November 2019 Medicare B Connection

C Medicare B ONNECTION medicare.

A Newsletter for MAC Jurisdiction N Providers

November 2019

In this issue

2020 Medicare physician fee schedule payment rates and participation program........................................... 5

Multiple LCD revisions ? Part A and Part B.................. 10 MLN Connects? ? Special Edition for November 15,

2019.......................................................................... 20

MLN Connects? ? Special Edition for November 4, 2019

Physician Fee Schedule and OPPS/ASC Final Rules Call -- November 6

Wednesday, November 6 from 2:15 to 3:45 pm ET

Register for Medicare Learning Network events.

During this call, learn about the provisions in two CMS CY 2020 final rules:

Physician Fee Schedule and Quality Payment Program: Final Rule, Press Release, Physician Fee Schedule Fact Sheet, and Quality Payment Program Fact Sheet

Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) payment systems: Final Rule and Fact Sheet

Changes to the Physician Fee Schedule are aimed at reducing burden, recognizing clinicians for the time they spend taking care of patients, removing unnecessary measures, and making it easier for clinicians to be on the path towards value-based care. Topics include:

Payment and supervision policy updates Merit-based Incentive Payment System Value

Pathways: Streamlining the Quality Payment Program to reduce clinician burden Creating the new Opioid Treatment Program benefit in response to the opioid epidemic

In addition, updates and policy changes under the Medicare OPPS and ASC payment systems lay the foundation for a patient-driven health care system. A question and answer session follows the presentation. We encourage you to review the final rules prior to the call. Target Audience: Medicare Part B fee-for-service clinicians; office managers and administrators; state and national associations that represent health care providers; all hospitals operating in the United States; and other stakeholders. The Medicare Learning Network?, MLN Connects?, and MLN Matters? are registered trademarks of the U.S. Department of Health and Human Services (HHS).

WHEN EXPERIENCE COUNTS & QUALITY MATTERS

Contents

Medicare B Connection

MLN Connects? ? Special Edition for November 4, 2019.............................................................1

About the Medicare B Connection

About the Medicare B Connection................................................................................................3 Advance beneficiary notices.........................................................................................................4

General Information

Appeals Changes to amount in controversy (AIC) for appeals in 2020......................................................5

Fee News 2020 Medicare physician fee schedule payment rates and participation program.......................5

Processing Issue Ambulance claims denied by common working file (CWF) skilled nursing facility (SNF)

consolidated billing (CB) edit 7275 ...........................................................................................5

Local Coverage Determinations

Looking for LCDs?........................................................................................................................6 Advance beneficiary notice..........................................................................................................6

New LCDs Endovenous stenting ? new Part A and Part B LCD....................................................................7

Gastrointestinal pathogen (GIP) panels utilizing multiplex nucleic acid amplification techniques (NAATs) ? new Part A and Part B LCD .....................................................................................7

Micro-invasive glaucoma surgery (MIGS) ? new Part A and Part B LCD.....................................7

Revisions to LCDs Proton beam radiotherapy ? revision to the Part B LCD..............................................................8

Noncovered services ? revision to the Part A and Part B LCD.....................................................9

Treatment of varicose veins of the lower extremity ? revision to the Part A and Part B LCD.......9

Multiple LCD revisions ? Part A and Part B.................................................................................10

4Kscore test algorithm ? revision to the Part A and Part B LCD.................................................. 11

Independent diagnostic testing facility (IDTF) ? revision to the Part B LCD.................................12

Retired LCDs Multiple Part A and Part B LCDs being retired...........................................................................13 Multiple Part B LCDs being retired.............................................................................................13

Educational Resources

Upcoming provider outreach and educational events................................................................14

CMS MLN Connects? MLN Connects? for Thursday, October 24, 2019.......................................................................15 MLN Connects? for Thursday, October 31, 2019.......................................................................15 MLN Connects? ? Special Edition for October 31, 2019............................................................16 MLN Connects? ? Special Edition for November 1, 2019...........................................................17

MLN Connects? for Thursday, November 7, 2019......................................................................18 MLN Connects? ? Special Edition for November 12, 2019.........................................................19 MLN Connects? for Thursday, November 14, 2019....................................................................19 MLN Connects? ? Special Edition for November 15, 2019.........................................................20

Contact Information

Florida Contact Information........................................................................................................21 U.S. Virgin Islands Contact Information......................................................................................22 Puerto Rico Contact Information................................................................................................23

Order Form

Medicare Part B materials..........................................................................................................24

The Medicare B Connection is published monthly by First Coast Service Options Inc.'s Provider Outreach & Education division to provide timely and useful information to Medicare Part B providers.

