[Federal Register: March 24, 2006 (Volume 71, Number 57)]
[Notices]
[Page 14903-14922]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr24mr06-82]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-9034-N]
Medicare and Medicaid Programs; Quarterly Listing of Program
Issuances--October Through December 2005
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice.
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SUMMARY: This notice lists CMS manual instructions, substantive and
interpretive regulations, and other Federal Register notices that were
published from October 2005 through December 2005, relating to the
Medicare and Medicaid programs. This notice provides information on
national coverage determinations (NCDs) affecting specific medical and
health care services under Medicare. Additionally, this notice
identifies certain devices with investigational device exemption (IDE)
numbers approved by the Food and Drug Administration (FDA) that
potentially may be covered under Medicare. This notice also includes
listings of all approval numbers from the Office of Management and
Budget for collections of information in CMS regulations. Finally, this
notice includes a list of Medicare-approved carotid stent facilities.
Section 1871(c) of the Social Security Act requires that we publish
a list of Medicare issuances in the Federal Register at least every 3
months. Although we are not mandated to do so by statute, for the sake
of completeness of the listing, and to foster more open and transparent
collaboration efforts, we are also including all Medicaid issuances and
Medicare and Medicaid substantive and interpretive regulations
(proposed and final) published during this 3-month time frame.
FOR FURTHER INFORMATION CONTACT: It is possible that an interested
party may have a specific information need and not be able to determine
from the listed information whether the issuance or regulation would
fulfill that need. Consequently, we are providing information contact
persons to answer general questions concerning these items. Copies are
not available through the contact persons. (See Section III of this
notice for how to obtain listed material.)
Questions concerning items in Addendum III may be addressed to
Timothy Jennings, Office of Strategic Operations and Regulatory
Affairs, Centers for Medicare & Medicaid Services, C4-26-05, 7500
Security Boulevard, Baltimore, MD 21244-1850, or you can call (410)
786-2134.
Questions concerning Medicare NCDs in Addendum V may be addressed
to Patricia Brocato-Simons, Office of Clinical Standards and Quality,
Centers for Medicare & Medicaid Services, C1-09-06, 7500 Security
Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-0261.
Questions concerning FDA-approved Category B IDE numbers listed in
Addendum VI may be addressed to John Manlove, Office of Clinical
Standards and Quality, Centers for Medicare & Medicaid Services, C1-13-
04, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call
(410) 786-6877.
Questions concerning approval numbers for collections of
information in Addendum VII may be addressed to Melissa Musotto, Office
of Strategic Operations and Regulatory Affairs, Regulations Development
and Issuances Group, Centers for Medicare & Medicaid Services, C5-14-
03, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call
(410) 786-6962.
Questions concerning Medicare-approved carotid stent facilities may
be addressed to Sarah J. McClain, Office of Clinical Standards and
Quality, Centers for Medicare & Medicaid Services, C1-09-06, 7500
Security Boulevard, Baltimore, MD 21244-1850, or you can call (410)
786-2994.
Questions concerning all other information may be addressed to
Gwendolyn Johnson, Office of Strategic Operations and Regulatory
Affairs, Regulations Development Group, Centers for Medicare & Medicaid
Services, C5-14-03, 7500 Security Boulevard, Baltimore, MD 21244-1850,
or you can call (410) 786-6954.
SUPPLEMENTARY INFORMATION:
I. Program Issuances
The Centers for Medicare & Medicaid Services (CMS) is responsible
for administering the Medicare and Medicaid programs. These programs
pay for health care and related services for 39 million Medicare
beneficiaries and 35 million Medicaid recipients. Administration of the
two programs involves (1) furnishing information to Medicare
beneficiaries and Medicaid recipients, health care providers, and the
public and (2) maintaining effective communications with regional
offices, State governments, State Medicaid agencies, State survey
agencies, various providers of health care, all Medicare contractors
that process claims and pay bills, and others. To implement the various
statutes on which the programs are based, we issue regulations under
the authority granted to the Secretary of the Department of Health and
Human Services under sections 1102, 1871, 1902, and related provisions
of the Social Security Act (the Act). We also issue various manuals,
memoranda, and statements necessary to administer the programs
efficiently.
