Medicare and Medicaid Programs; Quarterly Listing of Program Issuances-April through June 2009, 49076-49187 [E9-22160]

Agencies

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

[Federal Register Volume 74, Number 185 (Friday, September 25, 2009)]
[Notices]
[Pages 49076-49187]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E9-22160]



[[Page 49075]]

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Part II





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-- April through June 2009; Notice

Federal Register / Vol. 74, No. 185 / Friday, September 25, 2009 / 
Notices

[[Page 49076]]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-9053-N]


Medicare and Medicaid Programs; Quarterly Listing of Program 
Issuances--April through June 2009

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 April 2009 through June 2009, 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, a list of 
Medicare-approved clinical trials for fluorodeoxyglucose positron 
emissions tomogragphy for dementia, 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 need specific information and not be able to determine from 
the listed information whether the issuance or regulation would fulfill 
that need. Consequently, we are providing 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 CMS manual instructions in Addendum III may be 
addressed to Ismael Torres, 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) 786-1864.
    Questions concerning regulation documents published in the Federal 
Register in Addendum IV may be addressed to Gwendolyn Johnson, 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) 786-6954.
    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 Beverly Lofton, 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) 786-7136.
    Questions concerning one-time notices regarding national coverage 
provisions in Addendum XI may be addressed to Beverly Lofton, 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) 786-7136.
    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 fluorodeoxyglucose positron emission

[[Page 49077]]

tomography for dementia trials listed in Addendum XVI 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 all other information may be addressed to 
Gwendolyn Johnson, Office of Strategic Operations and Regulatory 
Affairs, Regulations Development Group, Centers for Medicare & Medicaid 
Services, C5-14-03, 7500 Security Boulevard, Baltimore, MD 21244-1850, 
or you can call (410) 786-6954.

SUPPLEMENTARY INFORMATION: 

I. Program Issuances

    The Centers for Medicare & Medicaid Services (CMS) is responsible 
for administering the Medicare and Medicaid programs. These programs 
pay for health care and related services for 39 million Medicare 
beneficiaries and 35 million Medicaid recipients. Administration of the 
two programs involves (1) furnishing information to Medicare 
beneficiaries and Medicaid recipients, health care providers, and the 
public and (2) maintaining effective communications with regional 
offices, State governments, State Medicaid agencies, State survey 
agencies, various providers of health care, all Medicare contractors 
that process claims and pay bills, and others. To implement the various 
statutes on which the programs are based, we issue regulations under 
the authority granted to the Secretary of the Department of Health and 
Human Services under sections 1102, 1871, 1902, and related provisions 
of the Social Security Act (the Act). We also issue various manuals, 
memoranda, and statements necessary to administer the programs 
efficiently.
    Section 1871(c)(1) of the Act requires that we publish a list of 
all Medicare manual instructions, interpretive rules, statements of 
policy, and guidelines of general applicability not issued as 
regulations at least every 3 months in the Federal Register. We 
published our first notice June 9, 1988 (53 FR 21730). Although we are 
not mandated to do so by statute, for the sake of completeness of the 
listing of operational and policy statements, and to foster more open 
and transparent collaboration, we are continuing our practice of 
including Medicare substantive and interpretive regulations (proposed 
and final) published during the respective 3-month time frame.

II. How To Use the Addenda

    This notice is organized so that a reader may review the subjects 
of manual issuances, memoranda, substantive and interpretive 
regulations, NCDs, and FDA-approved IDEs published during the subject 
quarter to determine whether any are of particular interest. We expect 
this notice to be used in concert with previously published notices. 
Those unfamiliar with a description of our Medicare manuals may wish to 
review Table I of our first three notices (53 FR 21730, 53 FR 36891, 
and 53 FR 50577) published in 1988, and the notice published March 31, 
1993 (58 FR 16837). Those desiring information on the Medicare NCD 
Manual (NCDM, formerly the Medicare Coverage Issues Manual (CIM)) may 
wish to review the August 21, 1989, publication (54 FR 34555). Those 
interested in the revised process used in making NCDs under the 
Medicare program may review the September 26, 2003, publication (68 FR 
55634).
    To aid the reader, we have organized and divided this current 
listing into 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.
     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

[[Page 49078]]

must meet our standards in order to receive coverage for bariatric 
surgery procedures.
     Addendum XVI includes a listing of Medicare-approved 
clinical trials for fluorodeoxyglucose positron emission tomography 
(FDG-PET) for dementia and neurodegenerative diseases.

