Medicare and Medicaid Programs; Quarterly Listing of Program Issuances-July Through September 2005, 76290-76313 [05-24023]
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76290
Federal Register / Vol. 70, No. 246 / Friday, December 23, 2005 / Notices
To be assured consideration,
comments and recommendations for the
proposed information collections must
be received by the OMB Desk Officer at
the address below, no later than 5 p.m.
on January 23, 2006. OMB Human
Resources and Housing Branch,
Attention: Carolyn Lovett, CMS Desk
Officer, New Executive Office Building,
Room 10235, Washington, DC 20503.
Dated: December 14, 2005.
Michelle Shortt,
Director, Regulations Development Group,
Office of Strategic Operations and Regulatory
Affairs.
[FR Doc. 05–24302 Filed 12–22–05; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–9033–N]
Medicare and Medicaid Programs;
Quarterly Listing of Program
Issuances—July Through September
2005
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Notice.
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AGENCY:
SUMMARY: This notice lists CMS manual
instructions, substantive and
interpretive regulations, and other
Federal Register notices that were
published from July 2005 through
September 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, 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
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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, C1–13–04, 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
Bonnie Harkless, 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) 786–5666.
Questions concerning Medicareapproved carotid stent facilities may be
addressed 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.
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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 3month 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
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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—
Æ Date published;
Æ Federal Register citation;
Æ Parts of the Code of Federal
Regulations (CFR) that have changed (if
applicable);
Æ Agency file code number; and
Æ 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
standards for performing carotid artery
stenting for high risk patients.
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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)
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/
index.html, 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
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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, 2003. (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
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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 ‘‘Cochlear Implantation,’’ use
CMS—Pub. 100–03, Transmittal No. 42.
(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: December 7, 2005.
Jacquelyn Y. White,
Director, Office of Strategic Operations and
Regulatory Affairs.
February 25, 2005 (70 FR 9338)
June 24, 2005 (70 FR 36620)
September 23, 2005 (70 FR 55863)
Addendum II—Description of Manuals,
Memoranda, and CMS Rulings
Addendum I
This addendum lists the publication dates
of the most recent quarterly listings of
program issuances.
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)
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
[July through September 2005]
Transmittal
No.
Manual/Subject/Publication No.
Medicare General Information
(CMS—Pub. 100–01)
25
26
27
28
29
Next Generation Desktop Testing Requirements Definitions
Next Generation Desktop Maintainer Requirements
Implement New Medicare Plan ID and Carrier Number for the Single Testing Contractor
Shared System Testing Requirements for Maintainers, Beta Testers, and Contractors
Provider Extract File
Conforming Changes for Change Request 3648 to Pub. 100–01
Hospital Insurance (Part A) for Inpatient Hospital, Hospice, and Skilled Nursing Facility Services—A Brief Description Home
Health Services
Supplementary Medical Insurance (Part B)—A Brief Description
Discrimination Prohibited
Role of Part A Intermediaries
Limitation on Physical Therapy, Occupational Therapy and Speech-Language Pathology Services
Certification for Hospital Services Covered by the Supplementary Medical Insurance Program
Content of the Physician’s Certification
Recertifications for Home Health Services
Physician’s Certification and Recertification for Outpatient Physical Therapy Occupational Therapy and Speech-Language Pathology Recertification
Under Arrangements
Term of Agreements
Determining Payment for Services Furnished After Termination, Expiration, or Cancellation
Home Health Agency Defined
2005 Scheduled Release for October Updates to Software Programs and Pricing/Coding Files
Medicare Benefit Policy
(CMS—Pub. 100–02)
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37
Conforming Changes for Change Request 3648 to Pub. 100–02
Medical and Other Health Services Furnished to Inpatients of Participating Hospitals Outpatient Hospital Services
Distinguishing Outpatient Hospital Services Provided Outside the Hospital Coverage of Outpatient Therapeutic Services
Medical and Other Health Services Furnished by Home Health Agencies Skilled Services Defined
Speech-Language Pathology
Physical Therapy, Speech-Language Pathology, and Occupational Therapy Furnished by the Skilled Nursing Facility or by Others Under Arrangements With the Facility and Under Its Supervision
Inpatient Physical Therapy, Occupational Therapy, and Speech-Language Pathology Services
Services Furnished Under Arrangements With Providers
Supplementary Medical Insurance Provisions
Services Not Provided Within United States
Medicare National Coverage Determinations
(CMS—Pub. 100–03)
42
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Cochlear Implantation
Cochlear Implantation (Effective April 4, 2005)
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ADDENDUM III.—MEDICARE AND MEDICAID MANUAL INSTRUCTIONS—Continued
[July through September 2005]
Transmittal
No.
Manual/Subject/Publication No.
Medicare Claims Processing
(CMS—Pub. 100–04)
601
602
603
604
605
606
607
608
609
610
611
612
613
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614
615
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Cochlear Implantation
Billing Requirements for Expanded Coverage of Cochlear Implantation
Intermediary Billing Procedures
Applicable Bill Types
Special Billing Requirements for Intermediaries
Intermediary Payment Requirements
Carrier Billing Procedures
Healthcare Common Procedure Coding System
Expansion of Various Alpha and Numeric Fields Within the Outpatient Prospective Payment System Outpatient Code Editor
Modification to the Appeals Language on the Medicare Summary Notice; Full Replacement of Change Request 3808
Appeals Section
Back of Medicare Summary Notice—Carriers and Intermediaries Carrier Spanish Medicare Summary Notices Back Intermediary
Spanish Medicare Summary Notices Back
Issued to a specific audience, not posted to Internet/Intranet due to Confidentiality of Instruction
Frequency Instructions for Smoking and Tobacco-Use Cessation Counseling Services
Remittance Advice Notices
Medicare Summary Notices
Medicare Program-Update to the Hospice Payment Rates, Hospice Cap, Hospice Wage Index, and the Hospice Pricer for FY
2005
Payment Rates
Issued to a specific audience, not posted to Internet/Intranet due to Confidentiality of Instruction
New Health Professional Shortage Area Modifier
Zip Code Files
Provider Education
Claims Coding Requirements
Services Eligible for Health Professional Shortage Area and Physician Scarcity Bonus Payments
Post-payment Review
Health Professional Shortage Area Incentive Payments for Physician Services Rendered in a Critical Access Hospital
Remittance Advice Remark Code and Claim Adjustment Reason Code Update
This Transmittal is rescinded and replaced by Transmittal 634
Payment Methodology for Rehabilitation Services in Indian Health Service/Tribally Owned and/or Operated Hospitals and Hospital Based Facilities
Services Paid Under the Physician Fee Schedule
Abarelix for Treatment of Prostate Cancer
New Healthcare Common Procedure Coding System Codes and Systems Edits for Supplies and Accessories for Ventricular Assist Devices—Full Replacement of CR 3761
Medicare Physician Fee Schedule Database 2006 File Layout
Revision of Chapter 24, Electronic Data Interchange Support Requirements
Electronic Data Interchange General Outreach Activities Carrier, Durable Medical Equipment Regional Carrier, and Fiscal Intermediary Analysis of Internal Information
Systems Information
Review of Provider Profiles
Contact with New Providers
Production and Distribution of Material to Increase Use of Electronic Data Interchange
Electronic Data Interchange Enrollment
New Enrollments and Maintenance of Existing Enrollments
Submitter Number
Release of Medicare Eligibility Data
Network Service Vendor Agreement
Electronic Data Interchange User Guidelines
Directory of Billing Software Vendors and Clearinghouses
Technical Requirements—Data, Media, and Telecommunications System Availability
Media
Telecommunications and Transmission Protocols
Toll-Free Service
Initial Editing
Translators
Required Electronic Data Interchange Formats
General Health Insurance Portability and Accountability Act Electronic Data Interchange Requirements
Continued Support of Pre-Health Insurance Portability and Accountability Act
Electronic Data Interchange Formats
National Council for Prescription Drug Program Claim Requirements
Crossover Claim Requirements
Direct Data Entry Screens
Use of Imaging, External Key Shop, and In-House Keying for Entry of Transaction Data Submitted on Paper
Electronic Funds Transfer
Electronic Data Interchange Testing Requirements
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ADDENDUM III.—MEDICARE AND MEDICAID MANUAL INSTRUCTIONS—Continued
[July through September 2005]
Transmittal
No.
616
617
618
619
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620
621
622
623
624
625
626
627
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Manual/Subject/Publication No.
Shared System and Common Working File Maintainers Internal Testing Requirements
Carrier, Durable Medical Equipment Regional Carrier, and Intermediary Internal Testing Requirements
Third-Party Certification Systems and Services
Electronic Data Interchange Submitter/Receiver Testing by Carriers, Durable Medical Equipment Regional Carriers, and Fiscal
Intermediaries
Testing Accuracy
Limitation on Testing of Multiple Providers That Use the Same Clearinghouse, Billing Service, or Vendor Software
Carrier, Durable Medical Equipment Regional Carrier, and Fiscal Intermediary Submitter/Receiver Testing With Legacy Formats
During the Health Insurance Portability and Accountability Act Contingency Period
Discontinuation of Use of Claim Legacy Formats following Successful Health Insurance Portability and Accountability Act Format
Testing
Electronic Data Interchange Receiver Testing by Carriers, Durable Medical Equipment Regional Carriers, and Intermediaries
Changes in Provider’s System or Vendor’s Software, and Use of Additional Electronic Data Interchange Formats
Support of Electronic Data Interchange Trading Partners
User Guidelines
Technical Assistance to Electronic Data Interchange Trading Partners
Training Content and Frequency
Prohibition Against Requiring Use of Proprietary Software or Direct Data Entry
Free Claim Submission Software
Remittance Advice Print Software
Medicare Remit Easy Print Software for Carrier and Durable Medical Equipment Regional Carrier Provider Use
Medicare Standard Fiscal Intermediary PC-Print Software
Newsletters/Bulletin Board/Internet Publication of Electronic Data Interchange Information
Provider Guidelines for Choosing a Vendor
Determining Goals/Requirements
Vendor Selection
Negotiating With Vendors
Electronic Data Interchange Edit Requirements
Carrier, Durable Medical Equipment Regional Carrier, and Fiscal Intermediary X12 Edit Requirements
Supplemental Fiscal Intermediary-Specific Shared System Edit Requirements
Fiscal Intermediary Health Insurance and Portability Accountability Act Claim
Level Implementation Guide Edits
Supplemental Carrier/Durable Medical Equipment Regional Carrier-Specific Shared System Implementation Guide Edit Requirements
Keyshop and Image Processing
Carrier, Durable Medical Equipment Regional Carrier, or Fiscal Intermediary Data Security and Confidentiality Requirements
Carrier, Durable Medical Equipment Regional Carrier, and Fiscal Intermediary Electronic Data Interchange Audit Trails
Security-Related Requirements for Carrier, Durable Medical Equipment
Regional Carrier, or Fiscal Intermediary Arrangements with Clearinghouses And Billing Services
Mandatory Electronic Submission of Medicare Claims
Small Providers and Full-Time Equivalent Employee Self-Assessments
Exceptions
Unusual Circumstance Waivers
Unusual Circumstance Waivers Subject to Provider Self-Assessment
Unusual Circumstance Waivers Subject to Medicare Contractor Approval
Unusual Circumstance Waivers Subject to Contractor Evaluation and CMS Decision
Electronic and Paper Claims Implications of Mandatory Electronic Submission Enforcement
Provider Education
Certified Registered Nurse Anesthetist Pass-Through Payments
Anesthesia and Certified Registered Nurse Anesthetist Services in a Critical Access Hospitals
Payment for Certified Registered Nurse Anesthetist Pass-Through Services
Payment for Anesthesia Services by a Certified Registered Nurse Anesthetist (Method II Critical Access Hospital Only)
Administration of Drugs and Biologicals in a Method II Critical Access Hospital
Coding for Administering Drugs in a Method II Critical Access Hospital
Coding for Low Osmolar Contrast Material
Coding for the Administration of Other Drugs and Biologicals
Clarification for Carriers and Durable Medical Equipment Regional Carriers About Correction and Recoupment of Previously
Processed Claims
Late IRF–PAI Data Submission Penalty Protocol Within the Inpatient Rehabilitation Facility Prospective Payment System
Payment Adjustment for Late Transmission of Patient Assessment Data
New Fiscal Intermediary (FI) Edit to Identify Potentially Excessive Medicare Payments
Fiscal Intermediary Edits Affecting Multiple Bill Types
Threshold Edit for Outpatient and Inpatient Part B Claims
Locality Codes for Purchased Diagnostic Tests
This Transmittal is rescinded and replaced by Transmittal 668
Durable Medical Equipment Regional Carrier Only—Corrections to the Billing Indicator Field for Adjusted Claims
This Transmittal is rescinded and replaced by Transmittal 686
Competitive Acquisition Program for Part B Drugs—Coding, Testing, and Implementation
Common Working File Expansion of Duplicate Claim Edit for Clinical Diagnostic Services
New Low Osmolar Contrast Material (LOCM) HCPCS Codes/Payment Criteria/Payment Level
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ADDENDUM III.—MEDICARE AND MEDICAID MANUAL INSTRUCTIONS—Continued
[July through September 2005]
Transmittal
No.
628
629
630
631
632
633
634
635
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636
637
638
639
640
641
642
643
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Manual/Subject/Publication No.
Low Osmolar Contrast Media (HCPCS Codes Q9945–Q9951)
Payment Criteria/Payment Level
Radiopharmaceutical Diagnostic Imaging Agents Codes Applicable to Positron Emission Tomography Scan Services Performed
on or After January 28, 2005
Appropriate Common Procedure Terminology Codes Effective for Positron Emission Tomography Scan Services Performed on
or After January 28, 2005
Tracer Codes Required for Positron Emission Tomography Scans
Certificate of Medical Necessity Claim Edits Workload Reporting
Durable Medical Equipment Regional Carrier Systems
Medicare Part A Skilled Nursing Facility Prospective Payment System Pricer
Update and Health Insurance Prospective Payment System Coding Update Effective January 1, 2006
Health Insurance Prospective Payment System Rate Code
Skilled Nursing Facility Prospective Payment System Rate Components
Decision Logic Used by the Pricer on Claims
Claim Status Category Code and Claim Status Code Update
Billing and Claims Processing Instructions for Claims Subject to Expedited Determinations
Limitation of Liability Notification and Coordination With Quality
Improvement Organizations
Limitation on Liability—Overview
Hospital Claims Subject to Hospital Issued Notices of Noncoverage
Scope of Issuance of Hospital Issued Notices of Noncoverage
General Responsibilities of Quality Improvement Organizations and Fiscal Intermediaries Related to Hospital Issued Notices of
Noncoverage
Billing and Claims Processing Requirements Related to Hospital Issued Notices of Noncoverage
Skilled Nursing Facility, Home Health Agency, Hospice, and Comprehensive Outpatient Rehabilitation Facility Claims Subject to
Expedited Determinations
Scope of Issuance of Expedited Determination Notices
General Responsibilities of Quality Improvement Organizations and Fiscal Intermediaries Related to Expedited Determinations
Billing and Claims Processing Requirements Related to Expedited Determinations
Coordination With the Quality Improvement Organization
Guidelines for Payment of Vaccines (Pneumococcal Pneumonia Virus, Influenza Virus, and Hepatitis B Virus) and Their Administration Provided by Indian Health Service/Tribally-Owned and/or Operated Hospitals and Hospital Based Facilities
Billing Requirements
Bills Submitted to Fiscal Intermediaries
Vaccines and Vaccine Administration
Guidelines for Payment of Vaccines (Pneumococcal Pneumonia Virus, Influenza Virus, and Hepatitis B Virus) and Their Administration at Renal Dialysis Facilities
Vaccines Furnished to End-Stage Renal Disease Patients
Fiscal Intermediary Payment for Pneumococcal Pneumonia, Influenza Virus, and Hepatitis B Vaccine
Bills Submitted by Hospices and Payment for Renal Dialysis Facilities
Financial Liability for Services Subject to Home Health Consolidated Billing
Home Health Prospective Payment System Consolidated Billing and Primary
Home Health Agencies
Home Health Prospective Payment System Consolidated Billing Beneficiary Notification and Payment Liability Under Home
Health Consolidated Billing
Responsibilities of Home Health Agencies
Responsibilities of Providers/Suppliers of Services Subject to Consolidated Billing
Responsibilities of Hospitals Discharging Medicare Beneficiaries to Home Health Care
Home Health Consolidated Billing Edits in Medicare Systems
Non-routine Supply Editing
Therapy Editing
Other Editing Related to Home Health Consolidated Billing
Only Request for Anticipated Payment Received and Services Fall Within 60 Days After Request for Anticipated Payment Start
Date
No Request for Anticipated Payment Received and Therapy Services Rendered in the Home
Health Insurance Eligibility Query to Determine Episode Status
Other Editing and Changes for Home Health Prospective Payment System Episodes
Coordination of Home Health Prospective Payment System Claims and Episodes With Inpatient Claim Types
Instructions for Implementation of CMS Ruling 05–01; Presbyopia-Correcting Intraocular Lens
Issued to a specific audience, not posted to Internet/Intranet due to Confidentiality of Instruction
New Medicare Summary Notice Messages
Adjustments
Ajustes
Cessation of Additional $50 Payment for New Technology Intraocular Lenses
Ambulatory Surgical Center Services on Ambulatory Surgical Center List
Payment for Intraocular Lens
Medicare Part A Skilled Nursing Facility Prospective Payment System Pricer Update FY 2006
October 2005 Quarterly Update to Skilled Nursing Facility Consolidated Billing
New Waived Tests
Nature and Effect of Assignment on Carrier Claims
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[July through September 2005]
Transmittal
No.
