Medicare and Medicaid Programs; Quarterly Listing of Program Issuances-January Through March 2006, 36101-36118 [06-5486]

Agencies

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

[Federal Register Volume 71, Number 121 (Friday, June 23, 2006)]
[Notices]
[Pages 36101-36118]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 06-5486]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-9035-N]


Medicare and Medicaid Programs; Quarterly Listing of Program 
Issuances--January Through March 2006

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

ACTION: Notice.

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SUMMARY: This notice lists CMS manual instructions, substantive and 
interpretive regulations, and other Federal Register notices that were 
published from January 2006 through March 2006, 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

[[Page 36102]]

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 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

[[Page 36103]]

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.

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 
``Cardiac Catheterization Performed in Other Than a Hospital Setting,'' 
use CMS-Pub. 100-03, Transmittal No. 46.

(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance, Program No. 93.774, Medicare--
Supplementary Medical Insurance Program, and Program No. 93.714, 
Medical Assistance Program.)

    Dated: June 6, 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.

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)
March 24, 2006 (71 FR 14903)

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

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

        Addendum III.--Medicare and Medicaid Manual Instructions
                      [January through March 2006]
------------------------------------------------------------------------
    Transmittal No.               Manual/subject/publication No.
------------------------------------------------------------------------
             Medicare General Information (CMS Pub. 100-01)
------------------------------------------------------------------------
34.....................  Change Management Process--Electronic Change
                          Information Management Portal (eChimp).

[[Page 36104]]

 
35.....................  Revisions to Instructions for Contractors Other
                          Than the Religious Nonmedical Health Care
                          Institution Specialty Contractor Regarding
                          Claims for Beneficiaries With Religious
                          Nonmedical Health Care Institution Elections.
                         Religious Nonmedical Health Care Institution
                          Defined.
36.....................  Scheduled Release for April 2006 Software
                          Programs and Pricing/Coding Files.
------------------------------------------------------------------------
                Medicare Benefit Policy (CMS Pub. 100-02)
------------------------------------------------------------------------
44.....................  Update to the End-Stage Renal Disease Composite
                          Payment Rates.
                         New End-Stage Renal Disease Composite Payment
                          Rates Effective January 1, 2006.
45.....................  Revisions to Instructions for Contractors Other
                          Than the Religious Nonmedical Health Care
                          Institution Specialty Contractor Regarding
                          Claims for Beneficiaries With Religious
                          Nonmedical Health Care Institution Elections.
                         Religious Nonmedical Health Care Institution
                          Services.
                         Beneficiary Eligibility for Religious
                          Nonmedical Health Care Institution Services.
                         Election of Religious Nonmedical Health Care
                          Institution Benefits.
                         Revocation of Religious Nonmedical Health Care
                          Institution Election.
                         Religious Nonmedical Health Care Institution
                          Election After Prior Revocation.
                         Medicare Payment for Religious Nonmedical
                          Health Care Institution Services and
                          Beneficiary Liability.
                         Coverage of Religious Nonmedical Health Care
                          Institution Items Furnished in the Home.
