Medicare and Medicaid Programs; Quarterly Listing of Program Issuances-October Through December 2005, 14903-14922 [06-2807]

Agencies

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

[Federal Register Volume 71, Number 57 (Friday, March 24, 2006)]
[Notices]
[Pages 14903-14922]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 06-2807]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-9034-N]


Medicare and Medicaid Programs; Quarterly Listing of Program 
Issuances--October Through December 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 October 2005 through December 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 Melissa Musotto, 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) 786-6962.
    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

[[Page 14904]]

regulations (proposed and final) published during the respective 3-
month time frame.

II. How To Use the Addenda

    This notice is organized so that a reader may review the subjects 
of manual issuances, memoranda, substantive and interpretive 
regulations, NCDs, and FDA-approved IDEs published during the subject 
quarter to determine whether any are of particular interest. We expect 
this notice to be used in concert with previously published notices. 
Those unfamiliar with a description of our Medicare manuals may wish to 
review Table I of our first three notices (53 FR 21730, 53 FR 36891, 
and 53 FR 50577) published in 1988, and the notice published March 31, 
1993 (58 FR 16837). Those desiring information on the Medicare NCD 
Manual (NCDM, formerly the Medicare Coverage Issues Manual (CIM)) may 
wish to review the August 21, 1989, publication (54 FR 34555). Those 
interested in the revised process used in making NCDs under the 
Medicare program may review the September 26, 2003, publication (68 FR 
55634).
    To aid the reader, we have organized and divided this current 
listing into eight addenda:
     Addendum I lists the publication dates of the most recent 
quarterly listings of program issuances.
     Addendum II identifies previous Federal Register documents 
that contain a description of all previously published CMS Medicare and 
Medicaid manuals and memoranda.
     Addendum III lists a unique CMS transmittal number for 
each instruction in our manuals or Program Memoranda and its subject 
matter. A transmittal may consist of a single or multiple 
instruction(s). Often, it is necessary to use information in a 
transmittal in conjunction with information currently in the manuals.
     Addendum IV lists all substantive and interpretive 
Medicare and Medicaid regulations and general notices published in the 
Federal Register during the quarter covered by this notice. For each 
item, we list the--
    [cir] Date published;
    [cir] Federal Register citation;
    [cir] Parts of the Code of Federal Regulations (CFR) that have 
changed (if applicable);
    [cir] Agency file code number; and
    [cir] Title of the regulation.
     Addendum V includes completed NCDs, or reconsiderations of 
completed NCDs, from the quarter covered by this notice. Completed 
decisions are identified by the section of the NCDM in which the 
decision appears, the title, the date the publication was issued, and 
the effective date of the decision.
     Addendum VI includes listings of the FDA-approved IDE 
categorizations, using the IDE numbers the FDA assigns. The listings 
are organized according to the categories to which the device numbers 
are assigned (that is, Category A or Category B), and identified by the 
IDE number.
     Addendum VII includes listings of all approval numbers 
from the Office of Management and Budget (OMB) for collections of 
information in CMS regulations in title 42; title 45, subchapter C; and 
title 20 of the CFR.
     Addendum VIII includes listings of Medicare-approved 
carotid stent facilities. All facilities listed meet CMS 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, 2005. (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.

[[Page 14905]]

IV. How To Review Listed Material

    Transmittals or Program Memoranda can be reviewed at a local 
Federal Depository Library (FDL). Under the FDL program, government 
publications are sent to approximately 1,400 designated libraries 
throughout the United States. Some FDLs may have arrangements to 
transfer material to a local library not designated as an FDL. Contact 
any library to locate the nearest FDL.
    In addition, individuals may contact regional depository libraries 
that receive and retain at least one copy of most Federal Government 
publications, either in printed or microfilm form, for use by the 
general public. These libraries provide reference services and 
interlibrary loans; however, they are not sales outlets. Individuals 
may obtain information about the location of the nearest regional 
depository library from any library. For each CMS publication listed in 
Addendum III, CMS publication and transmittal numbers are shown. To 
help FDLs locate the materials, use the CMS publication and transmittal 
numbers. For example, to find the Medicare NCD publication titled 
``Stem Cell Transplantation,'' use CMS-Pub. 100-03, Transmittal No. 45.

(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: March 20, 2006.
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.