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647
648
649
650
651
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Manual/Subject/Publication No.
October 2005 Non-Outpatient Prospective Payment System Code Editor Specifications Version 21
Issued to a specific audience, not posted to Internet/Intranet due to Confidentiality of Instruction
Update to the Inpatient Provider Specific File and the Outpatient Provider
Specific File to Retain Provider Information
The Supplemental Security Income/Medicare Beneficiary Data for Fiscal Year 2004 for Inpatient Prospective Payment System
Hospitals
Issued to a specific audience, not posted to Internet/Intranet due to Confidentiality of Instruction
Competitive Acquisition Program for Part B Drugs—Coding, Testing, and Implementation
This Transmittal is rescinded and replaced by Transmittal 673
Changes to the Laboratory National Coverage Determination Edit Software for October 2005
This Transmittal is rescinded and replaced by Transmittal 661
October 2005 Quarterly Average Sales Price Medicare Part B Drug Pricing File, Effective October 1, 2005 and Revisions to
April 2005 and July 2005 Quarterly Average Sale Price Medicare Part B Drug Pricing File
Services Not Provided Within the United States
Services Received by Medicare Beneficiaries Outside the United States Source of Part B Claims
Appeals of Denied Charges for Physicians and Ambulance Services in Connection With Foreign Hospitalization
Services Rendered in Nonparticipating Providers
Coverage Requirements for Emergency Hospital Services in Foreign Countries
Services Furnished in a Foreign Hospital Nearest to Beneficiary’s U.S. Residence
Coverage of Physician and Ambulance Services Furnished Outside U.S.
Payment by the Railroad Retirement Beneficiaries for Services Furnished in Canada to Qualified Railroad Retirement Beneficiaries
Foreign Religious Nonmedical Health Care Facility Claims
Elections to Bill for Services Rendered at Nonparticipating Hospitals
Processing Claims
Appeals on Claims for Emergency and Foreign Services
Payment for Services from Foreign Hospitals
Full Denial—Foreign Claim—Beneficiary Filed
This Transmittal is rescinded and replaced by Transmittal 663
Full Replacement of Change Request 3607, Payment Edits in Applicable States For Durable Medical Equipment Prosthetics,
Orthotics & Supplies
Provider Billing for Prosthetics and Orthotic Services
Quarterly Update to Correct Coding Initiative Edits, Version V11.3, Effective October 1, 2005
Billing for Devices Under the Hospital Outpatient Prospective Payment System
Billing for Devices Under the Outpatient Prospective Payment System
Requirements that Hospitals Report Device Codes on Claims on Which They Report Specified Procedures
Edits for Claims on Which Specified Procedures Are To Be Reported With Device Codes
Instructions for Downloading the Medicare Zip Code File
This Transmittal is rescinded and replaced by Transmittal 664
This Transmittal is rescinded and replaced by Transmittal 672
This Transmittal is rescinded and replaced by Transmittal 691
Update To The Hospice Payment Rates, Hospice Cap, Hospice Wage Index, and the Hospice Pricer for Fiscal Year 2006
This Transmittal is rescinded and replaced by Transmittal 683
October Quarterly Update for 2005 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Fees Schedule
Updates to the Coordination of Benefits Contractor Detailed Error
Report File Layout
Consolidation of the Claims Crossover Process
Coordination of Benefits Agreement Detailed Error Notification Process
Home Care and Domiciliary Care Visits (Codes 99321–99350)
Enforcement of Hospital Inpatient Bundling: Carrier Denial of Ambulance Claims During an Inpatient Stay
Hospital Inpatient Bundling
General Coverage and Payment Policies
Common Working File Editing of Ambulance Claims for Inpatients
Intermediary Guidelines
Provider/Intermediary Bill Processing Guidelines Effective April 1, 2002, as a Result of Fee Schedule Implementation
Schedule for Completing the Calendar Year 2006 Fee Updates and the Participating Physician Enrollment Procedures
Realignment of States and Medicare Claims Processing Workload From Durable Medical Equipment Regional Carrier Regions
A, B, C, and D to the Durable Medical Equipment Major Ambulatory Jurisdictions A, B, C and D
Updated Manual Instructions for the Medicare Claims Processing Manual, Regarding Smoking and Tobacco-Use Cessation
Counseling Services
Healthcare Common Procedure Coding System and Diagnosis Coding
Carrier Billing Requirements
Fiscal Intermediary Billing Requirements
Medicare Summary Notices
October Update to the 2005 Medicare Physician Fee Schedule Database
Manual Update on Medical Nutrition Therapy Services—Manualization
Medicare Nutrition Therapy Services
General Conditions and Limitations on Coverage
Referrals for Medicare Nutrition Therapy Services
Dietitians and Nutritionists Performing Medicare Nutrition Therapy Services
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[July through September 2005]
Transmittal
No.
674
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676
677
678
679
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Manual/Subject/Publication No.
Payment for Medicare Nutrition Therapy Services
General Claims Processing Information
Common Working File Edits
This Transmittal is rescinded and replaced by Transmittal 692
Changes to Appeals of Claims Decisions: Redeterminations and Reconsiderations (Implementation Date October 1, 2005)
Workload Data Analysis Program
Managing Appeals Workloads
Standard Operating Procedures
Execution of Workload Prioritization
Workload Priorities
2006 Healthcare Common Procedure Coding System Annual Update Reminder
This Transmittal is rescinded and replaced by 687
This Transmittal is rescinded and replaced by 688
Medicare Redetermination Notice and Effect of the Redetermination Medicare Redetermination Notice (for partly or fully unfavorable redeterminations)
Medicare Redetermination Notice (for fully favorable redeterminations) Effect of the Redetermination
Inpatient Rehabilitation Facility Annual Update: Prospective Payment System Pricer Changes for FY 2006
Guidelines For Payment of Vaccines (Pneumococcal Pneumonia Virus, Influenza Virus, And Hepatitis B Virus) and Their Administration Provided by Indian Health Services/Tribally-Owned and/or Operated Hospitals and Hospital Based Facilities
Billing Requirements
Bills Submitted to Fiscal Intermediaries
Vaccines and Vaccine Administration
Issued to a specific audience, not posted to Internet/Intranet due to Confidentiality of Instruction
October 2005 Outpatient Prospective Payment System Code Editor Specifications Version
Correction to Chapter 17, Section 80.2.3, MSN/ANSI X12 Denial Messages for Anti-Emetic Drugs
Discontinuation of the Skilled Nursing Facility Healthcare Common Procedure Coding System Help File and Notification to Fiscal Intermediaries and Providers of the Redesigned Skilled Nursing Facility Consolidated Billing Annual Update File Posted on
CMS Web site
Services Included in Part A Prospective Payment System Payment Not Billable Separately by the Skilled Nursing Facility
Services Beyond the Scope of the Part A Skilled Nursing Facility Benefit
Billing for Medical and Other Health Services
General Payment Rules and Application of Part B Deductible and Coinsurance
Common Working File Unsolicited Response Adjustments for Certain Claims Denied Due to an Open Medicare Secondary
Payer Group Health Plan Record Where the Group Health Plan Record Was Subsequently Deleted
Appeals of Claims Decisions: Redeterminations and Reconsiderations (Implementation Dates for Fiscal Intermediary Initial Determination Issued On or After May 1, 2005 and Carrier Initial Determinations Issued on or After January 1, 2006)
Filing a Request for Redetermination
Appeal Rights for Dismissals
Dismissal Letters
Model Dismissal Notices
Reconsideration—The Second Level of Appeal
Filing a Request for a Reconsideration
Time Limit for Filing a Request for a Reconsideration
Contractor Responsibilities—General
Qualified Independent Contractor Case File Development
Qualified Independent Contractor Case File Preparation
Forwarding Qualified Independent Contractor Case Files
Qualified Independent Contractor Jurisdictions
Tracking Cases
Effectuation of Reconsiderations
Appeals of Claims Decisions: Redeterminations and Reconsiderations (Implementation Dates for All Requests for Redetermination Received by Fiscal Intermediary on or After May 1, 2005, and All Requests for Redetermination Received by Carriers on
or After January 1, 2006)
Redetermination—The First Level of Appeal
The Redetermination
The Redetermination Decision
Dismissals
Vacating a Dismissal
One Time Update to the National Council Prescription Drug Programs
Companion Document Regarding Crossover Claims to Medicaid
Fiscal Year (FY) 2006 Payment for Services Furnished in Ambulatory Surgical Centers
October 2005 Update of the Hospital Outpatient Prospective Payment System
Fiscal Year 2006 Inpatient Prospective Payment System and Long Term Care Hospital Changes
Updates to the Inpatient Rehabilitation Facility and Skilled Nursing Facility
Provider Specific File and Changes in Inpatient Rehabilitation Facility
Prospective Payment System for FY 2006
Provider-Specific File
Case-Mix Groups
Facility Level Adjustments
Area Wage Adjustment
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ADDENDUM III.—MEDICARE AND MEDICAID MANUAL INSTRUCTIONS—Continued
[July through September 2005]
Transmittal
No.
694
Manual/Subject/Publication No.
Rural Adjustment
Outlier
Teaching Status Adjustment
Full Time Equivalent Resident Cap
Inpatient Rehabilitation Facility Prospective Payment System Pricer Software
Update to the Healthcare Provider Taxonomy Codes Version 5.1
Medicare Secondary Payer
(CMS—Pub. 100–05)
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32
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Full Replacement of Change Request 3770, Expanding the Number of Source Identifiers for Common Working File Medicare
Secondary Payer Records
Change Request 3770 Is Rescinded
Definition of Medicare Secondary Payer/Common Working File Terms
Medicare Secondary Payer Delete Transaction
Identification of Reimbursement Advisory Committee Created Group Health Plan Records
Exception for Small Employers in Multi-Employer Group Health Plans Overview and General Responsibilities
Introduction to the Coordination of Benefits Contractor
Scope of the Coordination of Benefit Contractor in Relation to Contractors
Contractors Claim Referrals to the Coordination of Benefit Contractors IRS/SSA/CMS Data Match
Coordination of Benefit Contractors Discontinues Dissemination of the Right of Recovery Letters to Contractors
Exception for Small Employers in Multi-Employer Group Health Plans
Purpose
Background
Specific Information
Working Aged Exception for Small Employers in Multi-Employer Group Health Plans
Manualization: Long-Standing Medicare Secondary Payer Policy in Chapter 1 of the Medicare Secondary Payer Internet Only
Manual
General Provisions
Working Aged
End-Stage Renal Disease
Workers’ Compensation
No-Fault Insurance
Liability Insurance
Conditional Primary Medicare Benefits
When Conditional Primary Medicare Benefits May Be Paid When a Group Health Plan Is a Primary Payer to Medicare
When Conditional Primary Medicare Benefits May Not Be Paid When a Group Health Plan Is a Primary Payer to Medicare
When Medicare Secondary Payer Benefits Are Payable and Not Payable
Multiple Insurers
Definitions
Crediting Deductible for Non-Inpatient Psychiatric Services
Clarification of Current Employment Status for Specific Groups
Actions Resulting From Group Health Plan or Large Group Health Plan
Nonconformance
Federal Government’s Right to Sue and Collect Double Damages
Updates to the Group Health Plan Identification and Recovery Processes
General
IRS/SSA/CMS Data Match (Data Match) Group Health Plan Identified Cases
Non-Data Match Group Health Plan Identified Cases
Other Sources of Recovery Actions
Group Health Plan Acknowledges Specific Debt (42 CFR 411.25)
Recovery When a State Medicaid Agency Has Also Requested a Refund From the Group Health Plan
Identification of Group Health Plan Mistaken Primary Payments Via the Recovery Management and Accounting System
Progression of Recovery Management Accounting System Group Health Plan
Lead Identification
Progression of Recovery Management Accounting System History Search
Contractor Recovery Case Files (Audit Trails)
Group Health Plan Letters (Used for Recovery Management Accounting
System/Healthcare Integrated General Ledger Accounting System (ReMAS/HIGLAS) When the Only Debtor Interfaced to
Healthcare Integrated General Ledger Accounting System Is the Employer)
Employer Group Health Plan Letter
Important Information for Employers
Insurer Group Health Plan Letter (Used for Recovery Management Accounting System/Healthcare Integrated General Ledger
Accounting System When the Only Debtor Interfaced to Healthcare Integrated General Ledger Accounting System Is the Employer)
Accountability Worksheet (Not Applicable to Recovery Management Accounting System/Healthcare Integrated General Ledger
Accounting System Users)
Summary Data Sheet (Not Applicable to ReMAS/HIGLAS Users)
Field Description on the Medicare Secondary Payer Summary Data Sheet Payment Record Summary (Used with ReMAS/
HIGLAS Users but in a Modified Format)
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ADDENDUM III.—MEDICARE AND MEDICAID MANUAL INSTRUCTIONS—Continued
[July through September 2005]
Transmittal
No.
36
Manual/Subject/Publication No.
Courtesy Copy of All Medicare Secondary Payer Group Health Plan-Based Recovery Demand Packages to the Employer’s Insurer/Third Party Administrator
Insurer/Third Party Administrator Courtesy Copy Letter
Recovery Management Accounting System Error Reports
Mistaken Group Health Plan Primary Payments
Mistaken Primary Payment Activities and Record Layouts
Contractor Actions Upon Receipt of the Data Match Cycle Tape or Other Notice of Non-Data Match Group Health Plan Mistaken Payments (for Contractor Not on ReMAS/HIGLAS for GHP Recovery) and Actions to Take for Those Contractors Using
Recovery Management Accounting System/Health Integrated General Ledger Accounting System Group Health Plan Functions
Coordination of Benefits Contractor Responsibility to Obtain Missing Medicare Secondary Payer Information
Time Limitations for Group Health Plan Recoveries
Actual Notice
Contractor History Search
Aggregate Claims for Recovery
Documentation of Debt
Recovery Attempt Audit Trails
Summary of Medicare Reimbursement
Claim Facsimiles for Each Claim Mistakenly Paid
IRS/SSA/CMS Mistaken Payment Recovery Tracking System
Inpatient, Skilled Nursing Facility, and Religious Non-Medicare Health Care
Outpatient Mistaken Payment Report Record Layout
Home Health Agency Mistaken Payment Record Layout
Communication Receive in Response to Recovery Actions
Update to the Healthcare Provider Taxonomy Codes Version 5.1
Medicare Financial Management
(CMS—Pub. 100–06)
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Notice of New Interest Rate for Medicare Overpayments and Underpayments
Claims Accounts Receivable Update
Intermediary Claims Accounts Receivable
Financial Reporting for Intermediary Claims Accounts Receivable
This Transmittal is rescinded and replaced by Transmittal 75
Discovery Code Indication for Recovery Audit Contractor (RAC) Non-MSP Identified Overpayments
New Thresholds for 2nd Demand Letter for Physicians/Suppliers
Part B Overpayment Demand Letters to Physicians/Suppliers
Development of New Report to Capture Benefits, Improvement and Protection Act and Medicare Prescription Drug, Improvement, and Modernization Act Appeals Data
Monthly Statistical Report on Intermediary and Carrier Part A and Part B
Appeals Activity Form
Redeterminations
Qualified Independent Contractor Reconsiderations
Administrative Law Judge Results
Department Appeals Board Effectuations
Clerical Error Reopenings
Validation of Reports
Non-Medicare Secondary Payer Debt Referral and Debt Collection Improvement Act of 1996 Activities
Background
Cross Servicing
Treasury Offset Program
Definition of Delinquent Debt
Referral Requirements
Exemptions to Referral
Debt to be Referred
Delinquent Non-Medicare Secondary Payer Fiscal Intermediary Debt, Including Debt on the Provider Overpayment Reporting
System
Delinquent Non-Medicare Secondary Payer Medicare Carrier Debt, Including Debt on the Physician/Supplier Overpayment Reporting System
Delinquent Non-Medicare Secondary Payer Debt Previously Ineligible for Referral
Debt Collection Improvement Act Language/Intent to Refer Letter
Response to ‘‘Intent to Refer’’ Letter
Provider Overpayment Reporting System Updates
Physician/Supplier Overpayment Reporting System Updates
Cross Servicing Collection Efforts
Actions Subsequent to Debt Collection System Input
Transmission of Debt
Update to Debt Collection System After Transmission
Financial Reporting for Debt Referred
Financial Reporting for Non-Medicare Secondary Payer Debt
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ADDENDUM III.—MEDICARE AND MEDICAID MANUAL INSTRUCTIONS—Continued
[July through September 2005]
Transmittal
No.
