Medicare and Medicaid Programs; Quarterly Listing of Program Issuances-October Through December 2006, 15282-15364 [07-1414]

Agencies

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

[Federal Register Volume 72, Number 61 (Friday, March 30, 2007)]
[Notices]
[Pages 15282-15364]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 07-1414]



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Part III





Department of Health and Human Services





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Centers for Medicare & Medicaid Services



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Medicare and Medicaid Programs; Quarterly Listing of Program 
Issuances--October Through December 2006; Notice

Federal Register / Vol. 72, No. 61 / Friday, March 30, 2007 / 
Notices

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-9039-N]


Medicare and Medicaid Programs; Quarterly Listing of Program 
Issuances--October Through December 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 October 2006 through December 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. 
Also included in this notice is a list of National Oncologic Positron 
Emissions Tomography Registry sites, a list of Medicare-approved 
ventricular assist device (destination therapy) facilities, a list of 
Medicare-approved lung volume reduction surgery facilities, and a list 
of Medicare-approved bariatric surgery facilities.
    Section 1871(c) of the Social Security Act requires that we publish 
a list of Medicare issuances in the Federal Register at least every 3 
months. Although we are not mandated to do so by statute, for the sake 
of completeness of the listing, and to foster more open and transparent 
collaboration efforts, we are also including all Medicaid issuances and 
Medicare and Medicaid substantive and interpretive regulations 
(proposed and final) published during this 3-month time frame.

FOR FURTHER INFORMATION CONTACT: It is possible that an interested 
party may have a specific information need and not be able to determine 
from the listed information whether the issuance or regulation would 
fulfill that need. Consequently, we are providing information contact 
persons to answer general questions concerning these items. Copies are 
not available through the contact persons. (See Section III of this 
notice for how to obtain listed material.)
    Questions concerning items in Addendum III may be addressed to 
Timothy Jennings, Office of Strategic Operations and Regulatory 
Affairs, Centers for Medicare & Medicaid Services, C4-26-05, 7500 
Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 
786-2134.
    Questions concerning items in Addendum IV may be addressed to 
Margaret Teeters, Office of Strategic Operations and Regulatory 
Affairs, Centers for Medicare & Medicaid Services, C4-14-03, 7500 
Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 
786-4678.
    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 National Oncologic Positron Emission 
Tomography Registry sites in Addendum XII may be addressed to Stuart 
Caplan, RN, MAS, 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) 786-8564.
    Questions concerning Medicare-approved ventricular assist device 
(destination therapy) facilities in Addendum XIII 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-approved lung volume reduction 
surgery facilities listed in Addendum XIV 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-approved bariatric surgery facilities 
listed in Addendum XV may be addressed to Kate Tillman, RN, MA, 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) 786-9252.
    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

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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 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--
     Date published;
     Federal Register citation;
     Parts of the Code of Federal Regulations (CFR) that have 
changed (if applicable);
     Agency file code number; and
     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.
     Addendum XII includes a listing of National Oncologic 
Positron Emission Tomography Registry (NOPR) sites. We cover positron 
emission tomography (PET) scans for particular oncologic indications 
when they are performed in a facility that participates in the NOPR.
     Addendum XIII includes a listing of Medicare-approved 
facitilites that receive coverage for ventricular assist devices used 
as destination therapy. All facilities were required to meet our 
standards in order to receive coverage for ventricular assist devices 
implanted as destination therapy.
     Addendum XIV includes a listing of Medicare-approved 
facilities that are eligible to receive coverage for lung volume 
reduction surgery. Until May 17, 2007, facilities that participated in 
the National Emphysema Treatment Trial are also eligible to receive 
coverage.
     Addendum XV includes a listing of Medicare-approved 
facilities that meet minimum standards for facilities modeled in part 
on professional society statements on competency. All facilities must 
meet our standards in order to receive coverage for bariatric surgery 
procedures.

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

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(202) 512-2250 (for credit card orders); or National Technical 
Information Service, Department of Commerce, 5825 Port Royal Road, 
Springfield, VA 22161, Telephone (703) 487-4630.
    In addition, individual manual transmittals and Program Memoranda 
listed in this notice can be purchased from NTIS. Interested parties 
should identify the transmittal(s) they want. GPO or NTIS can give 
complete details on how to obtain the publications they sell. 
Additionally, most manuals are available at the following Internet 
address: https://cms.hhs.gov/manuals/default.asp.

