Quarterly Healthcare Common Procedure Coding System (HCPCS)Drug/Biological Code Changes - July <strong>2013</strong> UpdateMLN Matters® MM8286Provider Types AffectedThis MLN Matters® Article is intended for physicians, other providers, and suppliers submitting claims toMedicare contractors (Fiscal Intermediaries (FIs), carriers, Regional Home Health Intermediaries (RHHIs),Durable Medical Equipment Medicare Administrative Contractors (DME/MACs) and A/B MedicareAdministrative Contractors (A/B MACs)) for services to Medicare beneficiaries.Provider Action NeededThis article is based on Change Request (CR) 8286 which informs Medicare contractors about the updatingof specific drug and biological HCPCS codes which occurs quarterly. Make sure that your billing staffs areaware of these changes. See the Background and Additional Information Sections of this article for furtherdetails regarding these changes.Key Points of CR8286Effective for claims with dates of service on or after July 1, <strong>2013</strong>, the following HCPCS codes will nolonger be payable for Medicare:J3487: Injection, Zoledronic Acid (Zometa), 1mg.J3488: Injection, Zoledronic Acid (Reclast), 1mg.J9002: Injection, Doxorubicin Hydrochloride, Liposomal, Doxil, 10mg.Effective for claims with dates of service on or after July 1, <strong>2013</strong>, the following HCPCS codes will bepayable for Medicare:Q2033: Influenza Vaccine, Recombinant Hemagglutinin Antigens, For Intramuscular Use (Flublok).Q2050: Injection, Doxorubicin Hydrochloride, Liposomal, Not Otherwise Specified, 10mg.Q2051: Injection, Zoledronic Acid, not otherwise specified, 1mg.Effective for claims with dates of service on or after July 1, <strong>2013</strong>, the following HCPCS code will beaccepted on claims, but not payable by Medicare:Q0090: Levonorgestrel-Releasing Intrauterine Contraceptive System (SKYLA), 13.5 mg.Additional InformationThe official instruction, CR8286 issued to your FI, carrier, RHHI, DME/MAC, and A/B MAC regardingthis change may be viewed at http://www.cms.hhs.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2695CP.pdf on the CMS website.Medicare A Newsline April <strong>2013</strong> 40
CMS Special Editions for All ProvidersReminder – Medicare Now Provides Coverage for Eligible Medicare Beneficiaries of aOne-Time Ultrasound Screening for Abdominal Aortic Aneurysms (AAA) WhenReferred for this Screening as a Result of the Initial Preventive Physical Examination(“Welcome to Medicare” Physical Exam)http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE0711.pdfMLN Matters ® SE0711 - RevisedQuestionable Billing by Suppliers of Lower Limb Prostheseshttp://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1213.pdfMLN Matters ® SE1213 - RevisedInformation on the National Physician Payment Transparency Program: OPENPAYMENTShttp://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1303.pdfMLN Matters ® SE1303Full Implementation of Edits on the Ordering/Referring Providers in Medicare Part B,DME, and Part A Home Health Agency (HHA) Claims (Change Requests 6417, 6421,6696, and 6856)http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1305.pdfMLN Matters ® SE1305 - RevisedMedicare A Newsline April <strong>2013</strong> 41