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. CMS Rulings are 
decisions of the Administrator that serve as precedent final opinions 
and orders and statements of policy and interpretation. They provide 
clarification and interpretation of complex or ambiguous provisions of 
the law or regulations relating to Medicare, Medicaid, Utilization and 
Quality Control Peer Review, private health insurance, and related 
matters. 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 ``Surgery for 
Diabetes,'' use CMS-Pub. 100-03, Transmittal No. 100.

(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: September 3, 2009.
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 22, 2007 (72 FR 34508)
September 28, 2007 (72 FR 55282)
December 28, 2007 (72 FR 73990)
April 1, 2008 (73 FR 17422)
June 27, 2008 (73 FR 36596)
September 26, 2008 (73 FR 55902)
December 30, 2008 (73 FR 79982)
March 27, 2009 (74 FR 13516)
June 26, 2009 (74 FR 30689)

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

[[Page 49079]]

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
                        [April through June 2009]
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     Transmittal No.               Manual/Subject/Publication No.
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                      Medicare General Information
                           (CMS--Pub. 100-01)
------------------------------------------------------------------------
00.......................  None
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                         Medicare Benefit Policy
                           (CMS--Pub. 100-02)
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105......................  List of Medicare Telehealth Services
                           Originating Site Facility Fee Payment (ESRD-
                            Related Services)
106......................  Speech-Language Pathology Private Practice
                            Payment Policy
                           Practice of Speech-Language Pathology
                           Services Furnished by a Therapist in Private
                            Practice
107......................  July 2009 Update of the Hospital Outpatient
                            Prospective Payment System
                           Outpatient Observation Services
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                Medicare National Coverage Determination
                           (CMS--Pub. 100-03)
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100......................  Surgery for Diabetes
                           Bariatric Surgery for Treatment of Morbid
                            Obesity (Various Effective Dates Below)
                           Surgery for Diabetes (Effective February 12,
                            2009)
101......................  Wrong Surgical or Other Invasive Procedure
                            Performed on a Patient; Surgical or Other
                            Invasive Procedure Performed on the Wrong
                            Body Part; Surgical or Other Invasive
                            Procedure Performed on the Wrong Patient
                           Wrong Surgical or Other Procedure Performed
                            on a Patient (Effective January 15, 2009)
                           Surgical or Other Invasive Procedure
                            Performed on the Wrong Body Part (Effective
                            January 15, 2009)
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                       Medicare Claims Processing
                           (CMS--Pub. 100-04)
------------------------------------------------------------------------
1708.....................  Hospice Cap Calculations Letters and
                            Administrative Appeals
1709.....................  Manualization of the Medicare Physician Fee
                            Schedule Record Layouts for Contractors
                            Processing Institutional Claims
                           Intermediary and Regional Home Health
                            Intermediary Record Layout for Clinical
                            Laboratory Fee Schedule
                           RHHI Fees for Hospice, Radiology and Other
                            Diagnostic Prices and Local HCPCS Codes
                           Intermediary Format for Durable Medical
                            Equipment, Prosthetic, Orthotic and Supply
                            Fee Schedule
                           Intermediary Outpatient Rehabilitation and
                            CORF Services Fee Schedule
                           Intermediary Format for Skilled Nursing
                            Facility Fee Schedule
                           Intermediary Format for CORF Services
                            Supplemental and Critical Access Hospital
                            Fee Schedule
                           Physician Fee Schedule Payment Policy
                            Indicator File Record Layout
                           Intermediary Format for Mammography Fee
                            Schedule
                           Intermediary Format for Ambulance Fee
                            Schedule
1710.....................  Billing Routine Cost of Clinical Trials
                           Carrier Specific Requirements for Certain
                            Specialties/Services
                           Requirements for Billing Routine Costs of
                            Clinical Trials
1711.....................  Surgery for Diabetes
                           General
                           ICD-9 Procedure Codes for Bariatric Surgery
                            (FIs Only)
                           Claims Guidance for Payment Medicare Summary
                            Notices (MSNs) and Claim Adjustment Reason
                            Codes
1712.....................  Issued to a specific audience, not posted to
                            Internet/Intranet due to Sensitivity of
                            Instruction
1713.....................  Additional Data Collection on Hospice Claims
                           Data Required on Claim to FI
1714.....................  Correction to Editing of Health Insurance
                            Prospective Payment System Codes on Home
                            Health Prospective Payment System Claims
                           Home Health Prospective Payment System Claims
1715.....................  New Physician Specialty Code for Hospice and
                            Palliative Care
                           Physician Specialty Codes
1716.....................  List of Medicare Telehealth Services
                           List of Medicare Telehealth Services
                           Submission of Telehealth Claims for Distant
                            Site Providers
1717.....................  Speech-Language Pathology Privateacility
                            Services--General
                           Part B Outpatient Rehabilitation and
                            Comprehensive Outpatient Rehabilitation
                            Facility Services--General
                           Services Paid Under the Medicare Physician's
                            Fee Schedule
                           Addendum
1718.....................  New Patient Discharge Status Code 21 to
                            Define Discharges or Transfers to Court/Law
                            Enforcement
                           Form Locators 16-30
1719.....................  Rural Health Clinic and Federally Qualified
                            Health Clinic Updates
                           RHCs/FQHCs Special Billing Instructions