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)
December 23, 2005 (70 FR 76290)

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
                     [October through December 2005]
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    Transmittal No.               Manual/Subject/Publication No.
------------------------------------------------------------------------
                      Medicare General Information
                            (CMS Pub. 100-01)
------------------------------------------------------------------------
30.....................  Initiate STC testing of the MCS for RRB and
                          HIGLAS Shared System Testing Requirements for
                          Maintainers, Beta Testers, and Contractors.
31.....................  Update to Medicare Deductible, Coinsurance and
                          Premium Rates for 2006 Basis for Determining
                          the Part A Coinsurance Amounts Part B Annual
                          Deductible.
32.....................  Scheduled Release for January 2006 Software
                          Programs and Pricing/Coding Files.
33.....................  Change Management Process--Electronic Change
                          Information Management Portal (eChimp).
------------------------------------------------------------------------
                         Medicare Benefit Policy
                            (CMS Pub. 100-02)
------------------------------------------------------------------------
39.....................  Auditory Osteointegrated and Auditory Brainstem
                          Devices Hearing Aids and Auditory Implants.
40.....................  Skilled Nursing Facility Prospective Payment
                          System.
                         Certification and Recertification by Physicians
                          for Extended Care Services.
                         Who May Sign the Certificate or Recertification
                          for Extended Care Services Rural Health Center/
                          Federally Qualified Health Center for Hospital/
                          Skilled Nursing Facility Outpatients or
                          Inpatients.
41.....................  Telehealth Originating Site Facility Fee
                          Payment Amount Update.
42.....................  January 2006 Update of the Hospital Outpatient
                          Prospective Payment System Manual Instruction:
                          Changes to Coding and Payment for Observation.
43.....................  List of Medicare Telehealth Services.
                         Payment-Physician/Practitioner at a Distant
                          Site.
------------------------------------------------------------------------
                Medicare National Coverage Determinations
                            (CMS Pub. 100-03)
------------------------------------------------------------------------
43.....................  This Transmittal is rescinded and replaced by
                          Transmittal 45.
44.....................  Lung Volume Reduction Surgery.
45.....................  Stem Cell Transplantation.
------------------------------------------------------------------------
                       Medicare Claims Processing
                            (CMS Pub. 100-04)
------------------------------------------------------------------------
695....................  General Appeals Process in Initial
                          Determinations (Implementation Dates for
                          Fiscal Intermediary Initial Determinations
                          Issued on or After May 1, 2005 and Carrier
                          Initial Determinations Issued on or After
                          January 1, 2006).
                         CMS Decisions Subject to the Administrative
                          Appeals Process.
                         Who May Appeal.
                         Provider or Supplier Appeals When the
                          Beneficiary Is Deceased.
                         Steps in the Appeals Process: Overview.
                         Where to Appeal.
                         Time Limits for Filing Appeals and Good Cause
                          for Extension of the Time Limit for Filing
                          Appeals.
                         Good Cause.

[[Page 14906]]