Section 1871(c)(1) of the Act requires that we publish a list of
all Medicare manual instructions, interpretive rules, statements of
policy, and guidelines of general applicability not issued as
regulations at least every 3 months in the Federal Register. We
published our first notice June 9, 1988 (53 FR 21730). Although we are
not mandated to do so by statute, for the sake of completeness of the
listing of operational and policy statements, and to foster more open
and transparent collaboration, we are continuing our practice of
including Medicare substantive and interpretive
[[Page 14904]]
regulations (proposed and final) published during the respective 3-
month time frame.
II. How To Use the Addenda
This notice is organized so that a reader may review the subjects
of manual issuances, memoranda, substantive and interpretive
regulations, NCDs, and FDA-approved IDEs published during the subject
quarter to determine whether any are of particular interest. We expect
this notice to be used in concert with previously published notices.
Those unfamiliar with a description of our Medicare manuals may wish to
review Table I of our first three notices (53 FR 21730, 53 FR 36891,
and 53 FR 50577) published in 1988, and the notice published March 31,
1993 (58 FR 16837). Those desiring information on the Medicare NCD
Manual (NCDM, formerly the Medicare Coverage Issues Manual (CIM)) may
wish to review the August 21, 1989, publication (54 FR 34555). Those
interested in the revised process used in making NCDs under the
Medicare program may review the September 26, 2003, publication (68 FR
55634).
To aid the reader, we have organized and divided this current
listing into eight addenda:
Addendum I lists the publication dates of the most recent
quarterly listings of program issuances.
Addendum II identifies previous Federal Register documents
that contain a description of all previously published CMS Medicare and
Medicaid manuals and memoranda.
Addendum III lists a unique CMS transmittal number for
each instruction in our manuals or Program Memoranda and its subject
matter. A transmittal may consist of a single or multiple
instruction(s). Often, it is necessary to use information in a
transmittal in conjunction with information currently in the manuals.
Addendum IV lists all substantive and interpretive
Medicare and Medicaid regulations and general notices published in the
Federal Register during the quarter covered by this notice. For each
item, we list the--
[cir] Date published;
[cir] Federal Register citation;
[cir] Parts of the Code of Federal Regulations (CFR) that have
changed (if applicable);
[cir] Agency file code number; and
[cir] Title of the regulation.
Addendum V includes completed NCDs, or reconsiderations of
completed NCDs, from the quarter covered by this notice. Completed
decisions are identified by the section of the NCDM in which the
decision appears, the title, the date the publication was issued, and
the effective date of the decision.
Addendum VI includes listings of the FDA-approved IDE
categorizations, using the IDE numbers the FDA assigns. The listings
are organized according to the categories to which the device numbers
are assigned (that is, Category A or Category B), and identified by the
IDE number.
Addendum VII includes listings of all approval numbers
from the Office of Management and Budget (OMB) for collections of
information in CMS regulations in title 42; title 45, subchapter C; and
title 20 of the CFR.
Addendum VIII includes listings of Medicare-approved
carotid stent facilities. All facilities listed meet CMS standards for
performing carotid artery stenting for high risk patients.
III. How To Obtain Listed Material
A. Manuals
Those wishing to subscribe to program manuals should contact either
the Government Printing Office (GPO) or the National Technical
Information Service (NTIS) at the following addresses: Superintendent
of Documents, Government Printing Office, ATTN: New Orders, P.O. Box
371954, Pittsburgh, PA 15250-7954, Telephone (202) 512-1800, Fax number
(202) 512-2250 (for credit card orders); or National Technical
Information Service, Department of Commerce, 5825 Port Royal Road,
Springfield, VA 22161, Telephone (703) 487-4630.
In addition, individual manual transmittals and Program Memoranda
listed in this notice can be purchased from NTIS. Interested parties
should identify the transmittal(s) they want. GPO or NTIS can give
complete details on how to obtain the publications they sell.
Additionally, most manuals are available at the following Internet
address: http://cms.hhs.gov/manuals/default.asp.
B. Regulations and Notices
Regulations and notices are published in the daily Federal
Register. Interested individuals may purchase individual copies or
subscribe to the Federal Register by contacting the GPO at the address
given above. When ordering individual copies, it is necessary to cite
either the date of publication or the volume number and page number.
The Federal Register is also available on 24x microfiche and as an
online database through GPO Access. The online database is updated by 6
a.m. each day the Federal Register is published. The database includes
both text and graphics from Volume 59, Number 1 (January 2, 1994)
forward. Free public access is available on a Wide Area Information
Server (WAIS) through the Internet and via asynchronous dial-in.