Articles included in the Medicare B Connection represent formal notice of coverage policies. Policies have or will take effect on the date given. Providers are expected to read, understand, and abide by the policies outlined within to ensure compliance with Medicare coverage and payment guidelines.

CPT? five-digit codes, descriptions, and other data only are copyright 2018 by American Medical Association (or such other date of publication of CPT?). All Rights Reserved. Applicable FARS/DFARS apply. No fee schedules, basic units, relative values or related listings are included in CPT?. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for data contained or not contained herein.

ICD-10-CM codes and its descriptions used in this publication are copyright 2018 Optum360, LLC. All rights reserved.

This document contains references to sites operated by third parties. Such references are provided for your convenience only. Florida Blue and/or First Coast Service Options Inc. do not control such sites and are not responsible for their content. The inclusion of these references within this document does not suggest any endorsement of the material on such sites or any association with their operators.

All stock photos used are obtained courtesy of a contract with .

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? Back to Contents

About the MeGdiecnaerreaBl ICnfoonrnmeaction

About the Medicare B Connection

The Medicare B Connection is a comprehensive publication developed by First Coast Service Options Inc. (First Coast) for Part B providers in Florida, Puerto Rico, and the U.S. Virgin Islands and is distributed on a monthly basis.

Important notifications that require communication in between publications will be posted to the First Coast Medicare provider education website. In some cases, additional unscheduled special issues may be posted.

Who receives the Connection

Anyone may view, print, or download the Connection from our provider education website(s). Providers who cannot obtain the Connection from the internet are required to register with us to receive a complimentary hardcopy.

Distribution of the Connection in hardcopy is limited to providers who have billed at least one Part B claim to First Coast Medicare during the twelve months prior to the release of each issue. Providers meeting these criteria are eligible to receive a complimentary copy of that issue, if a technical barrier exists that prevents them from obtaining it from the internet and they have returned a completed registration form to us.

Registration forms must be submitted annually or when you experience a change in circumstances that impacts your electronic access.

For additional copies, providers may purchase a separate annual subscription (see order form in the back of this issue). All issues published since 1997 may be downloaded from the internet, free of charge.

We use the same mailing address for all correspondence, and cannot designate that the Connection be sent to a specific person/department within a provider's office. To ensure continued receipt of all Medicare correspondence, providers must keep their addresses current with the Medicare provider enrollment department. Please remember that address changes must be done using the appropriate CMS-855.

Publication format

The Connection is arranged into distinct sections.

The Claims section provides claim submission requirements and tips.

The Coverage/Reimbursement section discusses specific CPT? and HCPCS procedure codes. It is arranged by categories (not specialties). For example,

"Mental Health" would present coverage information of interest to psychiatrists, clinical psychologists and clinical social workers, rather than listing articles separately under individual provider specialties. Also presented in this section are changes to the Medicare physician fee schedule, and other pricing issues.

The section pertaining to Electronic Data Interchange (EDI) submission also includes information pertaining to the Health Insurance Portability and Accountability Act (HIPAA).

The Local Coverage Determination section features summaries of new and revised local coverage determinations (LCDs) developed as a result of either local medical review or comprehensive data analysis initiatives.

The General Information section includes fraud and abuse, and national provider identifier topics, plus additional topics not included elsewhere.

In addition to the above, other sections include:

Educational Resources, and

Contact information for Florida, Puerto Rico, and the U.S. Virgin Islands.

The Medicare B Connection represents formal notice of coverage policies

Articles included in each edition represent formal notice that specific coverage policies either have or will take effect on the date given. Providers are expected to read, understand, and abide by the policies outlined in this document to ensure compliance with Medicare coverage and payment guidelines.

Never miss an appeals deadline again

When it comes to submitting a claims appeal request, timing is everything. Don't worry ? you won't need a desk calendar to count the days to your submission deadline. Try our "time limit" calculators on our Appeals of claim decisions page. Each calculator will automatically calculate when you must submit your request based upon the date of either the initial claim determination or the preceding appeal level.