                         Coverage and Payment of Durable Medical
                          Equipment Under the Religious Nonmedical
                          Health Care Institution Home Benefit.
                         Coverage and Payment of Home Visits Under the
                          Religious Nonmedical Health Care Institution
                          Home Benefit.
46.....................  This Transmittal is rescinded and replaced by
                          Transmittal 47.
47.....................  Therapy Caps Exception Process.
                         Coverage of Outpatient Rehabilitation Therapy
                          Services (Physical Therapy, Occupational
                          Therapy, and Speech-Language Pathology
                          Services) Under Medical Insurance.
                         Documentation Requirements for Therapy
                          Services.
48.....................  Glaucoma Screening Services.
                         Preventive and Screening Services.
                         Glaucoma Screening.
49.....................  Payment of Federally Qualified Health Centers
                          for Diabetes Self Management Training Services
                          and Medical Nutrition Therapy Services.
                         Rural Health Clinic and Federally Qualified
                          Health Center Service Defined.
                         Rural Health Clinic Services.
                         Federally Qualified Health Center Services.
------------------------------------------------------------------------
       Medicare National Coverage Determinations (CMS Pub. 100-03)
------------------------------------------------------------------------
46.....................  Cardiac Catheterization Performed in Other Than
                          a Hospital Setting.
47.....................  Changes to the Covered Indications for Tumor
                          Antigen by Immunoassay CA 125 to Add Primary
                          Peritoneal Carcinoma.
                         Tumor Antigen by Immunoassay CA 125.
48.....................  Technical Corrections to the NCD Manual.
                         Hyperbaric Oxygen Therapy.
                         Home Glucose Monitors.
                         Vitrectomy.
                         Abortion.
                         Diathermy Treatment.
                         Assessing Patients Suitability for Electrical
                          Nerve Stimulation Therapy.
                         Electroencephalographic Monitoring During
                          Surgical Procedures Involving the Cerebral
                          Vasculature.
                         Diagnostic Pap Smears.
                         Human Immunodeficiency Virus Testing
                          (Diagnosis).
                         Prostate Cancer Screening Tests.
                         Screening Pap Smears and Pelvic Examinations
                          for Early Detection of Cervical Or Vaginal
                          Cancer.
                         Non-Implantable Pelvic Floor Electrical
                          Stimulator.
                         Levocarnitine for Use in the Treatment of
                          Carnitine Deficiency in End-Stage Renal
                          Disease Patients.
                         Adult Liver Transplantation.
                         Obsolete or Unreliable Diagnostic Tests.
49.....................  Microvolt T-Wave Alternans Diagnostic Testing.
50.....................  External Counterpulsation Therapy.
------------------------------------------------------------------------
              Medicare Claims Processing (CMS Pub. 100-04)
------------------------------------------------------------------------
803....................  Administration of Drugs and Biologicals in a
                          Method II Critical Access Hospital--Rescinds
                          and replaces Change Request 3911.
                         Costs of Emergency Room On-Call Providers.
                         Coding for Administering Drugs in a Method II
                          Critical Access Hospital.
                         Coding for Low Osmolar Contrast Material.
                         Coding for Administration of Other Drugs and
                          Biologicals.
804....................  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.
805....................  Annual Update to the Therapy Code List.
                         Healthcare Common Procedure Coding System
                          Coding Requirement.

