Medicare and Medicaid Programs; Quarterly Listing of Program Issuances-July Through September 2006, 77202-77241 [E6-21735]

Agencies

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

[Federal Register Volume 71, Number 246 (Friday, December 22, 2006)]
[Notices]
[Pages 77202-77241]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E6-21735]



[[Page 77201]]

-----------------------------------------------------------------------

Part V





Department of Health and Human Services





-----------------------------------------------------------------------



Centers for Medicare & Medicaid Services



-----------------------------------------------------------------------



Medicare and Medicaid Programs; Quarterly Listing of Program 
Issuances--July Through September 2006; Notice

Federal Register / Vol. 71, No. 246 / Friday, December 22, 2006 / 
Notices

[[Page 77202]]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-9038-N]


Medicare and Medicaid Programs; Quarterly Listing of Program 
Issuances--July Through September 2006

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

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: This notice lists CMS manual instructions, substantive and 
interpretive regulations, and other Federal Register notices that were 
published from July 2006 through September 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 and a list of 
Medicare-approved carotid stent facilities. Included in this notice is 
a list of the American College of Cardiology's National Cardiovascular 
Data registry sites, active CMS coverage-related guidance documents, 
and special one-time notices regarding national coverage provisions.
    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 in 
Addendum VIII 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 Medicare's recognition of the American College 
of Cardiology-National Cardiovascular Data Registry sites in Addendum 
IX may be addressed to JoAnna Baldwin, MS, 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) 
786-7205.
    Questions concerning Medicare's active coverage-related guidance 
documents in Addendum X may be addressed to Kimberly Long, 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) 786-5702.
    Questions concerning one-time notices regarding national coverage 
provisions in Addendum XI may be addressed to Ellie Lund, 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) 786-2281.
    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,

[[Page 77203]]

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 11 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.
     Addendum IX includes a list of the American College of 
Cardiology's National Cardiovascular Data registry sites. We cover 
implantable cardioverter defibrillators (ICDs) for certain indications, 
as long as information about the procedures is reported to a central 
registry.
     Addendum X includes a list of active CMS guidance 
documents. As required by section 731 of the Medicare Prescription 
Drug, Improvement, and Modernization Act of 2003 (MMA) (Pub. L. 108-
173, enacted on December 8, 2003), we will begin listing the current 
versions of our guidance documents in each quarterly listings notice.
     Addendum XI includes a list of special one-time notices 
regarding national coverage provisions. We are publishing a list of 
issues that require public notification, such as a particular clinical 
trial or research study that qualifies for Medicare coverage.

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 https://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/

[[Page 77204]]

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 Benenfit Policy publication 
titled ``Psychological and Neuropsychological Tests,'' use CMS-Pub. 
100-02, Transmittal No. 55.

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

    Dated: December 11, 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.

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)
June 23, 2006 (71 FR 36101)
September 29, 2006 (71 FR 57604)

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

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

         Addendum III--Medicare and Medicaid Manual Instructions
                      [July Through September 2006]
------------------------------------------------------------------------
      Trans.  No.                 Manual/Subject/Publication No.
------------------------------------------------------------------------
                       Medicare General Information
                            (CMS Pub. 100-01)
------------------------------------------------------------------------
40.....................  Scheduled Release for October 2006 Software
                          Programs and Pricing/Coding Files.
------------------------------------------------------------------------
                         Medicare Benefit Policy
                            (CMS Pub. 100-02)
------------------------------------------------------------------------
53.....................  Medicare Telehealth Services Update.
                         List of Medicare Telehealth Services.
54.....................  Clarification/Update to Chapter 8, Pub. 100-02.
                         Requirements--General.
                         Medicare Skilled Nursing Facility Prospective
                          Payment System Overview.
                         Three-Day Prior Hospitalization.
                         Administrative Level of Care Presumption.
                         Daily Skilled Services Defined.
                         Respiratory Therapy.
55.....................  Psychological and Neuropsychological Tests.
------------------------------------------------------------------------
                Medicare National Coverage Determinations
                            (CMS-Pub. 100-03)
------------------------------------------------------------------------
00.....................  None.
------------------------------------------------------------------------
                       Medicare Claims Processing
                            (CMS Pub. 100-04)
------------------------------------------------------------------------
997....................  Medicare Telehealth Services Update.
                         List of Medicare Telehealth Services.
                         Contractor Editing of Telehealth Claims.
998....................  Issued to a specific audience, not posted to
                          Internet/Intranet due to Confidentiality of
                          Instruction.
999....................  Non-Physician Practitioner Payment for Care
                          Plan Oversight.