78
Manual/Subject/Publication No.
Coordination of Benefits Agreement Process for Contractor Financial Staff Notification
Medicare State Operations Manual
(CMS—Pub. 100–07)
09
10
11
Revision of Appendix P and Certain Exhibits of the State Operations Manual
Revisions—Appendix J—Interpretive Guidelines Intermediate Care Facilities With Mental Retardation
Revised Chapter 2—‘‘The Certification Process,’’ Sections 2180E thru 2200F, and Appendix B—‘‘Interpretive Guidelines: Home
Health Agencies’’
Medicare Program Integrity
(CMS—Pub. 100–08)
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116
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Program Integrity Manual Revision
Affiliated Contractor/Full Program Safeguard Contractor Communication With the Comprehensive Error Rate Testing Contractor
Overview of the Comprehensive Error Rate Testing Process
Providing Sample Information to the Comprehensive Error Rate Testing Contractor
Providing Review Information to the Comprehensive Error Rate Testing Contractor
Providing Feedback Information to the Comprehensive Error Rate Testing Contractor
Disputing/Disagreeing With a Comprehensive Error Rate Testing Decision Handling Overpayments and Underpayments Resulting From the Comprehensive Error Rate Testing Findings
Handling Appeals Resulting From Comprehensive Error Rate Testing Initiated Denials
Tracking Overpayments
Tracking Appeals
Potential Fraud
Full Program Safeguard Contractor Requirements Involving Comprehensive Error Rate Testing Information Dissemination
Full Program Safeguard Contractor Error Rate Reduction Plan
Contacting Non-Responders
Late Documentation Received by the Comprehensive Error Rate Testing Contractor
Voluntary Refunds
Local Coverage Determination/National Coverage Determination
Comprehensive Error Rate Testing Review Contractor Review Guidelines
Revise the Fiscal Intermediary Shared System to Allow Reporting of Data for the Comprehensive Error Rate Testing Program
Resolution File at a Line Level
Revise the Medicare Contractor System and the VIPS Medicare System To Allow Update of the Comprehensive Error Rate
Testing Program Resolution File Within Five Business Days of a Comprehensive Error Rate Testing Request
Various Benefit Integrity Clarifications
Goal of Medical Review Program
Overpayment Procedures
Disposition of the Suspension
The Medicare Fraud Program
Program Safeguard Contractor and Medicare Contractor Benefit Integrity Unit
Organizational Requirements
Training for Law Enforcement Organizations
Procedural Requirements
Requests for Information From Outside Organizations
Sharing Fraud Referrals Between the Office of Inspector General and the Department of Justice
Complaint Screening
Investigations
Conducting Investigations
Disposition of Cases
Reversed Denials by Administrative Law Judges on Open Cases
Types of Fraud Alerts
Coordination
Investigation, Case, and Suspension Entries
Update Requirements for Cases
Closing Investigations
Deleting Investigations, Cases, or Suspensions
Access
Harkin Grantees or Senior Medicare Patrol—Complaint Tracking System
Harkin Grantees or Senior Medicare Patrol Project Description
Harkin Grantees Tracking System Instructions
System Access to Metaframe and Data Collection
Data Dissemination/Aggregate Report
Referral of Cases to the Office of the Inspector General/Office of Investigations
Immediate Advisements to the Office of Inspector General/Office of Investigations
Denial of Payments for Cases Referred to and Accepted by Office of Inspector General/Office of Investigations
Take Administrative Action on Cases Referred to and Refused by Office of Inspector General /Office of Investigations
Referral to State Agencies or Other Organizations
Referral to Quality Improvement Organizations
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[July through September 2005]
Transmittal
No.
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120
121
122
123
124
125
Manual/Subject/Publication No.
Referral Process to CMS
Referrals to Office of Inspector General
Breaches of Assignment Agreement by Physician or Other Supplier
Annual Deceased-Beneficiary Postpayment Review
Vulnerability Report
Issued to a specific audience, not posted to Internet/Intranet due to Confidentiality of Instruction
Correction to Change Request (CR) 3222: Local Medical Review Policy/Local Coverage Determination Medicare Summary Notice Message Revision Denials Notices
This Transmittal is rescinded and replaced by Transmittal 124
Medical Review Collection Number Requirements
Overview of Prepayment and Postpayment Review for Medical Review Purposes
Chapter 3, Medicare Modernization Act Section 935
Verifying Potential Errors and Setting Priorities
Determining Whether the Problem Is Widespread or Provider Specific
Overpayment Procedures
‘‘Probe’’ Reviews
Evidence of Medical Necessity: Wheelchair and Power Operated Vehicle Claims
Medical Review Additional Documentation Requests
Additional Documentation Requests During Prepayment or Postpayment
Medical Review
Medicare Contractor Beneficiary and Provider Communications
(CMS—Pub. 100–09)
12
13
Next Generation Desktop Testing Requirements
Provider Contact Centers Training Program
Guidelines for Telephone Service
Staff Development and Training
Medicare Managed Care
(CMS—Pub. 100–16)
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68
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70
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Beneficiary Enrollment and Disenrollment Requirements for Medicare Advantage Plans
Changes in Requirements for Periodic Surveys of Current and Former Enrollees, and in the CMS Method for Calculating Interest on Overpayment and Underpayments to Health Maintenance Organizations, Comprehensive Medical Plans and Health
Care Prepayment Plans
Initial Publication of Chapter 1—General Provisions
Introduction
Definitions
Types of Medical Assistance Plans
Cost Sharing in Enrollment—Related Costs
Revisions to Chapter 12, ‘‘Effect of Change of Ownership,’’ and Chapter 14, ‘‘Contract Determination and Appeals’’
Effect of Change of Ownership
What Constitutes a Change of Ownership
Address for Sending Notifications to CMS
When a Novation Agreement Is Required
Acceptable Novation Agreements
Contract Determination Notice
Postponement of the Contract Determination’s Effective Date
Reconsiderations
Time Frames for Filing a Reconsideration Request
Parties to the Hearing
Conduct and Record of a Hearing
Reopening of Contract Reconsidered Determination or Decision of a Hearing Officer or the Administrator
Beneficiary Enrollment and Disenrollment Requirements for Medicare Advantage Plans
Deletion of MCM Chapter 19—The Enrollment and Payment User’s Guide, and Chapter 20—Managed Care and Medical Assistance Business Requirements
Changes in Manual Instructions for Benefits and Beneficiary Protections
Basic Rules
Types of Benefits
Availability and Structure of Plans
CMS Review and Approval of M+C Benefit—rewritten and relocated to § 20
Requirements Relating to Medicare Conditions of Participation—renumbered as § 4.10.7
Provider Networks—renumbered as new § 10.8 and parts of the old § 20, ‘‘Original Medicare Covered Benefits’’
CMS Approval of Proposed Plan MA Benefits—old 10.7 revised and located here
General Guidelines on Benefit Approval
Screening Mammography, Influenza Vaccine, and Pneumococcal Vaccine
Inpatient Hospital Rehabilitation Service
Value-Added Items and Services
Prescription Drug Discount Programs
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ADDENDUM III.—MEDICARE AND MEDICAID MANUAL INSTRUCTIONS—Continued
[July through September 2005]
Transmittal
No.
72
Manual/Subject/Publication No.
Waiting Periods and Exclusions That Are Not Present in Original Medicare
Annual Beneficiary Out-of-Pocket Cap
Drug Benefits
Drugs That Are Covered Under Original Medicare
Mid-Year Benefit Enhancements
Multi-Year Benefits
Return to Home Skilled Nursing Facility
Guidance on Acceptable Cost-Sharing and Deductibles
Homemaker Services
Caregiver Resource Services
Electronic Monitoring
Dentures
Chiropractic Services
Cash
Beauty Parlor
Transportation
Safety Items
Travel for Transplants
Meals
Basic Benefits
Cost-sharing Rules for Medical Assistance Regional Plans
Supplemental Benefits and Mandatory Supplemental and Optional Supplemental
Basic Versus Supplemental Benefits
The Annual Deductible
General Rule
Accessing Plan Contracting Providers
Enrollee Information and Disclosure
Definitions
Factors That Influence Service Area Approval
The ‘‘County Integrity Rule’’
General Rule
Employer Plans
Basic Rule
Medicare Benefits Secondary to Group Health Plans and Large Group Health Plans
Medicare Secondary Payer Rules and State Laws
Discrimination Against Beneficiaries Prohibited
Disclosure Requirements at Enrollment (and Annually Thereafter)
Information Pertaining to a Medical Assistance Organization Changing Their Rules or Provider Network
Other Information That Is Disclosable Upon Request
Access and Availability Rules for Coordinated Care Plans
Emergency and Urgently Needed Services
Post-Stabilization Care Services
General Description
Private Fee-for-Service Plan Terms and Conditions of Participation
Provider Types—Direct Contracting, Deemed Contracting, Non-Contracting Access to Services
Payments and Balance Billing
Advance Notice of Coverage
Prompt Payment Requirements
Original Medicare vs. Estimated Payment Amounts
Table Summarizing Private Fee-for-Service Plan Provider Types and Rules
Changes in Manual Instructions for Intermediate Sanctions
Types of Intermediate Sanctions
General Basis for Imposing Intermediate Sanctions on Medical Assistance Organizations
Imposing Sanctions for Specific Medical Assistance Contract Violations
Civil Monetary Penalties for Medical Assistance Organizations That Improperly Terminate the Medical Assistance Contract
CMS Process for Suspending Marketing, Enrollment, and Payment
Contract Termination by CMS
Medicare Business Partners Systems Security
(CMS—Pub. 100–17)
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Demonstrations
(CMS—Pub. 100–19)
26
27
28
VerDate Aug<31>2005
This Transmittal is rescinded and replaced by Transmittal 27
The Medicare Chronic Care Improvement, ‘‘Medicare Health Support,’’ Program
The Medicare Care Management for High Cost Beneficiaries Demonstration
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ADDENDUM III.—MEDICARE AND MEDICAID MANUAL INSTRUCTIONS—Continued
[July through September 2005]
Transmittal
No.
Manual/Subject/Publication No.
One-Time Notification
(CMS—Pub. 100–20)
161
162
Kansas Blue Cross Blue Shield Carrier Numbering Issue
Instructions for Fiscal Intermediary Standard System and Multi-Carrier System
Healthcare Integrated General Ledger Accounting System Changes
Qualified Independent Contractor Jurisdictions
Medicare HIPAA Electronic Claims Report—Third Reporting Timeframe Extension
Issued to a specific audience, not posted to Internet/Intranet due to Confidentiality of Instruction
This Transmittal is rescinded and replaced by Transmittal 173
Issued to a specific audience, not posted to Internet/Intranet due to Sensitivity of Instruction
Shared System Maintainer Hours for Resolution of Problems Detected During Health Insurance Portability and Accountability
Act Transaction January 2006 Release Testing
Analysis of Systems Improvements to Streamline POS Code Set Updates
Updates to the Coordination of Benefits Agreement Insurance File for Use in the National Claims Crossover Program
Preliminary system updates in preparation for ending the Medicare contingency plan in October 2005
Issued to a specific audience, not posted to Internet/Intranet due to Confidentiality of Instruction
Overnight Oximetry Testing
Fiscal Intermediary Shared System Modification
Common Working File Calculation of Next Eligible Date for Preventive Services
Change of the CareFirst Part A Plan to Highmark in the State of Maryland and Washington, DC
Termination of Existing Crossover Agreements as Trading Partners
Transition to the National Coordination of Benefits Agreement Program
Issued to a specific audience, not posted to Internet/Intranet due to Confidentiality of Instruction
Calculation of the Interim Payment of Indirect Medical Education Through the Inpatient Prospective Payment Pricer for Hospitals
That Received an Increase to Their Full-Time Equivalent Resident Cap Under Section 422 of the Medicare Modernization Act,
P.L. 108–173
Issued to a specific audience, not posted to Internet/Intranet due to Confidentiality of Instruction
National Modifier and Condition Code To Be Used To Identify Disaster Disaster Related Claims
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
ADDENDUM IV.—REGULATION DOCUMENTS PUBLISHED IN THE FEDERAL REGISTER
[July through September 2005]
FR Vol.
70
page
number
CFR parts affected
File code
Title of regulation
July 6, 2005 .........................
39022
414 ......................................
July 8, 2005 .........................
39514
..............................................
CMS–3125–
IFC
CMS–1288–N
July 12, 2005 .......................
40039
..............................................
CMS–2212–N
July 14, 2005 .......................
40788
484 ......................................
CMS–1301–P
July 14, 2005 .......................
40709
..............................................
CMS–1288–
CN
July 22, 2005 .......................
42331
..............................................
July 22, 2005 .......................
42330
..............................................
CMS–3142–
FN
CMS–1315–N
July 22, 2005 .......................
42329
..............................................
CMS–3153–N
July 22, 2005 .......................
42328
..............................................
CMS–4093–N
July 22, 2005 .......................
42327
..............................................
CMS–3158–N
July 22, 2005 .......................
wwhite on PROD1PC61 with NOTICES
Publication date
42276
146 ......................................
July 25, 2005 .......................
42674
419 and 485 ........................
CMS–4094–
F3
CMS–1501–P
August 4, 2005 ....................
45130
418 ......................................
CMS–1286–F
Medicare Program; Competitive Acquisition of Outpatient
Drugs and Biologicals Under Part B.
Medicare Program; Meeting of the Advisory Panel on
Ambulatory Payment Classification (APC) Groups—
August 17, 18, and 19, 2005.
Medicaid Program; Meeting of the Medicaid Commission—July 27, 2005.
Medicare Program; Home Health Prospective Payment
System Rate Update for Calendar Year 2006.
Medicare Program; Meeting of the Advisory Panel on
Ambulatory Payment Classification (APC) Groups—
August 17, 18, and 19, 2005; Correction.
Medicare Program; Evaluation Criteria and Standards for
Quality Improvement Program Contracts.
Medicare Program; August 22, 2005, Meeting of Practicing Physicians Advisory Council and Request for
Nominations.
Medicare Program; Meeting of the Medicare Coverage
Advisory Committee—October 6, 2005.
Medicare Program; Request for Nominations for the Advisory Panel on Medicare Education.
Medicare Program; Request for Nominations for Members for the Medicare Coverage Advisory Committee.
Amendment to the Interim Final Regulation for Mental
Health Parity.
Medicare Program; Proposed Changes to the Hospital
Outpatient Prospective Payment System and Calendar
Year 2006 Payment Rates.
Medicare Program; Hospice Wage Index for Fiscal Year
2006.
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ADDENDUM IV.—REGULATION DOCUMENTS PUBLISHED IN THE FEDERAL REGISTER—Continued
[July through September 2005]
FR Vol.
70
page
number
CFR parts affected
File code
Title of regulation
August 4, 2005 ....................
45026
409, 411, 424, and 489 .......
CMS–1282–F
August 4, 2005 ....................
44930
..............................................
CMS–2220–N
August 4, 2005 ....................
44879
402 ......................................
CMS–6019–P
August 8, 2005 ....................
45764
47278
405, 410, 411, 413, 414,
and 426.
405, 412, 413, 415, 419,
422, and 485.
CMS–1502–P
August 12, 2005 ..................
August 15, 2005 ..................
47880
412 ......................................
CMS–1290–F
August 15, 2005 ..................
47759
483 ......................................
CMS–3198–P
August 26, 2005 ..................
50940
410 ......................................
CMS–3017–
IFC
August 26, 2005 ..................
50680
419 and 485 ........................
CMS–1501–
CN
August 26, 2005 ..................
50375
..............................................
CMS–4111–N
August 26, 2005 ..................
50374
..............................................
CMS–1330–N
August 26, 2005 ..................
50373
..............................................
August 26, 2005 ..................
50372
..............................................
CMS–4106–
PN
CMS–1309–
NC
August 26, 2005 ..................
50358
..............................................
CMS–2209–N
August 26, 2005 ..................
50358
..............................................
CMS–1486–N
August 26, 2005 ..................
50262
447 and 455 ........................
CMS–2198–P
August 26, 2005 ..................
50214
433 ......................................
CMS–2210–
IFC
August 26, 2005 ..................
50214
405 ......................................
CMS–4064–
IFC3
August 30, 2005 ..................
51321
410 ......................................
CMS–6024–P
September 1, 2005 ..............
52105
..............................................
CMS–1308–
NC
September 1, 2005 ..............
52056
405, 410, 411, 413, 414,
and 426.
