Change request 10901 updates the "Medicare Program Integrity Manual" with detailed changes to the local coverage determination (LCD) process, which will help to increase transparency, clarity, consistency, reduce provider burden, and enhance public relations while retaining the ability to be responsive to local clinical and coverage policy concerns. [MM10901]
So coding changes can be made more efficiently without requiring reconsideration of an LCD, CPT® and ICD-10 codes are being relocated from LCDs to associated billing and coding articles or policy articles. [CR10901]
When a medical reviewer contacts the provider requesting to submit an attestation statement or signature log to authenticate a medical record, the provider must submit the attestation statement or signature log within the following 20 calendar days. [CR 6698]
Please review this article from the durable medical equipment Medicare administrative contractors (DME MACs) about ordering spinal orthoses for your Medicare patients.
Revisions have been made to the Self-administered drug (SAD) list to add Tremfya® (guselkumab) (J1628) and Stelara® (ustekinumab) subcutaneous (J3357).
Based on a review, this billing and coding article was revised to add the new Food and Drug Administration (FDA) approved drug Panzyga® (immune globulin intravenous, human – IFAS).
Based on a reconsideration request, the billing and coding article was revised to add ICD-10-CM diagnoses codes to the ICD-10 Codes that Support Medical Necessity/Group 4 Codes.
Based on review of the billing and coding article for controlled substance monitoring and drugs of abuse testing billing, the article was revised to remove Current Procedural Terminology (CPT®) code 83789 as it is not a test for drugs.
First Coast has implemented a new process to reduce provider burden and process claims more efficiently. If you submit claims for skin substitutes or radiopharmaceutical codes, learn how this new process will benefit you.
Based on the Food and Drug Administration (FDA) approval of Enhertu (fam-trastuzumab deruxtecan- nxki), the billing and coding article was revised to add HCPCS code C9399.
The local coverage determination (LCD) and the billing and coding article for pegfilgrastim was revised to add the new Food and Drug Administration (FDA) approved biosimilar drug pegfilgrastim-bmez.
Based on review of the peripheral nerve blocks billing and coding article, it was determined that Current Procedural Terminology (CPT®) code 64451 was added in error, therefore, it is being removed from the billing and coding article.
Revisions to the stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) local coverage determination and the billing and coding article.
The billing and coding article for major joint replacement (hip and knee) was revised to add ICD-10-CM diagnosis codes to the ICD-10 Codes that Support Medical Necessity/Group 1 Codes.
Please review this article from the durable medical equipment Medicare administrative contractors (DME MACs) about ordering surgical dressings for your Medicare patients.
Based on further review of the BRCA1 and BRCA2 genetic testing billing and coding article, the “CPT®/HCPCS Codes/Group 1 Codes:” section of the billing and coding article was revised.
Based on review of the local coverage determination (LCD) and Billing and Coding Article, it was determined that the LCD and Billing and Coding Article were no longer required and, therefore, are being retired.
Based on review of multiple local coverage determinations (LCDs) and billing and coding articles, it was determined that they are no longer required and therefore, are being retired.
The noncovered services billing and coding article for noncovered services was revised to remove Current Procedural Terminology (CPT®) codes for vaccines as they have no preventive benefit.
Please review these quick tips from the durable medical equipment Medicare administrative contractor (DME MAC) about ordering oxygen and oxygen equipment for your Medicare patients.
A revised Provider Compliance Tips for Polysomnography (Sleep Studies) fact sheet is available. Learn about coverage requirements, documentation, and how to prevent claim denials.
Please review this article from the durable medical equipment Medicare administrative contractors (DME MACs) about ordering lower limb orthoses (LLO) for your Medicare patients.
This calculator will assist you in determining when additional documentation requested by First Coast Service Options Inc. (First Coast) must be received.
The Centers for Medicare & Medicaid Services (CMS) requires that any Medicare service provided or ordered must be authenticated by the author -- the one who provided or ordered that service. This article outlines acceptable forms of authentication.
Payment will be considered for unused and discarded portions of a single-use drug/biological product. The JW modifier is not permitted when the actual dose of the drug or biological administered is less than the billing unit.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.