[[Page 77205]]

 
                         Care Plan Oversight.
                         Care Plan Oversight Services.
                         Care Plan Oversight Billing Requirements.
1000...................  Common Working File to the Medicare Beneficiary
                          Database Data Exchange Changes.
                         The Financial Limitation.
                         Provider Access to Smoking and Tobacco-Use
                          Cessation Counseling.
                         Services Eligibility Data.
1001...................  Modifications to the Common Working File
                          Interrupted Stay Edits for Long Term Care
                          Hospital Claims for Discharges to an Acute
                          Care Hospital.
1002...................  Issued to a specific audience, not posted to
                          Internet/Intranet due to Confidentiality of
                          Instruction.
1003...................  Issued to a specific audience, not posted to
                          Internet/Intranet due to Confidentiality of
                          Instruction.
1004...................  Non-Application of Deductible for Colorectal
                          Cancer Screening Tests Payment.
1005...................  Medicare Physician Fee Schedule Database 2007
                          File Layout.
                         Medicare Physician Fee Schedule Database Status
                          Indicators.
1006...................  Modification to the Coordination of Benefits
                          Agreement Claims.
                         Selection Criteria and File Transfer Protocols.
                         Consolidated Claims Crossover Process.
                         Claims Crossover Disposition Indicators.
                         Consolidation of the Claims Crossover Process.
1007...................  This Transmittal is rescinded and replaced by
                          Transmittal 1041.
1008...................  Medicare Part A Skilled Nursing Facility
                          Prospective Payment System.
                         Pricer Update for FY 2007.
1009...................  Correction to Skilled Nursing Facility
                          Consolidated Billing Enforcement if Skilled
                          Nursing Facility Inpatient Claims are
                          Partially Non-Covered Therapy Services.
1010...................  Additional Requirements Necessary to Implement
                          the Revised Health Insurance Claim Form CMS-
                          1500 (08/05).
                         Health Insurance Claim Form CMS-1500.
                         Items 14-33--Provider of Service or Supplier
                          Information.
1011...................  Instructions for Reporting Hospice Services in
                          Greater Line Item Detail.
                         Levels of Care.
                         Data Required on Claim to Fiscal Intermediary.
1012...................  Issued to a specific audience, not posted to
                          Internet/Intranet due to Confidentiality of
                          Instruction.
1013...................  Issued to a specific audience, not posted to
                          Internet/Intranet due to Sensitivity of
                          Instruction.
1014...................  Issued to a specific audience, not posted to
                          Internet/Intranet due to Sensitivity of
                          Instruction.
1015...................  Issued to a specific audience, not posted to
                          Internet/Intranet due to Confidentiality of
                          Instruction.
1016...................  This Transmittal is rescinded and replaced by
                          Transmittal 1019.
1017...................  This Transmittal is rescinded and replaced by
                          Transmittal 1022.
1018...................  Uniform Billing (UB-04) Implementation.
                         Completing and Processing the CMS-1450 Data
                          Set.
                         Uniform Bill (UB)--Form CMS-1450 for Billing
                          (UB-92).
                         General Instructions for Completion of Form CMS-
                          1450 for Billing (UB-92).
                         Uniform Billing with Form CMS-1450.
                         Disposition of Copies of Completed Forms.
                         General Instructions for Completion of Form CMS-
                          1450 (UB-04).
1019...................  Outpatient Therapy--Additional DRA Mandated
                          Service Edits.
                         Reporting of Service Units With Healthcare
                          Common Procedure Coding System.
1020...................  Issued to a specific audience, not posted to
                          Internet/Intranet due to Confidentiality of
                          Instruction.
1021...................  2007 Annual Update for the Health Professional
                          Shortage Area Bonus Payment.
1022...................  Issued to a specific audience, not posted to
                          Internet/Intranet due to Confidentiality of
                          Instruction.
1023...................  Update To The Hospice Payment Rates, Hospice
                          Cap, Hospice Wage Index, and the Hospice
                          Pricer For Fiscal Year 2007.
1024...................  This Transmittal is rescinded and replaced by
                          Transmittal 1054.
1025...................  Revised Home Health Advance Beneficiary Notice.
                         Beneficiary-Driven Demand Billing Home Health
                          Prospective Payment System.
                         No Payment Billing.
                         Advance Beneficiary Notices for Part B Services
                          Furnished in a Skilled Nursing Facility.
                         Background on the Home Health Advance
                          Beneficiary Notice.
                         Home Health Advance Beneficiary Notice
                          Triggering Events.
                         Completing the Home Health Advance Beneficiary
                          Notice.
                         Special Issues Associated with the Home Health
                          Advance Beneficiary Notice.
                         Effective Delivery/Effective Home Health
                          Advance Beneficiary Notices.
                         Defective Home Health Advance Beneficiary
                          Notices.
                         Collection of Funds and Liability Related to
                          the Home Health Advance Beneficiary Notice.
                         Revision, Re-issuance, and Retention of the
                          Home Health Advance Beneficiary Notice.
                         Form CMS-20007--Notice of Exclusions From
                          Medicare Benefits.
                         Using Notice of Exclusions From Medicare
                          Benefits With Categorical Denial.s
                         Using Notice of Exclusions From Medicare
                          Benefits With Technical Denials.
1026...................  Medicare Telehealth Services.
                         Originating Site Facility Fee Payment
                          Methodology.
                         Submission of Telehealth Claims for Distant
                          Site Practitioners.
1027...................  This Transmittal is rescinded and replaced by
                          Transmittal 1040.
1028...................  Downloading the Medicare Zip Code File.

