 
carotid stent facilities. All facilities listed meet CMS's standards 
for performing carotid artery stenting for high risk patients.

III. How To Obtain Listed Material

A. Manuals

    Those wishing to subscribe to program manuals should contact either 
the Government Printing Office (GPO) or the National Technical 
Information Service (NTIS) at the following addresses:
    Superintendent of Documents, Government Printing Office, ATTN: New 
Orders, P.O. Box 371954, Pittsburgh, PA 15250-7954, Telephone (202) 
512-1800, Fax number (202) 512-2250 (for credit card orders); or
    National Technical Information Service, Department of Commerce, 
5825 Port Royal Road, Springfield, VA 22161, Telephone (703) 487-4630.
    In addition, individual manual transmittals and Program Memoranda 
listed in this notice can be purchased from NTIS. Interested parties 
should identify the transmittal(s) they want. GPO or NTIS can give 
complete details on how to obtain the publications they sell. 
Additionally, most manuals are available at the following Internet 
address: https://cms.hhs.gov/manuals/default.asp.

B. Regulations and Notices

    Regulations and notices are published in the daily Federal 
Register. Interested individuals may purchase individual copies or 
subscribe to the Federal Register by contacting the GPO at the address 
given above. When ordering individual copies, it is necessary to cite 
either the date of publication or the volume number and page number.
    The Federal Register is also available on 24x microfiche and as an 
online database through GPO Access. The online database is updated by 6 
a.m. each day the Federal Register is published. The database includes 
both text and graphics from Volume 59, Number 1 (January 2, 1994) 
forward. Free public access is available on a Wide Area Information 
Server (WAIS)

[[Page 36622]]

through the Internet and via asynchronous dial-in. Internet users can 
access the database by using the World Wide Web; the Superintendent of 
Documents home page address is https://www.gpoaccess.gov/fr/, 
by using local WAIS client software, or by telnet to 
swais.gpoaccess.gov, then log in as guest (no password required). Dial-
in users should use communications software and modem to call (202) 
512-1661; type swais, then log in as guest (no password required).

C. Rulings

    We publish rulings on an infrequent basis. Interested individuals 
can obtain copies from the nearest CMS Regional Office or review them 
at the nearest regional depository library. We have, on occasion, 
published rulings in the Federal Register. Rulings, beginning with 
those released in 1995, are available online, through the CMS Home 
Page. The Internet address is https://cms.hhs.gov/rulings.

D. CMS' Compact Disk-Read Only Memory (CD-ROM)

    Our laws, regulations, and manuals are also available on CD-ROM and 
may be purchased from GPO or NTIS on a subscription or single copy 
basis. The Superintendent of Documents list ID is HCLRM, and the stock 
number is 717-139-00000-3. The following material is on the CD-ROM 
disk:
     Titles XI, XVIII, and XIX of the Act.
     CMS-related regulations.
     CMS manuals and monthly revisions.
     CMS program memoranda.
    The titles of the Compilation of the Social Security Laws are 
current as of January 1, 1999. (Updated titles of the Social Security 
Laws are available on the Internet at https://www.ssa.gov/OP_Home/
ssact/comp-toc.htm.) The remaining portions of CD-ROM are updated on a 
monthly basis.
    Because of complaints about the unreadability of the Appendices 
(Interpretive Guidelines) in the State Operations Manual (SOM), as of 
March 1995, we deleted these appendices from CD-ROM. We intend to re-
visit this issue in the near future and, with the aid of newer 
technology, we may again be able to include the appendices on CD-ROM.
    Any cost report forms incorporated in the manuals are included on 
the CD-ROM disk as LOTUS files. LOTUS software is needed to view the 
reports once the files have been copied to a personal computer disk.

IV. How To Review Listed Material

    Transmittals or Program Memoranda can be reviewed at a local 
Federal Depository Library (FDL). Under the FDL program, government 
publications are sent to approximately 1,400 designated libraries 
throughout the United States. Some FDLs may have arrangements to 
transfer material to a local library not designated as an FDL. Contact 
any library to locate the nearest FDL.
    In addition, individuals may contact regional depository libraries 
that receive and retain at least one copy of most Federal Government 
publications, either in printed or microfilm form, for use by the 
general public. These libraries provide reference services and 
interlibrary loans; however, they are not sales outlets. Individuals 
may obtain information about the location of the nearest regional 
depository library from any library. For each CMS publication listed in 
Addendum III, CMS publication and transmittal numbers are shown. To 
help FDLs locate the materials, use the CMS publication and transmittal 
numbers. For example, to find the Medicare NCD publication titled 
``Implantable Automatic Defibrillators,'' use CMS-Pub. 100-03, 
Transmittal No. 29.

(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance, Program No. 93.774, Medicare--
Supplementary Medical Insurance Program, and Program No. 93.714, 
Medical Assistance Program)
    Dated: June 20, 2005.
Jacquelyn White,
Director, Office of Strategic Operations and Regulatory Affairs.

Addendum I

    This addendum lists the publication dates of the most recent 
quarterly listings of program issuances.