[[Page 49080]]

 
                           General Billing Requirements for Preventive
                            Services
                           Initial Preventive Physical Exam
                           Ultrasound Screening for Abdominal Aortic
                            Aneurysms
                           Diabetes Self-Management Training Services
                           Medical Nutrition Therapy Services
                           RHCs/FQHCs Special Billing Instructions
                           HCs/FQHCs Special Billing Instructions
                           RHCs/FQHCs Special Billing Instructions
1720.....................  Health Insurance Portability and
                            Accountability Act American National
                           Standards Institute (ANSI) 837 5010
                            Coordination of Benefit Requirements--Part
                            II
                           COB Trading Partner and Contractor Crossover
                            Claim Requirements
                           Coordination of Benefits Agreement
                            Coordination of Benefits Requirements
1721.....................  Billing Routine Cost of Clinical Trials
                           Carrier Specific Requirements for Certain
                            Specialties/Services
                           Requirements for Billing Routine Cost of
                            Clinical Trials
1722.....................  Instructions for Downloading the Medicare ZIP
                            Code Files for October 2009
1723.....................  Only Clinical Trial Services Receive Fee-For-
                            Service Payment on Claims Billed for Managed
                            Care Beneficiaries
                           Requirements for Billing Routine Costs of
                            Clinical Trials
                           Billing and Processing Fee for Service Claims
                            for Covered Clinical Trial Services
                            Furnished to Managed Care Enrollees
1724.....................  Issued to a specific audience, not posted to
                            Internet/Intranet due to Sensitivity of
                            Instruction
1725.....................  Requirements for Specialty Codes
                           Requirements for Specialty Codes
1726.....................  Issued to a specific audience, not posted to
                            Internet/Intranet due to Confidentiality of
                            Instruction
1727.....................  Coordination of Benefits Agreement (COBA)
                            Repair and Claims Recovery Requirements
                            Stemming from the Health Insurance
                            Portability and Accountability Act 5010
                            Claims Transactions
                           Coordination of Benefits Agreement 837 5010
                            Coordination of Benefits Flat File Errors
                           Coordination of Benefits Agreement Full
                            Claims Repair Process
                           Coordination of Benefits Agreement (COBA)
                            Eligibility File Claims Recovery Process
1728.....................  Surgery for Diabetes
                           General
                           ICD-9 Procedure Codes for Bariatric Surgery
                            (FIs Only)
                           Claims Guidance for Payment
                           Medicare Summary Notices and Claim Adjustment
                            Reason Codes
1729.....................  Section 148 of the Medicare Improvements for
                            Patients and Providers Act (MIPPA)
                           Clinical Diagnostic Laboratory Tests
                            Furnished by CAHs
                           Hospital and Skilled Nursing Facility
                            Patients
                           General Explanation of Payment
                           Hospital Billing Under Part B
                           Critical Access Hospital Outpatient
                            Laboratory Service
1730.....................  Issued to a specific audience, not posted to
                            Internet/Intranet due to Confidentiality of
                            Instruction
1731.....................  Clarification of CMS Publication 100-04,
                            Chapter 32, Section 80.8 Billing of Routine
                            Foot Care When Payment Ceases for Loss of
                            Protective Sensation Evaluation and
                            Management
                           Billing Requirements for Special Services
1732.....................  Pricing Claims for Services Rendered in Place
                            of Service Home
                           General Billing Requirements
                           Medicare Claims Processing Manual/Chapter 1/
                            General Billing Requirements/Table of
                            Contents
                           Payment Jurisdiction Among Contractors for
                            Services Paid Under the Physician Fee
                            Schedule and Anesthesia Services
                           Claims Processing Instructions for Payment
                            Jurisdiction for Claims Received on or after
                            April 1, 2004
1733.....................  Manual Clarifications for Skilled Nursing
                            Facility and Therapy Billing
                           Inpatient Billing from Hospitals and SNFs
                           HCPCS Coding Requirements
                           Special Inpatient Billing Instructions
                           Bills with Covered and Noncovered Days
                           Billing in Benefits Exhaust and No-Payment
                            Situations
1734.....................  Claim Adjustment Reason Code (CARC),
                            Remittance Advice Remark Code and Medicare
                            Remit Easy Print Update
1735.....................  Changes to the Laboratory National Coverage
                            Determination Edit Software for July 2009
1736.....................  Chapter 24 Update to Restore Inadvertently
                            Deleted Information and to Remove
                           Reserved
                           Reserved
                           Contractor Roles in ASCA Reviews
1737.....................  July 2009 Quarterly Average Sales Price
                            Medicare Part B Drug Pricing
                           Files and Revisions to Prior Quarterly
                            Pricing Files
1738.....................  Additional Data Collection on Hospice Claims
                           Data Required on Claim to FI
1739.....................  July 2009 Integrated Outpatient Code Editor
                            Specifications Version 10.2
1740.....................  July 2009 Update to the ASC Payment System;
                            Summary of Payment Policy Changes
1741.....................  Update-Inpatient Psychiatric Facilities
                            Prospective Payment System Rate Year 2010
1742.....................  Clarification of Chapter 32, Section 80.8
                            Billing of Routine Foot Care When Payment
                            Ceases for Loss of Protective Sensation
                            Evaluation and Management
                           Billing Requirements for Special Services
1743.....................  Billing Routine Cost of Clinical Trials