Internet users can access the database by using the World Wide Web; the
Superintendent of Documents home page address is http://www.gpoaccess.gov/fr
/index.html, by using local WAIS client software,
or by telnet to swais.gpoaccess.gov, then log in as guest (no password
required). Dial-in users should use communications software and modem
to call (202) 512-1661; type swais, then log in as guest (no password
required).
C. Rulings
We publish rulings on an infrequent basis. Interested individuals
can obtain copies from the nearest CMS Regional Office or review them
at the nearest regional depository library. We have, on occasion,
published rulings in the Federal Register. Rulings, beginning with
those released in 1995, are available online, through the CMS Home
Page. The Internet address is http://cms.hhs.gov/rulings.
D. CMS' Compact Disk-Read Only Memory (CD-ROM)
Our laws, regulations, and manuals are also available on CD-ROM and
may be purchased from GPO or NTIS on a subscription or single copy
basis. The Superintendent of Documents list ID is HCLRM, and the stock
number is 717-139-00000-3. The following material is on the CD-ROM
disk:
Titles XI, XVIII, and XIX of the Act.
CMS-related regulations.
CMS manuals and monthly revisions.
CMS program memoranda.
The titles of the Compilation of the Social Security Laws are
current as of January 1, 2005. (Updated titles of the Social Security
Laws are available on the Internet at http://www.ssa.gov/OP_Home/ssact/comp-toc.htm.
) The remaining portions of CD-ROM are updated on a
monthly basis.
Because of complaints about the unreadability of the Appendices
(Interpretive Guidelines) in the State Operations Manual (SOM), as of
March 1995, we deleted these appendices from CD-ROM. We intend to re-
visit this issue in the near future and, with the aid of newer
technology, we may again be able to include the appendices on CD-ROM.
Any cost report forms incorporated in the manuals are included on
the CD-ROM disk as LOTUS files. LOTUS software is needed to view the
reports once the files have been copied to a personal computer disk.
[[Page 14905]]
IV. How To Review Listed Material
Transmittals or Program Memoranda can be reviewed at a local
Federal Depository Library (FDL). Under the FDL program, government
publications are sent to approximately 1,400 designated libraries
throughout the United States. Some FDLs may have arrangements to
transfer material to a local library not designated as an FDL. Contact
any library to locate the nearest FDL.
In addition, individuals may contact regional depository libraries
that receive and retain at least one copy of most Federal Government
publications, either in printed or microfilm form, for use by the
general public. These libraries provide reference services and
interlibrary loans; however, they are not sales outlets. Individuals
may obtain information about the location of the nearest regional
depository library from any library. For each CMS publication listed in
Addendum III, CMS publication and transmittal numbers are shown. To
help FDLs locate the materials, use the CMS publication and transmittal
numbers. For example, to find the Medicare NCD publication titled
``Stem Cell Transplantation,'' use CMS-Pub. 100-03, Transmittal No. 45.
(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance, Program No. 93.774, Medicare--
Supplementary Medical Insurance Program, and Program No. 93.714,
Medical Assistance Program.)
Dated: March 20, 2006.
Jacquelyn Y. White,
Director, Office of Strategic Operations and Regulatory Affairs.
Addendum I
This addendum lists the publication dates of the most recent
quarterly listings of program issuances.
September 26, 2003 (68 FR 55618)
December 24, 2003 (68 FR 74590)
March 26, 2004 (69 FR 15837)
June 25, 2004 (69 FR 35634)
September 24, 2004 (69 FR 57312)
December 30, 2004 (69 FR 78428)
February 25, 2005 (70 FR 9338)
June 24, 2005 (70 FR 36620)
September 23, 2005 (70 FR 55863)
December 23, 2005 (70 FR 76290)
Addendum II--Description of Manuals, Memoranda, and CMS Rulings
An extensive descriptive listing of Medicare manuals and
memoranda was published on June 9, 1988, at 53 FR 21730 and
supplemented on September 22, 1988, at 53 FR 36891 and December 16,
1988, at 53 FR 50577. Also, a complete description of the former CIM
(now the NCDM) was published on August 21, 1989, at 54 FR 34555. A
brief description of the various Medicaid manuals and memoranda that
we maintain was published on October 16, 1992, at 57 FR 47468.
Addendum III.--Medicare and Medicaid Manual Instructions
[October through December 2005]
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Transmittal No. Manual/Subject/Publication No.
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Medicare General Information
(CMS Pub. 100-01)
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30..................... Initiate STC testing of the MCS for RRB and
HIGLAS Shared System Testing Requirements for
Maintainers, Beta Testers, and Contractors.