December 27, 2002 (67 FR 79109).
March 28, 2003 (68 FR 15196).
June 27, 2003 (68 FR 38359).
September 26, 2003 (68 FR 55618).
December 24, 2003 (68 FR 74590).
March 26, 2004 (69 FR 15837).
June 25, 2004 (69 FR 35634).
September 24, 2004 (69 FR 57312).
December 30, 2004 (69 FR 78428).
February 25, 2005 (70 FR 9338).

Addendum II--Description of Manuals, Memoranda, and CMS Rulings

    An extensive descriptive listing of Medicare manuals and memoranda 
was published on June 9, 1988, at 53 FR 21730 and supplemented on 
September 22, 1988, at 53 FR 36891 and December 16, 1988, at 53 FR 
50577. Also, a complete description of the former CIM (now the NCDM) 
was published on August 21, 1989, at 54 FR 34555. A brief description 
of the various Medicaid manuals and memoranda that we maintain was 
published on October 16, 1992, at 57 FR 47468.

        Addendum III.--Medicare and Medicaid Manual Instructions
                      [January Through March 2005]
------------------------------------------------------------------------
    Transmittal No.               Manual/subject/publication No.
------------------------------------------------------------------------
             Medicare General Information (CMS Pub. 100-01)
------------------------------------------------------------------------
 15....................  Review of Contractor Implementation of Change
                          Requests (Replacement for expired CR 944).
                         Review of Contractor Implementation of Change
                          Requests.
                         CR Implementation Report--Summary Page.
                         CR Implementation Report--Details Page.
                         CR Implementation Report--Sample Cover Letter/
                          Attestation Statement.
16.....................  Standard Terminology for Claims Processing
                          Systems.
17.....................  This Transmittal rescinded and replaced
                          Transmittal 15.
18.....................  Billing for Blood and Blood Products Under the
                          Hospital Outpatient Prospective Payment
                          System.
                         Items Subject to Blood Deductibles.
                         Blood.
19.....................  Revisions to Chapter 5, Section 50 of
                          Publication 100-01 in the Internet Only.
                         Manual to Clarify Current Policy.
                         Home Health Agency Defined.
                         Arrangements by Home Health Agencies.

[[Page 36623]]

 
                         Rehabilitation Centers.
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                Medicare Benefit Policy (CMS Pub. 100-02)
------------------------------------------------------------------------
 29....................  Telehealth Originating Site Facility Fee
                          Payment Amount Update.
30.....................  Policy for Repair and Replacement of Durable
                          Medical Equipment.
------------------------------------------------------------------------
       Medicare National Coverage Determinations (CMS Pub. 100-03)
------------------------------------------------------------------------
 27....................  Infusion Pumps: C-Peptide Levels As A Criterion
                          for Use.
28.....................  Update of Laboratory NCDs to Reference New
                          Screening Benefits.
                         Blood Glucose Testing.
                         Lipid Testing.
29.....................  Implantable Automatic Defibrillators.
30.....................  Coverage of Colorectal Anti-Cancer Drugs
                          Included in Clinical Trials.
                         Anti-Cancer Chemotherapy for Colorectal Cancer
                          (Effective January 28, 2005).
------------------------------------------------------------------------
               Medicare Claims Processing (CMS Pub. 100-04)
------------------------------------------------------------------------
 423...................  January 2005 Update of the Hospital Outpatient
                          Prospective Payment System: Summary of Payment
                          Policy Changes.
424....................  Implementation of the Annual Desk Review
                          Program for Hospital Wage Data: Cost Reporting
                          Periods Beginning on or After October 1, 2001,
                          Through September 30, 2002 (FY 2006 Wage
                          Index).
425....................  Section 630 of the Medicare Modernization Act
                          allows for the Reimbursement for Ambulance
                          Services Provided by Indian Health Service/
                          Tribal Hospitals, Including Critical Access
                          Hospitals, Which Manage and Operate Hospital-
                          Based Ambulances.
                         General Coverage and Payment Policies.
                         Indian Health Service/Tribal Billing.
426....................  Modification to Reporting of Diagnosis Codes
                          for Screening Mammography Claims.
                         Healthcare Common Procedure Coding System and
                          Diagnosis Codes for Mammography Services.
427....................  Revision of Change Request 2928: Implementation
                          of Payment Safeguards for Home Health
                          Prospective Payment System Claims Failing to
                          Report Prior Hospitalizations.
                         Adjustments of Episode Payment--Hospitalization
                          Within 14 Days of Start of Care.
428....................  Update to Billing Requirements for FDG-Positron
                          Emission Tomography Scans For Use in the
                          Differential Diagnosis of Alzheimer's Disease
                          and Fronto-Temporal Dementia and Update to the
                          Fiscal Intermediaries Billing Requirements for
                          Special Payment Procedures for All Positron
                          Emission Tomography Scan.
                         Claims for Services Performed in a Critical
                          Access Hospital.
                         Billing Instructions.
                         Coverage for Positron Emission Tomography Scans
                          for Dementia and Neurodegenerative Disease.
429....................  Change to the Common Working File Skilled
                          Nursing Facility Consolidated Billing Edits
                          for Critical Access Hospitals That Have
                          Elected Method II Payment Option and Bill
                          Physician Services to Their Fiscal
                          Intermediaries.
                         Physician's Services and Other Professional
                          Services Excluded From Part A PPS Payment and
                          the Consolidated Billing Requirement.
430....................  Mandatory Assignment for Medicare Modernization
                          Act Sec.   630 Claims.
                         Other Part B Services.
                         Durable Medical Equipment Regional Carrier
                          Drugs.
                         Claims Processing Requirements for Medicare
                          Modernization Act Sec.   630.
                         Claims Processing for Durable Medical Equipment
                          Prosthetic, Orthotics & Supplies and Durable
                          Medical Equipment Regional Carrier Drugs.
                         Enrollment for Durable Medical Equipment
                          Prosthetic, Orthotics & Supplies and Durable
                          Medical Equipment Regional Carrier Drugs.
                         Enrollment and Billing for Clinical Laboratory
                          and Ambulance Services and Part B Drugs.
                         Claims Submission and Processing for Clinical
                          Laboratory and Ambulance Services and Part B
                          Drugs.
431....................  Updated Skilled Nursing Facility No Pay File
                          for April 2005.
432....................  Adding an Indicator to the National Claims
                          History to Indicate That Durable Medical
                          Regional Carriers, Carriers, and Fiscal
                          Intermediaries Have Reviewed a Potentially
                          Duplicate Claim.
                         Detection of Duplicate Claims.
433....................  Issued to a specific audience, not posted to
                          the Internet/Intranet due to the Sensitivity
                          of Instruction.
434....................  Addition of Clinical Laboratory Improvement Act
                          Edits to Certain Health Care Procedure Coding
                          System Codes for Mohs Surgery.
435....................  This Transmittal has been rescinded and
                          replaced by Transmittal 450.
436....................  Remittance Advice Remark Code and Claim
                          Adjustment Reason Code Update.
437....................  Revisions and Corrections to the Medicare
                          Claims Processing Manual, Chapter 6, Section
                          30 and Various Sections in Chapter 15.
                         Billing Skilled Nursing Facility Prospective
                          Payment System Services General Coverage and
                          Payment Policies.
                         Air Ambulance for Deceased Beneficiary.
                         General Billing Guidelines for Intermediaries
                          and Carriers.
                         Intermediary Guidelines.
438....................  Fiscal Intermediary Standard Paper Remittance
                          Advice Changes.
439....................  Modification to the Fiscal Intermediary
                          Standard System Regarding Ambulance Services
                          Billed on 18x and 21x Types of Bill.
440....................  Updating the Common Working File Editing for
                          Pap Smear (Q0091) and Adding a New Low Risk
                          Diagnosis Code (V72.31) for Pap Smear and
                          Pelvic Examination.