[[Page 77206]]

 
1029...................  Schedule for Completing the Calendar Year 2007
                          Fee Schedule Updates and the Participating
                          Physician Enrollment Process.
1030...................  Issued to a specific audience, not posted to
                          Internet/Intranet due to Sensitivity of
                          Instruction.
1031...................  Remittance Advice Remark Code and Claim
                          Adjustment Reason Code Update.
1032...................  Correction to Skilled Nursing Facility
                          Consolidated Billing Coding File.
1033...................  Revise Chapters 22 and 24 to Delete References
                          to Free Downloads of X12.
                         Implementation Guides Adopted as Health
                          Insurance Portability and Accountability Act
                          Standards from Washington Publishing Company.
                         Background.
                         Electronic Remittance Advice.
1034...................  Competitive Acquisition Program--Claim
                          Processing for Not Otherwise Classified Drugs.
                         Competitive Acquisition Program Not Otherwise
                          Classified Drugs.
                         Editing for Competitive Acquisition Program Not
                          Otherwise Classified Drugs.
1035...................  Updating Publication 100-04, Chapter 30
                          Regarding the CD ROM Initiative for the Annual
                          ``Dear Doctor'' Mailing.
                         Physician/Practitioner/Supplier Participation
                          Agreement and Assignment--Carrier Claims.
                         Carrier Participation and Billing Limitations.
1036...................  Updates to Chapter 10 of the Medicare Claims
                          Processing Manual.
                         Submission of Request for Anticipated Payment.
                         Adjustments of Episode Payment--Outlier
                          Payments.
                         Request for Anticipated Payment.
                         Home Health Prospective Payment System Claims.
                         Input/Output Record Layout.
                         Medical and Other Health Services Not Covered
                          Under the Plan of Care (Bill Type 34X).
1037...................  October Quarterly Update for 2006 Durable
                          Medical Equipment, Prosthetics, Orthotics and
                          Supplies Fee Schedule.
1038...................  The Coordination of Benefits Agreement
                          Eligibility File Claims Recovery Process.
                         Beneficiary Other Insurance Information
                          Maintenance Transaction Error Codes.
1039...................  Issued to a specific audience, not posted to
                          Internet/Intranet due to Confidentiality of
                          Instruction.
1040...................  Clarifications and Additions to Chapter 19,
                          Indian Health Services.
                         Carrier and Fiscal Intermediary Designation.
                         Durable Medical Equipment Medicare
                          Administrative Contractors Designation.
                         Overview of Medicare Part B Services.
                         Medicare Part B Services.
                         Provider Enrollment.
                         Provider Enrollment with Carrier Entities.
                         Individual Practitioners.
                         Multiple Sites.
                         Reassignment.
                         Mobile Units.
                         Mobile Mammography Units.
                         Clinical Laboratory, Ambulance and Medicare
                          Part B Drugs.
                         Provider Enrollment with Fiscal Intermediary.
                         Provider Enrollment with Fiscal Intermediary--
                          Ambulatory Surgical Services.
                         Provider Enrollment with Fiscal Intermediary--
                          Services Under Arrangements.
                         Provider Enrollment with Durable Medical
                          Equipment Medicare.
                         Administrative Contractor.
                         National Supplier Clearinghouse Supplier
                          Number.
                         Reporting Requirements and Specifications.
                         Incentive Payments.
                         Covered Medicare Part B Services That May Be
                          Paid to Indian Health Service Providers,
                          Physicians and Practitioners.
                         Carrier--Payment Policy and Claims Processing.
                         Carrier--Medicare Part B Physician and
                          Practitioner Services Paid Under the Medicare
                          Physician Fee Schedule--Payment Policy.
                         Carrier--Claims Processing Requirements.
                         Carrier--Ambulance Services--Payment Policy.
                         Carrier--Ambulance Services--Claims Processing.
                         Carrier--Vaccines and Vaccine Administration--
                          Payment Policy.
                         Carrier--Vaccines and Vaccine Administration--
                          Coverage Policy.
                         Carrier--Screening and Preventive Services.
                         Carrier--Clinical Laboratory Services--Payment
                          Policy.
                         Carrier--Clinical Laboratory Services--Claims
                          Processing.
                         Carrier--Medical Nutrition Therapy--Payment
                          Policy.
                         Carrier--Medical Nutrition Therapy--Claims
                          Processing.
                         Dual Eligibility.
                         Durable Medical Equipment General Information.
                         Durable Medical Equipment Prosthetics,
                          Orthotics and Supplies Payment Policy.
                         Licensure to Dispense Drugs.
                         Payment.
                         Durable Medical Equipment, Prosthetics,
                          Orthotics and Supplies Claims.
                         Processing Rules.
                         Services Billed to the Durable Medical
                          Equipment Medicare Administrative Contractors.
                         Prosthetics, Orthotics and Supplies Billed to
                          the Fiscal Intermediary.