B. Regulations and Notices

    Regulations and notices are published in the daily Federal 
Register. Interested individuals may purchase individual copies or 
subscribe to the Federal Register by contacting the GPO at the address 
given above. When ordering individual copies, it is necessary to cite 
either the date of publication or the volume number and page number.
    The Federal Register is also available on 24x microfiche and as an 
online database through GPO Access. The online database is updated by 6 
a.m. each day the Federal Register is published. The database includes 
both text and graphics from Volume 59, Number 1 (January 2, 1994) 
forward. Free public access is available on a Wide Area Information 
Server (WAIS) through the Internet and via asynchronous dial-in. 
Internet users can access the database by using the World Wide Web; the 
Superintendent of Documents home page address is https://
www.gpoaccess.gov/fr/, by using local WAIS client software, 
or by telnet to swais.gpoaccess.gov, then log in as guest (no password 
required). Dial-in users should use communications software and modem 
to call (202) 512-1661; type swais, then log in as guest (no password 
required).

C. Rulings

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

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

    Our laws, regulations, and manuals are also available on CD-ROM and 
may be purchased from GPO or NTIS on a subscription or single copy 
basis. The Superintendent of Documents list ID is HCLRM, and the stock 
number is 717-139-00000-3. The following material is on the CD-ROM 
disk:
     Titles XI, XVIII, and XIX of the Act.
     CMS-related regulations.
     CMS manuals and monthly revisions.
     CMS program memoranda.
    The titles of the Compilation of the Social Security Laws are 
current as of January 1, 2005. (Updated titles of the Social Security 
Laws are available on the Internet at https://www.ssa.gov/OP_Home/
ssact/comp-toc.htm.) The remaining portions of CD-ROM are updated on a 
monthly basis.
    Because of complaints about the unreadability of the Appendices 
(Interpretive Guidelines) in the State Operations Manual (SOM), as of 
March 1995, we deleted these appendices from CD-ROM. We intend to re-
visit this issue in the near future and, with the aid of newer 
technology, we may again be able to include the appendices on CD-ROM.
    Any cost report forms incorporated in the manuals are included on 
the CD-ROM disk as LOTUS files. LOTUS software is needed to view the 
reports once the files have been copied to a personal computer disk.

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 Benefit Policy publication titled ``Swing Bed Hospital 
Updates,'' use CMS-Pub. 100-02, Transmittal No. 58.

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

    Dated: March 16, 2007.
Jacquelyn Y. White,
Director, Office of Strategic Operations and Regulatory Affairs.

Addendum I

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

September 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)
December 22, 2006 (71 FR 77202)

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

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

        Addendum III.--Medicare and Medicaid Manual Instructions
                     [October Through December 2006]
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     Transmittal No.               Manual/Subject/Publication No.
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             Medicare General Information (CMS--Pub. 100-01)
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41.......................  Update to Medicare Deductible, Coinsurance
                            and Premium Rates for 2007.