[[Page 36624]]

 
                         Healthcare Common Procedure Coding System Codes
                          for Billing.
                         Diagnoses Codes.
                         Payment Method.
                         Revenue Codes and Healthcare Common Procedure
                          Coding System Codes for Billing.
                         Medicare Summary Notice Messages.
                         Remittance Advice Codes.
441....................  Viable Medicare Systems Changes to Durable
                          Medical Equipment Regional Carrier Processing
                          of Method II Home Dialysis Claims.
442....................  Hospital Outpatient Prospective Payment System:
                          Use of Modifiers -52, -73 and -74 for Reduced
                          or Discontinued Services
                         Use of Modifiers.
                         Use of Modifiers for Discontinued Services.
443....................  This Transmittal is rescinded and replaced by
                          Transmittal 505.
444....................  Further Information Related to Inpatient
                          Psychiatric Facility Prospective Payment
                          System
445....................  Payment to Providers/Suppliers Qualified to
                          Bill Medicare for Prosthetics and Certain
                          Custom-Fabricated Orthotics.
                         Provider Billing for Prosthetics and Orthotic
                          Services.
446....................  Diabetes Screening Tests.
447....................  Common Working File Editing for Method
                          Selection on Durable Medical Equipment
                          Regional Carrier Claims for EPO and Aranesp
                         Epoetin Alfa Furnished to Home Patients.
                         Darbepoetin Alfa Furnished to Home Patients.
448....................  Timeframe for Continued Execution of Crossover
                          Agreements and Update on the Transition to the
                          National Coordination of Benefits Agreement
                          Program
                         Crossover Claims Requirements.
                         Fiscal Intermediaries Requirements.
                         Durable Medical Equipment Regional Carrier
                          Requirements.
                         Consolidation of the Claims Crossover Process.
                         Electronic Transmission - General Requirements.
                         ANSI X12N 837 Coordination of Benefit
                          Transaction Fee Collection.
                         Medigap Electronic Claims Transfer Agreements.
                         Intermediary Crossover Claim Requirements.
                         Carrier/Durable Medical Equipment Regional
                          Carrier Crossover Claims Requirements.
449....................  April Quarterly Update to 2005 Annual Update of
                          Healthcare Common Procedure Coding System
                          Codes Used for Skilled Nursing Facility
                          Consolidated Billing Enforcement
450....................  Enforcement of Mandatory Electronic Submission
                          of Medicare Claims
                         Failure To Furnish Information Medicare Summary
                          Notice Message.
                         Falta De Information Sometida Medicare Summary
                          Notice Message Enforcement.
451....................  April 2005 Quarterly Fee Schedule Update for
                          Durable Medical Equipment, Prosthetics,
                          Orhtotics, and Supplies.
452....................  New Remittance Advice Message for Referred
                          Clinical Diagnostic/ Purchased Diagnostic
                          Service Duplicate Claims.
453....................  Instructions for Downloading the Medicare Zip
                          Code File.
454....................  Definitions of Electronic and Paper Claims.
                         Payment Ceiling Standards.
455....................  This transmittal is rescinded and replaced by
                          Transmittal 509.
456....................  Independent Laboratory Billing for the
                          Technical Component of Physician.
                         Pathology Services Furnished to Hospital
                          Patients (Supplemental to Change Request 3467)
457....................  Diabetes Screening Tests.
                         Healthcare Common Procedure Coding System
                          Coding for Diabetes Screening.
                         Carrier Billing Requirements.
                         Modifier Requirements for Pre-Diabetes.
                         Fiscal Intermediary Billing Requirements.
                         Diagnosis Code Reporting.
                         Medicare Summary Notices.
                         Remittance Advice Remark Codes.
                         Claims Adjustment Reason Codes.
458....................  Hospice Physician Recertification Requirements.
                         Data Required on Claim to Fiscal
                          Intermediaries.
459....................  Full Replacement of Change Request 3427,
                          Transmittal 342, Issued on October 29, 2004--
                          Change to the Common Working File Skilled
                          Nursing Facility.
                         Consolidated Billing Edits for Ambulance
                          Transports to or From a Diagnostic or
                          Therapeutic Site.
                         Ambulance Services.
                         Skilled Nursing Facility Billing.
460....................  Issued to a specific audience, not posted to
                          Internet/Intranet due to Confidentiality of
                          Instruction.
461....................  Processing Durable Medical Equipment,
                          Orthotics, Prosthetics, Drugs, and Surgical
                          Dressings Claims for Indian Health Services
                          and Tribally Owned and Operated Hospitals or
                          Hospital Based Facilities Including Critical
                          Access.
                         Hospital.
                         Other Part B Services.
                         Prosthetics and Orthotics.
                         Prosthetic Devices.
                         Surgical Dressings and Splints and Casts.
                         Drugs Dispensed by IHS Hospital-Based or
                          Freestanding Facilities.
                         Claims Processing for Durable Medical Equipment
                          Prosthetics, Orthotics & Supplies.

[[Page 36625]]