[[Page 36105]]

 
806....................  Termination of Healthcare Common Procedure
                          Coding System Codes Payable During the
                          Transition to the Ambulance Fee Schedule.
807....................  Revision to IOM 100-4, Chapter 12, Sections
                          90.4.1.1 and 90.4.2.
                         Carrier Web Pages.
                         Health Professional Shortage Area Designations.
808....................  Nursing Facility Services (Codes 99304--99318).
809....................  Update to Payment Rates for Religious
                          Nonmedical Health Care Institution Services
                          Furnished in the Home, Calendar Year 2006.
810....................  Issued to a specific audience, not posted to
                          Internet/Intranet due to Confidentiality of
                          Instruction.
811....................  Teaching Physician Services.
                         Payment for Physician Services in Teaching
                          Settings Under the Medicare Physician Fee
                          Schedule.
                         Evaluation and Management Services.
                         Surgical Procedures.
                         Psychiatry.
                         Time-Based Codes.
                         Miscellaneous.
                         Assistants at Surgery in Teaching Hospitals.
812....................  Medicare Payment for Pre-Administration-Related
                          Services Associated With Intravenous Immune
                          Globulin Administration.
813....................  Instructions for the Payment of Health
                          Professional Shortage Area and Physician
                          Scarcity Area Bonuses When the Place of
                          Service is ``Home.''
814....................  Claim Status Category Code and Claim Status
                          Code Update.
815....................  Healthcare Provider Taxonomy Codes Update.
816....................  Coverage and Billing for Ultrasound Stimulation
                          for Nonunion Fracture Healing.
                         Durable Medical Equipment Regional Carrier
                          Billing Instructions.
817....................  Update to the Inpatient Provider Specific File
                          and the Outpatient Provider Specific File to
                          Retain Provider Information.
                         Outpatient Provider Specific File.
818....................  Smoking and Tobacco-Use Cessation Counseling
                          Services: Common Working File Inquiry for
                          Providers.
                         Common Working File Inquiry.
819....................  Modification to Quarterly Refund Modifier Edit
                          for Automatic Implantable Cardiac
                          Defibrillator Services.
820....................  Sites of Service Revenue Codes for Rural Health
                          Clinics and Federally Qualified Health
                          Centers.
                         General Billing Requirements.
821....................  Billing and Payment of Certain Colorectal
                          Cancer Screenings for Non-Patients.
                         Type of Bill 14X.
                         Payment.
                         Billing Requirements for Claims Submitted to
                          Fiscal Intermediaries.
822....................  Update of Radiopharmaceutical Imaging Agents
                          Healthcare Common Procedure.
                         Coding System Codes Applicable to Positron
                          Emission Tomography.
                         Tracer Codes Required for Positron Emission
                          Tomography Scans.
823....................  New Temporary Code for Battery for Power
                          Mobility Devices.
                         Description of Healthcare Common Procedure
                          Coding System.
824....................  Quarterly Update to Correct Coding Initiative
                          Edits, V12.1, Effective April 1, 2006.
825....................  System Edits for Respiratory Assist Devices
                          with Bi-Level Capability and a Back-Up Rate.
826....................  April Quarterly Update to the 2006 Annual
                          Update of Healthcare Common Procedure Coding
                          System Codes Used for Skilled Nursing Facility
                          Consolidated Billing Enforcement.
827....................  Use of 12X Type of Bill for Billing Screening
                          Mammography, Screening Pelvic Examinations,
                          and Screening Pap Smears.
                         Billing Requirements--Fiscal Intermediary
                          Claims.
                         Rural Health Center/Federally Qualified Health
                          Center Claims With Dates of Service on or
                          After January 1, 2002.
                         Type of Bill and Revenue Codes for Form CMS-
                          1450.
                         Revenue Code and Healthcare Common Procedure
                          Coding System Codes for Billing.
828....................  Mammography Facility Certification File--
                          Updated Procedures and Content Mammography
                          Quality Standards Act.
                         Mammography Quality Standards Act File.
829....................  Modification of Roster Billing for Mass
                          Immunizers Billing for Inpatient Part B
                          Services (Type of Bills 12X and 22X).
                         Claims Submitted to Intermediaries for Mass
                          Immunizations of Influenza and Pneumococcal
                          Pneumonia Vaccine.
830....................  Denial of Claims Not Timely Filed.
                         Time Limitations for Filing Provider Claims to
                          Fiscal Intermediaries and Carriers.
                         Determination of Untimely Filing and Resulting
                          Actions.
                         Time Limitations for Filing Part B Reasonable
                          Charge and Fee Schedule Claims.
                         Time Limit for Filing.
831....................  Shared Systems Medicare Secondary Payer
                          Balancing Edit and Administrative
                          Simplification Compliance Act Enforcement
                          Update.
                         Crossover Claim Requirements.
                         Enforcement.
832....................  This Transmittal is rescinded and replaced by
                          Transmittal 868.
833....................  Medicare Remit Easy Print Enhancements, and
                          Clarification of Check Issue/Electronic Funds
                          Transfer Effective Date.
834....................  Revision to Health Professional Shortage Area
                          and Physician Scarcity Area Bonus Billing for
                          Some Globally Billed Services.
                         Services Eligible for Health Professional
                          Shortage Act and Physician Scarcity Bonus
                          Payment.
835....................  New Temporary Codes for Adjustable Wheelchair
                          Cushions.
836....................  This Transmittal is rescinded and replaced by
                          Transmittal 843.
837....................  Coordination of Benefits Agreement Full Claim
                          File Repair Process.
                         Coordination of Benefits Agreement Detailed
                          Error Report Notification Process.

[[Page 36106]]