31..................... Update to Medicare Deductible, Coinsurance and
Premium Rates for 2006 Basis for Determining
the Part A Coinsurance Amounts Part B Annual
Deductible.
32..................... Scheduled Release for January 2006 Software
Programs and Pricing/Coding Files.
33..................... Change Management Process--Electronic Change
Information Management Portal (eChimp).
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Medicare Benefit Policy
(CMS Pub. 100-02)
------------------------------------------------------------------------
39..................... Auditory Osteointegrated and Auditory Brainstem
Devices Hearing Aids and Auditory Implants.
40..................... Skilled Nursing Facility Prospective Payment
System.
Certification and Recertification by Physicians
for Extended Care Services.
Who May Sign the Certificate or Recertification
for Extended Care Services Rural Health Center/
Federally Qualified Health Center for Hospital/
Skilled Nursing Facility Outpatients or
Inpatients.
41..................... Telehealth Originating Site Facility Fee
Payment Amount Update.
42..................... January 2006 Update of the Hospital Outpatient
Prospective Payment System Manual Instruction:
Changes to Coding and Payment for Observation.
43..................... List of Medicare Telehealth Services.
Payment-Physician/Practitioner at a Distant
Site.
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Medicare National Coverage Determinations
(CMS Pub. 100-03)
------------------------------------------------------------------------
43..................... This Transmittal is rescinded and replaced by
Transmittal 45.
44..................... Lung Volume Reduction Surgery.
45..................... Stem Cell Transplantation.
------------------------------------------------------------------------
Medicare Claims Processing
(CMS Pub. 100-04)
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695.................... General Appeals Process in Initial
Determinations (Implementation Dates for
Fiscal Intermediary Initial Determinations
Issued on or After May 1, 2005 and Carrier
Initial Determinations Issued on or After
January 1, 2006).
CMS Decisions Subject to the Administrative
Appeals Process.
Who May Appeal.
Provider or Supplier Appeals When the
Beneficiary Is Deceased.
Steps in the Appeals Process: Overview.
Where to Appeal.
Time Limits for Filing Appeals and Good Cause
for Extension of the Time Limit for Filing
Appeals.
Good Cause.
[[Page 14906]]
General Procedure to Establish Good Cause.
Conditions and Examples That May Establish Good
Cause for Late Filing by Beneficiaries.
Conditions and Examples That May Establish Good
Cause for Late Filing by Providers,
Physicians, or Other Suppliers.
Good Cause Not Found for Beneficiary, or for
Provider, Physician, or Other Supplier.
Amount in Controversy Requirements.
Parties to an Appeal.
696.................... 2006 Annual Update of Healthcare Common
Procedure Coding System Codes for Skilled
Nursing Facility Consolidated Billing for the
Common Working File, Medicare Carriers and
Fiscal Intermediaries.
Skilled Nursing Facility Consolidated Billing
Annual Update Process for Fiscal
Intermediaries.
697.................... Appeals of Claims Decisions: Redeterminations
and Reconsiderations (implementation date May
1, 2005).
Time Limit for Filing a Request for
Redetermination.
Reporting Redeterminations on the Appeals
Report.
698.................... The Supplemental Security Income Medicare
Beneficiary Data for Fiscal Year 2006 for the
Inpatient Rehabilitation Facility Prospective
Payment System.
Low Income Percentage Adjustment: The
Supplemental Security Income Medicare
Beneficiary Data for Inpatient Rehabilitation
Facilities Paid Under the Prospective Payment
System.
699.................... This Transmittal is rescinded and replaced by
Transmittal 761.
700.................... Revision to Chapter 31--Attestation.
Eligibility Extranet Workflow.
701.................... New Diagnosis Code Requirements for Method II
Home Dialysis Claims Supplier Documentation
Required.
702.................... Manualization for Physician/Practitioner/
Supplier Participation Agreement and
Assignment Carrier Claims and Carrier Rules
for Limiting Charge.
Physician/Practitioner/Supplier Participation
Agreement and Assignment--Carrier Claims.
Mandatory Assignment on Carrier Claims.
Filing Claims to a Carrier for Nonassigned
Services.
Carrier Annual Participation Program.
Carrier Participation and Billing Limitations.
703.................... This Transmittal is rescinded and replaced by
Transmittal 707.
704.................... Discontinuation of Biannual Recertification
List for Certified Registered Nurse.