CMS–1502–
CN
September 1, 2005 ..............
wwhite on PROD1PC61 with NOTICES
Publication date
52023
422 ......................................
CMS–4069–
F3
September 1, 2005 ..............
52019
403 ......................................
CMS–4063–F
September 6, 2005 ..............
52930
414 ......................................
CMS–1325–
IFC2
Medicare Program; Prospective Payment System and
Consolidated Billing for Skilled Nursing Facilities for
FY 2006.
Medicare Program; Meeting of the Medicaid Commission—August 17–18, 2005.
Medicare Program; Revised Civil Money Penalties, Assessments, Exclusions, and Related Appeals Procedures.
Medicare Program; Revisions to Payment Policies Under
the Physician Fee Schedule for Calendar Year 2006.
Medicare Program; Changes to the Hospital Inpatient
Prospective Payment Systems and Fiscal Year 2006
Rates.
Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for FY 2006.
Medicare and Medicaid Programs; Condition of Participation: Immunization Standard for Long Term Care
Facilities.
Medicare Program; Conditions for Payment of Power
Mobility Devices, including Power Wheelchairs and
Power-Operated Vehicles.
Medicare Program; Proposed Changes to the Hospital
Outpatient Prospective Payment System and Calendar
Year 2006 Payment Rates; Correction.
Medicare Program; Meeting of the Advisory Panel on
Medicare Education, September 27, 2005.
Medicare Program; Town Hall Meeting on the Medicare
Provider Feedback Group (MPFG)—September 12,
2005.
Medicare Program; Changes in Medicare Advantage
Deeming Authority.
Medicare and Medicaid Programs; Announcement of an
Application From a Hospital Requesting Waiver for
Organ Procurement Service Area.
Medicaid Program; Fiscal Disproportionate Share Hospital Allotments and Disproportionate Share Hospital
Institutions for Mental Disease Limits.
Medicare Program; Announcement of New Members of
the Advisory Panel on Ambulatory Payment Classification (APC) Groups.
Medicaid Program; Disproportionate Share Hospital Payments.
Medicaid Program; State Allotments for Payment of
Medicare Part B Premiums for Qualifying Individuals:
Federal Fiscal Year 2005.
Medicare Program; Changes to the Medicare Claims Appeal Procedures: Correcting Amendment to a Correcting Amendment.
Medicare Program; Prior Determination for Certain Items
and Services.
Medicare Program; Withdrawal of Ambulance Fee
Schedule Issued in Accordance With Federal District
Court Order in Lifestar Ambulance v. United States,
No. 4:02–CV–127–1 (M.D. Ga., Jan. 16, 2003)—Medicare Covered Ambulance Services.
Medicare Program; Revisions to Payment Policies Under
the Physician Fee Schedule for Calendar Year 2006;
Correction.
Medicare Program; Establishment of the Medicare Advantage Program; Correcting Amendment; Partial Stay
of Effectiveness.
Medicare Program; Medicare Prescription Drug Discount
Card; Revision of Marketing Rules for Endorsed Drug
Card Sponsors.
Medicare Program; Competitive Acquisition of Outpatient
Drugs and Biologicals Under Part B: Interpretation and
Correction.
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76305
ADDENDUM IV.—REGULATION DOCUMENTS PUBLISHED IN THE FEDERAL REGISTER—Continued
[July through September 2005]
FR Vol.
70
page
number
CFR parts affected
File code
Title of regulation
September 16, 2005 ............
54751
..............................................
CMS–5017–N
September 23, 2005 ............
55905
..............................................
CMS–3159–N
September 23, 2005 ............
55903
..............................................
CMS–1269–
N5
September 23, 2005 ............
55897
..............................................
CMS–8027–N
September 23, 2005 ............
55896
..............................................
CMS–8025–N
September 23, 2005 ............
55887
..............................................
CMS–1307–
GNC
September 23, 2005 ............
55885
..............................................
CMS–8026–N
September 23, 2005 ............
55863
..............................................
CMS–9032–N
September 23, 2005 ............
55862
..............................................
CMS–2227–
PN
September 23, 2005 ............
55812
447 and 455 ........................
September 29, 2005 ............
56901
..............................................
CMS–2198–
CN
CMS–2230–
FN
September 30, 2005 ............
57376
505 ......................................
CMS–1320–P
September 30, 2005 ............
57368
505 ......................................
CMS–1287–
IFC
September 30, 2005 ............
57300
..............................................
CMS–1307–
CN
September 30, 2005 ............
57297
..............................................
CMS–3144–
NC
September 30, 2005 ............
57296
..............................................
CMS–1269–
N6
September 30, 2005 ............
57174
418 ......................................
September 30, 2005 ............
57166
412 ......................................
September 30, 2005 ............
57164
411 and 424 ........................
CMS–1286–
CN
CMS–1290–
CN
CMS–1282–
CN
September 30, 2005 ............
wwhite on PROD1PC61 with NOTICES
Publication date
57161
405, 412, 413, 415, 419,
422, and 485.
Medicare Program; Medicare Health Care Quality
(MHCQ) Demonstration Programs.
Medicare Program; Meeting of the Medicare Coverage
Advisory Committee—November 29, 2005.
Medicare Program; Emergency Medical Treatment and
Labor Act (EMTALA) Technical Advisory Group (TAG)
Meeting—October 26, 2005 Through October 28,
2005.
Medicare Program; Medicare Part B Monthly Actuarial
Rates, Premium Rate, and Annual Deductible for Calendar Year 2006.
Medicare Program; Part A Premium for Calendar Year
2006 for the Uninsured Aged and for Certain Disabled
Individuals Who Have Exhausted Other Entitlement.
Medicare Program; Criteria and Standards for Evaluating
Intermediary, Carrier, and Durable Medical Equipment,
Prosthetics, Orthotics, and Supplies (DMEPOS) Regional Carrier Performance During Fiscal Year 2006.
Medicare Program; Inpatient Hospital Deductible and
Hospital and Extended Care Services Coinsurance
Amounts for Calendar Year 2006.
Medicare and Medicaid Programs; Quarterly Listing of
Program Issuances-April Through June 2005.
Medicare and Medicaid Programs; Application by the Accreditation Commission of Healthcare for Deeming Authority for Home Health Agencies.
Medicaid Program; Disproportionate Share Hospital Payments.
State Children’s Health Insurance Program (SCHIP); Redistribution of Unexpended SCHIP Funds From the
Appropriation for Fiscal Year 2002.
Medicare Program; Health care Infrastructure Improvement Program; Forgiveness of Indebtness.
Medicare Program; Health Care Infrastructure Improvement Program; Selection Criteria of Loan Program for
Qualifying Hospitals Engaged in Cancer-Related
Health Care.
Medicare Program; Criteria and Standards for Evaluating
Intermediary, Carrier, and Durable Medical Equipment,
Prosthetics, Orthotics, and Supplies (DMEPOS) Regional Carrier Performance During Fiscal Year 2006;
Correction Notice.
Medicare Program; Calendar Year 2005 Review of Appropriateness of Payment Amounts for New Technology Intraocular Lenses (NTIOLs) Furnished by Ambulatory Surgical Centers (ASCs).
Medicare Program; Emergency Medical Treatment and
Labor Act (EMTALA) Technical Advisory Group (TAG):
Announcement of a New Member.
Medicare Program; Hospice Wage Index for Fiscal Year
2006.
Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for FY 2006; Correction.
Medicare Program; Prospective Payment System and
Consolidated Billing for Skilled Nursing Facilities; Correction.
Medicare Program; Changes to the Hospital Inpatient
Prospective Payment Systems and Fiscal Year 2006
Rates; Correction.
Addendum V—National Coverage
Determinations
[July Through September 2005]
A national coverage determination (NCD)
is a determination by the Secretary with
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CN
respect to whether or not a particular item or
service is covered nationally under Title
XVIII of the Social Security Act, but does not
include a determination of what code, if any,
is assigned to a particular item or service
covered under this title, or determination
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Sfmt 4703
with respect to the amount of payment made
for a particular item or service so covered.
We include below all of the NCDs that were
issued during the quarter covered by this
notice. The entries below include
information concerning completed decisions
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as well as sections on program and decision
memoranda, which also announce pending
decisions or, in some cases, explain why it
was not appropriate to issue an NCD. We
identify completed decisions 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.
Information on completed decisions as well
as pending decisions has also been posted on
the CMS Web site at https://cms.hhs.gov/
coverage.
National Coverage Determinations
[July Through September 2005]
There were no new NCDs posted during
this time period.
Addendum VI—FDA-Approved Category B
IDEs
[July Through September 2005]
Under the Food, Drug, and Cosmetic Act
(21 U.S.C. 360c) devices fall into one of three
classes. To assist CMS under this
categorization process, the FDA assigns one
of two categories to each FDA-approved IDE.
Category A refers to experimental IDEs, and
Category B refers to non-experimental IDEs.
To obtain more information about the classes
or categories, please refer to the Federal
Register notice published on April 21, 1997
(62 FR 19328).
The following list includes all Category B
IDEs approved by FDA during the second
quarter, July through September 2005.
IDE/Category
G040204
G050005
G050016
G050028
G050035
G050036
G050041
G050044
G050069
G050072
G050082
G050086
G050103
G050107
G050108
G050112
G050113
G050114
G050117
G050119
G050120
G050122
G050123
G050125
G050127
G050129
G050130
G050132
G050133
G050134
G050135
G050136
G050141
G050144
G050145
G050146
G050147
G050148
G050149
G050153
G050155
G050158
G050160
G050161
G050163
G050165
G050166
G050170
G050172
G050174
G050177
G050178
G050180
G050181
G050182
G050183
Addendum VII—Approval Numbers for
Collections of Information
Below we list all approval numbers for
collections of information in the referenced
sections of CMS regulations in Title 42; Title
45, Subchapter C; and Title 20 of the Code
of Federal Regulations, which have been
approved by the Office of Management and
Budget:
OMB CONTROL NUMBERS
[Approved CFR Sections in Title 42, Title 45, and Title 20 (Note: Sections in Title 45 are preceded by ‘‘45 CFR,’’ and sections in Title 20 are
preceded by ‘‘20 CFR’’)]
OMB number
Approved CFR sections
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
0938–0065
0938–0074
0938–0080
0938–0086
0938–0101
0938–0102
0938–0107
0938–0146
0938–0147
0938–0151
wwhite on PROD1PC61 with NOTICES
0938–0008
0938–0022
0938–0023
0938–0025
0938–0027
0938–0033
0938–0035
0938–0037
0938–0041
0938–0042
0938–0045
0938–0046
0938–0050
0938–0062
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
0938–0155
0938–0170
0938–0193
0938–0202
0938–0214
0938–0236
0938–0242
0938–0245
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
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Jkt 208001
414.40, 424.32, 424.44
413.20, 413.24, 413.106
424.103
406.28, 407.27
486.100–486.110
405.807
407.40
413.20, 413.24
408.6, 408.22
410.40, 424.124
405.711
405.2133
413.20, 413.24
431.151, 435.1009, 440.220, 440.250, 442.1, 442.10–442.16, 442.30, 442.40, 442.42,
442.100–442.119, 483.400–483.480, 488.332, 488.400, 498.3–498.5
485.701–485.729
491.1–491.11
406.7, 406.13
420.200–420.206, 455.100–455.106
430.30
413.20, 413.24
413.20, 413.24
431.800–431.865
431.800–431.865
493.1357, 493.1363, 493.1405, 493.1406, 493.1411, 493.1417, 493.1423, 493.1443,
493.1449, 493.1455, 493.1461, 493.1462, 493.1469, 493.1483, 493.1489, 493.1491
405.2470
493.1269–493.1285
430.10–430.20, 440.167
413.17, 413.20
411.25, 489.2, 489.20
413.20, 413.24
442.30, 488.26
407.10, 407.11
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76307
OMB CONTROL NUMBERS—Continued
[Approved CFR Sections in Title 42, Title 45, and Title 20 (Note: Sections in Title 45 are preceded by ‘‘45 CFR,’’ and sections in Title 20 are
preceded by ‘‘20 CFR’’)]
OMB number
Approved CFR sections
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
0938–0334
0938–0338
0938–0354
0938–0355
0938–0357
0938–0358
0938–0359
0938–0360
0938–0365
0938–0372
0938–0378
0938–0379
0938–0382
0938–0386
0938–0391
0938–0426
0938–0429
0938–0443
0938–0444
0938–0445
0938–0447
0938–0448
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
0938–0454
0938–0456
0938–0463
0938–0467
0938–0469
0938–0470
0938–0477
0938–0484
0938–0501
0938–0502
0938–0512
0938–0526
0938–0534
0938–0544
0938–0564
0938–0565
0938–0566
0938–0573
0938–0578
0938–0581
0938–0599
0938–0600
0938–0610
0938–0612
wwhite on PROD1PC61 with NOTICES
0938–0246
0938–0251
0938–0266
0938–0267
0938–0269
0938–0270
0938–0272
0938–0273
0938–0279
0938–0287
0938–0296
0938–0301
0938–0302
0938–0313
0938–0328
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
0938–0618
0938–0653
0938–0657
0938–0658
..........................................................
..........................................................
..........................................................
..........................................................
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Jkt 208001
431.800–431.865
406.7
416.41, 416.47, 416.48, 416.43
410.65, 485.56, 485.58, 485.60, 485.64, 485.66
412.116, 412.632, 413.64, 413.350, 484.245
405.376
440.180, 441.300–441.305
485.701–485.729
424.5
447.31
413.170, 413.184
413.20, 413.24
418.22, 418.24, 418.28, 418.56, 418.58, 418.70, 418.74, 418.83, 418.96, 418.100
489.11, 489.20
482.12, 482.13, 482.21, 482.22, 482.27, 482.30, 482.41, 482.43, 482.45, 482.53, 482.56,
482.57, 482.60, 482.61, 482.62, 485.618, 485.631
491.9, 491.10
486.104, 486.106, 486.110
441.60
442.30, 488.26
409.40–409.50, 410.36, 410.170, 411.4–411.15, 421.100, 424.22, 484.18, 489.21
412.20–412.30
412.40–412.52
488.60
484.10, 484.11, 484.12, 484.14, 484.16, 484.18, 484.20, 484.36, 484.48, 484.52
414.330
482.60–482.62
442.30, 488.26
442.30, 488.26
405.2100–405.2171
488.18, 488.26, 488.28
476.104, 476.105, 476.116, 476.134
447.53
473.18, 473.34, 473.36, 473.42
1004.40, 1004.50, 1004.60, 1004.70
412.44, 412.46, 431.630, 456.654, 466.71, 466.73, 466.74, 466.78
405.2133
405.2133, 45 CFR 5, 5b; 20 CFR Parts 401, 422 Subpart E 0938–0449 440.180, 441.300–
441.310
424.20
412.105
413.20, 413.24, 413.106
431.17, 431.306, 435.910, 435.920, 435.940–435.960
417.126, 422.502, 422.516
417.143, 417.800–417.840, 422.6
412.92
424.123
406.15
433.138
486.304, 486.306, 486.307
475.102, 475.103, 475.104, 475.105, 475.106
410.38, 424.5
493.1–493.2001
411.32
411.20–411.206
411.404, 411.406, 411.408
412.230, 412.256
447.534
493.1–493.2001
493.1–493.2001
405.371, 405.378, 413.20
484.10, 489.102
493.801, 493.803, 493.1232, 493.1233, 493.1234, 493.1235, 493.1236, 493.1239, 493.1241,
493.1242, 493.1249, 493.1251, 493, 1252, 493.1253, 493.1254, 493.1255, 493.1256,
493.1261, 493.1262, 493.1263, 493.1269, 493.1273, 493.1274, 493.1278, 493.1283,
493.1289, 493.1291, 493.1299
433.68, 433.74, 447.272
493.1771, 493.1773, 493.1777
405.2110, 405.2112
405.2110, 405.2112
PO 00000
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76308
Federal Register / Vol. 70, No. 246 / Friday, December 23, 2005 / Notices
OMB CONTROL NUMBERS—Continued
[Approved CFR Sections in Title 42, Title 45, and Title 20 (Note: Sections in Title 45 are preceded by ‘‘45 CFR,’’ and sections in Title 20 are
preceded by ‘‘20 CFR’’)]
OMB number
Approved CFR sections
0938–0659
0938–0667
0938–0679
0938–0685
0938–0686
0938–0688
0938–0691
0938–0692
0938–0701
0938–0702
0938–0703
0938–0713
0938–0714
0938–0717
0938–0721
0938–0723
0938–0730
0938–0732
0938–0734
0938–0739
0938–0742
0938–0749
0938–0753
0938–0754
0938–0758
0938–0760
0938–0761
0938–0763
..........................................................
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..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
0938–0770
0938–0778
0938–0779
0938–0781
0938–0786
0938–0783
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
0938–0787 ..........................................................
0938–0790 ..........................................................