 
                         General Procedure to Establish Good Cause.
                         Conditions and Examples That May Establish Good
                          Cause for Late Filing by Beneficiaries.
                         Conditions and Examples That May Establish Good
                          Cause for Late Filing by Providers,
                          Physicians, or Other Suppliers.
                         Good Cause Not Found for Beneficiary, or for
                          Provider, Physician, or Other Supplier.
                         Amount in Controversy Requirements.
                         Parties to an Appeal.
696....................  2006 Annual Update of Healthcare Common
                          Procedure Coding System Codes for Skilled
                          Nursing Facility Consolidated Billing for the
                          Common Working File, Medicare Carriers and
                          Fiscal Intermediaries.
                         Skilled Nursing Facility Consolidated Billing
                          Annual Update Process for Fiscal
                          Intermediaries.
697....................  Appeals of Claims Decisions: Redeterminations
                          and Reconsiderations (implementation date May
                          1, 2005).
                         Time Limit for Filing a Request for
                          Redetermination.
                         Reporting Redeterminations on the Appeals
                          Report.
698....................  The Supplemental Security Income Medicare
                          Beneficiary Data for Fiscal Year 2006 for the
                          Inpatient Rehabilitation Facility Prospective
                          Payment System.
                         Low Income Percentage Adjustment: The
                          Supplemental Security Income Medicare
                          Beneficiary Data for Inpatient Rehabilitation
                          Facilities Paid Under the Prospective Payment
                          System.
699....................  This Transmittal is rescinded and replaced by
                          Transmittal 761.
700....................  Revision to Chapter 31--Attestation.
                         Eligibility Extranet Workflow.
701....................  New Diagnosis Code Requirements for Method II
                          Home Dialysis Claims Supplier Documentation
                          Required.
702....................  Manualization for Physician/Practitioner/
                          Supplier Participation Agreement and
                          Assignment Carrier Claims and Carrier Rules
                          for Limiting Charge.
                         Physician/Practitioner/Supplier Participation
                          Agreement and Assignment--Carrier Claims.
                         Mandatory Assignment on Carrier Claims.
                         Filing Claims to a Carrier for Nonassigned
                          Services.
                         Carrier Annual Participation Program.
                         Carrier Participation and Billing Limitations.
703....................  This Transmittal is rescinded and replaced by
                          Transmittal 707.
704....................  Discontinuation of Biannual Recertification
                          List for Certified Registered Nurse.
                         Anesthetist Services.
                         Issuance of Unique Physician Identification
                          Numbers.
                         Annual Review of Certified Registered Nurse
                          Anesthetist Certifications.
705....................  Modification to Reporting of Diagnosis Codes
                          for Screening Mammography Claims.
                         Healthcare Common Procedure Coding System and
                          Diagnosis Codes for Mammography Services.
706....................  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.
707....................  Inpatient Prospective Payment System Outlier
                          Reconciliation Outliers.
                         Cost to Charge Ratios.
                         Statewide Average Cost to Charge Ratios.
                         Threshold and Marginal Cost.
                         Transfers.
                         Reconciliation.
                         Time Value of Money
                         Procedure for Fiscal Intermediaries to Perform
                          and Record Outlier.
                         Reconciliation Adjustments.
                         Specific Outlier Payments for Burn Cases.
                         Quality Improvement Organization Reviews and
                          Adjustments.
                         Return Codes for Pricer.
708....................  This Transmittal is rescinded and replaced by
                          Transmittal 722.
709....................  This Transmittal is rescinded and replaced by
                          Transmittal 720.
710....................  Issued to a specific audience, not posted to
                          Internet/Intranet due to sensitivity of
                          Instruction.
711....................  This Transmittal is rescinded and replaced by
                          Transmittal 763.
712....................  Correction to Change Request 3949, Section
                          50.3.3 in IOM to Add 23x Type of Bill.
                         Billing and Claims Processing Requirements
                          Related to Expedited Determinations.
713....................  This Transmittal is rescinded and replaced by
                          Transmittal 748.
714....................  Payment Window Edit Corrections Within the
                          Common Working File.
                         Outpatient Services Treated As Inpatient
                          Services.
715....................  New Designated Competitive Acquisition Program
                          Carrier Contractor ID Numbers.
716....................  Modifiers for Transportation of Portable X-rays
                          (R0075) When Billed by Skilled Nursing
                          Facilities.
                         Transportation of Equipment Billed by a Skilled
                          Nursing Facility to a Fiscal Intermediary.
717....................  Disabling the Revenue/Healthcare Common
                          Procedure Coding System Consistency.
                         Edit Codes in the Fiscal Intermediary Shared
                          System.
                         Fiscal Intermediary Consistency Edits.
718....................  Source of Admission Code `D'.
719....................  This Transmittal is rescinded and replaced by
                          Transmittal 736.
720....................  Issued to a specific audience, not posted to
                          Internet/Intranet due to sensitivity of
                          Instruction.
721....................  Use of Value Codes 48 and 49 on End-Stage Renal
                          Disease Bills.
                         Required Information for In-Facility Claims
                          Paid Under the Composite Rate.
                         Epoetin Alfa Facility Billing Requirements
                          Using UB-92/Form CMS-1450.

[[Page 14907]]