 
                         Enrollment for Durable Medical Equipment
                          Prosthetics, Orthotics & Supplies.
                         Claims Submission for Durable Medical Equipment
                          Prosthetics, Orthotics & Supplies.
462....................  Durable Medical Equipment Regional Carrier
                          Only--Dispensing Fees for Immunosuppressive
                          Drugs.
463....................  Update to 100-04 and Therapy Code Lists.
                         Healthcare Common Procedure Coding System
                          Coding Requirement.
                         Part B Outpatient Rehabilitation and
                          Comprehensive Outpatient Rehabilitation
                          Facility Services--General.
                         Discipline Specific Outpatient Rehabilitation
                          Modifiers--All Claims.
                         The Financial Limitation.
                         Reporting of Service Units With HCPCS--Form CMS-
                          1500 and Form CMS-1450.
464....................  Implementation of the Abstract File for
                          Purchased Diagnostic.
                         Test/Interpretations (Supplemental to CR 3481).
                         Payment Jurisdiction Among Local Carriers for
                          Services Paid Under the Physician Fee Schedule
                          and Anesthesia Services.
                         Payment Jurisdiction for Purchased Services.
                         Payment to Physician or Other Supplier for
                          Purchased Diagnostic Tests--Claims Submitted
                          to Carriers.
                         Payment to Supplier of Diagnostic Tests for
                          Purchased Interpretations.
465....................  Billing Requirements for Physician Services in
                          Method II Critical Access Hospitals.
                         Payment for Inpatient Services Furnished by a
                          Critical Access Hospital.
                         Special Rules for Critical Access Hospital
                          Outpatient Billing.
                         Billing and Payment in a Physician Scarcity
                          Area.
466....................  Quarterly Update to Correct Coding Initiative
                          Edits, Version 11.1, Effective April 1, 2005.
467....................  Modifications to Duplicate Editing for
                          Dispensing/Supply Fee Codes for Oral Anti-
                          Cancer, Oral Anti-Emetic, Immunosuppressive
                          and Inhalation Drugs.
468....................  Appeals Transition--Benefits, Improvement &
                          Protection Act Section 521.
                         Appeals.
469....................  New Waived Tests--April 1, 2005.
470....................  Standardization of Fiscal Intermediary Use of
                          Group and Claim Adjustment.
                         Reason Codes and Calculation and Balancing of
                          TS2 and TS3 Segment.
                         Data Elements.
471....................  This Transmittal is rescinded and replaced by
                          Transmittal 513.
472....................  Revisions to Payment for Services Provided
                          Under a Contractual Arrangement--Carrier
                          Claims Only.
                         Exceptions to Assignment of Provider's Right to
                          Payment--Claims Submitted to Fiscal
                          Intermediaries and Carriers.
                         Payment for Services Provided Under a
                          Contractual Arrangement--Carrier Claims Only.
473....................  Use of 12X Type of Bill for Billing Vaccines
                          and Their Administration Bills Submitted to
                          Fiscal Intermediaries.
474....................  Coordination of Benefits Agreement Detailed
                          Error Report Notification Process.
475....................  1st Update to the 2005 Medicare Physician Fee
                          Schedule Database.
476....................  Type of Service Corrections.
477....................  New Case-Mix Adjusted End-Stage Renal Disease
                          Composite Payment Rates And New Composite Rate
                          Exceptions Window for Pediatric End-Stage
                          Renal Disease Facilities.
                         Outpatient Provider-Specific File.
                         Calculation of Case-Mix Adjustment Composite
                          Rate.
                         Required Information for In-Facility Claims
                          Paid Under the Composite Rate.
478....................  Clarification of the Verification Process to be
                          Used to Determine If the Inpatient
                          Rehabilitation Facility Meets the Inpatient
                          Rehabilitation Classification Criteria
                          Verification Process To Be Used To Determine
                          If the Inpatient Rehabilitation Facility Met
                          the Classification Criteria.
479....................  Update to the Healthcare Provider Taxonomy
                          Codes Version 5.0.
480....................  April 2005 Quarterly Average Sale Price
                          Medicare Part B Drug Pricing File, Effective
                          April 1, 2005, and New January 2005 Quarterly
                          Average Sale Price File.
481....................  Updated Manual Instructions for the Medicare
                          Claims Processing Manual, Chapter 10.
                         General Guidelines for Processing Home Health
                          Agency Claims.
                         Effect of Election of Medicare Advantage
                          Organization and Eligibility Changes on Home
                          Health Prospective Payment System Episodes.
                         General Guidance on Line Item Billing Under the
                          Home Health Prospective Payment System.
                         Request for Anticipated Payment.
                         Home Health Prospective Payment System Claims.
                         Special Billing Situations Involving Outcome &
                          Assessment Information Set Assessments.
                         Medical and Other Health Services Not Covered
                          Under the Plan of Care (Bill Type 34X).
482....................  Manualization of Payment Change for Diagnostic
                          Mammography and Diagnostic Computer Aided
                          Detection.
                         Screening Mammography Services.
                         Computer Aided Design Billing Charts.
                         Payment for Screening Mammography Services
                          Provided Prior to January 1, 2002.
                         Payment for Screening Mammography Services
                          Provided On and After January 1, 2002.
                         Outpatient Hospital Mammography Payment Table.
                         Payment for Computer Add-On Diagnostic and
                          Screening Mammograms for Fiscal Intermediaries
                          and Carriers.
                         Mammograms Performed With New Technologies.
483....................  Hospital Partial Hospitalization Services
                          Billing Requirements.
                         Special Partial Hospitalization Billing
                          Requirements for Hospitals, Community Mental
                          Health Centers, and Critical Access Hospitals.
                         Bill Review for Partial Hospitalization
                          Services Provided in Community Mental Health
                          Centers.
484....................  New Remittance Advice Message for Referred
                          Clinical Diagnostic/Purchased Diagnostic
                          Service Duplicate Claims.

[[Page 36626]]