 
                         Coordination of Benefits Agreement Full Claim
                          File Repair Process.
838....................  Corrections to Common Working File Editing of
                          Home Health Prospective Payment System Claims
                          Regarding Non-Covered Episodes and Prior
                          Inpatient Stays and Fiscal Intermediary Shared
                          System Implementation of 2006 Therapy Code
                          Update.
839....................  This Transmittal is rescinded and replaced by
                          Transmittal 866.
840....................  This Transmittal is rescinded and replaced by
                          Transmittal 882.
841....................  MCS Screen Expansion for the Prescription Order
                          Number for the Competitive Acquisition Program
                          for Part B Drugs to be Developed Over the July
                          2006 and October 2006 Release With Final
                          Implementation on October 2, 2006.
842....................  Issued to a specific audience, not posted to
                          Internet/Intranet due to Confidentiality of
                          Instruction.
843....................  Inpatient Admission Followed by Discharge or
                          Death Prior to Room Assignment.
                         Charges to Beneficiaries for Part A Services.
844....................  This Transmittal is rescinded and replaced by
                          Transmittal 890.
845....................  National Council for Prescription Drug Program
                          Coordination of Benefits Workaround
                          Instructions.
846....................  New Skilled Nursing Facility Consolidated
                          Billing Web Site Address.
                         Services Beyond the Scope of the Part A Skilled
                          Nursing Facility Benefit.
                         Skilled Nursing Facility Consolidated Billing
                          Annual Update Process for Fiscal
                          Intermediaries.
                         Edit for Therapy Services Separately Payable
                          When Furnished by a Physician.
                         Annual Update Process.
                         Billing for Medical and Other Health Services.
                         Carrier Claims Processing for Consolidated
                          Billing for Physician and Non-Physician
                          Practitioner Services Rendered to
                          Beneficiaries in a Non-Covered Skilled Nursing
                          Facility Stay.
847....................  Hold on Medicare Payments.
848....................  Issued to a specific audience, not posted to
                          Internet/Intranet due to Confidentiality of
                          Instruction.
849....................  Update to the End-stage Renal Disease Composite
                          Payment Rates.
                         Drug Payment Amounts for Facilities.
850....................  Change Payment Floor Date for Paper Claims.
                         Payment Floor Standards.
851....................  Revisions to Instructions for Contractors Other
                          Than the Religious Nonmedical Health Care
                          Institutions Specialty Contractor Regarding
                          Claims for Beneficiaries With Religious
                          Nonmedical Health Care Institutions Election.
                         Religious Nonmedical Health Care Institution
                          Admission.
                         Designated Fiscal Intermediaries and Carriers.
                         Billing and Processing Instructions for
                          Religious Nonmedical Health Care Institutions
                          Claims.
                         Religious Nonmedical Health Care Institutions
                          Election Process.
                         Requirement for Religious Nonmedical Health
                          Care Institutions Election.
                         Revocation of Religious Nonmedical Health Care
                          Institutions Election.
                         Completion of the Uniform (Institutional
                          Provider) Bill (Form CMS 1450) Notice of
                          Election for Religious Nonmedical Health Care
                          Institutions.
                         Common Working File Processing of Elections,
                          Revocations and Cancelled Elections.
                         Billing Process for Religious Nonmedical Health
                          Care Institutions Services.
                         When to Bill for Religious Nonmedical Health
                          Care Institutions Services.
                         Required Data Elements on Claims for Religious
                          Nonmedical Health Care Institution Services.
                         Religious Nonmedical Health Care Institutions
                          Claims Processing by Religious Nonmedical
                          Health Care Institutions Specialty Contractor.
                         Informing Beneficiaries of the Results of
                          Religious Nonmedical Health Care Institutions
                          Claims Processing.
                         Billing and Payment of Religious Nonmedical
                          Health Care Institutions Items and Services
                          Furnished in the Home.
                         Processing Claims For Beneficiaries With
                          Religious Nonmedical Health Care Institutions
                          Elections by Contractors Other Than the
                          Religious Nonmedical Health Care Institutions
                          Specialty Intermediary.
                         Recording Determinations of Excepted/
                          Nonexcepted Care on Claim Records Informing
                          Beneficiaries of the Results of Excepted/
                          Nonexcepted Care Determinations by the Non-
                          specialty Contractor.
852....................  Ambulance Fee Schedule--CY 2006 Update:
                          Correction to CR 4061 Ambulance Inflation
                          Factor.
853....................  This Transmittal is rescinded and replaced by
                          Transmittal 855.
854....................  Medicare Summary Notice Format Changes for
                          Durable Medical Equipment.
                         Medicare Administrative Contracts Transition.
                         Title Section of the Medicare Summary Notice.
                         Appeals Section.
855....................  Therapy Caps Exception Process.
                         The Financial Limitation.
856....................  January 2006 Quarterly Average Sales Price
                          Medicare Part B Drug Pricing File, Effective
                          January 1, 2006, and Revisions to April 2005,
                          July 2005, and October 2005 Quarterly Average
                          Sales Price Medicare Part B Drug Pricing
                          Files.
857....................  Medicare Part B Drug Pricing Update--Payment
                          Limit for J7620.
858....................  This Transmittal is rescinded and replaced by
                          Transmittal 873.
859....................  Remittance Advice Remark Code and Claim
                          Adjustment Reason Code Update.
860....................  Remittance Advice Remark Code and Claim
                          Adjustment Reason Code Update.
861....................  Sunset of the Policies for Provider Nominations
                          for an Intermediary and the Provider Requests
                          for a Change of Intermediary--Revisions to
                          Publication 100-04, Chapter 1, Section 20.
                         Provider Assignment to a Fiscal Intermediary.
                         Provider Change of Ownership.
                         Multi-State Provider Chains Billing Fiscal
                          Intermediaries.
                         CMS No Longer Accepts Provider Requests to
                          Change Their Fiscal Intermediary.
                         Solicitation of a Provider to Secure a Change
                          of Fiscal Intermediary.
                         Communications.