Anesthetist Services.
Issuance of Unique Physician Identification
Numbers.
Annual Review of Certified Registered Nurse
Anesthetist Certifications.
705.................... Modification to Reporting of Diagnosis Codes
for Screening Mammography Claims.
Healthcare Common Procedure Coding System and
Diagnosis Codes for Mammography Services.
706.................... Payment Methodology for Rehabilitation Services
in Indian Health Service/Tribally Owned and/or
Operated Hospitals and Hospital-Based
Facilities.
Services Paid Under the Physician Fee Schedule.
707.................... Inpatient Prospective Payment System Outlier
Reconciliation Outliers.
Cost to Charge Ratios.
Statewide Average Cost to Charge Ratios.
Threshold and Marginal Cost.
Transfers.
Reconciliation.
Time Value of Money
Procedure for Fiscal Intermediaries to Perform
and Record Outlier.
Reconciliation Adjustments.
Specific Outlier Payments for Burn Cases.
Quality Improvement Organization Reviews and
Adjustments.
Return Codes for Pricer.
708.................... This Transmittal is rescinded and replaced by
Transmittal 722.
709.................... This Transmittal is rescinded and replaced by
Transmittal 720.
710.................... Issued to a specific audience, not posted to
Internet/Intranet due to sensitivity of
Instruction.
711.................... This Transmittal is rescinded and replaced by
Transmittal 763.
712.................... Correction to Change Request 3949, Section
50.3.3 in IOM to Add 23x Type of Bill.
Billing and Claims Processing Requirements
Related to Expedited Determinations.
713.................... This Transmittal is rescinded and replaced by
Transmittal 748.
714.................... Payment Window Edit Corrections Within the
Common Working File.
Outpatient Services Treated As Inpatient
Services.
715.................... New Designated Competitive Acquisition Program
Carrier Contractor ID Numbers.
716.................... Modifiers for Transportation of Portable X-rays
(R0075) When Billed by Skilled Nursing
Facilities.
Transportation of Equipment Billed by a Skilled
Nursing Facility to a Fiscal Intermediary.
717.................... Disabling the Revenue/Healthcare Common
Procedure Coding System Consistency.
Edit Codes in the Fiscal Intermediary Shared
System.
Fiscal Intermediary Consistency Edits.
718.................... Source of Admission Code `D'.
719.................... This Transmittal is rescinded and replaced by
Transmittal 736.
720.................... Issued to a specific audience, not posted to
Internet/Intranet due to sensitivity of
Instruction.
721.................... Use of Value Codes 48 and 49 on End-Stage Renal
Disease Bills.
Required Information for In-Facility Claims
Paid Under the Composite Rate.
Epoetin Alfa Facility Billing Requirements
Using UB-92/Form CMS-1450.
[[Page 14907]]
Darbeopoetin Alfa Facility Billing Requirements
Using UB-92/Form CMS-1450.
722.................... 2006 Annual Update for the Health Professional
Shortage Area Bonus Payments.
723.................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction.
724.................... Appeals of Claims Decisions: Redeterminations
and Reconsiderations (Implementation Dates for
Fiscal Intermediary Initial Determinations
Issued on or After May 1, 2005 and Carrier
Initial Determinations Issued on or After
January 1, 2006).
Filing a Request for Redetermination.
Appeal Rights for Dismissals.
Dismissal Letters.
Model Dismissal Notices.
Reconsideration--The Second Level of Appeal.
Filing a Request for a Reconsideration.
Time Limit for Filing a Request for a
Reconsideration.
Contractor Responsibilities--General.
Qualified Independent Contractor Case File
Development.
Qualified Independent Contractor Case File
Preparation.
Forwarding Qualified Independent Contractor
Case Files.
Qualified Independent Contractor Jurisdictions.
Tracking Cases.
Effectuation of Reconsiderations.
725.................... This Transmittal is rescinded and replaced by
Transmittal 737.
726.................... Smoking and Tobacco-Use Cessation Counseling
Services: Common Working File Inquiry for
Providers.
Common Working File Inquiry.
727.................... Annual Type of Service.
728.................... Installation of the January 2006 Inpatient
Prospective Payment System Pricer and Hospice
Pricer.
729.................... Revised October 2005 Quarterly Average Sales
Price Medicare Part B Drug Pricing File,
Effective October 1, 2005.
730.................... Calendar Year 2006 Participation Enrollment and
Medicare Participating Physicians and
Suppliers Directory Procedures.