 
485....................  Calculating Payment-to-Cost Ratios for Purposes
                          of Determining Transitional Corridor Payments
                          Under the Outpatient Prospective Payment
                          System.
486....................  Manualization of Carrier Claims Processing
                          Instructions for Stem Cell Transplantation.
                         Stem Cell Transplantation.
                         General.
                         Healthcare Common Procedure Coding System and
                          Diagnosis Coding.
                         Non-Covered Conditions.
                         Edits.
                         Suggested Medicare Summary Notice and
                          Remittance Advice Messages.
487....................  Medicare Qualifying Clinical Trials.
                         Chapter 32, Section 69.0--Qualifying Clinical
                          Trials.
488....................  This Transmittal has been rescinded and
                          replaced by Transmittal 497.
489....................  Correction to Healthcare Common Procedure
                          Coding System Code A4217.
                         Payment of Durable Medical Equipment
                          Prosthetics, Orthotics & Supplies Items Based
                          on Modifiers.
490....................  Claims Status Code/Claims Status Category Code
                          Update.
                         Health Care Claims Status Category Codes and
                          Health Care Claims Status Codes for Use With
                          Health Care Claims Status Request and Response
                          ASC X12N 276/277.
491....................  Issued to a specific audience, not posted to
                          Internet/Intranet due to Confidentiality of
                          Instruction.
492....................  Adding an Indicator to the National Claims
                          History to Indicate That Durable Medical
                          Equipment Regional Carrier, Carriers and
                          Fiscal Intermediaries Have Reviewed a
                          Potentially Duplicate Claim.
                         Detection of Duplicate Claims.
493....................  Revision to Chapter 1, and Removal of Section
                          70 from Chapter 25 of the Medicare Claims
                          Processing Manual.
                         Inpatient Billing From Hospitals and Skilled
                          Nursing Facilities.
                         Submitting Bills in Sequence for a Continuous
                          Inpatient Stay or Course of Treatment.
                         Intermediary Processing of No-Payment Bills.
                         Time Limitations for Filing Provider Claims to
                          Fiscal Intermediaries.
                         Statement of Intent.
                         Filing Request for Payment to Carriers--
                          Medicare Part B.
                         Fiscal Intermediary Consistency Edits.
                         Patient is a Member of a Medicare Advantage
                          Organization for Only a Portion of the Billing
                          Period.
                         Late Charges.
                         Inpatient Part A Hospital Adjustment Bills.
494....................  April 2005 Outpatient Prospective Payment
                          System Code Editor Specifications Version 6.1.
495....................  Inpatient Psychiatric Facility Prospective
                          Payment System--Further Clarifications.
496....................  Billing for Blood and Blood Products Under the
                          Hospital Outpatient Prospective Payment
                          System.
                         When a Provider Paid Under the Outpatient
                          Prospective Payment System Does Not Purchase
                          the Blood or Blood Products That It Procures
                          From a Community Blood Bank, or When a
                          Provider Paid Under the Outpatient Prospective
                          Payment System Does Not Assess a Charge for
                          Blood or Blood Products Supplied by the
                          Provider's Own Blood Bank Other Than Blood
                          Processing and Storage.
                         When a Provider Paid Under the Outpatient
                          Prospective Payment System Purchases Blood or
                          Blood Products from a Community Blood Bank or
                          When a Provider Paid Under the Outpatient
                          Prospective Payment System Assesses a Charge
                          for Blood or Blood Products Collected by Its
                          Own Blood Bank That Reflects More Than Blood
                          Processing and Storage.
                         Billing for Autologous Blood (Including
                          Salvaged Blood) and Directed Donor Blood.
                         Billing for Split Unit of Blood.
                         Billing for Irradiation of Blood Products.
                         Billing for Frozen and Thawed Blood and Blood
                          Products.
                         Billing for Unused Blood.
                         Billing for Transfusion Services.
                         Billing for Pheresis and Apheresis Services.
                         Correct Coding Initiative Edits.
                         Blood Products and Drugs Classified in Separate
                          Average Projected Costs for Hospital
                          Outpatients.
497....................  Billing for Implantable Automatic
                          Defibrillators for Beneficiaries in a Medicare
                          Advantage Plan and Use of the Quarterly Refund
                          Modifier to Identify Patient Registry
                          Participation.
498....................  Billing of the Diagnosis and Treatment of
                          Peripheral Neuropathy With Loss of Protective
                          Sensation in People With Diabetes.
                         General Billing Requirements.
                         Applicable Healthcare Common Procedure Coding
                          System Codes.
                         Diagnosis Codes.
                         Payment.
                         Applicable Revenue Codes.
                         Editing Instructions for Fiscal Intermediaries.
                         Common Working File General Information.
                         Common Working File Utilization Edits.
499....................  2005 Scheduled Release for April Updates to
                          Software Programs and Pricing/Coding Files.
500....................  Changes to the Laboratory National Coverage
                          Determination Edit.
                         Software for April 2005.
501....................  Bone Mass Measurements--Procedure Coding.
502....................  New Contrast Agents Healthcare Common Procedure
                          Coding System Codes.
503....................  April Update to the Medicare Non-Outpatient
                          Prospective Payment Systems.
                         Outpatient Code Editor Specification Version
                          20.2.
504....................  Update to Pub 100-04, Chapter 12, Section 200
                          of the Internet Only Manual.

[[Page 36627]]