 
                         Darbeopoetin Alfa Facility Billing Requirements
                          Using UB-92/Form CMS-1450.
722....................  2006 Annual Update for the Health Professional
                          Shortage Area Bonus Payments.
723....................  Issued to a specific audience, not posted to
                          Internet/Intranet due to Confidentiality of
                          Instruction.
724....................  Appeals of Claims Decisions: Redeterminations
                          and Reconsiderations (Implementation Dates for
                          Fiscal Intermediary Initial Determinations
                          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.
725....................  This Transmittal is rescinded and replaced by
                          Transmittal 737.
726....................  Smoking and Tobacco-Use Cessation Counseling
                          Services: Common Working File Inquiry for
                          Providers.
                         Common Working File Inquiry.
727....................  Annual Type of Service.
728....................  Installation of the January 2006 Inpatient
                          Prospective Payment System Pricer and Hospice
                          Pricer.
729....................  Revised October 2005 Quarterly Average Sales
                          Price Medicare Part B Drug Pricing File,
                          Effective October 1, 2005.
730....................  Calendar Year 2006 Participation Enrollment and
                          Medicare Participating Physicians and
                          Suppliers Directory Procedures.
731....................  Payment for Office or Other Outpatient
                          Evaluation and Management Visits (Codes 99201-
                          99215).
732....................  Issued to a specific audience, not posted to
                          Internet/Intranet due to Confidentiality of
                          Instruction.
733....................  Repeat Tests for Automated Multi-Channel
                          Chemistries for End-Stage Renal Disease
                          Beneficiaries.
734....................  Redefined Type of Bill, 14x, for Non-Patient
                          Laboratory Specimens.
                         Maryland Waiver Hospitals.
                         Clinical Diagnostic Laboratory Tests Furnished
                          by Critical Access Hospitals.
                         Hospital Laboratory Services Furnished to
                          Nonhospital Patients.
735....................  Processing All Diagnosis Codes Reported on
                          Claims Submitted to Carriers.
                         Items 14-33-Provider of Service or Supplier
                          Information.
736....................  Clarification and Update to Hospital Billing
                          Instructions and Payment for Epoetin Alfa and
                          Darbepoetin Alfa for Beneficiaries With End-
                          Stage Renal Disease.
                         Epoetin Alfa for End-Stage Renal Disease
                          Patients.
                         Payment Amount for Epoetin Alfa.
                         Payment for Epoetin Alfa in Other Settings.
                         Epoetin Alfa Provided in Hospital Outpatient
                          Departments.
                         Payment for Darbepoetin Alfa in Other Settings.
                         Payment for Darbepoetin Alfa in the Hospital
                          Outpatient Department.
                         Hospitals Billing for Epoetin Alfa for Non-End-
                          Stage Renal Disease Patients.
                         Hospitals Billing for Darbepoetin Alfa for Non-
                          End-Stage Renal Disease Patients.
737....................  New ICD-9-CM Codes for Beneficiaries With
                          Chronic Kidney Disease and New Healthcare
                          Common Procedure Coding System for Reporting
                          Epoetin Alfa and Darbepoetin Alfa.
                         Required Information for In-Facility Claims
                          Under the Composite Rate.
738....................  Calendar Year 2005 Payment for Medicare Part B
                          Radiopharmaceuticals Not Paid on a Cost or
                          Prospective Payment Basis.
739....................  Erroneous Guidance--Basis to Waive Penalty.
                         Overview.
                         Erroneous Program Guidance: Basis to Waive
                          Penalty.
                         Policy.
                         Basic Conditions That Must Be Met To Waive
                          Penalty.
                         Guidance Was Erroneous.
                         Guidance Was Issued by the Secretary or
                          Contractor.
                         Contractor Acted Within Scope of Authority.
                         Guidance Was in Writing.
                         Guidance Related to Item, Service, or Claim.
                         Guidance Was Issued Timely.
                         Provider Accurately Presented Circumstances in
                          Writing.
                         Alternative Basis for Satisfying the
                          ``Presentation'' Condition.
                         Provider Followed Guidance.
                         Provider's Reliance Was Reasonable.
                         Penalty Considered.
                         General Limitations on Scope.
                         Notice of Penalty Waiver Policy.
                         Request for a Penalty Waiver Determination.
                         Jurisdiction.
                         Jurisdiction Regarding Error.

[[Page 14908]]