[[Page 36107]]

 
862....................  Appeals of Claims Decisions: Administrative Law
                          Judge; Departmental Appeals Board; U.S.
                          District Court Review.
                         Administrative Law Judge--The Third Level of
                          Appeal.
                         Right to an Administrative Law Judge Hearing.
                         Requests for an Administrative Law Judge
                          Hearing.
                         Forwarding Request to Department of Health &
                          Human Services/Office of Medicare Hearings and
                          Appeals.
                         Review and Effectuation of Administrative Law
                          Judge Decisions.
                         Effectuation Time Limits & Responsibilities.
                         Duplicate Administrative Law Judge Decisions.
                         Payment of Interest on Administrative Law Judge
                          Decisions.
                         Departmental Appeals Board--The Fourth Level of
                          Appeal.
                         Recommending Agency Referral of Administrative
                          Law Judge Decisions or Dismissals.
                         Effectuation of Departmental Appeal Board
                          Orders and Decisions.
                         Requests for Case Files.
                         Payment of Interest on Departmental Appeals
                          Board Decisions.
                         U.S. District Court Review--The Fifth Level of
                          Appeal.
                         Requests for U.S District Court Review by a
                          Party.
                         Effectuation of U.S District Court Decisions.
                         Payment of Interest of U.S. District Court
                          Decisions.
863....................  Update to Chapter 20, ``Billing for Oxygen and
                          Oxygen Equipment,'' Section 130.6.
                         Billing for Oxygen and Oxygen Equipment.
864....................  Changes to the Laboratory National Coverage
                          Determination Edit Software for April 2006.
865....................  Health Common Procedure Coding System Codes
                          Subject to and Exclude from Clinical
                          Laboratory Improvement Amendments Edits.
                         Verifying Clinical Laboratory Improvement Act
                          Certification.
                         Certificate for Physician-Performed Microscopy
                          Procedures.
                         Clinical Laboratory Improvement Act License or
                          Licensure Exemption.
866....................  Additional Requirements for the Competitive
                          Acquisition Program for Part B Drugs.
                         Duplicates.
                         General Information Section.
                         Duplicados.
                         Seccion De Informacion General.
                         The Competitive Acquisition Program of
                          Outpatient Drugs and Biologicals Under Part B.
                         Physician Election and Information Transfer
                          Between Carriers and the Designated Carrier
                          for Competitive Acquisition Program Claims.
                         Physician Information for the Designated
                          Carrier.
                         Quarterly Updates.
                         Format for Data.
                         Physician Information for the Vendors.
                         Claims Processing Instructions for Competitive
                          Acquisition Program Claims for The Local
                          Carrier.
                         Competitive Acquisition Program Required
                          Modifiers.
                         Submitting the Administration/Evaluation and
                          Management Services and the No Pay Service
                          Lines.
                         Submitting the Prescription Order Numbers and
                          No Pay Modifiers.
                         Competitive Acquisition Program Claims
                          Submitted With Only the No Pay Line.
                         Only Competitive Acquisition Program Related
                          Services on a Claim.
                         Use of the Restocking Modifier.
                         Use of the Furnish as Written Modifier.
                         Monitoring of Claims Submitted With the J2 and/
                          or J3 Modifiers.
                         Claims Submitted for Only Drugs Listed on the
                          Approved CAP Vendors Drug List.
                         Application of Local Medical Review Policies.
                         Claims Processing Instructions for the
                          Designated Carrier.
                         Creation of Internal Vendor Provider Files.
                         Submission of Paper Claims by Vendors.
                         Submission of Claims from Vendors With the J1
                          No Pay Modifier.
                         Submission of Claims from Vendors Without a
                          Provider Primary Identifier for The Ordering
                          Physician.
                         New Medicare Summary Notice Message To Be
                          Included on All Vendor Claims Additional
                          Medical Information.
                         Competitive Acquisition Program Fee Schedule.
                         Matching the Physician Claim to the Vendor
                          Claim.
                         Denials Due to Medical Necessity.
                         Denials For Reasons Other Than Medical
                          Necessity.
                         Changes to Pay/Process Indicators.
                         Post-Payment Overpayment Recovery Actions.
                         Pending and Recycling the Claim When All Lines
                          Do Not Have a Match.
                         Creation of a Weekly Report for Claims That
                          Have Pended More Than 90 Days and Subsequent
                          Action.
                         Coordination of Benefits.
                         National Claims History.
                         Adding New Drugs to Competitive Acquisition
                          Program.
                         Updating Fee Schedule for New Drugs in
                          Competitive Acquisition Program.
                         Non-Participating Physicians Who Elect the
                          Competitive Acquisition Program.
                         Discarded Drugs and Biologicals.
                         Carrier Specific Requirements for Certain
                          Specialties/Services.