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42.......................  Swing Bed Hospital Updates.
                           Hospital Insurance (Part A) for Inpatient
                            Hospital, Hospice, Home Health and Skilled
                            Nursing Facility Services--A Brief
                            Description.
                           Determining Payment for Services Furnished
                            After Termination of Provider Agreement.
                           Hospital Defined.
                           Hospital Providers of Extended Care Services.
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                Medicare Benefit Policy CMS--Pub. 100-02)
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56.......................  This Transmittal is rescinded and replaced by
                            Transmittal 59.
57.......................  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.
58.......................  Swing Bed Hospital Updates.
                           Hospital Providers of Extended Care Services.
59.......................  Inpatient Psychiatric Facility Prospective
                            Payment System.
                           Inpatient Psychiatric Facility Services.
                           Background.
                           Statutory Requirements.
                           Affected Medicare Providers.
                           Admission Requirements.
                           Medical Records Requirements.
                           Development of Assessment/Diagnostic Data.
                           Psychiatric Evaluation.
                           Certification and Recertification
                            Requirements.
                           Certification.
                           Recertification.
                           Active Treatment.
                           Principles for Evaluating a Period of Active
                            Treatment.
                           Services Supervised and Evaluated by a
                            Physician.
                           Treatment Plan.
                           Individualized Treatment or Diagnostic Plan.
                           Services Expected to Improve the Condition or
                            for Purpose of Diagnosis.
                           Recording Progress.
                           Discharge Planning and Discharge Summary.
                           Personnel Requirements.
                           Director of Inpatient Psychiatric Services;
                            Medical Staff.
                           Nursing Services.
                           Psychological Services.
                           Social Services.
                           Therapeutic Activities.
                           Benefit Application.
60.......................  Outpatient Therapy Cap Clarifications.
                           Coverage of Outpatient Rehabilitation Therapy
                            Services (Physical Therapy, Occupational
                            Therapy, and Speech-Language Pathology
                            Services) Under Medical Insurance.
                           Plans of Care for Outpatient Physical
                            Therapy, Occupational Therapy, or Speech-
                            Language Pathology Services.
                           Documentation Requirements for Therapy
                            Services.
61.......................  Implementation of Changes in End-Stage Renal
                            Disease Payment for Calendar Year 2007 New
                            End-Stage Renal Disease Composite Payment
                            Rates.
62.......................  Private Contracting--Definition of Physician/
                            Practitioner.
63.......................  Outpatient Therapy Cap Exceptions Process for
                            Calendar Year (CY) 2007.
                           Coverage of Outpatient Rehabilitation Therapy
                            Services (Physical Therapy, Occupational
                            Therapy, and Speech-Language Pathology
                            Services) Under Medical Insurance.
                           Reasonable and Necessary Outpatient
                            Rehabilitation Therapy Services.
                           Documentation Requirements for Therapy
                            Services.
                           Practice of Physical Therapy, Occupational
                            Therapy, and Speech-Language Pathology.
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      Medicare National Coverage Determinations (CMS--Pub. 100-03]
------------------------------------------------------------------------
61.......................  Cavernous Nerves Electrical Stimulation With
                            Penile Plethysmography.
62.......................  Infrared Therapy Devices.
63.......................  Cardiac Output Monitoring by Thoracic
                            Electrical Bioimpedance.
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              Medicare Claims Processing (CMS Pub. 100-04)
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1072.....................  Inpatient Prospective Payment System Outlier
                            Reconciliation Technical Corrections.
                           Cost-to-Charge Ratios.

[[Page 15286]]