 
                         Jurisdiction to Complete the Penalty Waiver
                          Determination.
                         Determining Whether the Guidance Was Erroneous.
                         Completing the Penalty Waiver Determination.
                         Timeliness of Request.
                         Ripeness.
                         Sufficient Information.
                         Mootness.
                         Required Conditions Other Than Error.
                         Completing the Determination.
                         Notice of the Penalty Waiver Determination.
                         Reconsideration of the Penalty Waiver
                          Determination.
                         Recordkeeping.
                         Reporting.
                         Corrective Action.
                         Effective Date.
740....................  Change to the Common Working File Skilled
                          Nursing Facility Consolidated.
                         Billing Edits for Evaluation and Management
                          Services Billed to Fiscal.
                         Intermediaries by Hospitals.
                         Hospital's ``Facility Charge'' in Connection
                          with Clinic Services of a Physician.
741....................  New Condition Codes 49 and 50.
742....................  Quarterly Update to Correct Coding Initiative
                          Edits, V12.0, Effective January 1, 2006.
743....................  Remittance Advice Remark Code and Claim
                          Adjustment Reason Code Update.
744....................  File Descriptions and Instructions for
                          Retrieving the 2006 Fee Schedules and
                          Healthcare Common Procedure Coding System
                          through CMS'' Mainframe Telecommunications
                          System.
                         Recurring Update Notification Containing New
                          Pricing File Names and Retrieval Dates for
                          2006.
745....................  Elimination of the Durable Medical Equipment
                          Regional Carrier Information Form.
                         Billing Drugs Electronically `` National
                          Council Prescription Drug Program.
                         Certificate of Medical Necessity.
746....................  January 2006 Quarterly Average Sales Price
                          Medicare Part B Drug Pricing File, Effective
                          January 1, 2006, and Revisions to January
                          2005, April 2005, July 2005, and October 2005
                          Quarterly Average Sales Price Medicare Part B
                          Drug Pricing Files.
747....................  Issued to a specific audience, not posted to
                          Internet/Intranet due to Confidentiality of
                          Instruction.
748....................  New G Code for Power Mobility Devices.
                         Power Mobility Devices Code G0372.
749....................  Reasonable Charge Update for 2006 for Splints,
                          Casts, Dialysis Supplies, Dialysis Equipment,
                          and Certain Intraocular Lenses.
750....................  2006 Annual Update for Clinical Laboratory Fee
                          Schedule and Laboratory Services Subject to
                          Reasonable Charge Payment.
751....................  National Monitoring Policy for EPO and Aranesp
                          for End-Stage Renal Disease.
                         Patients Treated in Renal Dialysis Facilities.
                         Chapter 8, Section 60.4, Epoetin Alfa.
                         Chapter 8, section 60.7, Darbepoetin Alfa for
                          End-Stage Renal Disease Patients.
752....................  Eliminate the Use of Surrogate Unique
                          Physicians Identification Numbers (OTH000) on
                          Medicare Claims.
753....................  Update of Contact Information for the Do Not
                          Forward Reports.
                         Reporting Requirements--Carriers.
754....................  Supplying Fee and Inhalation Drug Dispensing
                          Fee Revisions and Clarifications.
                         Pharmacy Supplying Fee and Inhalation Drug
                          Dispensing Fee.
755....................  Common Working File Updates for Carrying
                          National Provider Identifier.
756....................  Issued to a specific audience, not posted to
                          Internet/Intranet due to Sensitivity of
                          Instruction.
757....................  Resubmission of Inpatient Psychiatric Facility
                          Prospective Payment System.
                         Claims with Chronic Renal Failure Comorbid
                          Condition.
758....................  Changes to the Laboratory National Coverage
                          Determination Edit Software for January 2006.
759....................  Therapy Caps to be Effective January 1, 2006.
                         The Financial Limitation.
                         Discipline Specific Outpatient Rehabilitation
                          Modifiers--All Claims.
760....................  Instructions for Downloading the Medicare Zip
                          Code File.
761....................  This Transmittal is rescinded and replaced by
                          Transmittal 777.
762....................  Ambulance Inflation Factor for CY 2006.
763....................  Update to Repetitive Billing--Manualization.
                         Frequency of Billing to Fiscal Intermediaries
                          for Outpatient Services Hospital and Community
                          Mental Health Center Reporting Requirements
                          for Services Performed on the Same Day.
764....................  Update to the Prospective Payment System for
                          Home Health Agencies for Calendar Year 2006.
765....................  Instructions for Downloading the Medicare Zip
                          Code File.
766....................  This Transmittal is rescinded and replaced by
                          Transmittal 776.
767....................  Skilled Nursing Facility Prospective Payment
                          System Revisions to IOM 100-4--Manualization.
                         Physician's Services and Other Professional
                          Services Excluded From Part A.
                         Prospective Payment System Payment and the
                          Consolidated Billing Requirement.
                         Billing Skilled Nursing Facility Prospective
                          Payment System Services.
                         Billing Procedures for a Composite Skilled
                          Nursing Facility or a Change in Provider
                          Number.
                         Billing for Services After Termination of
                          Provider Agreement, or After Payment is Denied
                          for New Admission.
                         General Rules.
                         Billing for Covered Services.
                         Part B Billing.

[[Page 14909]]