[[Page 36108]]

 
867....................  Elimination of the Durable Medical Equipment
                          Regional Carrier Information Form.
                         Billing Drugs Electronically--National Council
                          of Prescription Drug Programs.
                         Certificate of Medical Necessity.
868....................  Payment of Same Day Transfer Claims Under the
                          Inpatient Psychiatric Facility Prospective
                          Payment System.
869....................  Installation of Pricing Software Containing the
                          Customer Information Control System Formatting
                          Update.
870....................  Type of Service Corrections.
871....................  2005 Revised American National Standards
                          Institute X12N 837 Professional Health Care
                          Claim Companion Document.
872....................  New Waived Tests.
873....................  Increase Remittance File Retention.
874....................  Instructions for Downloading the Medicare Zip
                          Code File.
875....................  Maintenance and Update of the Temporary Hook
                          Created to Hold Out Patient Prospective
                          Payment System Claims That Include Certain
                          Drug Healthcare Common Procedure Coding System
                          Codes.
876....................  April 2006 Quarterly Average Sales Price
                          Medicare Part B Drug Pricing File and
                          Revisions to January 2005, April 2005, July
                          2005, October 2005, and January 2006 Quarterly
                          Average Sales Price Medicare Part B Drug
                          Pricing Files.
877....................  Changes in Transitional Outpatient Payments for
                          Rural Sole Community Hospitals and Small Rural
                          Hospitals for 2006.
878....................  Healthcare Integrated General Ledger Accounting
                          System and 835 Implementation Guide Provider
                          Adjustment Code Mapping and Standard Paper
                          Remittance Advice Changes.
879....................  Announcement of Federally Qualified Health
                          Centers Designation As Urban and Rural--
                          Skilled Nursing Facility Consolidated Billing
                          As It Applies to FQHC Services Furnished to
                          Swing-Bed Patients.
880....................  April Quarterly Update for 2006 Durable Medical
                          Equipment, Prosthetics, Orthotics, and
                          Supplies Fee Schedule.
881....................  Outpatient Prospective Payment System Hospital
                          Emergency Room Services Exceeding 24 Hours.
                         Accurate Reporting of Surgical and Medical
                          Procedures and Services.
882....................  Hospital Billing for Take-Home Drugs.
                         Claims Processing Jurisdiction for Oral Anti-
                          Emetic Drugs.
                         Billing and Payment Instructions for Fiscal
                          Intermediaries.
883....................  Claims Processing Requirements for Medicare
                          Beneficiaries in State or Local Custody Under
                          a Penal Authority--Manualization.
884....................  Issued to a specific audience, not posted to
                          Internet/Intranet due to Confidentiality of
                          Instruction.
885....................  Suppression of Standard Paper Remittance Advice
                          to Providers and Suppliers Also Receiving
                          Electronic Remittance Advice for 45 Days or
                          More.
                         Medicare Remit Easy Print Software for Carrier
                          and Durable Medical Equipment Regional Carrier
                          Provider/Supplier Use.
886....................  April 2006 Update to the Medicare Outpatient
                          Code Editor Version 21.2 for Bills From
                          Hospitals That Are Not Paid Under The
                          Outpatient Prospective Payment System.
887....................  Correction to Change Request 4282--Application
                          of Temporary 5 Percent Payment Increase for
                          Home Health Services Furnished in a Rural Area
                          for One Year Under the Home Health Prospective
                          Payment System.
888....................  April 2006 Outpatient Prospective Payment
                          System Code Editor Specifications Version 7.1.
889....................  This Transmittal is rescinded and replaced by
                          Transmittal 897.
890....................  Guidelines for Payment of Vaccine (Pneumococcal
                          Pneumonia Virus, Influenza Virus, and
                          Hepatitis B Virus) Administration.
                         Healthcare Common Procedure Coding System and
                          Diagnosis Codes.
                         Fiscal Intermediary Payment for Pneumococcal
                          Pneumonia Virus, Influenza Virus, and
                          Hepatitis B Virus Vaccines and Their
                          Administration.
891....................  Redesignate HCPCS Codes J8597 and E1239 to
                          Their Proper Common Working File Category.
892....................  Eligibility Transaction URL update.
                         Eligiblity Extranet Workflow.
893....................  2006 Juridiction List.
894....................  Microvolt T-Wave Alternans Diagnostic Testing.
895....................  Expansion of Glaucoma Screening Services.
                         Remittance Advice Notices.
                         Medicare Summary Notice Messages.
896....................  April 2006 Update of the Hospital Outpatient
                          Prospective Payment System: Summary of Payment
                          Policy Changes.
897....................  April Update to the 2006 Medicare Physician Fee
                          Schedule Database.
898....................  External Counterpulsation Therapy.
                         Billing and Payment Requirements.
                         Special Intermediary Billing and Payment
                          Requirements.
899....................  Revised Health Insurance Claim Form CMS-1500.
                         Items 14-33--Provider of Service or Supplier
                          Information.
                         Patient's Request for Medicare Payment Form CMS-
                          1490S.
                         Printing Standards and Print File
                          Specifications Form CMS-1500.
------------------------------------------------------------------------
               Medicare Secondary Payer (CMS Pub. 100-05)
------------------------------------------------------------------------
47.....................  Medicare Secondary Payer Debt Collection and
                          Referral Updates.
                         Debt and Debtor Definitions.
                         Debt Selection and Verification.
                         Debt Selection Criteria.
                         Debts Excluded From Referral.
                         Monitoring Debts Excluded From the Debt
                          Collection Improvement Act Referral Process.
                         Validation of Possible Eligible Debts for
                          Referral.
                         Issuance of the ``Intent to Refer'' Letter and
                          Inquiries/Replies Related to Debt Collection
                          Improvement Act Activities.
                         Issuance of the ``Intent to Refer'' to Treasury
                          Letter.
                         Responding to Correspondence as a Result of the
                          Issuance of the Intent to Refer Letter.