 
                           Statewide Average Cost-to-Charge Ratios.
                           Reconciliation.
                           Procedure for Fiscal Intermediaries to
                            Perform and Record Outlier Reconciliation
                            Adjustments.
1073.....................  Indian Health Service Hospital Payment Rates
                            for Calendar Year 2006.
1074.....................  Calendar Year 2007 Participation Enrollment
                            and Medicare Participating Physician and
                            Suppliers Directory Procedures.
1075.....................  2007 Healthcare Common Procedure Coding
                            Systems Annual Update Reminder.
1076.....................  Competitive Acquisition Program--Instructions
                            on Special CAP Appeals Requirements and
                            Delivery of Dispute Resolution Services.
                           The Competitive Acquisition Program for Drugs
                            and Instructions on Special CAP Appeals
                            Requirements and Delivery of Dispute
                            Resolution Services.
                           Dispute Resolution Services for Vendors.
                           Dispute Resolution Services for Physicians.
                           Dispute Resolution Services for
                            Beneficiaries.
1077.....................  This Transmittal is rescinded and replaced by
                            Transmittal 1081.
1078.....................  Updating the Medicare Secondary Payer Manual
                            for Consistency on Instructing Part A
                            Contactors on Handling MSP Claims with
                            Condition Code (cc) 08.
                           Form Locators 21/30.
1079.....................  Changes to the Process for Recovering
                            Medicare Payments for Home Health.
                           Prospective Payment System Claims Failing to
                            Report Prior Hospitalizations.
1080.....................  This Transmittal is rescinded and replaced by
                            Transmittal 1091.
1081.....................  Electronic Data Interchange Media Changes.
                           Media.
1082.....................  Annual Update of Healthcare Common Procedure
                            Coding System Codes Used for Home Health
                            Consolidated Billing Enforcement.
1083.....................  Release of a Separate File Containing the
                            Payment Cap for the Technical Component of
                            Imaging Procedures for Disclosure.
1084.....................  Line Item Billing Requirement for End-Stage
                            Renal Disease Claims Amount of Payment.
                           Calculation of Case Mix Adjusted Composite
                            Rate.
                           Laboratory Services Included in the Composite
                            Rate.
                           Drugs and Biologicals Included in the
                            Composite Rate.
                           Required Information for In-Facility Claims
                            Paid Under the Composite Rate.
                           Intermittent Peritoneal Dialysis in the
                            Facility.
                           Training and Retraining.
                           Coding Adequacy of Hemodialysis.
                           Lab Services.
                           Drugs Furnished in Dialysis Facilities.
                           Billing Procedures for Drugs for Facilities.
                           Payment Amount for Epoetin Alfa.
                           Vaccines Furnished to End-Stage Renal Disease
                            Patients.
                           Method Selection for Home Dialysis Payment.
                           Required Billing Information for Method I
                            Claims.
                           Intermittent Peritoneal Dialysis at Home for
                            Method I Claims Submitted to the
                            Intermediary.
                           Calculating Payment for Intermittent
                            Peritoneal Dialysis for Method I Claims
                            Submitted to the Intermediary.
                           Calculating Payment for for Continuous
                            Ambulatory Peritoneal Dialysis and
                            Continuous Cycling Peritoneal Dialysis Under
                            the Composite Rate.
1085.....................  Issued to a specific audience, not posted to
                            Internet/Intranet due to Confidentiality of
                            Instruction.
1086.....................  Annual Type of Service Update.
1087.....................  Remittance Advice Remark Code and Claim
                            Adjustment Reason Code Update.
1088.....................  Instructions for the Coordination of Medicare
                            Secondary Payer Claims for the Competitive
                            Acquisition Program.
                           Competitive Acquisition Program Required
                            Modifiers.
                           Medicare Secondary Payer Situations Under
                            Competitive Acquisition Program.
1089.....................  Claim Status Category Code and Claim Status
                            Code Update.
1090.....................  Medicare Summary Notice Format Changes for
                            Jurisdiction 3 A/B MAC Transition.
                           Title Section of the Medicare Summary Notice.
                           Appeals Section.
1091.....................  The Supplemental Security Income/Medicare
                            Beneficiary Data for Fiscal Year 2005 for
                            Inpatient Prospective Payment System
                            Hospitals.
1092.....................  File Descriptions and Instructions for
                            Retrieving the 2007 Fee Schedules and
                            Healthcare Common Procedure Coding System
                            Through CMS? Mainframe Telecommunication
                            System.
1093.....................  Changes to the Laboratory National Coverage
                            Determination Edit Software for January
                            2007.
1094.....................  Update to the Hospice Payment Rates, Hospice
                            Cap, Hospice Wage Index and the Hospice
                            Pricer for FY 2007.
1095.....................  Processing All Diagnosis Codes Reported on
                            Claims Submitted to Carriers.
1096.....................  Issued to a specific audience, not posted to
                            Internet/Intranet due to Confidentiality of
                            Instruction.
1097.....................  Issued to a specific audience, not posted to
                            Internet/Intranet due to Confidentiality of
                            Instruction.
1098.....................  Common Working File Duplicate Claim Edit for
                            the Technical Component of Radiology and
                            Pathology Laboratory Services Provided to
                            Hospital Patients.
                           Hospital and Skilled Nursing Facility
                            Patients.
                           Technical Component of Physician Pathology
                            Services to Hospital Patients.
1099.....................  New Edits Established to Enforce Proper
                            Transfer Coding and Payment in Inpatient
                            Rehabilitation Facility Prospective Payment
                            System Claims.
1100.....................  Jurisdiction for Ambulance Supplier Claims.
1101.....................  Inpatient Psychiatric Facility Prospective
                            Payment System.

[[Page 15287]]