 
768....................  Lung Volume Reduction Surgery.
769....................  Surrogate Unique Provider Identification
                          Numbers Reported on Independent Diagnostic
                          Testing Facility Claims.
770....................  Fee Schedule Update for 2006 for Durable
                          Medical Equipment, Prosthetics, Orthotics, and
                          Supplies.
771....................  Revisions to Pub. 100-04, Medicare Claims
                          Processing Manual in Preparation for the
                          National Provider Identifier.
                         Fiscal Intermediary Consistency Edits.
                         Identifying Institutional Providers.
                         Payment Under Prospective Payment System
                          Diagnosis-Related Groups.
                         Payment to Hospitals and Units Excluded From
                          Inpatient Prospective Payment System for
                          Direct Graduate Medical Education and Nursing
                          and Allied Health.
                         Education for Medicare Advantage Enrollees.
                         Requirements for Critical Access Hospital
                          Services, Critical Access Hospital.
                         Skilled Nursing Care Services and Distinct Part
                          Units.
                         Payment for Post-Hospital Skilled Nursing
                          Facility Care Furnished by a Critical Access
                          Hospital.
                         Swing-Bed Services.
                         Outlier Payments: Cost-to-Charge Ratios.
                         Affected Medicare Providers.
                         Billing Requirements Under Long Term Care
                          Hospital Prospective Payment System.
                         Coinsurance Election.
                         Maryland Waiver Hospitals.
                         Zip Code Files.
                         Special Partial Hospitalization Billing
                          Requirements for Hospitals, Community Mental
                          Health Centers, and Critical Access Hospitals.
                         Bill Review for Partial Hospitalization
                          Services Provided in Community Mental Health
                          Centers.
                         Part B Outpatient Rehabilitation and
                          Comprehensive Outpatient Rehabilitation
                          Facility Services--General.
                         Dialysis Provider Number Series.
                         Shared Systems Changes for Medicare Part B
                          Drugs for End-Stage Renal Disease Independent
                          Dialysis Facilities.
                         Federally Qualified Health Centers.
                         Request for Anticipated Payment.
                         Home Health Prospective Payment System Claims.
                         Completing the Uniform (Institutional Provider)
                          Bill (Form CMS-1450) for Hospice Election.
                         Care Plan Oversight.
772....................  Fiscal Intermediary Shared System Edit Updates
                          for Epoetin Alfa and Darbepoetin Alfa
                          Healthcare Common Procedure Coding System
                          Changes Effective January 1, 2006.
773....................  Announcement of the Medicare Federally
                          Qualified Health Center Supplemental Payment.
                         Billing for Supplemental Payments for Federally
                          Qualified Health Centers Under Contract With
                          Medicare Advantage Plans.
774....................  Implementation of Changes in End-Stage Renal
                          Disease Payment for Calendar Year 2006.
                         Required Information for In-Facility Claims
                          Paid Under the Composite Rate.
775....................  Home Care and Domiciliary Care Visits (Codes
                          99324-99350).
776....................  Stem Cell Transplantation.
777....................  Competitive Acquisition Program for Part B
                          Drugs.
778....................  Issued to a specific audience, not posted to
                          Internet/Intranet due to Confidentiality of
                          Instruction.
779....................  New Waived Tests.
780....................  Common Working File Database Extract into Next
                          Generation Desktop Data Mart.
781....................  Revised Manual Instructions for Processing End-
                          Stage Renal Disease Exceptions Under the
                          Composite Rate Reimbursement System.
                         General Instructions for Processing Requests
                          Under the Composite Rate Reimbursement System.
                         Criteria for Approval of End-Stage Renal
                          Disease Exception Requests.
                         Procedures for Requesting Exceptions to End-
                          Stage Renal Disease Payment Rates.
                         Period of Approval: Payment Exception Request.
                         Criteria for Re-filing a Denied Exception
                          Request.
                         Responsibility of Intermediaries.
                         Payment Exception: Pediatric Patient Mix.
                         Payment Exception: Self Dialysis Training Costs
                          in Pediatric Facilities.
782....................  This Transmittal is rescinded and replaced by
                          Transmittal 788.
783....................  January 2006 Non-Outpatient Prospective Payment
                          System Outpatient Code Editor Specifications
                          Version 21.1.
784....................  January 2006 Outpatient Prospective Payment
                          System Code Editor Specifications Version 7.0.
785....................  January 2006 Update of the Hospital Outpatient
                          Prospective Payment System.
                         Manual Instruction: Changes to Coding and
                          Payment for Drug Administration--Manulization.
                         Coding and Payment for Drug Administration.
                         Administration of Drugs via Implantable or
                          Portable Pumps.
                         Chemotherapy Drug Administration.
                         Non-Chemotherapy Drug Administration.
786....................  January 2006 Update of the Hospital Outpatient
                          Prospective Payment System: Summary of Payment
                          Policy Changes, Outpatient Prospective Payment
                          System Pricer Logic Changes, and Instructions
                          for Updating the Outpatient Provider Specific
                          File.
787....................  January 2006 Update of the Hospital Outpatient
                          Prospective Payment System.
                         Manual Instruction: Changes to Coding and
                          Payments for Observation.
                         Observation Services Overview.
                         General Billing Requirements for Observation
                          Services.
                         Revenue Code Reporting.

[[Page 14910]]

