February 1, 2010, Home Health & Hospice Medicare A ... - CGS

The following additional billing requirements are applicable to KDE claims submitted by institutionalproviders to MACs or FIs:• MACs/FIs will reimburse for KDE Services when rendered in a rural area and submitted on thefollowing TOBs: 12X, 13X, 22X, 23X, 34X, 75X, 81X, and 82X. NOTE: TOB 85X is reimbursable forKDE Services regardless of the provider’s geographical location.• MACs/FIs will use the Actual Geographic Location CBSA to identify facilities located in rural areasunder the MPFS.• KDE Services are covered when claims containing the above-mentioned TOBs are received fromsection 401 hospitals (the provider is found on the annual updated Table 9C of the Inpatient ProspectivePayment System final rule);• Revenue code 0942 (Other therapeutic services; education/training) should be reported when billing forKDE Services on TOBs 22X, 23X, 34X, 75X, 81X, 82X, and 85X;• Medicare will return to provider hospice claims, TOBs 81X and 82X, billing forked services withrevenue code 0942 when any other services are also included:• Hospices must include value code 61 or G8 when billing for G0420 or G0421; and• Hospital outpatient departments should bill for KDE Services under any valid/appropriate revenue code,and they are not required to report revenue 0942. Maryland hospitals under jurisdiction of the HealthServices Cost Review Commission, TOBs 12X and 13X, are paid on an inpatient Part B basis inaccordance with the terms of the Maryland Waiver.Additional InformationBe aware that Medicare contractors will not search their files for claims with service dates on or afterJanuary 1, 2010, that are processed prior to the implementation of CR 6557. However, if you identify suchclaims to your Medicare contractor, they will adjust them. The official instruction, CR 6557, was issued viatwo transmittals, one revising the Medicare Claims Processing Manual, (CMS Pub. 100-04), Chapter 32,Section 20, and one for revisions to the Medicare Benefit Policy Manual, (CMS Pub. 100-02), Chapter 15,Section 310. These transmittals are available athttp://www.cms.hhs.gov/Transmittals/downloads/R1876CP.pdf andhttp://www.cms.hhs.gov/Transmittals/downloads/R117bp.pdf, respectively, on the CMS Web site. If youhave questions regarding this issue, refer to the “Contact Us” page of our Web site and select “TelephoneUs” to call the Provider Contact Center.DisclaimerThis article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article maycontain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be ageneral summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review thespecific statutes, regulations and other interpretive materials for a full and accurate statement of their contents. CPT onlycopyright 2008 American Medical Association.Home Health & Hospice February 1, 2010 9Medicare A Newsline Vol. 17, No. 5