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0938–0792
0938–0798
0938–0802
0938–0818
0938–0829
0938–0832
0938–0833
0938–0841
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
..........................................................
0938–0842
0938–0846
0938–0857
0938–0860
0938–0866
0938–0872
0938–0873
0938–0874
0938–0878
0938–0883
0938–0884
0938–0887
0938–0897
0938–0907
0938–0910
0938–0911
0938–0916
..........................................................
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VerDate Aug<31>2005
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456.700, 456.705, 456.709, 456.711, 456.712
482.12, 488.18, 489.20, 489.24
410.38
410.32, 410.71, 413.17, 424.57, 424.73, 424.80, 440.30, 484.12
493.551–493.557
486.304, 486.306, 486.307, 486.310, 486.316, 486.318, 486.325
412.106
466.78, 489.20, 489.27
422.152
45 CFR 146.111, 146.115, 146.117, 146.150, 146.152, 146.160, 146.180
45 CFR 148.120, 148.124, 148.126, 148.128
441.16, 489.66, 489.67
411.370–411.389
424.57
410.33
421.300–421.318
405.410, 405.430, 405.435, 405.440, 405.445, 405.455, 410.61, 415.110, 424.24
417.126, 417.470
45 CFR 5b
413.337, 413.343, 424.32, 483.20
422.300–422.312
424.57
422.000–422.700
441.151, 441.152
413.20, 413.24
484 Subpart E, 484.55, 484.205, 484.245, 484.250
484.11, 484.20
422.1–422.10, 422.50–422.80, 422.100–422.132, 422.300–422.312, 422.400–422.404,
422.560–422.622
410.2
422.64, 422.111
417.126, 417.470, 422.64, 422.210
411.404–411.406, 484.10
438.352, 438.360, 438.362, 438.364
422.66, 422.562, 422.564, 422.568, 422.570, 422.572, 422.582, 422.584, 422.586, 422.590,
422.594, 422.602, 422.612, 422.618, 422.619, 422.620, 422.622
406.28, 407.27
460.12, 460.22, 460.26, 460.30, 460.32, 460.52, 460.60, 460.70, 460.71, 460.72, 460.74,
460.80, 460.82, 460.98, 460.100, 460.102, 460.104, 460.106, 460.110, 460.112, 460.116,
460.118, 460.120, 460.122, 460.124, 460.132, 460.152, 460.154, 460.156, 460.160,
460.164, 460.168, 460.172, 460.190, 460.196, 460.200, 460.202, 460.204, 460.208,
460.210
491.8, 491.11
413.24, 413.65, 419.42
419.43
410.141, 410.142, 410.143, 410.144, 410.145, 410.146, 414.63
422.568
Parts 489 and 491
483.350–483.376
431.636, 457.50, 457.60, 457.70, 457.340, 457.350, 457.431, 457.440, 457.525, 457.560,
457.570, 457.740, 457.750, 457.810, 457.940, 457.945, 457.965, 457.985, 457.1005,
457.1015, 457.1180
412.23, 412.604, 412.606, 412.608, 412.610, 412.614, 412.618, 412.626, 413.64
411.352–411.361
Part 419
413.65, 419.42
45 CFR Part 162
413.337, 483.20,
422.152
45 CFR Parts 160 and 162
Part 422 Subpart F & G
45 CFR Parts 160 and 164
405.940
45 CFR 148.316, 148.318, 148.320
412.22, 412.533
412.230, 412.304, 413.65
422.620, 422.624, 422.626
426.400, 426.500
483.16
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76309
OMB CONTROL NUMBERS—Continued
[Approved CFR Sections in Title 42, Title 45, and Title 20 (Note: Sections in Title 45 are preceded by ‘‘45 CFR,’’ and sections in Title 20 are
preceded by ‘‘20 CFR’’)]
OMB number
Approved CFR sections
0938–0920 ..........................................................
438.6, 438.8, 438.10, 438.12, 438.50, 438.56, 438.102, 438.114, 438.202, 438.206, 438.207,
438.240, 438.242, 438.402, 438.404, 438.406, 438.408, 438.410, 438.414, 438.416,
438.710, 438.722, 438.724, 438.810
414.804
45 CFR Part 142.408, 162.408, and 162.406
438.50
403.766
423
484 and 488
422.250, 422.252, 422.254, 422.256, 422.258, 422.262, 422.264, 422.266, 422.270, 422.300,
422.304, 422.306, 422.308, 422.310, 422.312, 422.314, 422.316, 422.318, 422.320,
422.322, 422.324, 423.251, 423.258, 423.265, 423.272, 423.279, 423.286, 423.293,
423.301, 423.308, 423.315, 423.322, 423.329, 423.336, 423.343, 423.346, 423.350
405.910
423.48
405.1200 and 405.1202
414.906, 414.908, 414.914, 414.916
Part 423 Subpart R
0938–0921
0938–0931
0938–0933
0938–0934
0938–0936
0938–0940
0938–0944
..........................................................
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0938–0950
0938–0951
0938–0953
0938–0954
0938–0957
..........................................................
..........................................................
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Medicare Provider #190263
Medicare Provider #240036
Johns Hopkins Hospital, 600 North Wolfe
Street, Baltimore, MD 21287–1629
St. Joseph’s Regional Medical Center, 703
Main Street, Paterson, NJ 07530
On March 17, 2005, we issued our decision
memorandum on carotid artery stenting. We
determined that carotid artery stenting with
embolic protection is reasonable and
necessary only if performed in facilities that
have been determined to be competent in
performing the evaluation, procedure, and
follow-up necessary to ensure optimal
patient outcomes. We have created a list of
minimum standards for facilities modeled in
part on professional society statements on
competency. All facilities must at least meet
our standards in order to receive coverage for
carotid artery stenting for high risk patients.
wwhite on PROD1PC61 with NOTICES
Addendum VIII—Medicare-Approved
Carotid Stent Facilities [July Through
September 2005]
Medicare Provider #210009
Medicare Provider #310019
Kingman Regional Medical Center, 3269
Stockton Hill Road, Kingman, AZ 86401
St. Luke’s Hospital, 5901 Monclova Road,
Maumee, OH 43537–1899
Medicare Provider #030055
Medicare Provider #360090
Lafayette General Medical Center, 1214
Coolidge Street, P.O. Box 52009,
Lafayette, LA 70505
Medicare Provider #190002
Manatee Memorial Hospital and Health
Systems, 206 2nd Street East, Bradenton,
FL 34208
Medicare Provider #100035
Mercy Health System, 1000 Mineral Point
Avenue, P.O. Box 5003, Janesville, WI
53547–5003
Medicare Provider #520066
The Methodist Hospital, 6565 Fannin Street,
Houston, TX 77030
Medicare Provider #450358
Mohawk Valley Vascular Center of Faxton,
St. Luke’s Healthcare, 1656 Champlain
Avenue, Utica, NY 13502
Medicare Provider #330044
Northwest Medical Center, 2801 North State
Road 7, Margate, FL 33063–9002
Medicare Provider #100189
Oakwood Hospital and Medical Center,
18101 Oakwood Boulevard, P.O. Box
2500, Dearborn, MI 48123–2500
Medicare Provider #230020
Rhode Island Hospital, 593 Eddy Street,
Providence, RI 02903
Medicare Provider #041007
Scripps Green Hospital, 10666 North Torrey
Pines Road, La Jolla, CA 92037–9100
Medicare Provider #050424
St. Cloud Hospital, 1406 Sixth Avenue North,
St. Cloud, MN 56303–1901
St. Vincent Hospital, 835 S. Van Buren
Street, P.O. Box 13508, Green Bay, WI
54307–3508
Effective Date—July 7, 2005
Antelope Valley Hospital, 1600 West Avenue
J, Lancaster, CA 93534
Medicare Provider #050056
Baptist St. Anthony’s Hospital, 1600 Wallace
Boulevard, Amarillo, TX 79106
Medicare Provider #450231
Dayton Heart Hospital, 707 S. Edwin Moses
Boulevard, Dayton, OH 45408
Medicare Provider #360253
Duke Health Raleigh Hospital, 3400 Wake
Forest Road, Raleigh, NC 27609
Medicare Provider #340073
East Pasco Medical Center, 7050 Gall
Boulevard, Zephyrhills, FL 33541–1399
Medicare Provider #100046
FirstHealth Moore Regional Hospital, 1555
Memorial Drive, P.O. Box 3000
Pinehurst, NC 28374
Medicare Provider #340115
The George Washington University Hospital,
900 23rd Street, NW., Washington, DC
20037
Medicare Provider #090001
Heart Hospital of Lafayette, 1105 Kaliste
Saloom Road, Lafayette, LA 70508
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Medicare Provider #520075
St. Vincent’s Medical Center, 1800 Barrs
Street, Jacksonville, FL 32204
Medicare Provider #100040
Stormont-Vail HealthCare, 1500 S.W. 10th
Avenue, Topeka, KS 66604–1353
Medicare Provider #170086
Tomball Regional Hospital, 605 Holderrieth
Street, Tomball, TX 77375
Medicare Provider #450670
Trinity Mother Frances Health System, 800 E.
Dawson, Tyler, TX 75701
Medicare Provider #450102
Effective Date—July 15, 2005
Allen Memorial Hospital, 1825 Logan
Avenue, Waterloo, IA 50703–1999
Medicare Provider #160110
Alta Bates Summit Medical Center, Alta
Bates Campus, 2450 Ashby Avenue
Berkley, CA 94705
Medicare Provider #050305
Alta Bates Summit Medical Center, Summit
Campus, 350 Hawthorne Avenue,
Oakland, CA 94609
Medicare Provider #050043
Banner Baywood Heart Hospital, 6750 East
Baywood Avenue, Mesa, AZ 85206
Medicare Provider #030105
Battle Creek Health System, 300 North
Avenue, Battle Creek, MI 49016
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76310
Federal Register / Vol. 70, No. 246 / Friday, December 23, 2005 / Notices
Medicare Provider #230075
Beth Israel Deaconess Medical Center, 330
Brookline Avenue, Boston, MA 02215
Medicare Provider #220086
BryanLGH Medical Center, 1600 South 48th
Street, Lincoln, NE 68506–1299
Medicare Provider #280003
Deborah Heart & Lung Center, 200 Trenton
Road, Browns Mills, NJ 08015
Medicare Provider #310031
Erie County Medical Center Corporation, 462
Grinder Street, Buffalo, NY 14215
Medicare Provider #330219
Fairview Southdale Hospital, 6401 France
Avenue, Edina, MN 55435
Medicare Provider #240078
Gratiot Medical Center, 300 East Warwick
Drive, Alma, MI 48801–1096
Medicare Provider #230030
Harbor Hospital, 3001 South Hanover Street,
Baltimore, MD 21225–1290
Medicare Provider #210034
Holmes Regional Medical Center, 1350 South
Hickory Street, Melbourne, FL 32901
Medicare Provider #100019
Holy Cross Hospital, 4725 North Federal
Highway, Fort Lauderdale, FL 33308
Medicare Provider #100073
Marion General Hospital, 1000 McKinley
Park Drive, Marion, OH 43301
Medicare Provider #360011
Mease Countryside Hospital, 3231 McMullen
Booth Road, Safety Harbor, FL 34695
Medicare Provider #100265
Mercy General Hospital, 4001 J Street, P.O.
Box 19245, Sacramento, CA 95819–9990
Medicare Provider #050017
OU Medical Center, 1200 Everett Drive,
Oklahoma City, OK 73104
Medicare Provider #370093
Pennsylvania Hospital of the University of
Pennsylvania Health System, 800 Spruce
Street, Philadelphia, PA 19071–6192
Medicare Provider #390226
Provena Mercy Medical Center, 1325 North
Highland Avenue, Aurora, IL 60506
Medicare Provider #140174
Reading Hospital and Medical Center, P.O.
Box 16052, Reading, PA 19612–6052
Medicare Provider #390044
Regional Medical Center of Hopkins County,
900 Hospital Drive, Madisonville, KY
42431
Medicare Provider #180093
Sacred Heart Medical Center, 101 West 8th
Avenue, P.O. Box 2555, Spokane, WA
99220–2555
Medicare Provider #500054
Scripps Mercy Hospital, 4077 Fifth Avenue,
San Diego, CA 92103
Medicare Provider #050077
Sisters of Charity Providence Hospitals, 2435
Forest Drive, Columbia, SC 29204
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16:55 Dec 22, 2005
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Medicare Provider #420026
Tucson Medical Center, 5301 East Grant
Road, Tucson, AZ 85712
Medicare Provider #030006
UCLA Medical Center, 10833 Le Conte
Avenue, Los Angeles, CA 90095–1730
Medicare Provider #050262
University of Colorado Hospital, 4200 East
9th Avenue, Denver, CO 80262
Medicare Provider #060024
Effective Date—July 20, 2005
Christus St. Patrick Hospital, 524 South Ryan
Street, Lake Charles, LA 70601
Medicare Provider #190027
Condell Medical Center, 801 South
Milwaukee Avenue, Libertyville, IL
60048
Medicare Provider #140202
Florida Hospital Ormond Memorial, 875
Sterthaus Avenue, Ormond Beach, FL
32174
Medicare Provider #100169
Lakewood Hospital, 14519 Detroit Avenue,
Lakewood, OH 44107
Medicare Provider #360212
Loma Linda University Medical Center,
11234 Anderson Street, P.O. Box 2000,
Loma Linda, CA 92354
Medicare Provider #050327
Miami Valley Hospital, Medical Imaging,
One Wyoming Street, Dayton, OH
45409–2793
Medicare Provider #360051
National Park Medical Center, 1910 Malvern
Avenue, Hot Springs, AR 71901
Medicare Provider #040078
Newark Beth Israel Medical Center, 201
Lyons Avenue, Newark, NJ 07112
Medicare Provider #310002
Salina Regional Health Center, P.O. Box
5080, Salina, KS 67402–5080
Medicare Provider #170012
Scott and White Memorial Hospital and
Scott, Sherwood and Brindley
Foundation, 2401 South 31st Street,
Temple, TX 76508
Medicare Provider #450054
Sentra Norfolk General Hospital, 600
Gersham Drive, Norfolk, VA 23507
Medicare Provider #490007
Spartanburg Regional Medical Center, 101
East Wood Street, Spartanburg, SC 29303
Medicare Provider #420007
St. Francis Hospital, 3237 South 16th Street,
Milwaukee, WI 53215–4592
Medicare Provider #520078
St. Vincent Indianapolis Hospital, 2001 West
86th Street, Indianapolis, IN 46260
Medicare Provider #150084
Tulsa Regional Medical Center, 744 West 9th,
Tulsa, OK 74127
Medicare Provider #370078
University Hospital, SUNY Upstate Medical
PO 00000
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University, 750 East Adams Street,
Syracuse, NY 13210
Medicare Provider #330241
UT Southwestern University Hospitals—Zale
Lipshy, 5151 Harry Hines Boulevard,
Dallas, TX 75390
Medicare Provider #450766
UT Southwestern University Hospitals—St.