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GAebnoeurtatlhIenMforemdiacatiroenB Connection

? Back to Contents

Medicare Part B advance beneficiary notices

Medicare Part B allows coverage for services and items deemed medically reasonable and necessary for treatment and diagnosis of the patient.

For some services, to ensure that payment is made only for medically necessary services or items, coverage may be limited based on one or more of the following factors (this list is not inclusive):

believe to be noncovered items or services. The ABN must meet all of the standards found in Chapter 30. Beginning March 1, 2009, the ABN-G and ABN-L was no longer valid; and notifiers must use the revised Advance Beneficiary Notice of Noncoverage (CMS-R-131). Section 50 of the Medicare Claims Processing Manual.

Coverage for a service or item may be allowed only for specific diagnoses/conditions. Always code to the highest level of specificity.

Coverage for a service or item may be allowed only when documentation supports the medical need for the service or item.

Coverage for a service or item may be allowed only when its frequency is within the accepted standards of medical practice (i.e., a specified number of services in a specified timeframe for which the service may be covered).

If the provider believes that the service or item may not be covered as medically reasonable and necessary, the patient must be given an acceptable advance notice of Medicare's possible denial of payment if the provider does not want to accept financial responsibility for the service or item. Advance beneficiary notices (ABNs) advise beneficiaries, before items or services actually are furnished, when Medicare is likely to deny payment.

Patient liability notice

The Centers for Medicare & Medicaid Services' (CMS) has developed the Advance Beneficiary Notice of Noncoverage (ABN) (Form CMS-R-131), formerly the "Advance Beneficiary Notice." Section 50 of the Medicare Claims Processing Manual provides instructions regarding the notice that these providers issue to beneficiaries in advance of initiating, reducing, or terminating what they

Reproducible copies of Form CMS-R-131 ABNs (in English and Spanish) and other BNI information may be found here.

ABN modifiers

When a patient is notified in advance that a service or item may be denied as not medically necessary, the provider must annotate this information on the claim (for both paper and electronic claims) by reporting modifier GA (waiver of liability statement on file) or GZ (item or service expected to be denied as not reasonable and necessary) with the service or item.

Failure to report modifier GA in cases where an appropriate advance notice was given to the patient may result in the provider having to assume financial responsibility for the denied service or item.

Modifier GZ may be used in cases where a signed ABN is not obtained from the patient; however, when modifier GZ is billed, the provider assumes financial responsibility if the service or item is denied.

Note: Line items submitted with the modifier GZ will be automatically denied and will not be subject to complex medical review.

GA modifier and appeals

When a patient is notified in advance that a service or item may be denied as not medically necessary, the provider must annotate this information on the claim (for both paper and electronic claims) by reporting the modifier GA (waiver of liability statement on file).

Failure to report modifier GA in cases where an appropriate advance notice was given to the patient may result in the provider having to assume financial responsibility for the denied service or item.

Nonassigned claims containing the modifier GA in which the patient has been found liable must have the patient's written consent for an appeal. Refer to the applicable contact section located at the end of this publication for the address in which to send written appeals requests.

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About the MeGdiecnaerreaBl ICnfoonrnmeaction

Appeals

Changes to amount in controversy (AIC) for appeals in 2020

The amount that must remain in controversy for Administrative Law Judge (ALJ) hearing requests (thirdlevel appeal) filed on or before December 31, 2019, is $160. This amount will increase to $170 for ALJ hearing requests filed on or after January 1, 2020.

The amount that must remain in controversy for reviews in Federal District Court (fifth-level appeal) requested on or before December 31, 2019, is $1,630. This amount will increase to $1,670 for appeals to Federal District Court filed on or after January 1, 2020.

Fee News

2020 Medicare physician fee schedule payment rates and participation program

The annual physician and supplier participation period begins January 1 of each year, and runs through December 31. The annual participation enrollment is scheduled to begin mid-November of each year.

The 2020 Medicare physician fee schedule (MPFS) payment rates have been posted to First Coast Service

Options' Medicare Provider website as publication of the MPFS final rule has been put in display in the Federal Register.