[[Page 77207]]

 
                         General Claims Processing Rules for Durable
                          Medical Equipment, Prosthetics, Orthotics and
                          Supplies.
                         Fiscal Intermediary Payment Policy and Claims
                          Processing.
                         Fiscal Intermediary--Medicare Part B Services
                          Paid Under Various Fee Schedule.
                         Fiscal Intermediary--Medicare Part B Services
                          Included in the All Inclusive Rate.
                         Fiscal Intermediary--Inpatient Acute Care--
                          Medicare Part A--Payment Policy.
                         Fiscal Intermediary--Inpatient Acute Care--
                          Medicare Part A--Claims Processing.
                         Fiscal Intermediary--Physician Acknowledgement
                          Statement.
                         Fiscal Intermediary--Social Admissions.
                         Fiscal Intermediary--Inpatient Ancillary
                          Services--Medicare Part B--Payment Policy.
                         Fiscal Intermediary--Inpatient Ancillary
                          Services--Medicare Part B--Claims Processing.
                         Fiscal Intermediary--Swing-Bed.
                         Fiscal Intermediary--Swing-Bed--Medicare Part
                          A--Payment Policy.
                         Fiscal Intermediary--Swing-Bed--Medicare Part
                          A--Claims Processing.
                         Fiscal Intermediary--Swing-Bed--Inpatient
                          Ancillary Services--Medicare Part B--Payment
                          Policy.
                         Fiscal Intermediary--Swing-Bed--Inpatient
                          Ancillary Services--Medicare Part B--Claims
                          Processing.
                         Fiscal Intermediary--Outpatient--Medicare Part
                          B--Payment Policy.
                         Fiscal Intermediary--Outpatient--Medicare Part
                          B--Claims Processing.
                         Fiscal Intermediary--Ambulatory Surgical
                          Center--Medicare Part B--Payment Policy.
                         Fiscal Intermediary--Ambulatory Surgical
                          Center--Medicare Part B--Claims Processing.
                         Fiscal Intermediary--Critical Access Hospital
                          Inpatient--Medicare Part A--Payment Policy.
                         Fiscal Intermediary--Critical Access Hospital
                          Inpatient--Medicare Part A--Claims Processing.
                         Fiscal Intermediary--Critical Access Hospital
                          Ancillary Services--Medicare Part B--Payment
                          Policy.
                         Fiscal Intermediary--Critical Access Hospital
                          Ancillary Services--Medicare Part B--Claims
                          Processing.
                         Fiscal Intermediary--Critical Access Hospital
                          Swing-Bed--Medicare Part A--Payment Policy.
                         Fiscal Intermediary--Critical Access Hospital
                          Swing-Bed--Medicare Part A--Claims Processing.
                         Fiscal Intermediary--Critical Access Hospital
                          Swing-Bed--Inpatient Ancillary Services--
                          Medicare Part B--Payment Policy.
                         Fiscal Intermediary--Critical Access Hospital
                          Swing-Bed--Inpatient Ancillary Services--
                          Medicare Part B Claims Processing.
                         Fiscal Intermediary--Critical Access Hospital
                          Outpatient--Medicare Part B--Payment Policy.
                         Fiscal Intermediary--Critical Access Hospital
                          Outpatient--Medicare Part B--Claims
                          Processing.
                         Fiscal Intermediary--Critical Access Hospital
                          Election of Method I or Method II.
                         Fiscal Intermediary--Vaccines and Vaccine