Paul, 5909 Harry Hines Boulevard,
Dallas, TX 75390
Medicare Provider #450044
Effective Date—July 22, 2005
Forrest General Hospital, 6051 Highway 49,
Hattiesburg, MS 39401–7243
Medicare Provider #250078
Hamilton Medical Center, P.O. Box 1168,
Dalton, GA 30722–1168
Medicare Provider #110001
Heritage Valley Health System, The Medical
Center, 100 Dutch Ridge Road, Beaver,
PA 15009–9700
Medicare Provider #390036
Northeast Georgia Medical Center, 743
Spring Street, Gainesville, GA 30501
Medicare Provider #110029
Wishard Health Services, 1001 West Tenth
Street, Indianapolis, IN 46202
Medicare Provider #150024
Effective Date—July 27, 2005
East Texas Medical Center Athens, 2000
South Palestine, Athens, TX 75751
Medicare Provider #450389
Glendale Adventist Medical Center, 1509
Wilson Terrace, Glendale, CA 91206
Medicare Provider #050239
Lahey Clinic Medical Center, Inc., 41 Mall
Road, Burlington, MA 01805
Medicare Provider #220171
Saint Joseph Hospital, One Saint Joseph
Drive, Lexington, KY 40504
Medicare Provider #180010
St. Mary’s Medical Center, 2900 First
Avenue, Huntington, WV 25702
Medicare Provider #510007
Yakima Regional Medical and Cardiac
Center, 110 South 9th Avenue, Yakima,
WA 98902
Medicare Provider #500012
Effective Date—August 1, 2005
Alegent Health Bergan Mercy Medical
Center, 7500 Mercy Rd., Omaha, NE
68124–9832
Medicare Provider #280060
Bon Secours DePaul Medical Center, 150
Kingsley Ln., Norfolk, VA 23505
Medicare Provider #490011
Hendrick Medical Center, 1900 Pine St.,
Abilene, TX 79601–2316
Medicare Provider #450229
Nebraska Heart Hospital, 7500 S. 91st St.,
Lincoln, NE 68526
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Federal Register / Vol. 70, No. 246 / Friday, December 23, 2005 / Notices
Medicare Provider #280128
Singing River Hospital System, 3109
Bienville Blvd., Ocean Springs, MS
39564
Medicare Provider #250040
St. Peter’s Hospital,315 South Manning
Blvd., Albany, NY 12208
Medicare Provider #330057
University of California San Francisco
Medical Center, 500 Parnassus Ave., San
Francisco, CA 94143–0296
Medicare Provider #050454
Effective Date—August 4, 2005
Bowling Green Warren County Community
Hospital Corp. d/b/a The Medical Center,
250 Park Street, P.O. Box 90010, Bowling
Green, KY 42102–9010
Medicare Provider #180013
Carson-Tahoe Hospital, 775 Fleischmann
Way, P.O. Box 2168, Carson City, NV
89702–2168
Medicare Provider #290010
Heart Hospital of Austin, 3801 N. Lamar
Boulevard, Austin, TX 78756
Medicare Provider #450824
Indiana Heart Hospital, 8040 Clearvista
Parkway, Suite 200, Indianapolis, IN
46256
Medicare Provider #150154
JFK Medical Center, 5301 South Congress
Avenue, Atlantis, FL 33462
Medicare Provider #100080
Sierra Vista Regional Medical Center, 1010
Murray Avenue, San Luis Obispo, CA
93405
Medicare Provider #050506
St. Joseph Hospital, 1100 West Stewart Drive,
P.O. Box 5600 Orange, CA 92863–5600
Medicare Provider #050069
St. Luke’s Cornwall Hospital, 70 Dubois
Street, Newburgh, NY 12550
Medicare Provider #330264
UCI Medical Center, 101 The City Drive
South, Orange, CA 92868
Medicare Provider #050348
wwhite on PROD1PC61 with NOTICES
Effective Date—August 8, 2005
Lynchburg General Hospital, 1920 Atherholt
Road, Lynchburg, VA 24501–1104
Medicare Provider #490021
Mercy Hospitals Bakersfield, 2215 Truxtun
Avenue, P.O. Box 119, Bakersfield, CA
93302
Medicare Provider #050295
Virginia Regional Medical Center, 901 Ninth
Street North, Virginia, MN 55792
Medicare Provider #240084
Effective Date—August 9, 2005
Columbia Hospital, 2201 45th Street, West
Palm Beach, FL 33407
Medicare Provider #100234
Fairview Hospital, 14519 Detroit Avenue,
Fairview, OH 44107
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Medicare Provider #360077
Forum Health-Northside Medical Center,
Cardiovascular Administration, 500
Gypsy Lane, Youngstown, OH 44501
Medicare Provider #360141
Mercy Hospital, 144 State Street, Portland,
ME 04101
Medicare Provider #020008
New Hanover Regional Medical Center, 2131
South 17th Street, P.O. Box 9000,
Wilmington, NC 28402–9000
Medicare Provider #340141
Sharp Grossmont Hospital, P.O. Box 158, La
Mesa, CA 91944–0158
Medicare Provider #050026
Torrance Memorial Medical Center, 3330
Lomita Boulevard, Torrance, CA 90505–
5073
Medicare Provider #050351
Effective Date—August 16, 2005
Englewood Hospital and Medical Center, 350
Engle Street, Englewood, NJ 07631
Medicare Provider #310045
Mobile Infirmary Medical Center, Five
Mobile Infirmary Circle, Mobile, AL
36607
Medicare Provider #010113
Ocean Medical Center, 425 Jack Martin
Boulevard, Brick, NJ 08724
Medicare Provider #310052
OSF St. Joseph Medical Center, 200 East
Washington Street, Bloomington, IL
61701
Medicare Provider #140162
St. Luke’s Medical Center, LP, 1800 East Van
Buren Street, Phoenix, AZ 85006
Medicare Provider #030037
Effective Date—August 19, 2005
Inova Alexandria Hospital, 4320 Seminary
Road, Alexandria, VA 22304
Medicare Provider #490040
Inova Fairfax Hospital, Inova Fairfax Hospital
for Children and Inova Heart and
Vascular Institute, 3300 Gallows Road,
Falls Church, VA 22042–3300
Medicare Provider #490063
Milford Hospital, 300 Seaside Avenue, P.O.
Box 3015, Milford, CT 06460–0815
Medicare Provider #070019
Our Lady of the Lakes Regional Medical
Center, 5000 Hennessy Boulevard, Baton
Rouge, LA 70808
Medicare Provider #190064
Summit Hospital, 17000 Medical Center
Drive, Baton Rouge, LA 70816
Medicare Provider #190202
University of Michigan Health System, 1500
E. Medical Center Drive, Ann Arbor, MI
48109–0060
Medicare Provider #230046
Effective Date—August 22, 2005
Baptist Hospital of Miami, 8900 North
Kendall Drive, Miami, FL 33176
PO 00000
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76311
Medicare Provider #100008
Camden-Clark Memorial Hospital, 800
Garfield Avenue, P.O. Box 718,
Parkersburg, WV 26102
Medicare Provider #510058
HCA Dauterive Hospital, 600 North Lewis
Avenue, New Iberia, LA 70563
Medicare Provider #190003
Kadlec Medical Center, 888 Swift Boulevard,
Richland, WA 99352
Medicare Provider #500058
Lancaster Community Hospital, 43830 10th
Street West, Lancaster, CA 93534
Medicare Provider #050204
Mercy Hospital, 4050 Coon Rapids
Boulevard, Coon Rapids, MN 55433
Medicare Provider #240115
Montefiore Medical Center, 111 East 210th
Street, New York, NY 10467
Medicare Provider #330059
Morristown Memorial Hospital, 100 Madison
Avenue, Morristown, NJ 07962–1956
Medicare Provider #310015
Palmetto Health Richland, 5 Richland
Medical Park Drive, Columbia, SC
29203–6897
Medicare Provider #420018
Saint Elizabeth Regional Medical Center, 555
South 70th Street, Lincoln, NE 68510
Medicare Provider #280020
Springhill Medical Center, 3710 Dauphine
Street, Mobile, AL 36608
Medicare Provider #010144
Unity Hospital, 550 Osborne Road, Fridley,
MN 55432
Medicare Provider #240132
Wilson Memorial Regional Medical Center,
33–57 Harrison Street, Johnson City, NY
13790
Medicare Provider #330394
Effective Date—August 23, 2005
Jackson Madison County General Hospital,
708 West Forest Avenue, Jackson, TN
38301–3956
Medicare Provider #044002
Leesburg Regional Medical Center, 600 E.
Dixie Avenue, Leesburg, FL 34748
Medicare Provider #100084
Meriter Hospitals, Inc., 202 South Park
Street, Madison, WI 53715
Medicare Provider #520089
Poplar Bluff Regional Medical Center, 2620
North Westwood Boulevard, Poplar
Bluff, MO 63901
Medicare Provider #260119
Saint Francis Hospital, 241 North Road,
Poughkeepsie, NY 12601–1399
Medicare Provider #330067
The Western Pennsylvania Hospital, 4800
Friendship Avenue, Pittsburg, PA 15224
Medicare Provider #390090
Effective Date—August 24, 2005
Halifax Medical Center, 303 N. Clyde Morris
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Boulevard, Daytona Beach, FL 32114
Medicare Provider #100017
Jackson Hospital, 1725 Pine Street,
Montgomery, AL 36106–1117
Medicare Provider #010024
Marietta Memorial Hospital, 401 Matthew
Street, Marietta, OH 45750
Medicare Provider #360147
Meadowcrest Hospital, 2500 Belle Chasse
Highway, Gretna, LA 70056
Medicare Provider #190152
Medical Center Hospital, P.O. Box 7239,
Odessa, TX 79760–7239
Medicare Provider #450132
REX Healthcare, 4420 Lake Boone Trail,
Raleigh, NC 27607
Medicare Provider #340114
St. John’s Mercy Medical Center, 615 South
New Ballas Road, St. Louis, MO 63141
Medicare Provider #260020
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Effective Date—August 26, 2005
Candler Hospital, 5353 Reynolds Street,
Savannah, GA 31405
Medicare Provider #110024
CHRISTUS Santa Rosa, 333 North Santa Rosa
Street, San Antonio, TX 78207–3198
Medicare Provider #450237
Durham Regional Hospital, 3643 North
Roxboro Road, Durham, NC 27704
Medicare Provider #344155
Hillcrest Medical Center, 1120 South Utica
Avenue, Tulsa, OK 74104
Medicare Provider #370001
Houston Northwest Medical Center, 710 FM
1960 West, Houston, TX 77090
Medicare Provider #450638
Mercy Hospital, 3663 South Miami Avenue,
Miami, FL 33133
Medicare Provider #100061
Saint Barnabas Medical Center, Old Short
Hills Road, Livingston, NJ 07039
Medicare Provider #310076
Effective Date—August 31, 2005
Columbia St. Mary’s Hospital Milwaukee,
Inc., 2323 North Lake Drive, Milwaukee,
WI 53211
Medicare Provider #520051
Franklin Square Hospital Center, 9000
Franklin Square Drive, Baltimore, MD
21237–9986
Medicare Provider #210015
The Griffin Hospital, 130 Division Street,
Derby, CT 06418
Medicare Provider #070031
Gwinnett Medical Center, 1000 Medical
Center Boulevard, Lawrenceville, GA
30045
Medicare Provider #110087
Louis A. Weiss Memorial Hospital, 4646
North Marine Drive, Chicago, IL 60640
Medicare Provider #140082
The North Shore Medical Center, 81
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16:55 Dec 22, 2005
Jkt 208001
Highland Avenue, Salem, MA 01970
Medicare Provider #220006
South Pointe Hospital, 20000 Harvard Road,
Warrensville Hts., OH 44122
Medicare Provider #360144
Southwest Medical Center—Lafayette, 2810
Ambassador Caffery, Lafayette, LA 70506
Medicare Provider #190205
St. Mary’s Hospital Ozaukee, Inc., 13111
North Port Washington Road, Mequon,
WI 53097
Medicare Provider #520027
St. Tammany Parish Hospital, 1202 South
Tyler Street, Covington, LA 70433
Medicare Provider #190045
Trinity Medical Center Terrace Park, 4500
Utica Ridge Road, Bettendorf, IA 52722
Medicare Provider #160104
UAMS Medical Center, 4301 West Markham,
Little Rock, AK 72205–7199
Medicare Provider #040016
Valley Baptist Medical Center—Harlingen,
P.O. Drawer 2588, 2101 Pease Street,
Harlingen, TX 78551
Medicare Provider #450033
Effective Date—September 6, 2005
Carilion Roanoke Memorial Hospital, 1906
Belleview Avenue, Roanoke, VA 24014
Medicare Provider #490024
Midland Memorial Hospital, 2200 West
Illinois Avenue, Midland, TX 79701–
6499
Medicare Provider #450133
Provena Saint Joseph Medical Center, 333
North Madison Street, Joliet, IL 60435–
6595
Medicare Provider #140007
Salinas Valley Memorial Healthcare System,
450 E. Romie Lane, Salinas, CA 93901
Medicare Provider #050334
UHHS Geauga Regional Hospital, 13207
Ravenna Road, Chardon, OH 44024
Medicare Provider #360192
Effective Date—September 8, 2005
Howard Regional Health System, 3500 South
Lafountain Street, P.O. Box 9011,
Kokomo, IN 46904–9011
Medicare Provider #150007
Luther Hospital, 1221 Whipple Street, P.O.
Box 4105, Eau Claire, WI 54702–4105
Medicare Provider #520070
Our Lady of Fatima Hospital, 200 High
Service Avenue, No. Providence, RI
02904
Medicare Provider #041005
Pitt County Memorial Hospital, Inc., P.O. Box
6028, Greenville, NC 27835–6028
Medicare Provider #340040
Effective Date—September 12, 2005
Baylor All Saints Medical Center, 1400
Eighth Avenue, Fort Worth, TX 76104
PO 00000
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Medicare Provider #450137
St. Vincent’s Hospital, Staten Island, 355
Bard Avenue, Staten Island, NY 10310
Medicare Provider #330028
SUNY Stony Brook University Hospital,
Nicolls Road, Stony Brook, NY 11794
Medicare Provider #330393
The Washington Hospital, 155 Wilson
Avenue, Washington, PA 15301
Medicare Provider #390042
Effective Date—September 15, 2005
Abilene Regional Medical Center, 6250
Highway 83/84, Abilene, TX 79606
Medicare Provider #450558
Bon Secours Cottage Health Services, 468
Cadieux Road, Grosse Pointe, MI 48230
Medicare Provider #230089
HealthOne/HCA Rose Medical Center, 4567
E. 9th Avenue, Denver, CO 80220
Medicare Provider #060032
Providence Health Center, 6901 Medical
Parkway, Waco, TX 76712
Medicare Provider #450042
St. Edward Mercy Medical Center, 7301
Rogers Avenue, P.O. Box 17000, Fort
Smith, AR 72917–7000
Medicare Provider #040062
St. Joseph’s Hospital, 3001 W. Dr. M.L. King
Jr. Boulevard, Tampa, FL 33607
Medicare Provider #100075
Effective Date—September 22, 2005
Baylor University Medical Center,
Department of Radiology, 3500 Gaston
Avenue, Dallas, TX 75246
Medicare Provider #450021
Delray Medical Center, 5352 Linton
Boulevard, Delray Beach, FL 33484
Medicare Provider #100258
Desert Springs Hospital, 2075 East Flamingo
Road, Las Vegas, NV 89119
Medicare Provider #290022
Ellis Hospital, 1101 Nott Street, Schenectady,
NY 12308
Medicare Provider #330153
Ingham Regional Medical Center, 401 West
Greenlawn Avenue, Lansing, MI 48910
Medicare Provider #230167
St. Joseph’s Hospital, 11705 Mercy
Boulevard, Savannah, GA 31419
Medicare Provider #110043
Mercy Hospital of Pittsburgh, 1400 Locust
Street, Pittsburgh, PA 15219–5166
Medicare Provider #390028
The Pottsville Hospital and Warne Clinic,
420 South Jackson Street, Pottsville, PA
17901
Medicare Provider #390030
Southwest Mississippi Regional Medical
Center, 215 Marion Avenue, McComb,
MS 39648
Medicare Provider #250097
Sparks Regional Medical Center, 1311 South
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I Street, P.O. Box 17006, Fort Smith, AR
72917–7006
Medicare Provider #040055
Tampa General Hospital, 2 Columbia Drive,
Tampa, FL 33606
Medicare Provider #100128
Wesley Medical Center, 550 N. Hillside,
Wichita, KS 67214
Medicare Provider #170123
Effective Date—September 28, 2005
Advocate Illinois Masonic Medical Center,
836 W. Wellington Avenue, Chicago, IL
60657–5193
Medicare Provider #140182
East Texas Medical Center-Tyler, 1000 South
Beckham, Tyler, TX 75701
Medicare Provider #450083
Maimonides Medical Center, 4802 Tenth
Avenue, Brooklyn, NY 11219
Medicare Provider #330914
Mesa General Hospital, 515 North Mesa
Drive, Mesa, AZ 85201
Medicare Provider #030017
Opelousas General Health System, 539 E.
Prudhomme Street, P.O. Box 1389,
Opelousas, LA 70570
Medicare Provider #190017
Southern Ohio Medical Center, 1895 27th
Street, Portsmouth, OH 45662
Medicare Provider #360008
St. Joseph Hospital, 2901 Squalicum
Parkway, Bellingham, WA 98264
Medicare Provider #500030
St. Lukes Hospital, 801 Ostrum Street,
Bethlehem, PA 18015
Medicare Provider #390049
WakeMed Health and Hospitals, 3000 New
Bern Avenue, Raleigh, NC 27610
Medicare Provider #340069
Yale-New Haven Hospital, 20 York Street,
New Haven, CT 06504,
Medicare Provider #070022
[FR Doc. 05–24023 Filed 12–22–05; 8:45 am]
BILLING CODE 4120–01–U
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–1289–N]
Medicare Program: Meeting of the
Advisory Panel on Ambulatory
Payment Classification (APC)
Groups—March 1, 2, and 3, 2006
Centers for Medicare &
Medicaid Services (CMS), Department
of Health and Human Services (DHHS).
ACTION: Notice.
wwhite on PROD1PC61 with NOTICES
AGENCY:
SUMMARY: In accordance with section
10(a) of the Federal Advisory Committee
VerDate Aug<31>2005
16:55 Dec 22, 2005
Jkt 208001
Act (FACA) (5 U.S.C. Appendix 2), this
notice announces the first biannual
meeting of the Ambulatory Payment
Classification (APC) Panel (the Panel)
for 2006.