 
                         Allergy Testing and Immunotherapy.
505....................  Unprocessable Unassigned Form CMS-1500 Claims.
                         Incomplete or Invalid Claims Processing
                          Terminology.
506....................  Updated Manual Instructions for Item 24G (Days
                          or Units), Chapter 26.
507....................  New Healthcare Common Procedure Coding System
                          for Intravenous Immune Globulin.
508....................  This Transmittal is rescinded and replaced by
                          Transmittal 514.
509....................  Number of Drug Pricing Files That Must Be
                          Maintained Online for Medicare--Durable
                          Medical Equipment Regional Carriers Only.
                         Online Pricing Files for Average Sales Price.
510....................  Update to Fiscal Year 2005 Pricer for IPPS
                          Hospitals.
511....................  Type of Service Corrections.
512....................  Coverage of Colorectal Anti-Cancer Drugs
                          Included in Clinical Trials.
513....................  Infusion Pumps: C-Peptide Levels As a Criterion
                          for Use.
514....................  April 2005 Update of the Hospital Outpatient
                          Prospective Payment System: Summary of Payment
                          Policy Changes.
------------------------------------------------------------------------
                Medicare Secondary Payer (CMS Pub. 100-05)
------------------------------------------------------------------------
 23....................  Modification to Online Medicare Secondary Payer
                          Questionnaire.
                         Admission Questions to Ask Medicare
                          Beneficiaries.
24.....................  Issued to a specific audience, not posted to
                          Internet/Intranet, due to Sensitivity of
                          Instruction.
25.....................  Update Medicare Secondary Payer Manual
                          Publication 100-05 to reflect Statutory
                          Changes included in the Medicare Modernization
                          Act.
                         General Provisions.
                         Conditional Primary Medicare Benefits.
                         When Conditional Primary Medicare Benefits May
                          Be Paid.
                         When Medicare Secondary Benefits Are Payable
                          and Not Payable.
                         Definitions.
                         Beneficiary's Rights and Responsibility.
                         Statutory Provisions.
                         No-Fault Insurance.
                         Situations in Which Medicare Secondary Payer
                          Billing Applies.
                         Incorrect Group Health Plan Primary Payments.
                         General Policy.
                         Conditional Primary Medicare Benefits.
                         Conditional Medicare Payment.
                         Medicare Right of Recovery.
                         Conflicting Claims by Medicare and Medicaid.
                         Third Party Payer Refund Requests Served on
                          Medicare.
                         General Operational Instructions.
                         Conditional Primary Medicare Benefits.
                         Existence of Overpayment.
26.....................  Clarification for Change Request (CR) 3267.
                         General Policy.
27.....................  Updates to the Electronic Correspondence
                          Referral System User Guide v8.0 and Quick
                          Reference Card v8.0.
                         Coordination of Benefits Contractor Electronic
                          Correspondence Referral System.
                         Providing Written Documents to the Coordination
                          of Benefits Contractor.
------------------------------------------------------------------------
             Medicare Financial Management (CMS Pub. 100-06)
------------------------------------------------------------------------
 55....................  Reporting Appeals Redetermination Information
                          on Forms CMS-2591 and 2590.
56.....................  Revision to Balancing Requirement on Form 5,
                          Line 10, of the Contractor.
                         Reporting of Operational and Workload Data.
57.....................  Revised Reporting Requirements for Contractor
                          Reporting of Operational Workload Data Health
                          Professional Shortage Area Quarterly Report.
58.....................  Issued to specific audience, not posted to
                          Internet/Intranet due to Sensitivity of
                          Instruction.
59.....................  Notice of New Interest Rate for Medicare
                          Overpayments and Underpayments.
60.....................  Revised instructions on contractor procedures
                          for provider audit and the Provider.
                         Statistical & Reimbursement Report.
                         Submission of Cost Report Data to CMS.
                         Desk Review Exceptions Resolution Process.
                         Definition of Field Audits.
                         Purpose of Field Audits.
                         Establishing the Objective/Scope of the Field
                          Audit.
                         Audit Confirmation Letter.
                         Entrance Conference.
                         Tests of Internal Control.
                         Designing Tests/Sampling.