                          Administration--Payment Policy.
                         Fiscal Intermediary--Vaccines and Vaccine
                          Administration--Claims Processing.
                         Fiscal Intermediary--Physical Therapy,
                          Occupational Therapy, Speech-Language
                          Pathology and Diagnostic Audiology Services--
                          Payment Policy.
                         Fiscal Intermediary--Physical Therapy,
                          Occupational Therapy, Speech-Language
                          Pathology and Diagnostic Audiology Services--
                          Claims Processing.
                         Fiscal Intermediary--Ambulance Services.
                         Fiscal Intermediary--Outpatient Hospital-Based
                          Ambulance Services--Medicare Part B--Payment
                          Policy.
                         Fiscal Intermediary--Outpatient Hospital-Based
                          Ambulance Services--Medicare Part B--Claims
                          Processing.
                         Fiscal Intermediary--Critical Access Hospital
                          Ambulance Services--Medicare Part B--Payment
                          Policy.
                         Fiscal Intermediary--Critical Access Hospital
                          Ambulance Services--Medicare Part B--Claims
                          Processing.
                         Fiscal Intermediary--Ambulance Services--
                          Medicare Part A--Payment Policy.
                         Fiscal Intermediary--Other Screening and
                          Preventive Services--Payment Policy.
                         Fiscal Intermediary--Other Screening and
                          Preventive Services--Claims Processing.
                         Fiscal Intermediary--Medical Nutritional
                          Therapy--Payment Policy.
                         Fiscal Intermediary--Medical Nutritional
                          Therapy--Claims Processing.
                         Fiscal Intermediary--Laboratory Services.
                         Fiscal Intermediary--Drugs.
                         Audit.
                         Audit of Indian Health Service Cost Reports.
                         Method E Cost Reports.
                         Critical Access Hospitals.
1041...................  Change in Healthcare Common Procedure Coding
                          System for Renal Dialysis.
                         Facilities and Hospitals Billing for End-Stage
                          Renal Disease Related Epoetin Alfa Effective
                          January 1, 2007.
                         Hospital Services for Patients with End-Stage
                          Renal Disease.
                         Hospital Services.
                         Epoetin Alfa Facility Billing Requirements.
                         Payment for Epoetin Alfa in Other Settings.
                         Epoetin Alfa Provided in the Hospital
                          Outpatient Departments.
                         Darbepoetin Alfa (Aranesp) Facility Billing
                          Requirements.
                         Payment for Darbepoetin Alfa (Aranesp) in Other
                          Settings.
                         Payment for Darbepoetin Alfa (Aranesp) in the
                          Hospital Outpatient Department.
1042...................  Clarification on Billing Requirements for
                          Percutaneous Transluminal.
                         Angioplasty Concurrent with the Placement of an
                          Investigational or FDA-Approved Carotid Stent.
                         Percutaneous Transluminal Angioplasty for
                          Implanting the Carotid Stent.
                         Category B Investigational Device Exemptions
                          Trial Coverage.
                         Post Approval Study Coverage.
                         Carotid Artery Stenting with Embolic Protection
                          Coverage.
1043...................  Revisions to the Epoetin Alfa/ Aranesp
                          Monitoring Policy.
                         Epoetin Alfa.

[[Page 77208]]