 
                         Reporting Hours of Observation.
                         Billing and Payment for Observation Services
                          Furnished Prior to January 1, 2006.
                         Billing and Payment for Packaged Observation
                          Services Furnished Between August 1, 2000 and
                          December 31, 2005.
                         Billing and Payment for Separately Payable
                          Observation Services Furnished Between April
                          1, 2002 and December 31, 2005.
                         Billing and Payment for Direct Admission to
                          Observation Services Furnished Between January
                          1, 2003 and December 31, 2005.
                         Billing and Payment for Observation Services
                          Furnished On or After January 1, 2006.
                         Billing and Payment for All Hospital
                          Observation Services Furnished on or After
                          January 1, 2006.
                         Separate and Package Payment for Direct
                          Admission to Observation.
                         Separate and Package Payments for Observation.
                         Services Not Covered as Observation Services.
788....................  Consultation Services (Codes 99241-99255).
789....................  Ambulance Fee Schedule--Medical Conditions
                          List: Manualization.
790....................  List of Medicare Telehealth Services.
                         Payment Methodology for Physician/Practitioner
                          at the Distant Site.
                         Originating Site Facility Fee Payment
                          Methodology.
                         Submission of Telehealth Claims for Distant
                          Site Practitioners.
                         Contractor Editing of Telehealth Claims.
791....................  This Transmittal is rescinded and replaced by
                          Transmittal 793.
792....................  Nursing Facility Services (Codes 99304-99318).
793....................  Revision to Chapter 31--Addition of Hospice
                          Data HIPAA 270/271 Eligibility.
                         Eligibility Extranet Workflow.
794....................  Announcement of Medicare Supplemental Payments
                          to Federally Qualified Health Centers Under
                          Contract with Medicare Advantage Plans.
                         Billing for Supplemental Payments for Federally
                          Qualified Health Centers Under Contract with
                          Medicare Advantage Plans.
795....................  Redefined Type of Bill 14X for Non-Patient
                          Laboratory Specimens--Change.
                         Request 3835 Manualization.
                         Type of Bill.
                         Packaging.
                         General Rules for Reporting Outpatient Hospital
                          Services.
                         Bill Types Subject to Outpatient Prospective
                          Payment System.
                         Standard Method--Cost-Based Facility Services,
                          With Billing of Carrier for Professional
                          Services.
                         Optional Method for Outpatient Services: Cost-
                          Based Facility Services Plus 115.
                         Percentage Fee Schedule Payment for
                          Professional Services.
                         Certified Registered Nurse Anesthetist Services
                          (Certified Registered Nurse Anesthetist Pass-
                          Through Exemption of 115 Percent Fee Schedule
                          Payments for Certified Registered Nurse
                          Anesthetist Services).
                         Optional Method for Outpatient Services: Cost-
                          Based Facility Services Plus 115.
                         Percent Fee Schedule Payment for Professional
                          Services.
                         Hospital and Skilled Nursing Facility Patients.
                         Special Billing Instructions for Rural Health
                          Centers and Federally Qualified Health
                          Centers.
                         Payment Requirements.
                         Payment Methodology and Healthcare Common
                          Procedure Coding System Coding.
                         General Explanation of Payment.
                         Method of Payment for Clinical Laboratory
                          Tests--Place of Service Variation.
                         Hospital Billing Under Part B.
                         Critical Access Hospital Outpatient Laboratory
                          Service.
                         Computer-Aided Detection Add-On Codes.
                         Payment Method for Rural Health Centers and
                          Federally Qualified Health Centers.
                         Healthcare Common Procedure Coding System Codes
                          for Billing.
                         Type of Bill and Revenue Codes for Form CMS-
                          1450.
                         Revenue Code and Health Common Procedure Coding
                          System Codes for Billing.
                         Payment Method--Fiscal Intermediaries and
                          Carriers.
                         Healthcare Common Procedure Coding System,
                          Revenue, and Type of Service Codes.
                         Ambulatory Blood Pressure Monitoring Billing
                          Requirements.
                         Fiscal Intermediary Billing Requirements.
                         Bill Types.
796....................  Announcement of Medicare Rural Health Clinics
                          and Federally Qualified Health Centers Payment
                          Rate.
797....................  Full Replacement of CR 4095, Diagnosis Code
                          Requirements for Method II.
                         Home Dialysis Claims CR 4095 Is Rescinded.
                         Supplier Documentation Required.
798....................  Emergency Update to the 2006 Medicare Physician
                          Fee Schedule Database.
799....................  Reminder Notice of the Implementation of
                          Ambulance Transition Schedule.
800....................  Clinical Diagnostic Laboratory Date of Service
                          for Archived Specimens.
801....................  Instructions for Reporting New HCPCS Code V2788
                          for Presbyopia-Correcting Intraocular Lenses.
                         Presbyopia-Correcting Intraocular Lenses
                          (General Policy Information).
                         Payment for Physician Services and Supplies.
                         Coding and General Billing Requirements.
                         Provider Notification Requirements.
                         Beneficiary Liability.

[[Page 14911]]