The purpose of the Panel is to review
the APC groups and their associated
weights and to advise the Secretary of
the Department of Health and Human
Services (HHS) and the Administrator of
the Centers for Medicare & Medicaid
Services (CMS) concerning the clinical
integrity of the APC groups and their
associated weights. The advice provided
by the Panel will be considered as CMS
prepares its annual updates of the
hospital Outpatient Prospective
Payment System (OPPS) through
rulemaking.
Meeting Dates: The first biannual
meeting for 2006 is scheduled for the
following dates and times:
• Wednesday, March 1, 2006, 1 p.m.
to 5 p.m. (e.s.t.).
• Thursday, March 2, 2006, 8 a.m. to
5 p.m. (e.s.t.).
• Friday, March 3, 2006, 8 a.m. to 12
noon (e.s.t.).
Deadlines:
Deadline for Hardcopy Comments/
Suggested Agenda Topics—
5 p.m. (e.s.t.), Wednesday, February 1,
2006.
Deadline for Hardcopy
Presentations—
5 p.m. (e.s.t.), Wednesday, February 1,
2006.
Deadline for Attendance
Registration—
5 p.m. (e.s.t.), Wednesday, February 8,
2006.
Deadline for Special
Accommodations—
5 p.m. (e.s.t.), Wednesday, February 8,
2006.
Submittal of Materials to the
Designated Federal Officer (DFO):
Because of staffing and resource
limitations, we cannot accept written
comments and presentations by FAX,
nor can we print written comments and
presentations received electronically for
dissemination at the meeting.
Only hardcopy comments and
presentations will be accepted for
placement in the meeting booklets. All
hardcopy presentations must be
accompanied by Form CMS–20017. The
form is now available through the CMS
Forms Web site. The URL for linking to
this form is (https://www.cms.hhs.gov/
forms/cms20017.pdf.)
We are also requiring electronic
versions of the written comments and
presentations (in addition to the
hardcopies), so we can send them
electronically to the Panel members for
their review before the meeting.
DATES:
PO 00000
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Fmt 4703
Sfmt 4703
76313
Consequently, you must send BOTH
electronic and hardcopy versions of
your presentations and written
comments by the prescribed deadlines.
(Electronic transmission must be sent to
the e-mail address below, and
hardcopies—accompanied by Form
CMS–20017—must be mailed to the
Designated Federal Officer [DFO], as
specified in the FOR FURTHER
INFORMATION CONTACT: section of this
notice.)
ADDRESSES: The meeting will be held in
the Multipurpose Room, 1st Floor, CMS
Central Office, 7500 Security Boulevard,
Baltimore, Maryland 21244–1850.
FOR FURTHER INFORMATION CONTACT: For
inquiries regarding the meeting; meeting
registration; and hardcopy submissions
of oral presentations, agenda items, and
comments, please contact the DFO:
Shirl Ackerman-Ross, DFO, CMS, CMM,
HAPG, DOC, 7500 Security Boulevard,
Mail Stop C4–05–17, Baltimore, MD
21244–1850. Phone: (410) 786–4474.
• E-mail Address for comments,
presentations, and registration requests
is APCPanel@cms.hhs.gov
• News media representatives must
contact our Public Affairs Office at (202)
690–6145.
Advisory Committees’ Information
Lines:
The CMS Advisory Committees’
Information Line is 1–877–449–5659
(toll free) and (410) 786–9379 (local).
Web Sites:
• For additional information on the
APC meeting agenda topics and updates
to the Panel’s activities, search our Web
site at: https://www.cms.hhs.gov/faca/
apc/default.asp.
• To obtain Charter copies, search our
Web site at https://www.cms.hhs.gov/
faca or e-mail the Panel DFO.
SUPPLEMENTARY INFORMATION:
I. Background
The Secretary is required by section
1833(t)(9)(A) of the Act, as amended and
redesignated by sections 201(h) and
202(a)(2) of the Medicare, Medicaid, and
SCHIP Balanced Budget Refinement Act
of 1999 (BBRA) (Pub. L. 106–113),
respectively, to establish and consult
with an expert, outside advisory panel
on Ambulatory Payment Classification
(APC) groups. The APC Panel (the
Panel), which was re-chartered by the
Secretary on November 1, 2004, meets
up to three times annually to review the
APC groups and to provide technical
advice to the Secretary and the
Administrator concerning the clinical
integrity of the groups and their
associated weights. All members must
have technical expertise that shall
enable them to participate fully in the
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]]>Agencies
[Federal Register Volume 70, Number 246 (Friday, December 23, 2005)]
[Notices]
[Pages 76290-76313]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 05-24023]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-9033-N]
Medicare and Medicaid Programs; Quarterly Listing of Program
Issuances--July Through September 2005
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: This notice lists CMS manual instructions, substantive and
interpretive regulations, and other Federal Register notices that were
published from July 2005 through September 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, 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, C1-13-
04, 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 Bonnie Harkless, 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) 786-5666.
Questions concerning Medicare-approved carotid stent facilities may
be addressed 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
[[Page 76291]]
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 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) 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, 2003. (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
[[Page 76292]]
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 ``Cochlear Implantation,'' use CMS--Pub. 100-03,
Transmittal No. 42.
(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: December 7, 2005.
Jacquelyn Y. 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.
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)
June 24, 2005 (70 FR 36620)
September 23, 2005 (70 FR 55863)
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
[July through September 2005]
------------------------------------------------------------------------
Transmittal No. Manual/Subject/Publication No.
------------------------------------------------------------------------
Medicare General Information
(CMS--Pub. 100-01)
------------------------------------------------------------------------
25 Next Generation Desktop Testing Requirements
Definitions
Next Generation Desktop Maintainer Requirements
26 Implement New Medicare Plan ID and Carrier
Number for the Single Testing Contractor
Shared System Testing Requirements for
Maintainers, Beta Testers, and Contractors
27 Provider Extract File
28 Conforming Changes for Change Request 3648 to
Pub. 100-01
Hospital Insurance (Part A) for Inpatient
Hospital, Hospice, and Skilled Nursing
Facility Services--A Brief Description Home
Health Services
Supplementary Medical Insurance (Part B)--A
Brief Description
Discrimination Prohibited
Role of Part A Intermediaries
Limitation on Physical Therapy, Occupational
Therapy and Speech-Language Pathology Services
Certification for Hospital Services Covered by
the Supplementary Medical Insurance Program
Content of the Physician's Certification
Recertifications for Home Health Services
Physician's Certification and Recertification
for Outpatient Physical Therapy Occupational
Therapy and Speech-Language Pathology
Recertification
Under Arrangements
Term of Agreements
Determining Payment for Services Furnished
After Termination, Expiration, or Cancellation
Home Health Agency Defined
29 2005 Scheduled Release for October Updates to
Software Programs and Pricing/Coding Files
------------------------
Medicare Benefit Policy
(CMS--Pub. 100-02)
------------------------------------------------------------------------
37 Conforming Changes for Change Request 3648 to
Pub. 100-02
Medical and Other Health Services Furnished to
Inpatients of Participating Hospitals
Outpatient Hospital Services
Distinguishing Outpatient Hospital Services
Provided Outside the Hospital Coverage of
Outpatient Therapeutic Services
Medical and Other Health Services Furnished by
Home Health Agencies Skilled Services Defined
Speech-Language Pathology
Physical Therapy, Speech-Language Pathology,
and Occupational Therapy Furnished by the
Skilled Nursing Facility or by Others Under
Arrangements With the Facility and Under Its
Supervision
Inpatient Physical Therapy, Occupational
Therapy, and Speech-Language Pathology
Services
Services Furnished Under Arrangements With
Providers
Supplementary Medical Insurance Provisions
Services Not Provided Within United States
------------------------
Medicare National Coverage Determinations
(CMS--Pub. 100-03)
------------------------------------------------------------------------
42 Cochlear Implantation
Cochlear Implantation (Effective April 4, 2005)
------------------------
[[Page 76293]]
Medicare Claims Processing
(CMS--Pub. 100-04)
------------------------------------------------------------------------
601 Cochlear Implantation
Billing Requirements for Expanded Coverage of
Cochlear Implantation
Intermediary Billing Procedures
Applicable Bill Types
Special Billing Requirements for Intermediaries
Intermediary Payment Requirements
Carrier Billing Procedures
Healthcare Common Procedure Coding System
602 Expansion of Various Alpha and Numeric Fields
Within the Outpatient Prospective Payment
System Outpatient Code Editor
603 Modification to the Appeals Language on the
Medicare Summary Notice; Full Replacement of
Change Request 3808
Appeals Section
Back of Medicare Summary Notice--Carriers and
Intermediaries Carrier Spanish Medicare
Summary Notices Back Intermediary Spanish
Medicare Summary Notices Back
604 Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction
605 Frequency Instructions for Smoking and Tobacco-
Use Cessation Counseling Services
Remittance Advice Notices
Medicare Summary Notices
606 Medicare Program-Update to the Hospice Payment
Rates, Hospice Cap, Hospice Wage Index, and
the Hospice Pricer for FY 2005
Payment Rates
607 Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction
608 New Health Professional Shortage Area Modifier
Zip Code Files
Provider Education
Claims Coding Requirements
Services Eligible for Health Professional
Shortage Area and Physician Scarcity Bonus
Payments
Post-payment Review
Health Professional Shortage Area Incentive
Payments for Physician Services Rendered in a
Critical Access Hospital
609 Remittance Advice Remark Code and Claim
Adjustment Reason Code Update
610 This Transmittal is rescinded and replaced by
Transmittal 634
611 Payment Methodology for Rehabilitation Services
in Indian Health Service/Tribally Owned and/or
Operated Hospitals and Hospital Based
Facilities
Services Paid Under the Physician Fee Schedule
612 Abarelix for Treatment of Prostate Cancer
613 New Healthcare Common Procedure Coding System
Codes and Systems Edits for Supplies and
Accessories for Ventricular Assist Devices--
Full Replacement of CR 3761
614 Medicare Physician Fee Schedule Database 2006
File Layout
615 Revision of Chapter 24, Electronic Data
Interchange Support Requirements
Electronic Data Interchange General Outreach
Activities Carrier, Durable Medical Equipment
Regional Carrier, and Fiscal Intermediary
Analysis of Internal Information
Systems Information
Review of Provider Profiles
Contact with New Providers
Production and Distribution of Material to
Increase Use of Electronic Data Interchange
Electronic Data Interchange Enrollment
New Enrollments and Maintenance of Existing
Enrollments
Submitter Number
Release of Medicare Eligibility Data
Network Service Vendor Agreement
Electronic Data Interchange User Guidelines
Directory of Billing Software Vendors and
Clearinghouses
Technical Requirements--Data, Media, and
Telecommunications System Availability
Media
Telecommunications and Transmission Protocols
Toll-Free Service
Initial Editing
Translators
Required Electronic Data Interchange Formats
General Health Insurance Portability and
Accountability Act Electronic Data Interchange
Requirements
Continued Support of Pre-Health Insurance
Portability and Accountability Act
Electronic Data Interchange Formats
National Council for Prescription Drug Program
Claim Requirements
Crossover Claim Requirements
Direct Data Entry Screens
Use of Imaging, External Key Shop, and In-House
Keying for Entry of Transaction Data Submitted
on Paper
Electronic Funds Transfer
Electronic Data Interchange Testing
Requirements
[[Page 76294]]
Shared System and Common Working File
Maintainers Internal Testing Requirements
Carrier, Durable Medical Equipment Regional
Carrier, and Intermediary Internal Testing
Requirements
Third-Party Certification Systems and Services
Electronic Data Interchange Submitter/Receiver
Testing by Carriers, Durable Medical Equipment
Regional Carriers, and Fiscal Intermediaries
Testing Accuracy
Limitation on Testing of Multiple Providers
That Use the Same Clearinghouse, Billing
Service, or Vendor Software
Carrier, Durable Medical Equipment Regional
Carrier, and Fiscal Intermediary Submitter/
Receiver Testing With Legacy Formats During
the Health Insurance Portability and
Accountability Act Contingency Period
Discontinuation of Use of Claim Legacy Formats
following Successful Health Insurance
Portability and Accountability Act Format
Testing
Electronic Data Interchange Receiver Testing by
Carriers, Durable Medical Equipment Regional
Carriers, and Intermediaries
Changes in Provider's System or Vendor's
Software, and Use of Additional Electronic
Data Interchange Formats
Support of Electronic Data Interchange Trading
Partners
User Guidelines
Technical Assistance to Electronic Data
Interchange Trading Partners
Training Content and Frequency
Prohibition Against Requiring Use of
Proprietary Software or Direct Data Entry
Free Claim Submission Software
Remittance Advice Print Software
Medicare Remit Easy Print Software for Carrier
and Durable Medical Equipment Regional Carrier
Provider Use
Medicare Standard Fiscal Intermediary PC-Print
Software
Newsletters/Bulletin Board/Internet Publication
of Electronic Data Interchange Information
Provider Guidelines for Choosing a Vendor
Determining Goals/Requirements
Vendor Selection
Negotiating With Vendors
Electronic Data Interchange Edit Requirements
Carrier, Durable Medical Equipment Regional
Carrier, and Fiscal Intermediary X12 Edit
Requirements
Supplemental Fiscal Intermediary-Specific
Shared System Edit Requirements
Fiscal Intermediary Health Insurance and
Portability Accountability Act Claim
Level Implementation Guide Edits
Supplemental Carrier/Durable Medical Equipment
Regional Carrier-Specific Shared System
Implementation Guide Edit Requirements
Keyshop and Image Processing
Carrier, Durable Medical Equipment Regional
Carrier, or Fiscal Intermediary Data Security
and Confidentiality Requirements
Carrier, Durable Medical Equipment Regional
Carrier, and Fiscal Intermediary Electronic
Data Interchange Audit Trails
Security-Related Requirements for Carrier,
Durable Medical Equipment
Regional Carrier, or Fiscal Intermediary
Arrangements with Clearinghouses And Billing
Services
Mandatory Electronic Submission of Medicare
Claims
Small Providers and Full-Time Equivalent
Employee Self-Assessments
Exceptions
Unusual Circumstance Waivers
Unusual Circumstance Waivers Subject to
Provider Self-Assessment
Unusual Circumstance Waivers Subject to
Medicare Contractor Approval
Unusual Circumstance Waivers Subject to
Contractor Evaluation and CMS Decision
Electronic and Paper Claims Implications of
Mandatory Electronic Submission Enforcement
Provider Education
616 Certified Registered Nurse Anesthetist Pass-
Through Payments
Anesthesia and Certified Registered Nurse
Anesthetist Services in a Critical Access
Hospitals
Payment for Certified Registered Nurse
Anesthetist Pass-Through Services
Payment for Anesthesia Services by a Certified
Registered Nurse Anesthetist (Method II
Critical Access Hospital Only)
617 Administration of Drugs and Biologicals in a
Method II Critical Access Hospital
Coding for Administering Drugs in a Method II
Critical Access Hospital
Coding for Low Osmolar Contrast Material
618 Coding for the Administration of Other Drugs
and Biologicals
Clarification for Carriers and Durable Medical
Equipment Regional Carriers About Correction
and Recoupment of Previously Processed Claims
619 Late IRF-PAI Data Submission Penalty Protocol
Within the Inpatient Rehabilitation Facility
Prospective Payment System
Payment Adjustment for Late Transmission of
Patient Assessment Data
620 New Fiscal Intermediary (FI) Edit to Identify
Potentially Excessive Medicare Payments
Fiscal Intermediary Edits Affecting Multiple
Bill Types
Threshold Edit for Outpatient and Inpatient
Part B Claims
621 Locality Codes for Purchased Diagnostic Tests
622 This Transmittal is rescinded and replaced by
Transmittal 668
623 Durable Medical Equipment Regional Carrier
Only--Corrections to the Billing Indicator
Field for Adjusted Claims
624 This Transmittal is rescinded and replaced by
Transmittal 686
625 Competitive Acquisition Program for Part B
Drugs--Coding, Testing, and Implementation
626 Common Working File Expansion of Duplicate
Claim Edit for Clinical Diagnostic Services
627 New Low Osmolar Contrast Material (LOCM) HCPCS
Codes/Payment Criteria/Payment Level
[[Page 76295]]
Low Osmolar Contrast Media (HCPCS Codes Q9945-
Q9951)
Payment Criteria/Payment Level
628 Radiopharmaceutical Diagnostic Imaging Agents
Codes Applicable to Positron Emission