[[Page 49081]]

 
                           Carrier Specific Requirements for Certain
                            Specialties/Services
                           Requirements for Billing Routine Cost of
                            Clinical Trials
1744.....................  Manual Update to Include Billing Instructions
                            for Professional Component and Technical
                            Component in Regards to One Line Global
                            Billing for Pathology Services DOS for
                            Clinical Laboratory and Pathology Specimen
1745.....................  July 2009 Update of the Hospital Outpatient
                            Prospective Payment System When an Inpatient
                            Admission May Be Changed to Outpatient
                            Status
                           Background
                           Policy and Billing Instructions for Condition
                            Code 44
                           Outlier Adjustments
                           Identifying Hospitals and CMHCs Subject to
                            Outlier Reconciliation
                           Reconciling Outlier Payments for Hospitals
                            and CMHCs
                           Time Value of Money
                           Procedures for Medicare Contractors to
                            Perform and Record Outlier
                           Reconciliation Adjustments
                           Observation Services Overview
                           Revenue Code Reporting
                           Reporting Hours of Observation
                           Billing and Payment for All Hospital
                            Observation Services Furnished between
                            January 1, 2006 and December 31, 2007
                           Separate and Packaged Payment for Direct
                            Referral for Observation Services Furnished
                            between January 1, 2006 and December 31,
                            2007
                           Separate and Packaged Payment for Observation
                            Services Furnished between January 1, 2006
                            and December 31, 2007
                           Billing and Payment for Observation Services
                            Beginning January 1, 2008
                           Billing and Payment for Direct Referral for
                            Observation Care Furnished Beginning January
                            1, 2008
                           Hospital Outpatient Payment Under OPPS for
                            New, Unclassified Drugs and Biologicals
                            After FDA Approval But Before Assignment of
                            a Product-Specific Drug or Biological HCPCS
                            Code
1746.....................  Quarterly Update to Correct Coding Initiative
                            Edits, Version 15.2, Effective July 1, 2009
1747.....................  Beneficiary-Submitted Claims
                           Monitoring Claims Submission Violations
                           Handling Incomplete or Invalid Claims
1748.....................  July Update to the 2009 Medicare Physician
                            Fee Schedule Database
1749.....................  Revised Billing Instructions for Occurrence
                            Span Code 74 on Skilled Nursing Facility No
                            Payment Claims
                           Billing in Benefits Exhaust and No-Payment
                            Situations
1750.....................  October Quarterly Update to 2009 Annual
                            Update of HCPCS Codes Used for Skilled
                            Nursing Facility Consolidated Billing
                            Enforcement
1751.....................  New Waived Tests
1752.....................  Addition/Deletion of HCPCS Codes--July 2009
                            Quarterly Update
1753.....................  Issued to a specific audience, not posted to
                            Internet/Intranet due to Confidentiality of
                            Instruction
1754.....................  July Quarterly Update for 2009 Durable
                            Medical Equipment, Prosthetics, Orthotics,
                            and Suppliers Fee Schedule
1755.....................  Wrong Surgical or Other Invasive Procedure
                            Performed on a Patient; Surgical or Other
                            Invasive Procedure Performed on the Wrong
                            Body Part; Surgical or Other Invasive
                            Procedure Performed on the Wrong Patient
                           Billing Wrong Surgical or Other Invasive
                            Procedures Performed on a Patient, Surgical
                            or Other Invasive Procedures Performed on
                            the Wrong Body Part, and Surgical or Other
                            Invasive Procedures Performed on the Wrong
                            Patient
1756.....................  Claim Status Category Code and Claim Status
                            Code Update
1757.....................  Claims Processing for Skilled Nursing
                            Facility Consolidated Billing
                           Carrier/Part B MAC/DMEMAC Claims Processing
                            for Consolidated Billing for Physician and
                            Non-Physician Practitioner Services Rendered
                            to Beneficiaries in a SNF Part A Stay
                           Reject and Unsolicited Response Edits
                           A/B Crossover Edits
                           Duplicate Edits
                           Edit for Ambulance Services
                           Edit for Clinical Social Workers (CSWs)
                           Edit for Therapy Services Separately Payable
                            when Furnished by a Physician
                           CWF Override Codes
                           Coding Files and Updates
                           Annual Update Process
1758.....................  Correction to Fiscal Year (FY) 2009 Medicare
                            Severity Long-Term Care Diagnosis-Related
                            Group (MS-LTC-DRG) Weights
1759.....................  July 2009 Update to the ASC Payment System;
                            Summary of Payment Policy Changes
1760.....................  July 2009 Update of the Hospital Outpatient
                            Prospective Payment System when an Inpatient
                            Admission May Be Changed to Outpatient
                            Status
                           Background
1761.....................  Billing Routine Cost of Clinical Trials
                           Carrier Specific Requirements for Certain
                            Specialties/Services
                           Requirements for Billing Routine Cost of
                            Clinical Trials
                           Policy and Billing Instructions for Condition
                            Code 44
                           Outlier Adjustments
                           Identifying Hospitals and CMHCs Subject to
                            Outlier Reconciliation
                           Reconciling Outlier Payments for Hospitals
                            and CMHCs
                           Time Value of Money
                           Procedures for Medicare Contractors to
                            Perform and Record Outlier Reconciliation
                            Adjustments
                           Observation Services Overview
                           Revenue Code Reporting

[[Page 49082]]