                         Pre-Exit Conference.
                         Finalization of Audit Adjustments.
                         Exit Conference.

[[Page 36628]]

 
                         Medicare Cost Report and All Related Documents.
                         Qualifications.
                         Internal Quality Control.
                         Final Settlement of the Cost Report.
                         Audit Responsibility When Provider Changes
                          Contractors.
                         Audits of Home Offices.
                         Standards for Issuance of an Audit Report for a
                          Home Office.
                         Provider Permanent File.
                         Contractor Responsibility in Suspected Fraud or
                          Abuse Cases.
61.....................  New Location Code Interstate Commerce
                          Commission, Status Code AR and Modified Intent
                          Letter for Unfiled Cost Reports Only.
                         Recovery of Overpayment Due to Overdue Cost
                          Report.
                         Provider Overpayment Recovery System User
                          Manual.
                         List of Status Codes.
                         Content of Demand Letters-Fiscal Intermediary
                          Serviced Providers.
62.....................  Timeframe for Continued Execution of Crossover
                          Agreements and Updated on the Transition to
                          the National Coordination of Benefits
                          Agreement Program.
                         Coordination of Medicare and Complementary
                          Insurance Programs.
63.....................  Notice of New Interest Rate for Medicare
                          Overpayments and Underpayments.
64.....................  For Fiscal Intermediaries, a New Provider Type
                          80, Status Code CH, and Method of Recoupment
                          Codes. For Carriers and Durable Medical
                          Equipment.
                         Regional Carriers Status Code 2.
                         Provider Overpayment Reporting System User
                          Manual.
                         List of Status Codes.
                         Physician/Supplier Overpayment Reporting System
                          User Manual.
65.....................  Revised Reporting Requirements for Contractor
                          Reporting of Operational Workload Data
                          Physician Scarcity Area Quarterly Report (CMS
                          Form--1565F, CROWD Form6).
                         Completing Physician Scarcity Area Quarterly
                          Report Form CMS 1565F, CROWD Form 6.
                         Physician Scarcity Area Quarterly Report, Line
                          Descriptors.
                         Error Descriptors.
                         Checking Reports.
66.....................  Chapter 7, Internal Control Requirements
                          Update.
                         Federal Managers' Financial Integrity Act of
                          1982.
                         Federal Managers Financial Integrity Act and
                          the CMS Medicare Contractor Contract.
                         Chief Financial Officers Act of 1990.
                         Office of Management & Budget Circular A-123.
                         General Accounting Office Standards for
                          Internal Controls in the Federal Government.
                         Fundamental Concepts.
                         Control Activities.
                         Monitoring.
                         Risk Assessment.
                         Internal Control Objectives.
                         Fiscal Year 2005 Medicare Control Objectives.
                         Policies and Procedures.
                         Control Activities.
                         Testing Methods.
                         Documentation and Working Papers.
                         Requirements.
                         Certification Statement.
                         Executive Summary.
                         Certification Package for Internal Controls
                          Report of Material Weaknesses.
                         Certification Package for Internal Controls
                          Report of Reportable Conditions.
                         Definitions and Examples of Reportable
                          Conditions and Material Weaknesses.
                         Material Weaknesses Identified During the
                          Fiscal Year.
                         Corrective Action Plans.
                         Submission, Review, and Approval of Corrective
                          Action Plans.
                         Corrective Action Plan Reports.
                         CMS Finding Numbers.
                         Initial Corrective Action Plan Report.
                         Quarterly Corrective Action Plan Report.
                         Entering Data: Initial or Quarterly Corrective
                          Action Plan Report.
------------------------------------------------------------------------
            Medicare State Operations Manual (CMS Pub. 100-07)
------------------------------------------------------------------------
 00....................  None
------------------------------------------------------------------------
              Medicare Program Integrity (CMS Pub. 100-08))
------------------------------------------------------------------------
 93....................  This Transmittal has been rescinded and
                          replaced by Transmittal 102.
------------------------------------------------------------------------