 
                         Darbepoetin Alfa (Aranesp) for End-Stage Renal
                          Disease Patients.
1044...................  Issued to a specific audience, not posted to
                          Internet/Intranet due to Confidentiality of
                          Instruction.
1045...................  October 2006 Outpatient Prospective Payment
                          System Outpatient Code Editor Specifications
                          Version 7.3.
1046...................  Independent Laboratory Billing for the
                          Technical Component of Physician Pathology
                          Services.
1047...................  October Update to the 2006 Medicare Physician
                          Fee Schedule Database.
1048...................  New Waived Tests.
1049...................  Update to the Place of Service Code Set to Add
                          a Code for Prison/Correctional Facility.
                         Place of Service Codes and Definitions.
1050...................  Changes to the Laboratory National Coverage
                          Determination Edit Software for October 2006.
1051...................  Claims Submission Instructions for
                          Institutional Providers Billing Vaccine Claims
                          in Cases Where a National Provider Identifier
                          is Not Available.
                         Healthcare Common Procedure Coding System and
                          Diagnosis Codes.
                         Claims Submitted to Fiscal Intermediaries for
                          Mass Immunizations of Influenza and
                          Pneumococcal Pneumonia Vaccine.
1052...................  This Transmittal is rescinded and replaced by
                          Transmittal 1057.
1053...................  Inpatient Rehabilitation Facility Annual
                          Update: Prospective Payment System.
                         Pricer Changes for FY 2007.
1054...................  Reporting of Taxonomy Codes to Identify
                          Provider Subparts on Institutional Claims.
1055...................  Competitive Acquisition Program--Creation of
                          Automated Tables for Provider Information,
                          Expansion of Competitive Acquisition Program
                          Fee Schedule File Layout, and Additional
                          Instructions for Claims Received from Railroad
                          Retirement Board Beneficiaries.
                         Competitive Acquisition Program Claims
                          Submitted with Only the No Pay Line.
                         Competitive Acquisition Program Fee Schedule.
                         Changes to the List of Drugs Supplied by
                          Approved Competitive Acquisition Program
                          Vendors.
1056...................  Quarterly Update to Correct Coding Initiative
                          Edits, Version 12.3, Effective October 1,
                          2006.
1057...................  Maintenance and Update of the Temporary Hook
                          Created to Hold Outpatient Prospective Payment
                          System Claims That Include Certain Drug
                          Healthcare Common Procedure Coding System
                          Codes.
1058...................  Additional Requirements Necessary to Implement
                          the Revised Health Insurance Claim Form CMS-
                          1500 (08/05).
1059...................  This Transmittal is rescinded and replaced by
                          Transmittal 1066.
1060...................  October 2006 Update of the Hospital Outpatient
                          Prospective Payment System: Summary of Payment
                          Policy Changes.
                         Transitional Outpatient Payments.
                         Transitional Outpatient Payments Calculation
                          for CY 2000 and CY 2001.
                         Transitional Outpatient Payments Calculation
                          for CY 2002.
                         Transitional Outpatient Payments Calculation
                          for CY 2003.
                         Transitional Outpatient Payments Calculation
                          for CY 2004 and CY 2005.
                         Transitional Outpatient Payments Calculation
                          for CY 2006--CY 2008.
                         Transitional Outpatient Payments Overpayments.
                         Background--Payment-to-Cost Ratios.
                         Using the Newly Calculated PCR for Determining
                          Interim Transitional Outpatient Payments.
1061...................  October 2006 Non-Outpatient Prospective Payment
                          System Outpatient Code Editor Specifications
                          Version 22.0.
1062...................  Termination of Healthcare Common Procedure
                          Coding System Code G0107, Colorectal Cancer
                          Screening, Fecal Occult Blood Test (FOBT), 1-3
                          Simultaneous Determinations.
                         Payment.
                         Healthcare Common Procedure Coding System
                          Codes, Frequency Requirement, and Age
                          Requirements (If Applicable).
                         Common Working Files Edits.
                         Billing Requirements for Claims Submitted to
                          Fiscal Intermediaries.
                         Medicare Summary Notices Messages.
1063...................  Ending the Contingency Plan for Remittance
                          Advice and Charging for PC Print, Medicare
                          Remit Easy Print, and Duplicate Remittance
                          Advice.
                         Background.
                         General Remittance Completion Requirements.
                         Remittance Balancing.
                         Electronic Remittance Advice.
                         ANSI ASC X12N 835.
                         Generating an Electronic Remittance Advice if
                          Required Data is Missing or Invalid.
                         Medicare Standard Electronic PC Print Software
                          for Institutional Providers.
                         Medicare Remit Easy Print Software for
                          Professional Providers and Suppliers.
                         Implementation Guide.
                         Standard Paper Remittance Advice.
                         The Do Not Forward Initiative.
                         Standard Paper Remittance Formats.
                         Part A ( A/B MACs/FIs/RHHIs) Standard Paper
                          Remittance Format.
                         Part B (A/B MAC/Carrier/DMERC/DME MAC) Standard
                          Paper Remittance.
                         Format.
                         Part A (A/B MAC/FI/RHHI) Standard Paper
                          Remittance Crosswalk to the 835.
                         Part B (A/B MAC/Carrier/ DMERC/DME MAC)
                          Standard Paper Remittance.
                         Crosswalk to the 835.
                         Remittance Advice Codes.
                         Claim Adjustment Reason Codes.
                         Remittance Advice Remark Codes.
                         Group Codes.