 
                           Reporting Hours of Observation
                           Billing and Payment for All Hospital
                            Observation Services Furnished Between
                            January 1, 2006 and December 31, 2007
                           Billing and Payment for All Hospital
                            Observation Services Furnished Between
                            January 1, 2006 and December 31, 2007
                           Separate and Packaged Payment for Direct
                            Referral for Observation Services Furnished
                            Between January 1, 2006 and December 31,
                            2007
                           Separate and Packaged Payment for Direct
                            Referral for Observation Services Furnished
                            Between January 1, 2006 and December 31,
                            2007
                           Billing and Payment for Observation Services
                            Beginning January 1, 2008
                           Billing and Payment for Direct Referral for
                            Observation Care Furnished Beginning January
                            1, 2008
                           Hospital Outpatient Payment Under OPPS for
                            New, Unclassified Drugs and Biologicals
                            After FDA Approval But Before Assignment of
                            a Product-Specific Drug or Biological HCPCS
                            Code
------------------------------------------------------------------------
                        Medicare Secondary Payer
                           (CMS--Pub. 100-05)
------------------------------------------------------------------------
68.......................  Claim Adjustment Reason Code Update for
                            Medicare Secondary Payer Claims Processing
69.......................  Update to the Electronic Correspondence
                            Referral System User Guide v10.0 and Quick
                            Reference Card v10.0
                           Coordination With the Coordination of
                            Benefits Contractor
                           Contractor MSP Auxiliary File Update
                            Responsibility
                           COBC Electronic Correspondence Referral
                            System
                           Attachment 1--ECRS User Guide, Software
                            Version 10.0
                           Attachment 1A--ECRS Part D Plan User Guide,
                            Software
                           Providing Written Documents to the COBC
70.......................  Instructions on utilizing 837 Institutional
                            CAS segments for Medicare Secondary Payer
                            Part A Claims
------------------------------------------------------------------------
                      Medicare Financial Management
                           (CMS--Pub. 100-06)
------------------------------------------------------------------------
150......................  Internal Control Requirements Update
                           Introduction
                           Authority
                           FMFIA and the CMS Contractor Contract
                           GAO Standards for Internal Controls in the
                            Federal Government
                           Definition and Objectives
                           Monitoring
                           Contractor Internal Control Review Process
                           Risk Assessment
                           Risk Analysis Chart
                           Internal Control Objectives
                           CMS Contractor Control Objectives
                           Policies and Procedures
                           Testing Methods
                           Documentation and Working Papers
                           Certification Package for Internal Controls
                           OMB Circular A-123, Appendix A: Internal
                            Control Over Financial Reporting
                           CPIC Requirements
                           Certification Statement
                           Executive Summary
                           CPIC Report of Material Weaknesses
                           CPIC Report of Internal Control Deficiencies
                           Definitions of Control Deficiency,
                            Significant Deficiency, and Material
                            Weaknesses Corrective Action Plans
                           Submission, Review, and Approval of
                            Corrective Action Plans
                           CMS Finding Numbers
                           Initial CAP Report
                           Quarterly CAP Report
                           Entering Data into the Initial or Quarterly
                            CAP Report
                           List of CMS Contractor Control Objectives
                           CMS Financial Reporting Cycle Memo
                           Financial Reporting Cycle Memo Inclusions
                           List of Appendices
151......................  Notice of New Interest Rate for Medicare
                            Overpayments and Underpayments--3rd
                            Notification for FY 2009
152......................  Recovery Audit Contractors (RACs)
                           Handling Appeals Resulting from RAC Initiated
                            Denials
                           Referrals to the Department of Treasury
                           Tracking Overpayments
                           Tracking Appeals
                           Reporting Administrative Costs Directly
                            Associated with the RAC Program Potential
                            Fraud
                           AC and MAC Requirements Involving RAC
                            Information Dissemination
                           Contacting Non-Responders
                           Voluntary Refunds
                           Working with RAC Support Contractors

[[Page 49083]]