[[Page 36109]]

 
                         Debt Collection System and Debt Collection
                          System Entry.
                         Debt Collection System.
                         Debt Collection System Entry of Delinquent
                          Debt.
                         Contractor Actions Subsequent to Debt
                          Collection System Entry.
                         Steps Contractors Shall Take Upon Knowledge or
                          Receipt of Certain Information.
                         Debt Collection Improvement Act Treasury
                          Collection (Placeholder) Financial Reporting.
48.....................  Request for Claims Detail in Support of
                          Medicare's Debt.
------------------------------------------------------------------------
             Medicare Financial Management (CMS Pub. 100-06)
------------------------------------------------------------------------
88.....................  Clarification to IOM 100-06, Sections 290.7 and
                          290.8.
                         Completing Physician Scarcity Area Quarterly
                          Report, Form CMS-1565F, CROWD Report 6.
                         Checking Reports.
89.....................  Mandated Use of Autoload Program in System
                          Tracking for Audit and Reimbursement.
90.....................  Recurring Update Notification for the Notice of
                          New Interest Rate for Medicare Overpayments
                          and Underpayments.
91.....................  Clarification of Instructions in Pub. 100-6,
                          Chapter 5 Financial Reporting, Section 310.4--
                          Line 4(a) through (e), Reclassified CNC Debt
                          (Principal and Interest).
92.....................  Clarification of the Form CMS-1522 Monthly
                          Contractor Financial Report Procedures for the
                          Reconciliation of Total Funds Expended for
                          Fiscal Intermediary Shared System Medicare
                          Contractors Used in the Preparation of Form
                          CMS-1522 Monthly Contractor Financial Report.
                         Identification and Summarization of Detailed
                          Claims Data Records For Use in the Financial
                          Reconciliation of Total Funds Expended to
                          Fiscal Intermediary Shared System Reports.
                         Using the Electronic Spreadsheet to Complete
                          the Reconciliation of the Detailed Claims Data
                          File to Fiscal Intermediary Shared System
                          Reports.
                         Electronic Spreadsheet Input Schedule.
                         Total Funds Expended (Net Disbursements and
                          Adjustments to Net Disbursements).
                         Reconciliation of Detailed Claims Data File to
                          Fiscal Intermediary Shared Systems System
                          Reports.
                         Reconciliation of Non-Physician Incentive Plan
                          Payments on Fiscal Intermediary Shared Systems
                          System Reports.
                         Reconciliation of Interest Received and Paid on
                          Fiscal Intermediary Shared Systems System
                          Reports.
                         Categorization of Total Funds Expended by
                          Category.
------------------------------------------------------------------------
           Medicare State Operations Manual (CMS Pub. 100-07)
------------------------------------------------------------------------
16.....................  Revisions to Chapter 2, ``The Certification
                          Process,'' Appendix E--``Providers of
                          Outpatient Physical Therapy or Outpatient
                          Speech Language Pathology Services,'' and
                          Appendix K--``Comprehensive Outpatient
                          Rehabilitation Facilities''.
17.....................  Revisions to Chapter 2, The Certification
                          Process.
18.....................  Complete Revision to Chapter 5, ``Complaint
                          Procedures.''
------------------------------------------------------------------------
              Medicare Program Integrity (CMS Pub. 100-08)
------------------------------------------------------------------------
135....................  Changes to the GTL Titles.
                         Prepayment Edits.
                         Location of Postpayment Reviews.
                         Notification of Provider(s) or Supplier(s) and