Source: Publication 100-04, Chapter 1, Section 30.3.12.1 (B2)

Processing Issue

Ambulance claims denied by common working file (CWF) skilled nursing facility (SNF) consolidated billing (CB) edit 7275

Issue

CWF SNF CB edit 7275 is denying Part B ambulance claims inappropriately. This is occurring when the beneficiary is in a covered Part A SNF stay but requires a Part B covered transport for emergency services and when the transport claim is billed with Healthcare Common Procedure Coding System (HCPCS) code A0427, A0429, or A0433.

Resolution

Medicare administrative contractors (MACs) will manually bypass the CWF SNF CB 7275 for incoming ambulance transportation claims containing HCPCS code A0427, A0429, or A0433 billed with or without A0425.

Status/date resolved

Open.

Provider action

None; however, MACs will reprocess claims brought to their attention that were denied in error.

Current processing issues

Here is a link to a table of current processing issues for both Part A and Part B.

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Local Coverage Determinations

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This section of Medicare B Connection features summaries of new and revised local coverage determinations (LCDs) developed as a result of either local medical review or comprehensive data analysis initiatives. These initiatives are designed to ensure the appropriateness of medical care and to make sure that the Medicare administrative contractor (MAC) jurisdiction N (JN) Part A LCDs and review guidelines are consistent with accepted standards of medical practice.

Refer to our LCDs/Medical Coverage webpage for full-text LCDs, including final LCDs, draft LCDs available for comment, LCD statuses, and LCD comment/response summaries.

Effective and notice dates

Effective dates are provided in each LCD, and are based on the date services are furnished unless otherwise noted in the LCD. Medicare contractors are required to offer a 45-day notice period for LCDs; the date the LCD is posted to the website is considered the notice date.

Electronic notification

To receive quick, automatic notification when new and revised LCDs are posted to the website, subscribe to the First Coast eNews mailing list. Simply enter your email address and select the subscription option that best meets your needs.

More information

For more information, or, if you do not have internet access, to obtain a hardcopy of a specific LCD, contact Medical Policy at:

Medical Policy and Procedures PO Box 2078 Jacksonville, FL 32231-0048

Looking for LCDs?

Would you like to find local coverage determinations (LCD) in 10 seconds or less? First Coast's LCD lookup helps you find the coverage information you need quickly and easily. Just enter a procedure code, keyword, or the LCD's "L number," click the corresponding button, and the application will automatically display links to any LCDs applicable to the parameters you specified. Best of all, depending upon the speed of your internet connection, the LCD search process can be completed in less than 10 seconds.

Advance beneficiary notice

Modifier GZ must be used when physicians, practitioners, or suppliers want to indicate that they expect that Medicare will deny an item or service as not reasonable and necessary and they have not had an advance beneficiary notification (ABN) signed by the beneficiary.

Note: Line items submitted with the modifier GZ will be automatically denied and will not be subject to complex medical review.

Modifier GA must be used when physicians, practitioners, or suppliers want to indicate that they expect that Medicare will deny a service as not reasonable and necessary and they do have on file an ABN signed by the beneficiary.

All claims not meeting medical necessity of a local coverage determination must append the billed service with modifier GA or GZ.

Your Feedback Matters

To ensure that our website meets the needs of our provider community, we carefully analyze your feedback and implement changes to better meet your needs. Discover the results of your feedback on our "Website enhancements" page. You'll find the latest enhancements to our provider websites and find out how you can share your thoughts and ideas with First Coast's web team.

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LoEcalelcCtroovneircaDgeatDaeItnertemrcinhaatniognes

New LCDs

Endovenous stenting ? new Part A and Part B LCD

LCD ID number: L38231 (Florida/Puerto Rico/ U.S. Virgin Islands)

This new local coverage determination (LCD) addresses "Coverage Indications, Limitations, and/or Medical Necessity," "Place of Service," and "Provider Qualifications" requirements for endovenous stenting. The central focus is on the indications for placement of endovenous stents in severely symptomatic obstructions. Also, the related Billing and Coding article (A56644) addresses coding guidelines in support of the reasonable and necessary services as outlined in the LCD.

Effective date

This new LCD is effective for services rendered on or after December 30, 2019. LCDs are available through the CMS Medicare coverage database at . gov/medicare-coverage-database/overview-and-quicksearch.aspx.