 
                           Background.
                           Statutory Requirements.
                           Affected Medicare Providers.
                           Federal Per Diem Base Rate.
                           Standardization Factor.
                           Budget Neutrality.
                           Budget Neutrality Components.
                           Annual Update.
                           Calculating the Federal Payment Rate.
                           Patient-Level Adjustments.
                           Diagnosis-Related Groups Adjustments.
                           Application of Code First.
                           Comorbidity Adjustments.
                           Age Adjustments.
                           Variable Per Diem Adjustments.
                           Facility-Level Adjustments.
                           Wage Index.
                           Rural Location Adjustment.
                           Teaching Status Adjustment.
                           Full-Time Equivalent Resident Cap.
                           Reconciliation of Teaching Adjustment on Cost
                            Report.
                           Emergency Department Adjustment.
                           Source of Admission for Inpatient Psychiatric
                            Facility Prospective Payment System Claims
                            for Payment of Emergency Department
                            Adjustment.
                           Cost-of-Living Adjustment for Alaska and
                            Hawaii.
                           Other Payment Policies.
                           Interrupted Stays.
                           Outlier Policy.
                           How to Calculate Outlier Payments.
                           Determining the Cost-to-Charge Ratio.
                           Electroconvulsive Therapy Payment.
                           Stop Loss Provision (Transition Period Only).
                           Transition (Phase-In Implementation).
                           Implementation Date for Provider.
                           Definition of New Inpatient Psychiatric
                            Facility Providers Versus Tax Equity &
                            Fiscal Responsibility Act Providers.
                           New Providers Defined.
                           Claims Processing Requirements Under
                            Inpatient Psychiatric Facility Prospective
                            Payment System.
                           General Rules.
                           Billing Period.
                           Patient Status Coding.
                           Reporting Electroconvulsive Therapy
                            Treatments.
                           Outpatient Services Treated as Inpatient
                            Services.
                           Patient is a Member of a Medicare Advantage
                            Organization for Only a Portion of a Billing
                            Period.
                           Billing for Interrupted Stay.
                           Grace Days.
                           Billing Stays Prior to and Discharge After
                            Prospective Payment System Implementation
                            Date.
                           Billing Ancillary Services Under Inpatient
                            Psychiatric Facility Prospective Payment
                            System.
                           Covered Costs Not Included in Inpatient
                            Psychiatric Facility Prospective Payment
                            System Amount.
                           Same Day Transfer Claims.
                           Remittance Advice--Reserved.
                           Medicare Summary Notices and Explanation of
                            Medicare Benefits.
                           Benefit Application and Limits--190 Days.
                           Beneficiary Liability.
                           Periodic Interim Payments.
                           Intermediary Benefit Payment Report.
                           Monitoring Implementation of Inpatient
                            Psychiatric Facility Prospective Payment
                            System Through Pulse.
                           Inpatient Psychiatric Facility Prospective
                            Payment System Edits.
                           Inpatient Psychiatric Facility Prospective
                            Payment System PRICER Software Inputs/
                            Outputs to PRICER.
1102.....................  Ambulance Inflation Factor for CY 2007.
1103.....................  Reporting and Payment of No-Cost Devices
                            Furnished by Outpatient Prospective Payment
                            System Hospitals.
                           Use of Healthcare Common Procedure Coding
                            System Modifier--FB.
                           Billing for Devices Replaced Without Cost to
                            an Outpatient Prospective Payment System
                            Hospital or Beneficiary or for Which the
                            Hospital Receives a Credit and Payment for
                            Outpatient Prospective Payment System
                            Services Required to Replace the Device.
                           Reporting and Charge Requirements When a
                            Device is Replaced Without Cost to the
                            Hospital.
                           Reporting and Charge Requirements When the
                            Hospital Receives Credit for the Replaced
                            Device Against the Cost of a More Expensive
                            Replacement Device.
                           Medicare Payment Adjustment.
1104.....................  Uniform Billing (UB-04) Implementation.
                           Completing and Processing the CMS 1450 Data
                            Set.
                           Uniform Bill (UB)--Form CMS-1450 for Billing
                            (UB-92).

[[Page 15288]]