 
153......................  Implementation of the Redesigned Provider
                            Statistical and Reimbursement (PS&R) System
                           Contractor's Responsibility Prior to
                            Submission of Cost Reports
------------------------------------------------------------------------
                    Medicare State Operations Manual
                           (CMS--Pub. 100-07)
------------------------------------------------------------------------
41.......................  Revisions to Appendices P and PP
42.......................  Revision to Appendix P, ``Survey Protocol for
                            Long Term Care Facilities--Part I''
                           ``Investigative Protocol--Unintended Weight
                            Loss''
43.......................  Revised Chapter 2, ``The Certification
                            Process,'' Section 2008A
                           Early Surveys of New Providers and Suppliers
44.......................  Revisions to Exhibit 286, ``Hospital/CAH
                            Medicare Database Worksheet''
45.......................  Revisions to Chapter 6--``Special Procedures
                            for Laboratories''
                           Background
                           Consultative CLIA Activities
                           Certificate of Registration
                           Certificate of Compliance
                           CLIA Certificate Status Changes
                           Criteria for One Certificate for Multiple
                            Sites
                           Laboratories Under Direct RO Jurisdiction
                           Laboratories Performing Limited Public Health
                            Testing
46.......................  Revisions to Appendix V, ``Emergency Medical
                            Treatment and Labor Act Interpretive
                            Guidelines''
47.......................  Revised Appendix A, ``Interpretive Guidelines
                            for Hospitals''
48.......................  Revisions to Appendix PP, ``Guidance to
                            Surveyors of Long Term Care Facilities''
49.......................  New Critical Access Hospital (CAH)
                            Requirements Under 42 CFR 485.610(e) Related
                            to CAH Co-location and CAH Provider-based
                            Locations
------------------------------------------------------------------------
                       Medicare Program Integrity
                           (CMS--Pub. 100-08)
------------------------------------------------------------------------
288......................  Incorporation of Physician Fee Schedule
                            Regulatory Changes
                           Definitions
                           Pre-Screening Process
                           Application Rejections
                           Denials for Incomplete Applications
                           Returning the Application
                           Types of Business Organizations
                           Certification Statement
                           Delegated Officials
                           IDTF Standards
                           Requesting and Receiving Clarifying
                            Information
                           Definitions
                           Determining Whether a CHOW Has Occurred
                           Processing CHOW Applications
                           Effective Billing Date for Physicians, Non-
                            Physician Practitioners, and Physician or
                            Non-Physician Practitioner Organizations
                           Denials
                           General Procedures
                           Electronic Fund Transfers
                           Medicare Advantage and Other Managed Care
                            Organizations
                           Clinical Nurse Specialists
                           Nurse Practitioners
                           Physicians
                           Speech Language Pathologists in Private
                            Practice
                           Contractor Issued Revocations
                           File Maintenance
289......................  Incorporation of Physician Fee Schedule
                            Regulatory Changes
                           Definitions
                           Pre-Screening Process
                           Application Rejections
                           Denials for Incomplete Applications
                           Returning the Application
                           Types of Business Organizations
                           Certification Statement
                           Delegated Officials
                           IDTF Standards
                           Requesting and Receiving Clarifying
                            Information
                           Determining Whether a CHOW Has Occurred
                           Effective Billing Date for Physicians, Non-
                            Physician Practitioners, and Physician or
                            Non-Physician Practitioner Organizations
                           Denials
                           General Procedures
                           Electronic Fund Transfers

[[Page 49084]]