[[Page 36629]]

 
94.....................  Informing Beneficiaries About Which Local
                          Medical Review Policy and/or Local Coverage
                          Determination and/or National Coverage.
                         Determination Is Associated With Their Claim
                          Denial.
                         Prepayment Edits.
95.....................  Change in Provider Enrollment Appeals Process.
                         Administrative Appeals.
96.....................  Consent Settlements.
                         Postpayment Review Case Selection.
                         Location of Postpayment Reviews.
                         Re-adjudication of Claims.
                         Calculation of the Correct Payment Amount and
                          Subsequent Over/Underpayment.
                         Notification of Provider(s) or Supplier(s) and
                          Beneficiaries of the Postpayment Review
                          Results.
                         Provider(s) or Supplier(s) Rebuttal(s) of
                          Findings.
                         Evaluation of the Effectiveness of Postpayment
                          Review and Next Steps.
                         Consent Settlement Instructions.
                         Background on Consent Settlement.
                         Opportunity to Submit Additional Information
                          Before Consent Settlement Offer.
                         Consent Settlement Offer.
                         Election to Proceed to Statistical Sampling for
                          Overpayment Estimation.
                         Acceptance of Consent Settlement Offer.
                         Consent Settlement Budget and Performance
                          Requirements for Medicare Contractors.
97.....................  Provider Enrollment and Inpatient
                          Rehabilitation Facility (IRF) Compliance
                          Reviews.
98.....................  Psychotherapy Notes.
                         Additional Documentation Requests During
                          Prepayment or Postpayment Medical Review.
99.....................  Program Integrity Manual Modification--Changes
                          Waivers Approved by the Regional Office by
                          Replacing Regional Office With Central Office.
                         Contractor Medical Director.
                         Benefit Integrity Security Requirements.
                         The Carrier Advisory Committee.
100....................  Review of Documentation During Medical Review.
                         Additional Documentation Requests During
                          Prepayment or Postpayment Medical Review.
                         Documentation in the Patient's Medical Records.
101....................  Benefit Integrity Personal Information Manager
                          Revisions.
                         Sources of Data for Program Safeguard
                          Contractors.
                         Procedural Requirements.
                         Benefit Integrity Security Requirements.
                         Requests for Information From Outside
                          Organizations.
                         Program Safeguard Contractor and Medicare
                          Contractor Coordination With Other Program.
                         Safeguard Contractors and Medicare Contractors.
                         Complaint Screening.
                         Types of Fraud Alerts.
                         Alert Specifications.
                         Editorial Requirements.
                         Coordination.
                         Distribution of Alerts.
                         Information Not Captured in the Fraud
                          Investigation Database.
                         Initial Entry Requirements for Investigations.
                         Designated Program Safe Guard and Medicare
                          Contractor Background Investigation.
                         Unit Staff and the Fraud Investigation
                          Database.
                         Affiliated Contractor and Program Safeguard
                          Contractor Coordination on Voluntary Refunds.
                         Referral of Cases to the Office of the
                          Inspector General/Office of Investigations.
                         Referral to State Agencies or Other
                          Organizations.
                         Civil Monetary Penalties Delegated to Office of
                          the Inspector General.
                         Annual Deceased-Beneficiary Postpayment Review.
                         Vulnerability Report.
102....................  Medical Review of Rural Air Ambulance Services.
                         ``Reasonable'' Requests.
                         Emergency Medic