 
                           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).
1105.....................  Swing Bed Hospital Updates.
1106.....................  Outpatient Therapy Cap Clarifications.
                           The Financial Limitation.
                           Non-physician Services.
                           General Information Section.
                           Servicios Que No Fueron Prestados Por
                            Doctores.
                           Cuidado Preventivo.
                           Secci[yacute]n De Informaci[yacute]n General.
1107.....................  Notification and Testing of an Integrated
                            Outpatient Code Editor for the July 2007
                            Release.
                           Outpatient Code Editor.
                           Integrated Outpatient Code Editor (July 2007
                            and Later).
                           Outpatient Prospective Payment System
                            Outpatient Code Editor (Prior to July 1,
                            2007).
                           Patient Status Code and Reason for Patient
                            Visit for the Hospital Outpatient
                            Prospective Payment System.
                           Non-Outpatient Prospective Payment System
                            Outpatient Code Editor (Rejected Items and
                            Processing Requirements) (Prior to July 1,
                            2007).
1108.....................  Reporting of Taxonomy Codes to Identify
                            Provider Subparts on Institutional Claims.
1109.....................  Skilled Nursing Facility Consolidated Billing
                            Common Working File Edit Bypass Instructons
                            for Hospital Emergency Room Services
                            Spanning Multiple Service Dates.
1110.....................  Excluding Sanctioned Provider Claims From the
                            Coordination of Benefits Agreement Crossover
                            Process.
                           Consolidated Claims Crossover Process.
                           Coordination of Medicare With Medigap and
                            Other Complementary Health Insurance
                            Policies.
1111.....................  Clarification on Billing for Cryosurgery of
                            the Prostate Gland.
                           Special Rules for Critical Access Hospital
                            Outpatient Billing.
                           Optional Method for Outpatient Services: Cost-
                            Based Facility Services Plus 115 Percent Fee
                            Schedule for Professional Services.
1112.....................  Issued to a specific audience, not posted to
                            Internet/Intranet due to Confidentiality of
                            Instruction.
1113.....................  Implementation of an Ultrasound Screening for
                            Abdominal Aortic Aneurysms.
                           Definitions.
                           Coverage.
                           Payment.
                           Deductible and Coinsurance.
                           Healthcare Common Procedure Coding System
                            Code.
                           Advanced Beneficiary Notice.
1114.....................  This Transmittal is rescinded and replaced by
                            Transmittal 1133.
1115.....................  New Waived Tests.
1116.....................  Revised American National Standards Institute
                            X12N 837 Institutional Health Care Claim
                            Companion Document.
1117.....................  Issued to a specific audience, not posted to
                            Internet/Intranet due to Sensitivity of
                            Instruction.
1118.....................  Reasonable Charge Update for 2007 for
                            Splints, Casts, Dialysis Supplies, Dialysis
                            Equipment, and Certain Intraocular Lenses.
1119.....................  Installation of the January Inpatient
                            Psychiatric Facility Prospective Payment
                            System Pricer Software Containing Customer
                            Information Control System Formatting (Off-
                            Cycle Release).
1120.....................  Additional Provider Education for Upcoming
                            Changes in Payment for Oxygen Equipment and
                            Capped Rentals for Durable Medical Equipment
                            Based on the Deficit Reduction Act of 2005.
1121.....................  Issued to a specific audience, not posted to
                            Internet/Intranet due to Confidentiality of
                            Instruction.
1122.....................  2007 Annual Update for Clinical Laboratory
                            Fee Schedule and Laboratory Services Subject
                            to Reasonable Charge Payment
1123.....................  Instructions for Downloading the Medicare Zip
                            Code File.
1124.....................  Quarterly Update to Correct Coding Initiative
                            (CCI) Edits, Version 13.0, Effective January
                            1, 2007.
1125.....................  Fee Schedule Update for 2007 for Durable
                            Medical Equipment, Prosthetics, Orthotics
                            and Supplies.
1126.....................  Announcement of Medicare Rural Health Clinics
                            and Federally Qualified Health Centers
                            Payment Rate Increases.
1127.....................  Infrared Therapy Devices.
                           Coding Guidance for Certain Physical Medicine
                            CPT Codes--All Claims.
1128.....................  January 2007 Non-Outpatient Prospective
                            Payment System Outpatient Code Editor
                            Specifications Version 22.1.
1129.....................  January 2007 Quarterly Average Sales Price
                            Medicare Part B Drug Pricing File, Effective
                            January 1, 2007, and Revisions to April
                            2006, July 2006, and October 2006 Quarterly
                            ASP Medicare Part B Drug Pricing Files.
1130.....................  January 2007 Outpatient Prospective Payment
                            System Outpatient Code Editor Specifications
                            Version 8.0.
1131.....................  Legislative Change to the Update Factor for
                            the 2007 Medicare Physician Fee Schedule and
                            Extension of the Participating Enrollment
                            Period.
1132.....................  Issued to a specific audience, not posted to
                            Internet/Intranet due to Confidentiality of
                            Instruction.
1133.....................  Reporting of Taxonomy Codes to Identify
                            Provider Subparts on Institutional Claims.
1134.....................  Update of Healthcare Common Procedure Coding
                            System Codes and Payments for Ambulatory
                            Surgical Centers and File Names,
                            Descriptions and Instructions for Retrieving
                            the 2007 ASC HCPCS Additions, Deletions and
                            Master Listing.
1135.....................  Correction of Instructions for Calculating
                            IRF Compliance Percentage Threshold.
                           Verification Process To Be Used To Determine
                            If the Inpatient Rehabilitation Facility Met
                            the Classification Criteria.
1136.....................  Revisions to Procedure to Establish Good
                            Cause and Qualified Independent Contractor
                            Jurisdictions.
                           General Procedure to Establish Good Cause.
                           Appeals Rights for Dismissals.
                           Vacating a Dismissal.