[[Page 77209]]

 
                         Requests for Additional Codes.
                         A/B Medicare Administrative Contractor/Fiscal
                          Intermediary/Regional Home.
                         Home Health Intermediary Electronic Remittance
                          Advice Requirement.
                         Changes to Accommodate Outpatient Prospective
                          Payment System and Home Health Prospective
                          Payment System.
                         Scope of Remittance Changes for Home Health
                          Prospective Payment System.
                         Items Not Included in Home Health Prospective
                          Payment System Episode Payment.
                         Version 004010A1 Line Level Reporting
                          Requirements for the Request for Anticipated
                          Payment for an Episode.
                         Version 004010A1 Line Level Reporting
                          Requirements for the Claim Payment in an
                          Episode (More Than Four Visits).
                         Version 004010A1 Line Level Reporting
                          Requirements for the Claim Payment in an
                          Episode (Four or Fewer Visits).
                         Prospective Payment System Partial Episode
                          Payment Adjustment.
                         General Health Insurance Portability &
                          Accountability Act Electronic Data Interchange
                          Requirements.
                         Continued Support of Pre-Health Insurance
                          Portability & Accountability Act.
                         Electronic Data Interchange Formats.
                         Electronic Remittance Advice.
                         Standard Paper Remittance Notices.
                         Remittance Advice Remark Codes.
                         Electronic Funds Transfer.
                         Medicare Remit Easy Print Software for
                          Professional Providers and Suppliers.
                         Medicare Standard Electronic PC Print Software
                          for Institutional Providers.
1064...................  Issued to a specific audience, not posted to
                          Internet/Intranet due to Confidentiality of
                          Instruction.
1065...................  Disabling the Revenue/Healthcare Common
                          Procedure Coding System.
                         Consistency Edit Codes in the Fiscal
                          Intermediary Shared System.
                         Fiscal Intermediary Consistency Edits.
1066...................  October 2006 Quarterly Average Sales Price
                          Medicare Part B Drug Pricing File, Effective
                          October 1, 2006, and Revisions to April 2006
                          and July 2006 Quarterly Average Sale Price
                          Medicare Part B Drug Pricing Files.
1067...................  Fiscal Year 2007 Inpatient Prospective Payment
                          System, Long Term Care Hospital Prospective
                          Payment System, and Inpatient Psychiatric
                          Facility Prospective Payment System Changes.
1068...................  2007 Annual Update of HCPCS Codes for Skilled
                          Nursing Facility.
                         Consolidated Billing for the Common Working
                          File, Medicare Carriers and Fiscal
                          Intermediaries.
                         Services Included in Part A Prospective Payment
                          System Payment Not Billable Separately by the
                          Skilled Nursing Facility.
1069...................  Reopenings and Revisions of Claim
                          Determinations and Decisions.
                         Authority to Conduct a Reopening.
                         Refusal to Reopen Is Not an Initial
                          Determination.
                         Reopening of Denials Based on an Unanswered
                          Additional Documentation Request.
                         Reopenings Based on Clerical or Minor Errors
                          and Omissions.
                         Providers Submitting Adjustments.
                         Telephone Reopenings--Carriers Only.
                         Informing the Provider Communities About the
                          Telephone Reopenings Process.
                         Issues for Telephone Reopenings.
                         Conducting the Telephone Reopening.
                         Documenting the Telephone Reopening.
                         Monitoring the Telephone Reopening.
                         Timeframes to Reopen Claim Determinations.
                         Timeframes for Contractor Initiated Reopenings.
                         Timeframes for Party Requested Reopenings.
                         Timeframes for Adjudicator to Reopen.
                         Timeframes When Party Requests an Adjudicator
                          Reopen Their Decision.
                         Timeframes to Complete a Reopening Requested by
                          a Party.
                         Notice of a Revised Determination or Decision.
                         Revised Determination or Decision.
                         Effect of a Revised Determination or Decision.
                         Good Cause for Reopening.
                         What Constitutes New and Material Evidence.
                         What Constitutes Error on the Face of the
                          Evidence.
                         Change in Substantive Law or Interpretative
                          Policy.
1070...................  Issued to a specific audience, not posted to
                          Internet/Intranet due to Sensitivity of
                          Instruction.
1071...................  Issued to specific audience, not posted to
                          Internet/Intranet due to Confidentiality of
                          Instruction.
------------------------------------------------------------------------
                        Medicare Secondary Payer
                            (CMS Pub. 100-05)
------------------------------------------------------------------------
54.....................  Revision to the Contents of the Intent to Refer
                          Demand Packages.
                         Issuance of the ``Intent to Refer'' to Treasury
                          Letter.
                         Debt Collection System Entry of Delinquent
                          Debt.
55.....................  Update to the Fiscal Intermediary Shared System
                          on Processing.
                         Medicare Secondary Payer Fully Paid Claims When
                          Condition Code 77 Is Not Present on Outpatient
                          and Home Health Claims.
                         Processing Medicare Secondary Payer Fully Paid
                          Claims for Outpatient and Home Health Claims.
------------------------------------------------------------------------

