STATE OF MARYLAND



STATE OF MARYLAND

DHMH

Maryland Department of Health and Mental Hygiene

Martin O’Malley, Governor – Anthony G. Brown, Lt. Governor – Joshua M. Sharfstein, M.D., Secretary

Prevention and Health Promotion Administration

Michelle Spencer, MS, Director

Donna Gugel, MHS, Deputy Director

Ilise D. Marrazzo, RN, BSN, MPH, Director, Maternal and Child Health Bureau

Deborah B. McGruder, MPH, PMP, Director, Infectious Disease Bureau

Clifford S. Mitchell, MS, MD, MPH, Director, Environmental Health Bureau

Donald Shell, MD, MA, Director, Cancer and Chronic Disease Bureau

HEALTH OFFICER MEMORANDUM

DATE: July 1, 2014 CCPC HO Memo#14-16

TO: Health Officers

CRF CPEST Program Directors, Coordinators, and Staff

SAHC CRF Program Directors, Coordinators, and Staff

THROUGH: Courtney Lewis, Director

Center for Cancer Prevention and Control

FROM: Barbara Andrews, Program Manager

CRF Programs Unit

RE: CPT Codes and CY 2014 Medicare, Medicaid, and Dental Reimbursement Schedule

Attached is the Excel spreadsheet and Adobe (PDF) files containing the Calendar Year (CY) 2014 Medicare and Medical Assistance reimbursement rates. This spreadsheet replaces the information distributed last on April 26, 2013 as Health Officer Memo #13-17, updated on September 4, 2013.

The attached Excel spreadsheet lists some of the most common of the Medicare and Medicaid (Medical Assistance) Current Procedural Terminology (CPT) codes used in CPEST programs. There are many other CPT codes that may appear on invoices for reimbursement. Please remember that programs should reimburse diagnosis and treatment services at the appropriate Medicaid rate. If programs negotiated contracts with providers for diagnosis or treatment services above the Medicaid rates, remember the rates may not go above the Medicare rates. Program staff may contact DHMH CPEST staff to obtain the current Medicare rate or may access the Medicare rates through Novitas Solutions’ web site at: , select Jurisdiction L, then select “Fee Schedules” from the left banner. There is a search tool available for codes or rates not listed in the reimbursement chart.

NOTE:

• The pharmacy J-Code rates for diagnosis and treatment are no longer in the CPEST fee schedule because injectables are now reimbursed at the provider acquisition cost in accordance with the current Maryland Medical Assistance (MMA) Physician’s Services Billing Manual. The 2014 Maryland Medical Assistance (MMA) Billing Manual and Fee Schedule can be accessed at (click on “About Our Programs”, then scroll down and click on “Provider Information” to find the reimbursement information). The laboratory fees and the dental reimbursement fees are also listed on this site.

• The Excel document attached includes 6 tabs for spreadsheets: Colorectal (CRC), Oral, Prostate, and Skin cancer Medicare and Medical Assistance reimbursement rates which include the county-specific Core Based Statistical Area (CBSA) Ambulatory Surgical Center (ASC) facility fee rates for CRC screening procedures. The fifth tab is “All Cancers By CPT Code” that combines all 4 rate charts into one sheet sorted by CPT code for easy look-up. The sixth tab contains the Office Visits, Initial Inpatient Consultation Rates, Additional Notes, Footnotes, and CPT modifier codes that pertain to the CRC, oral, prostate, and skin cancers.

• Also attached are six PDF files that contain the same spreadsheets noted above. This formatting is locked therefore makes printing easier.

Please remember that programs contracting with a facility/hospital regulated under the Maryland Health Services Cost Review Commission (MSHCRC) should review and follow Health Officer Memos #12-44 dated December 17, 2012 and #13-11 dated March 19, 2013 regarding the facility contracts for HSCRC regulated facilities and the current reimbursement guidance.

Please feel free to contact Dwayne Selph by e-mail at Dwayne.Selph@ or 410-767-5139 if you have any reimbursement questions or comments. You may also call Barbara Andrews at

410-767-5123 or Barbara.Andrews@ for further assistance.

Attachments: (electronically sent to Health Officers, CRF Local Health Departments, and CRF Cancer Program Coordinators)

Electronic cc:

Sarah Hokenmaier

Courtney Lewis

Donald Shell

File

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