A coding article for an LCD (when present) may be found by selecting "Related Local Coverage Documents" in the "Section Navigation" drop-down menu at the top of the LCD page.

Note: To review active, future and retired LCDs, please click here.

Gastrointestinal pathogen (GIP) panels utilizing multiplex nucleic acid amplification techniques (NAATs) ? new Part A and Part B LCD

LCD ID number: L38227 (Florida/Puerto Rico/ U.S. Virgin Islands)

This new local coverage determination (LCD) addresses "Coverage Indications, Limitations, and/or Medical Necessity," and "Provider Qualifications" requirements for gastrointestinal pathogen (GIP) panels utilizing multiplex nucleic acid amplification techniques (NAATs) panels, for the evaluation of Medicare beneficiaries with acute or persistent diarrhea, paralytic ileus or persistent diarrhea with an immunocompromising medical condition. Also, the related Billing and Coding article (A56638) addresses coding guidelines in support of the reasonable and necessary services as outlined in the LCD.

Effective date

This new LCD is effective for services rendered on or after December 30, 2019. LCDs are available through the CMS Medicare coverage database at . gov/medicare-coverage-database/overview-and-quicksearch.aspx.

A coding article for an LCD (when present) may be found by selecting "Related Local Coverage Documents" in the "Section Navigation" drop-down menu at the top of the LCD page.

Note: To review active, future and retired LCDs, please click here.

Micro-invasive glaucoma surgery (MIGS) ? new Part A and Part B LCD

LCD ID number: L38233 (Florida/Puerto Rico/ U.S. Virgin Islands)

This new local coverage determination (LCD) addresses "Coverage Indications, Limitations, and/ or Medical Necessity," and "Provider Qualifications" requirements for micro-invasive glaucoma surgery (MIGS) and corresponding available U.S. Food and Drug Administration (FDA) approved glaucoma drainage devices, for the treatment of Medicare beneficiaries with mild or moderate open-angle glaucoma. Also, the related Billing and Coding article (A56647) addresses coding guidelines in support of the reasonable and necessary services as outlined in the LCD.

Effective date

This new LCD is effective for services rendered on or after December 30, 2019. LCDs are available through the CMS Medicare coverage database at . gov/medicare-coverage-database/overview-and-quicksearch.aspx.

A coding article for an LCD (when present) may be found by selecting "Related Local Coverage Documents" in the "Section Navigation" drop-down menu at the top of the LCD page.

Note: To review active, future and retired LCDs, please click here.

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Local Coverage Determinations

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Revisions to LCDs

Proton beam radiotherapy ? revision to the Part B LCD

LCD ID number: L33937 (Florida/Puerto Rico/ U.S. Virgin Islands)

Based on change request (CR) 10901, the local coverage determination (LCD) for proton beam radiotherapy was revised to remove all billing and coding and all language not related to reasonable and necessary provisions ("Bill Type Codes," "Revenue Codes," "CPT?/HCPCS Codes," "ICD-10 Codes that Support Medical Necessity," "Documentation Requirements" and "Utilization Guidelines" sections of the LCD) and place them into a newly created billing and coding article. During the process of moving the ICD-10-CM diagnosis codes to the billing and coding article, the ICD-10-CM diagnosis code ranges were broken out and listed individually. In addition, the Social Security Act and Internet Only Manual (IOM) reference sections were updated.