                          Beneficiaries of the Postpayment Review
                          Results.
                         Evaluation of the Effectiveness of Postpayment
                          Review and Next Steps.
                         Postpayment Files.
                         Overpayment Procedures.
                         Fraud or Willful Misrepresentation Exists--
                          Fraud Suspensions.
                         Overpayment Exists But the Amount Is Not
                          Determined--General Suspensions.
                         Payments to be Made May Not be Correct--General
                          Suspensions.
                         Provider Fails to Furnish Records and Other
                          Requested Information--General Suspensions.
                         CMS Approval.
                         Prior Notice Versus Concurrent Notice.
                         Content of Notice.
                         Shortening the Notice Period for Cause.
                         Mailing the Notice to the Provider.
                         Opportunity for Rebuttal.
                         Claims Review.
                         Duration of Suspension of Payment.
                         Removing the Suspension.
                         Durable Medical Equipment Regional Carriers and
                          Durable Medical Equipment Regional Carrier
                          Program Safeguard Contractors.
                         Other Multi-Regional Contractors.
                         Informational Copies to Primary Government Task
                          Leaders, Associate Government.
                         Task Leaders, Subject Matter Experts, or CMS
                          Regional Office.
                         Notification of Provider or Supplier of the
                          Review and Selection of the Review Site.
                         Sampling Methodology Overturned.
136....................  Policy Changes to Program Integrity Manual.
                         Contractor Medical Director.
137....................  Provider Enrollment Workload and Timeliness
                          Reports.

[[Page 36110]]

 
                         Tracking Requirements.
138....................  This Transmittal is rescinded and replaced by
                          Transmittal 142.
139....................  This Transmittal is rescinded and replaced by
                          Transmittal 140.
140....................  Therapy Caps Exception Process.
                         Exception from the Uniform Dollar Limitation.
                         Prepay Complex Review Workload and Cost.
141....................  Modification to the Unique Physician
                          Identification Number Process.
                         National Registry of Physicians/Health Care
                          Practitioners/Group Practices.
                         Ongoing Data Collection on Physicians/Health
                          Care Practitioners/Group Practices
                          Applications.
                         Physicians/Health Care Practitioners/Group
                          Practices Record--Required Information and
                          Format.
                         Maintaining Physician/Health Care Practitioner/
                          Group Practices Memberships.
                         Validation of Physician/Health Care
                          Practitioner/Group Practice Credentials,
                          Certification, Sanction, and License
                          Information for Prior Practices.
                         Unique Physician Identification Number Cross-
                          Referral Requirement.
                         Maintenance of the Registry.
                         General.
                         Add Records.
                         Adding Physician/Health Care Practitioner/Group
                          Practice Setting.
                         Update Records.
                         Rejections.
                         Exceptions.
                         Batching Procedures.
                         Privacy Act Requirements.
                         Release of Unique Physician Identification
                          Numbers.
                         Release of Unique Physician Identification
                          Numbers to Physicians, Nurse Practitioners,
                          Clinical Nurse Specialists, and Physician
                          Assistants.
                         Automatic Notifications.
                         Unique Physician Identification Number
                          Directory.
                         Unique Physician Identification Numbers for
                          Ordering/Referring Physicians.