[[Page 15289]]

 
                           QIC Jurisdictions.
1137.....................  Inpatient Rehabilitation Facility Teaching
                            Status Adjustment.
                           Full Time Equivalent Resident Cap.
1138.....................  Issued to a specific audience, not posted to
                            Internet/Intranet due to Confidentiality of
                            Instruction.
1139.....................  January 2007 Update of the Hospital
                            Outpatient Prospective Payment System:
                            Summary of Payment Policy Changes and OPPS
                            PRICER Logic Changes and Instruction for
                            Updating the Outpatient Provider Specific
                            File.
                           Reporting and Charging Requirements When a
                            Device Is Replaced Without Cost to the
                            Hospital.
                           Reporting and Charging Requirements When the
                            Hospital Receives Credit for the Replaced
                            Device Against the Cost of a More Expensive
                            Replacement Device.
                           Clinic and Emergency Visits.
                           Critical Care Services.
                           Billing for IMRT Planning and Delivery.
                           Additional Billing Instructions for IMRT
                            Planning.
                           Billing for Multi-Source Photon (Cobalt 60-
                            Based) Stereotactic Radiosurgery Planning
                            and Delivery.
                           Billing for Linear Accelerator (Robotic Image-
                            Guided and Non-Robotic Image-Guided) SRS
                            Planning and Delivery.
                           Coding and Payment for Drug Administration.
1140.....................  Medicare Payment for Preadministration-
                            Related Services Associated With IVIG
                            Administration.
1141.....................  Issued to a specific audience, not posted to
                            Internet/Intranet due to Confidentiality of
                            Instruction.
1142.....................  Durable Medical Equipment Regional Carrier
                            Claim Modifiers for Upgrades.
                           Durable Medical Equipment Regional
                            Carriers?Billing Procedures Related to
                            Advanced Beneficiary Notice Upgrades.
                           Providing Upgrades of Durable Medical
                            Equipment, Prosthetics, Orthotics & Supplies
                            Without Any Extra Charge.
1143.....................  Emergency Update to the 2007 Medicare
                            Physician Fee Schedule Database.
1144.....................  Elimination of CMS-1491 and CMS-1490U Forms.
                           Claim Forms.
                           Coding Instructions for Form CMS-1491.
1145.....................  Outpatient Therapy Cap Exceptions Process for
                            Calendar Year (CY) 2007.
                           The Financial Limitation.
                           Group Therapy Services (Code 97150).
                           Therapy Students.
1146.....................  Payment by Durable Medical Equipment Medicare
                            Administrative Contractors and Durable
                            Medical Equipment Regional Carriers for the
                            Administration of Part D Vaccines.
------------------------------------------------------------------------
               Medicare Secondary Payer (CMS--Pub. 100-05)
------------------------------------------------------------------------
56.......................  Updating the Medicare Secondary Payer (MSP)
                            Manual for Consistency on Instructing Part A
                            Contactors on Handling MSP Claims With
                            Condition Code 08.
                           Further Development Is Required.
                           Limits on Development.
57.......................  Instructions for the Coordination of Medicare
                            Secondary Payer Claims for the Competitive
                            Acquisition Program.
                           Medicare Secondary Payer Situations Under
                            Competitive Acquisition Program.
------------------------------------------------------------------------
            Medicare Financial Management (CMS--Pub. 100-06)
------------------------------------------------------------------------
108......................  Notice of New Interest Rate for Medicare
                            Overpayments and Underpayments--1st Qtr. FY
                            2007.
109......................  Claims Accounts Receivable--Clarification to
                            CR 3963.
                           Intermediary Claims Accounts Receivable.
110......................  Waiving Reporting Requirements on the CMS-
                            2592 Report in Fiscal Year 2007 Due to
                            Funding Constraints.
111......................  Status Codes for Financial Reporting of Debts
                            Once the MMA Section 935 Appeal Process Has
                            Been Completed.
112......................  Chapter 7, Internal Control Requirements
                            Update.
                           Control Activities.
                           Risk Assessment.
                           Risk Analysis Chart.
                           Internal Control Objectives.
                           Fiscal Year 2007 Medicare Control Objectives.
                           Testing Methods.
                           Documentation and Working Papers.
                           Certification Package for Internal Controls
                            Requirements.
                           OMB Circular A-123 and Internal Control Over
                            Financial Reporting.
                           Certification Statement.
                           Certification Package for Internal Controls--
                            Report of Material Weaknesses.
                           Certification Package for Internal Controls--
                            Report of Reportable Conditions.
                           Definitions of Reportable Conditions and
                            Material Weaknesses.
                           Material Weaknesses Identified During the
                            Reporting Period.
                           Corrective Action Plans.
                           Submission, Review, and Approval of
                            Corrective Action Plans.
                           CMS Finding Numbers.
                           Initial CAP Report.
                           Quarterly CAP Report.
                           Enter Data into the Initial or Quarterly CAP
                            Report.
                           List of FY 2007 Medicare Control Objectives.
------------------------------------------------------------------------