 
                           Medicare Advantage and Other Managed Care
                            Organizations
                           Clinical Nurse Specialists
                           Nurse Practitioners
                           Speech Language Pathologists in Private
                            Practice
                           Contractor Issued Revocations
                           File Maintenance
291......................  Reassignment and Ambulatory Surgical Centers
                            (ASCs)
292......................  Submission of Paper and Electronic CMS--855
                            Enrollment Applications
293......................  Review of Durable Medical Equipment,
                            Prosthetics, Orthotics, and Supplies
                           Period of Medical Necessity for Serial DMEPOS
                            claims
                           Accessories
                           Repairs
                           Maintenance
                           General DMEPOS Review Reminders
294......................  Additional Extract from Multi-Carrier System
                            to Provider Enrollment, Chain and Ownership
                            System for 4th Quarter Deactivations
295......................  Revision to Certain Instructions Related to
                            Provider Enrollment Deactivations and
                            Revocations
                           Radiation Therapy Centers
                           Certified Registered Nurse Anesthetists
                           CMS or Contractor Issued Deactivations
                           Contractor Issued Revocations
                           DPSE Issued Revocations
                           PSC Identified Revocations
                           CMS Satellite Office or Regional Office
                            Identified Revocations
------------------------------------------------------------------------
       Medicare Contractor Beneficiary and Provider Communications
                           (CMS--Pub. 100-09)
------------------------------------------------------------------------
00.......................  None
------------------------------------------------------------------------
         Medicare End Stage Renal Disease Network Organizations
                            (CMS--Pub 100-14)
------------------------------------------------------------------------
00.......................  None
------------------------------------------------------------------------
                          Medicare Managed Care
                           (CMS--Pub. 100-16)
------------------------------------------------------------------------
00.......................  None
------------------------------------------------------------------------
               Medicare Business Partners Systems Security
                           (CMS--Pub. 100-17)
------------------------------------------------------------------------
00.......................  None
------------------------------------------------------------------------
                             Demonstrations
                           (CMS--Pub. 100-19)
------------------------------------------------------------------------
61.......................  Method of Payment for Extended Stay Services
                            under the Frontier Extended Stay Clinic
                            Demonstration, Authorized by Section 434 of
                            the Medicare Modernization Act. This Change
                            Request provides additional information to
                            CR 6057
------------------------------------------------------------------------
                          One Time Notification
                           (CMS--Pub. 100-20)
------------------------------------------------------------------------
469......................  Issued to a specific audience, not posted to
                            Internet/Intranet due to Confidentiality of
                            Instruction
------------------------------------------------------------------------