Also, based on review of the newly created billing and coding article, the following ICD-10-CM diagnosis code was added to the "ICD-10 Codes that Support Medical Necessity/Group 1 Codes" section: D43.3. The following ICD-10-CM diagnosis codes were removed from the "ICD-10 Codes that Support Medical Necessity/ Group 1 Codes" section: C40.00, C40.01, C40.02, C40.10, C40.11, C40.12, C40.20, C40.21, C40.22, C40.30, C40.31, C40.32, C40.80, C40.81, C40.82, C40.90, C40.91, C40.92, C41.9, C47.0, C47.10, C47.11, C47.12, C47.20, C47.21, C47.22, C47.3, C47.4, C47.5, C47.6, C47.8, C47.9, C49.0, C49.10, C49.11, C49.12, C49.20, C49.21, C49.22, C49.3, C49.4, C49.5, C49.6, C49.8, C49.9, C64.1, C64.2, C64.9, C69.00, C69.01, C69.02, C69.10, C69.11, C69.12, C69.20, C69.30, C69.40, C69.50, C69.51, C69.52, C69.60, C69.80, C69.90, C69.91, C69.92, C70.9, C71.9, C72.20, C72.30, C72.40, C72.50, C72.9, D32.9, D33.2, D42.9, and D43.2. The following ICD-10-CM diagnosis codes were added to the "ICD-10 Codes that Support Medical Necessity/ Group 2 Codes" section: C02.0, C02.1, C02.2, C02.4, C02.8, C14.8, C15.5, C16.0, C16.1, C16.2, C16.3, C16.4, C16.8, C26.1, C40.01, C40.02, C40.11, C40.12, C40.21, C40.22, C40.31, C40.32, C40.81, C40.82, C47.0, C47.11, C47.12, C47.21, C47.22, C47.3, C47.4, C47.5, C49.0, C49.11, C49.12, C49.21, C49.22, C49.3, C49.4, C49.5, C49.8, C50.022, C50.122, C50.222, C50.322, C50.422, C50.522, C50.622, C50.812, C50.822, C54.0, C54.1, C54.2, C54.3, C54.8, C57.01, C57.02, C57.11, C57.12, C57.21, C57.22, C57.3, C57.7, C57.8, C74.01, C74.02, C74.11, C74.12, C7A.026, C7A.090, C7B.02, C79.49, C79.71, and C79.72. The following ICD-10-CM diagnosis codes were removed from the "ICD-10 Codes that Support

Medical Necessity/Group 2 Codes" section: C04.9, C05.9, C06.80, C06.9, C10.9, C11.9, C13.9, C14.0, C21.0, C25.9, C31.9, C32.9, C34.00, C34.10, C34.30, C34.80, C34.90, C34.91, C34.92, C44.00, C44.101, C44.1021, C44.1022, C44.1091, C44.1092, C44.111, C44.121, C44.131, C44.191, C44.201, C44.202, C44.209, C44.211, C44.221, C44.291, C44.300, C44.301, C44.309, C44.310, C44.320, C44.390, C44.40, C44.500, C44.501, C44.509, C44.601, C44.602, C44.609, C44.611, C44.621, C44.691, C44.701, C44.702, C44.709, C44.711, C44.721, C44.791, C44.80, C44.90, C44.91, C44.92, C44.99, C50.011, C50.019, C50.111, C50.119, C50.211, C50.219, C50.311, C50.319, C50.411, C50.419, C50.511, C50.519, C50.611, C50.619, C56.9, C67.9, C76.1, C76.2 and C78.00.

In addition, the following ICD-10-CM diagnosis codes under the "ICD-10 Codes that Support Medical Necessity/ Group 2 Codes" section of the billing and coding article now require a dual diagnosis: ICD-10-CM diagnosis code C44.01, C44.02, C44.09, C44.1121, C44.1122, C44.1191, C44.1192, C44.1221, C44.1222, C44.1291, C44.1292, C44.1321, C44.1322, C44.1391, C44.1392, C44.1921, C44.1922, C44.1991, C44.1992, C44.212, C44.219, C44.222, C44.229, C44.292, C44.299, C44.311, C44.319, C44.321, C44.329, C44.391, C44.399, C44.41, C44.42, C44.49, C44.510, C44.511, C44.519, C44.520, C44.521, C44.529, C44.590, C44.591, C44.599, C44.612, C44.619, C44.622, C44.629, C44.692, C44.699, C44.712, C44.719, C44.722, C44.729, C44.792, C44.799, C44.81, C44.82 and C44.89 must be billed with ICD-10-CM diagnosis code C79.49.

Effective date

The LCD revision related to CR 10901 is effective for claims processed on or after January 8, 2019, for services rendered on or after October 3, 2018.

The LCD revision related to the addition/deletion of ICD-10-CM diagnosis codes and dual diagnosis requirement is effective for services rendered on or after December 16, 2019.

LCDs are available through the CMS Medicare coverage database at .

A billing and coding article for an LCD (when present) may be found by selecting "Related Local Coverage Documents" in the "Section Navigation" drop-down menu at the top of the LCD page.

Note: To review active, future and retired LCDs, please click here.

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