[[Page 15290]]

 
           Medicare State Operations Manual (CMS--Pub. 100-07)
------------------------------------------------------------------------
21.......................  Revised Appendix & Appendix PP--New Tag F334.
22.......................  Revisions to Appendix P and PP.
------------------------------------------------------------------------
              Medicare Program Integrity (CMS--Pub. 100-08)
------------------------------------------------------------------------
165......................  Durable Medical Equipment Medicare
                            Administrative Contractors Adoption or
                            Rejection of.
                           Local Coverage Determinations Recommended by
                            Durable Medical Equipment Program.
                           Safeguard Contractors.
                           Local Coverage Determinations.
166......................  This Transmittal is rescinded and replaced by
                            Transmittal 168.
167......................  New Durable Medical Equipment Prosthetic,
                            Orthotics & Supplies Certificates of Medical
                            Necessity and DME Information Forms for
                            Claims Processing.
                           Documentation Specifications for Areas
                            Selected for Prepayment or Postpayment
                            Medical Review.
                           Home Use of Durable Medical Equipment.
                           Rules Concerning Prescriptions (Orders).
                           Physician Orders.
                           Verbal Orders.
                           Written Orders.
                           Written Orders Prior to Delivery.
                           Requirement of New Orders.
                           Certificates of Medical Necessity and Durable
                            Medical Equipment Information Forms.
                           Completing a Certificates of Medical
                            Necessity or Durable Medical Equipment
                            Information Forms.
                           Cover Letters for Certificates of Medical
                            Necessity.
                           Acceptability of Faxed Orders and Facsimile
                            or Electronic Certificates of Medical
                            Necessity and Durable Medical Equipment
                            Information Forms.
                           Durable Medical Equipment Medicare
                            Administrative Contractors and Durable
                            Medical Equipment Program Safeguard
                            Contractor?s Authority to Initiate an
                            Overpayment or Civil Monetary Penalty When
                            Invalid Certificates of Medical Necessity
                            Are Identified.
                           Nurse Practitioner or Clinical Nurse
                            Specialist Rules Concerning Orders and
                            Certificates of Medical Necessity.
                           Physician Assistant Rules Concerning Orders
                            and Certificates of Medical Necessity.
                           Documentation in the Patient's Medical
                            Record.
                           Supplier Documentation.
                           Evidence of Medical Necessity.
                           Evidence of Medical Necessity for the Oxygen
                            Certificates of Medical Necessity.
                           Evidence of Medical Necessity: Wheelchair and
                            Power Operated Vehicle Claims.
                           Period of Medical Necessity--Home Dialysis
                            Equipment.
                           Safeguards in Making Monthly Payments.
                           Guidance on Safeguards in Making Monthly
                            Payments.
                           Pick-up Slips.
                           Incurred Expenses for DME and Orthotic and
                            Prosthetic Devices.
                           Patient Equipment Payments Exceed Deductible
                            and Coinsurance on Assigned Claims.
                           Definitions of Customized Durable Medical
                            Equipment.
                           Advance Determination of Medicare Coverage of
                            Customized Durable Medical Equipment.
                           Items Eligible for Advance Determination of
                            Medicare Coverage.
                           Instructions for Submitting Advance
                            Determination of Medicare Coverage Requests.
                           Instructions for Processing Advance
                            Determination of Medicare Coverage Requests.
                           Affirmative Advance Determination of Medicare
                            Coverage Decisions.
                           Negative Advance Determination of Medicare
                            Coverage Decisions.
                           Durable Medical Equipment Program Safeguard
                            Contractor Tracking.
168......................  Durable Medical Equipment Prosthetic,
                            Orthotics & Supplies Transcutaneous
                            Electrical.
                           Nerve Stimulators Certificate of Medical
                            Necessity for Purchases: Form CMS-848.
                           Certificates of Medical Necessity and Durable
                            Medical Equipment Information Forms.
169......................  Update the MCS System to Validate National
                            Provider Identifiers in Place of Unique
                            Physician Identification Numbers.
170......................  This Transmittal is rescinded and replaced by
                            Transmittal 174.
171......................  Outpatient Therapy Cap Clarifications.
                           Exception From the Uniform Dollar Limitation.
                           Prepay Complex Review Workload and Cost
                            (Activity Code 21221).
172......................  Issued to a specific audience, not posted to
                            Internet/Intranet due to Confidentiality of
                            Instruction.
173......................  Update to Chapter 10--Medicare Provider/
                            Supplier Enrollment.