470......................  Expansion of the Current Scope of Editing for
                            Ordering/Referring Providers for Claims
                            Processed by Medicare Carriers and Part B
                            Medicare
                           Administrative Contractors
471......................  Revision to Processing Hospice Visit Charges
                            on Remittance Advices and Medicare Summary
                            Notices
472......................  Request for Common Working Files to Send
                            Common Working Files Medicare Quality
                            Assurance the 5010 File Formats as of
                            October 5, 2009
473......................  Deductible Application on Clinical Trial
                            Claims
474......................  Ten (10) percent Write-off from the Nine CWF
                            data bases for the Tables called: Medicare
                            Secondary Payment and Beneficiary ESRD
                            Dialysis Auxiliary, for the Calendar Years
                            2000-2008
475......................  Modification to Accommodate Acute Care
                            Episode Demonstration
476......................  Implementation of Indirect Medical Education
                            and Long Term Care Hospital Provisions from
                            the American Recovery and Reinvestment Act
                            of 2009
477......................  Change Type of Bill (TOB) for Federally
                            Qualified Health Centers from 73x to 77x
478......................  Internet-based Provider Enrollment, Chain and
                            Ownership Outreach to Academic Medical
                            Institutions and Large Group Practices

[[Page 49085]]

 
479......................  Issued to a specific audience, not posted to
                            Internet/Intranet due to Sensitivity of
                            Instruction
480......................  Expansion of the Current Scope of Editing for
                            Ordering/Referring Providers for Durable
                            Medical Equipment, Prosthetics, Orthotics,
                            and Supplier
                           Suppliers Claims Process by Durable Medical
                            Equipment Medicare Administrative
                            Contractors
481......................  Implementation of the Health Care Claim
                            Status Inquiry and Response (276/277)
                            Version 005010--Durable Medical Equipment
                            Shared System Change
482......................  Mainframe Integrated Outpatient Code Editor
                            Tool Set Upgrade
483......................  Fiscal Intermediary Shared System Analysis
                            for System-Related Outpatient Prospective
                            Payment System Processing Issues
484......................  Archiving and Retrieving of the Integrated
                            Outpatient Code Editor for Processing Claims
485......................  Implementation--Systems Improvements to
                            Streamline Updates to the Place of Service
                            Code Set
486......................  Jurisdiction 5 A/B MAC Merge of the Part B
                            East Missouri, West Missouri, Nebraska,
                            Kansas, and Iowa Production and User
                           Acceptance Test Regions
487......................  Modification of the Common Working File
                            Copybook to Transmit a ``WC'' Qualifier to
                            Distinguish Workers Compensation Medicare
                            Set-Aside
                           Arrangement MSP Records
488......................  Processing and Payment of Physician and Non-
                            Physician Practitioner Services Reassigned
                            to ASCs
489......................  Require Medicare Administrative Contractors
                            Fiscal Intermediaries and