[[Page 77210]]

 
                      Medicare Financial Management
                            (CMS Pub. 100-06)
------------------------------------------------------------------------
100....................  Collection of Fee-for-Service Payments Made
                          During Periods of Managed Care Enrollment.
                         Collection of Fee-for-Service Payments Made
                          During Periods of Medicare Advantage
                          Enrollment.
101....................  This Transmittal is rescinded and replaced by
                          Transmittal 102.
102....................  Notice of New Interest Rate for Medicare
                          Overpayments and Underpayments.
103....................  Internal Control Requirement Update.
                         Requirements.
                         Certification Statement.
104....................  Updated Procedures for Appeals Council
                          Communication with Recovery Audit Contractor.
                         Appeals Council/Program Safeguard Contractor
                          Communication with the Recovery Audit
                          Contractors.
105....................  Benefits Payable Survey and Trending Analysis
                          Procedures.
106....................  Collection of Fee-for-Service Payments Made
                          During Periods of Managed Care Enrollment.
                         Collection of Fee-for-Service Payments Made
                          During Periods of Medicare Advantage
                          Enrollment.
107....................  Instructions for Conducting In-House Audits and
                          Revision to Part II.
                         Acceptability Checklist Requirements.
                         Acceptance of Medicare Cost Report.
                         Definition.
                         Components of the Uniform Desk Review.
                         Desk Review Exceptions Resolution Process.
                         Field and In-House Audits.
                         Definition of Field and In-House Audits.
                         Purpose of Field and In-House Audits.
                         Planning and Management (Global Scoping) Field
                          and In-House Audits.
                         Scoping/Planning of Individual Field and In-
                          House Audits.
                         Establishing the Objective/Scope of the Field
                          and In-House Audits.
                         Tailoring of the Audit Program.
                         Field or In-House Audit Process.
                         Audit Confirmation Letter (a.k.a. Engagement
                          Letter).
                         Audit Confirmation Letter (a.k.a. Engagement
                          Letter)--Field Audit.
                         Audit Confirmation Letter (a.k.a. Engagement
                          Letter)--In-House Audit.
                         Entrance Conference.
                         Entrance Conference for Field Audit.
                         Entrance Conference for In-House Audit.
                         Coordination of Activities During the Field and
                          In-House Audits.
                         Evidence.
                         Documentation Standards.
                         Pre-Exit Conference.
                         Exit Conference.
                         Supervision During the Audit Process.
                         Content and Structure of the Medicare Cost
                          Report Audit Report.
                         Provider Permanent File
------------------------------------------------------------------------
                    Medicare State Operations Manual
                            (CMS Pub. 100-07)
------------------------------------------------------------------------
00.....................  None.
------------------------------------------------------------------------
                      Medicare Program Integrity
                            (CMS Pub. 100-08)
------------------------------------------------------------------------
151....................  Provider Enrollment Appeals Process.
                         Administrative Appeals.
                         Model Letter Formation.
152....................  Correction of Common Working File Edit D903 for
                          Wheelchair and Power Operated Vehicle Codes.
153....................  The Medicare Claims System and The Provider
                          Enrollment System Changes for the National
                          Provider Identifier.
154....................  Coding Change to Medicare Claims System to
                          Accept National Provider Identifier From
                          Provider Enrollment Chain & Ownership System
                          Extract File.
155....................  Medically Unlikely Edits.
156....................  This Transmittal is rescinded and replaced by
                          Transmittal 157.
157....................  Evidence of Medical Necessity: Wheelchair and
                          Power-Operated Vehicle Claims (Clarification
                          of CR 3952, Transmittal 128, Dated October 28,
                          2005).
158....................  Provider Enrollment Disenrollment Actions.
                         Deactivation of Billing Numbers.
                         Contractor Issued Revocations.
159....................  New Durable Medical Equipment Prosthetic,
                          Orthotics & Supplies Certificates of Medical
                          Necessity and Durable Medical Equipment
                          Information Forms for Claims Processing.
                         Documentation Specifications for Areas Selected
                          for Prepayment or Postpayment Medical Review.
                         Home Use of Durable Medical Equipment.

[[Page 77211]]

 
                         Rules Concerning Prescriptions (Orders).
                         Physician Orders.
                         Verbal Orders.
                         Written Orders.
                         Written Orders Prior to Deliv