Tomography Scan Services Performed on or After
January 28, 2005
Appropriate Common Procedure Terminology Codes
Effective for Positron Emission Tomography
Scan Services Performed on or After January
28, 2005
Tracer Codes Required for Positron Emission
Tomography Scans
629 Certificate of Medical Necessity Claim Edits
Workload Reporting
Durable Medical Equipment Regional Carrier
Systems
630 Medicare Part A Skilled Nursing Facility
Prospective Payment System Pricer
Update and Health Insurance Prospective Payment
System Coding Update Effective January 1, 2006
Health Insurance Prospective Payment System
Rate Code
Skilled Nursing Facility Prospective Payment
System Rate Components
Decision Logic Used by the Pricer on Claims
631 Claim Status Category Code and Claim Status
Code Update
632 Billing and Claims Processing Instructions for
Claims Subject to Expedited Determinations
Limitation of Liability Notification and
Coordination With Quality
Improvement Organizations
Limitation on Liability--Overview
Hospital Claims Subject to Hospital Issued
Notices of Noncoverage
Scope of Issuance of Hospital Issued Notices of
Noncoverage
General Responsibilities of Quality Improvement
Organizations and Fiscal Intermediaries
Related to Hospital Issued Notices of
Noncoverage
Billing and Claims Processing Requirements
Related to Hospital Issued Notices of
Noncoverage
Skilled Nursing Facility, Home Health Agency,
Hospice, and Comprehensive Outpatient
Rehabilitation Facility Claims Subject to
Expedited Determinations
Scope of Issuance of Expedited Determination
Notices
General Responsibilities of Quality Improvement
Organizations and Fiscal Intermediaries
Related to Expedited Determinations
Billing and Claims Processing Requirements
Related to Expedited Determinations
Coordination With the Quality Improvement
Organization
633 Guidelines for Payment of Vaccines
(Pneumococcal Pneumonia Virus, Influenza
Virus, and Hepatitis B Virus) and Their
Administration Provided by Indian Health
Service/Tribally-Owned and/or Operated
Hospitals and Hospital Based Facilities
Billing Requirements
Bills Submitted to Fiscal Intermediaries
Vaccines and Vaccine Administration
634 Guidelines for Payment of Vaccines
(Pneumococcal Pneumonia Virus, Influenza
Virus, and Hepatitis B Virus) and Their
Administration at Renal Dialysis Facilities
Vaccines Furnished to End-Stage Renal Disease
Patients
Fiscal Intermediary Payment for Pneumococcal
Pneumonia, Influenza Virus, and Hepatitis B
Vaccine
Bills Submitted by Hospices and Payment for
Renal Dialysis Facilities
635 Financial Liability for Services Subject to
Home Health Consolidated Billing
Home Health Prospective Payment System
Consolidated Billing and Primary
Home Health Agencies
Home Health Prospective Payment System
Consolidated Billing Beneficiary Notification
and Payment Liability Under Home Health
Consolidated Billing
Responsibilities of Home Health Agencies
Responsibilities of Providers/Suppliers of
Services Subject to Consolidated Billing
Responsibilities of Hospitals Discharging
Medicare Beneficiaries to Home Health Care
Home Health Consolidated Billing Edits in
Medicare Systems
Non-routine Supply Editing
Therapy Editing
Other Editing Related to Home Health
Consolidated Billing
Only Request for Anticipated Payment Received
and Services Fall Within 60 Days After Request
for Anticipated Payment Start Date
No Request for Anticipated Payment Received and
Therapy Services Rendered in the Home
Health Insurance Eligibility Query to Determine
Episode Status
Other Editing and Changes for Home Health
Prospective Payment System Episodes
Coordination of Home Health Prospective Payment
System Claims and Episodes With Inpatient
Claim Types
636 Instructions for Implementation of CMS Ruling
05-01; Presbyopia-Correcting Intraocular Lens
637 Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction
638 New Medicare Summary Notice Messages
Adjustments
Ajustes
639 Cessation of Additional $50 Payment for New
Technology Intraocular Lenses
Ambulatory Surgical Center Services on
Ambulatory Surgical Center List
Payment for Intraocular Lens
640 Medicare Part A Skilled Nursing Facility
Prospective Payment System Pricer Update FY
2006
641 October 2005 Quarterly Update to Skilled
Nursing Facility Consolidated Billing
642 New Waived Tests
643 Nature and Effect of Assignment on Carrier
Claims
[[Page 76296]]
644 October 2005 Non-Outpatient Prospective Payment
System Code Editor Specifications Version 21
645 Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction
646 Update to the Inpatient Provider Specific File
and the Outpatient Provider
Specific File to Retain Provider Information
647 The Supplemental Security Income/Medicare
Beneficiary Data for Fiscal Year 2004 for
Inpatient Prospective Payment System Hospitals
648 Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction
649 Competitive Acquisition Program for Part B
Drugs--Coding, Testing, and Implementation
650 This Transmittal is rescinded and replaced by
Transmittal 673
651 Changes to the Laboratory National Coverage
Determination Edit Software for October 2005
652 This Transmittal is rescinded and replaced by
Transmittal 661
653 October 2005 Quarterly Average Sales Price
Medicare Part B Drug Pricing File, Effective
October 1, 2005 and Revisions to April 2005
and July 2005 Quarterly Average Sale Price
Medicare Part B Drug Pricing File
654 Services Not Provided Within the United States
Services Received by Medicare Beneficiaries
Outside the United States Source of Part B
Claims
Appeals of Denied Charges for Physicians and
Ambulance Services in Connection With Foreign
Hospitalization
Services Rendered in Nonparticipating Providers
Coverage Requirements for Emergency Hospital
Services in Foreign Countries
Services Furnished in a Foreign Hospital
Nearest to Beneficiary's U.S. Residence
Coverage of Physician and Ambulance Services
Furnished Outside U.S.
Payment by the Railroad Retirement
Beneficiaries for Services Furnished in Canada
to Qualified Railroad Retirement Beneficiaries
Foreign Religious Nonmedical Health Care
Facility Claims
Elections to Bill for Services Rendered at
Nonparticipating Hospitals
Processing Claims
Appeals on Claims for Emergency and Foreign
Services
Payment for Services from Foreign Hospitals
Full Denial--Foreign Claim--Beneficiary Filed
655 This Transmittal is rescinded and replaced by
Transmittal 663
656 Full Replacement of Change Request 3607,
Payment Edits in Applicable States For Durable
Medical Equipment Prosthetics, Orthotics &
Supplies
Provider Billing for Prosthetics and Orthotic
Services
657 Quarterly Update to Correct Coding Initiative
Edits, Version V11.3, Effective October 1,
2005
658 Billing for Devices Under the Hospital
Outpatient Prospective Payment System
Billing for Devices Under the Outpatient
Prospective Payment System
Requirements that Hospitals Report Device Codes
on Claims on Which They Report Specified
Procedures
Edits for Claims on Which Specified Procedures
Are To Be Reported With Device Codes
659 Instructions for Downloading the Medicare Zip
Code File
660 This Transmittal is rescinded and replaced by
Transmittal 664
661 This Transmittal is rescinded and replaced by
Transmittal 672
662 This Transmittal is rescinded and replaced by
Transmittal 691
663 Update To The Hospice Payment Rates, Hospice
Cap, Hospice Wage Index, and the Hospice
Pricer for Fiscal Year 2006
664 This Transmittal is rescinded and replaced by
Transmittal 683
665 October Quarterly Update for 2005 Durable
Medical Equipment, Prosthetics, Orthotics, and
Supplies Fees Schedule
666 Updates to the Coordination of Benefits
Contractor Detailed Error
Report File Layout
Consolidation of the Claims Crossover Process
Coordination of Benefits Agreement Detailed
Error Notification Process
667 Home Care and Domiciliary Care Visits (Codes
99321-99350)
668 Enforcement of Hospital Inpatient Bundling:
Carrier Denial of Ambulance Claims During an
Inpatient Stay
Hospital Inpatient Bundling
General Coverage and Payment Policies
Common Working File Editing of Ambulance Claims
for Inpatients
Intermediary Guidelines
Provider/Intermediary Bill Processing
Guidelines Effective April 1, 2002, as a
Result of Fee Schedule Implementation
669 Schedule for Completing the Calendar Year 2006
Fee Updates and the Participating Physician
Enrollment Procedures
670 Realignment of States and Medicare Claims
Processing Workload From Durable Medical
Equipment Regional Carrier Regions A, B, C,
and D to the Durable Medical Equipment Major
Ambulatory Jurisdictions A, B, C and D
671 Updated Manual Instructions for the Medicare
Claims Processing Manual, Regarding Smoking
and Tobacco-Use Cessation Counseling Services
Healthcare Common Procedure Coding System and
Diagnosis Coding
Carrier Billing Requirements
Fiscal Intermediary Billing Requirements
Medicare Summary Notices
672 October Update to the 2005 Medicare Physician
Fee Schedule Database
673 Manual Update on Medical Nutrition Therapy
Services--Manualization
Medicare Nutrition Therapy Services
General Conditions and Limitations on Coverage
Referrals for Medicare Nutrition Therapy
Services
Dietitians and Nutritionists Performing
Medicare Nutrition Therapy Services
[[Page 76297]]
Payment for Medicare Nutrition Therapy Services
General Claims Processing Information
Common Working File Edits
674 This Transmittal is rescinded and replaced by
Transmittal 692
675 Changes to Appeals of Claims Decisions:
Redeterminations and Reconsiderations
(Implementation Date October 1, 2005)
Workload Data Analysis Program
Managing Appeals Workloads
Standard Operating Procedures
Execution of Workload Prioritization
Workload Priorities
676 2006 Healthcare Common Procedure Coding System
Annual Update Reminder
677 This Transmittal is rescinded and replaced by
687
678 This Transmittal is rescinded and replaced by
688
679 Medicare Redetermination Notice and Effect of
the Redetermination Medicare Redetermination
Notice (for partly or fully unfavorable
redeterminations)
Medicare Redetermination Notice (for fully
favorable redeterminations) Effect of the
Redetermination
680 Inpatient Rehabilitation Facility Annual
Update: Prospective Payment System Pricer
Changes for FY 2006
681 Guidelines For Payment of Vaccines
(Pneumococcal Pneumonia Virus, Influenza
Virus, And Hepatitis B Virus) and Their
Administration Provided by Indian Health
Services/Tribally-Owned and/or Operated
Hospitals and Hospital Based Facilities
Billing Requirements
Bills Submitted to Fiscal Intermediaries
Vaccines and Vaccine Administration
682 Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction
683 October 2005 Outpatient Prospective Payment
System Code Editor Specifications Version
684 Correction to Chapter 17, Section 80.2.3, MSN/
ANSI X12 Denial Messages for Anti-Emetic Drugs
685 Discontinuation of the Skilled Nursing Facility
Healthcare Common Procedure Coding System Help
File and Notification to Fiscal Intermediaries
and Providers of the Redesigned Skilled
Nursing Facility Consolidated Billing Annual
Update File Posted on CMS Web site
Services Included in Part A Prospective Payment
System Payment Not Billable Separately by the
Skilled Nursing Facility
Services Beyond the Scope of the Part A Skilled
Nursing Facility Benefit
Billing for Medical and Other Health Services
General Payment Rules and Application of Part B
Deductible and Coinsurance
686 Common Working File Unsolicited Response
Adjustments for Certain Claims Denied Due to
an Open Medicare Secondary Payer Group Health
Plan Record Where the Group Health Plan Record
Was Subsequently Deleted
687 Appeals of Claims Decisions: Redeterminations
and Reconsiderations (Implementation Dates for
Fiscal Intermediary Initial Determination
Issued On or After May 1, 2005 and Carrier
Initial Determinations Issued on or After
January 1, 2006)
Filing a Request for Redetermination
Appeal Rights for Dismissals
Dismissal Letters
Model Dismissal Notices
Reconsideration--The Second Level of Appeal
Filing a Request for a Reconsideration
Time Limit for Filing a Request for a
Reconsideration
Contractor Responsibilities--General
Qualified Independent Contractor Case File
Development
Qualified Independent Contractor Case File
Preparation
Forwarding Qualified Independent Contractor
Case Files
Qualified Independent Contractor Jurisdictions
Tracking Cases
Effectuation of Reconsiderations
688 Appeals of Claims Decisions: Redeterminations
and Reconsiderations (Implementation Dates for
All Requests for Redetermination Received by
Fiscal Intermediary on or After May 1, 2005,
and All Requests for Redetermination Received
by Carriers on or After January 1, 2006)
Redetermination--The First Level of Appeal
The Redetermination
The Redetermination Decision
Dismissals
Vacating a Dismissal
689 One Time Update to the National Council
Prescription Drug Programs
Companion Document Regarding Crossover Claims
to Medicaid
690 Fiscal Year (FY) 2006 Payment for Services
Furnished in Ambulatory Surgical Centers
691 October 2005 Update of the Hospital Outpatient
Prospective Payment System
692 Fiscal Year 2006 Inpatient Prospective Payment
System and Long Term Care Hospital Changes
693 Updates to the Inpatient Rehabilitation
Facility and Skilled Nursing Facility
Provider Specific File and Changes in Inpatient
Rehabilitation Facility
Prospective Payment System for FY 2006
Provider-Specific File
Case-Mix Groups
Facility Level Adjustments
Area Wage Adjustment
[[Page 76298]]
Rural Adjustment
Outlier
Teaching Status Adjustment
Full Time Equivalent Resident Cap
Inpatient Rehabilitation Facility Prospective
Payment System Pricer Software
694 Update to the Healthcare Provider Taxonomy
Codes Version 5.1
------------------------
Medicare Secondary Payer
(CMS--Pub. 100-05)
------------------------------------------------------------------------
31 Full Replacement of Change Request 3770,
Expanding the Number of Source Identifiers for
Common Working File Medicare Secondary Payer
Records
Change Request 3770 Is Rescinded
Definition of Medicare Secondary Payer/Common
Working File Terms
Medicare Secondary Payer Delete Transaction
Identification of Reimbursement Advisory
Committee Created Group Health Plan Records
32 Exception for Small Employers in Multi-Employer
Group Health Plans Overview and General
Responsibilities
Introduction to the Coordination of Benefits
Contractor
Scope of the Coordination of Benefit Contractor
in Relation to Contractors
Contractors Claim Referrals to the Coordination
of Benefit Contractors IRS/SSA/CMS Data Match
Coordination of Benefit Contractors
Discontinues Dissemination of the Right of
Recovery Letters to Contractors
Exception for Small Employers in Multi-Employer
Group Health Plans
Purpose
Background
Specific Information
33 Working Aged Exception for Small Employers in
Multi-Employer Group Health Plans
34 Manualization: Long-Standing Medicare Secondary
Payer Policy in Chapter 1 of the Medicare
Secondary Payer Internet Only Manual
General Provisions
Working Aged
End-Stage Renal Disease
Workers' Compensation
No-Fault Insurance
Liability Insurance
Conditional Primary Medicare Benefits
When Conditional Primary Medicare Benefits May
Be Paid When a Group Health Plan Is a Primary
Payer to Medicare
When Conditional Primary Medicare Benefits May
Not Be Paid When a Group Health Plan Is a
Primary Payer to Medicare
When Medicare Secondary Payer Benefits Are
Payable and Not Payable
Multiple Insurers
Definitions
Crediting Deductible for Non-Inpatient
Psychiatric Services
Clarification of Current Employment Status for
Specific Groups
Actions Resulting From Group Health Plan or
Large Group Health Plan
Nonconformance
Federal Government's Right to Sue and Collect
Double Damages
35 Updates to the Group Health Plan Identification
and Recovery Processes
General
IRS/SSA/CMS Data Match (Data Match) Group
Health Plan Identified Cases
Non-Data Match Group Health Plan Identified
Cases
Other Sources of Recovery Actions
Group Health Plan Acknowledges Specific Debt
(42 CFR 411.25)
Recovery When a State Medicaid Agency Has Also
Requested a Refund From the Group Health Plan
Identification of Group Health Plan Mistaken
Primary Payments Via the Recovery Management
and Accounting System
Progression of Recovery Management Accounting
System Group Health Plan
Lead Identification
Progression of Recovery Management Accounting
System History Search
Contractor Recovery Case Files (Audit Trails)
Group Health Plan Letters (Used for Recovery
Management Accounting
System/Healthcare Integrated General Ledger
Accounting System (ReMAS/HIGLAS) When the Only
Debtor Interfaced to Healthcare Integrated
General Ledger Accounting System Is the
Employer)
Employer Group Health Plan Letter
Important Information for Employers
Insurer Group Health Plan Letter (Used for
Recovery Management Accounting System/
Healthcare Integrated General Ledger
Accounting System When the Only Debtor
Interfaced to Healthcare Integrated General
Ledger Accounting System Is the Employer)
Accountability Worksheet (Not Applicable to
Recovery Management Accounting System/
Healthcare Integrated General Ledger
Accounting System Users)
Summary Data Sheet (Not Applicable to ReMAS/
HIGLAS Users)
Field Description on the Medicare Secondary
Payer Summary Data Sheet Payment Record
Summary (Used with ReMAS/HIGLAS Users but in a
Modified Format)
[[Page 76299]]
Courtesy Copy of All Medicare Secondary Payer
Group Health Plan-Based Recovery Demand
Packages to the Employer's Insurer/Third Party
Administrator
Insurer/T