 
802....................  Termination of the Medicare HIPAA Incoming
                          Claim Contingency Plan, Addition of a Self-
                          Assessable Unusual Circumstance, Modification
                          of the Obligated to Accept as Payment in Full
                          Exception, and Modification of Administrative
                          Simplification Compliance Act Exhibit Letters
                          A, B and C General HIPAA Electronic Data
                          Interchange Requirements.
                         Continued Support of Pre-HIPAA Electronic Data
                          Interchange Formats.
                         National Council Prescription Drug Plans
                          Narrative Portion of Prior Authorization
                          Segment.
                         A/X12 837 Coordination of Benefits.
                         C/Legacy Formats.
                         Use of Imaging, External Keyshop, and In-House
                          Keying for Entry of Transaction Data Submitted
                          on Paper.
                         Electronic Data Interchange Receiver Testing by
                          Carriers, Durable Medical Equipment Regional
                          Carriers and Intermediaries.
                         Carrier, Durable Medical Equipment Regional
                          Carrier, and Fiscal Intermediary Submitter/
                          Receiver Testing with Legacy Formats during
                          the HIPAA Contingency Period.
                         Discontinuation of Use of Coordination of
                          Benefit Claim Legacy Formats Following
                          Successful HIPAA Format Testing.
                         Free Claim Submission Software.
                         Key Shop and Image Processing.
                         Mandatory Electronic Submission of Medicare
                          Claims.
                         Exceptions.
                         Unusual Circumstance Waivers.
                         Unusual Circumstance Waivers Subject to
                          Provider Self-Assessment.
------------------------------------------------------------------------
                        Medicare Secondary Payer
                            (CMS Pub. 100-05)
------------------------------------------------------------------------
37.....................  Manualizing Long-Standing Medicare Secondary
                          Payer Policy in Chapter 3 of the Medicare
                          Secondary Payer Internet Only Manual.
                         Limitation on Right To Charge a Beneficiary
                          Where Services Are Covered by a Group Health
                          Plan.
                         Right of Providers to Charge Beneficiary Who
                          Has Received Primary Payment From a Group
                          Health Plan.
                         Right of Physicians and Other Suppliers To
                          Charge Beneficiary Who Has Received Primary
                          Payment From a Group Health Plan.
                         Payment When Proper Claim Not Filed.
                         Situations in Which Medicare Secondary Payer
                          Billing Applies.
                         Provider, Physician, and Other Supplier
                          Responsibility When a Request is Received From
                          an Insurance Company or Attorney.
                         Provider, Physician, and Other Supplier
                          Responsibility When Duplicate Payments Are
                          Received.
                         Incorrect Group Health Plan Primary Payments.
                         Retroactive Application.
                         General Policy.
                         Provider, Physician, and Other Supplier
                          Billing.
                         Provider Billing Where Services Are Covered by
                          a Group Health Plan.
                         Provider Billing Where Services Are Accident-
                          Related and No-Fault Insurance May Be
                          Available.
                         Provider Bills No-Fault Insurance First.
                         No-Fault Insurance Does Not Pay.
                         Liability Claim Also Involved.
                         Responsibility of Provider Where Benefits May
                          Be Payable Under Workers' Compensation.
                         Responsibility of Provider Where Benefits May
                          Be Payable Under the Federal Black Lung
                          Program.
                         Provider Billing Medicare for Secondary
                          Benefits Where Services Are Covered by a Group
                          Health Plan.
                         Instructions to Providers on How To Submit
                          Claims to a Contractor When There Are Multiple
                          Payers.
                         Instructions to Physicians and Other Suppliers
                          on How to Submit Claims to Contractors When
                          There Are One or More Primary Payers.
                         Completing the Form CMS 1450 in Medicare
                          Secondary Payer Situations by Providers.
                         Inpatient Services.
                         Outpatient Bills, Part B Inpatient Services,
                          and Home Health Agency Bills.
                         Partial Payment by Primary Payer for Inpatient
                          Services, Outpatient Services, Part B
                          Inpatient Services and Home Health Agency
                          Bills.
                         Partial Payment by Primary Payer That Applies
                          to Medicare Covered Services.
                         Annotation of Claims Denied by Group Health
                          Plans, Liability or No-Fault Insurers.
                         Annotation of Claims to Request Conditional
                          Payments.
                         Completing the Form CMS 1500 in MSP Situations
                          by Physicians and Other Suppliers of Services.
38.....................  Hospital Audit Workload Updates.
                         Hospital Review Protocol for Medicare Secondary
                          Payer.
                         Reviewing Hospital Files.
                         Frequency of Reviews and Hospital Selection
                          Criteria.
                         Methodology for Review of Admission and Bill
                          Processing Procedures.
                         Selection of Bill Sample.
                         Methodology for Review of Hospital Billing
                          Data.
                         Review of Form CMS-1450.
                         Use of Systems Files for Review.
                         Assessment of Hospital Review.
39.....................  Request to Change Lead Contractor.
                         Coordination with the Coordination of Benefits
                          Contractor.
                         Contractors Medicare Secondary Payer Auxiliary
                          File Update Responsibility.
                         Coordination of Benefit Contractor Electronic
                          Correspondence Referral System.

[[Page 14912]]

 
                         Providing Written Documents to the Coordination
                          of Benefit Contractor.
                         Contractor Record Retention.
                         Notification to Contractor of Medicare
                          Secondary Payer Auxiliary File Updates.
                         Referring Calls to Coordination of Benefit
                          Contractor.
                         Changes in Contractor Initial Medicare
                          Secondary Payer Development Activities.
                         Additional Activities Arranged by Non-Group