731.................... Payment for Office or Other Outpatient
Evaluation and Management Visits (Codes 99201-
99215).
732.................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction.
733.................... Repeat Tests for Automated Multi-Channel
Chemistries for End-Stage Renal Disease
Beneficiaries.
734.................... Redefined Type of Bill, 14x, for Non-Patient
Laboratory Specimens.
Maryland Waiver Hospitals.
Clinical Diagnostic Laboratory Tests Furnished
by Critical Access Hospitals.
Hospital Laboratory Services Furnished to
Nonhospital Patients.
735.................... Processing All Diagnosis Codes Reported on
Claims Submitted to Carriers.
Items 14-33-Provider of Service or Supplier
Information.
736.................... Clarification and Update to Hospital Billing
Instructions and Payment for Epoetin Alfa and
Darbepoetin Alfa for Beneficiaries With End-
Stage Renal Disease.
Epoetin Alfa for End-Stage Renal Disease
Patients.
Payment Amount for Epoetin Alfa.
Payment for Epoetin Alfa in Other Settings.
Epoetin Alfa Provided in Hospital Outpatient
Departments.
Payment for Darbepoetin Alfa in Other Settings.
Payment for Darbepoetin Alfa in the Hospital
Outpatient Department.
Hospitals Billing for Epoetin Alfa for Non-End-
Stage Renal Disease Patients.
Hospitals Billing for Darbepoetin Alfa for Non-
End-Stage Renal Disease Patients.
737.................... New ICD-9-CM Codes for Beneficiaries With
Chronic Kidney Disease and New Healthcare
Common Procedure Coding System for Reporting
Epoetin Alfa and Darbepoetin Alfa.
Required Information for In-Facility Claims
Under the Composite Rate.
738.................... Calendar Year 2005 Payment for Medicare Part B
Radiopharmaceuticals Not Paid on a Cost or
Prospective Payment Basis.
739.................... Erroneous Guidance--Basis to Waive Penalty.
Overview.
Erroneous Program Guidance: Basis to Waive
Penalty.
Policy.
Basic Conditions That Must Be Met To Waive
Penalty.
Guidance Was Erroneous.
Guidance Was Issued by the Secretary or
Contractor.
Contractor Acted Within Scope of Authority.
Guidance Was in Writing.
Guidance Related to Item, Service, or Claim.
Guidance Was Issued Timely.
Provider Accurately Presented Circumstances in
Writing.
Alternative Basis for Satisfying the
``Presentation'' Condition.
Provider Followed Guidance.
Provider's Reliance Was Reasonable.
Penalty Considered.
General Limitations on Scope.
Notice of Penalty Waiver Policy.
Request for a Penalty Waiver Determination.
Jurisdiction.
Jurisdiction Regarding Error.
[[Page 14908]]
Jurisdiction to Complete the Penalty Waiver
Determination.
Determining Whether the Guidance Was Erroneous.
Completing the Penalty Waiver Determination.
Timeliness of Request.
Ripeness.
Sufficient Information.
Mootness.
Required Conditions Other Than Error.
Completing the Determination.
Notice of the Penalty Waiver Determination.
Reconsideration of the Penalty Waiver
Determination.
Recordkeeping.
Reporting.
Corrective Action.
Effective Date.
740.................... Change to the Common Working File Skilled
Nursing Facility Consolidated.
Billing Edits for Evaluation and Management
Services Billed to Fiscal.
Intermediaries by Hospitals.
Hospital's ``Facility Charge'' in Connection
with Clinic Services of a Physician.
741.................... New Condition Codes 49 and 50.
742.................... Quarterly Update to Correct Coding Initiative
Edits, V12.0, Effective January 1, 2006.
743.................... Remittance Advice Remark Code and Claim
Adjustment Reason Code Update.
744.................... File Descriptions and Instructions for
Retrieving the 2006 Fee Schedules and
Healthcare Common Procedure Coding System
through CMS'' Mainframe Telecommunications
System.
Recurring Update Notification Containing New
Pricing File Names and Retrieval Dates for
2006.
745.................... Elimination of the Durable Medical Equipment
Regional Carrier Information Form.
Billing Drugs Electronically `` National
Council Prescription Drug Program.
Certificate of Medical Necessity.
746.................... January 2006 Quarterly Average Sales Price
Medicare Part B Drug Pricing File, Effective
January 1, 2006, and Revisions to January
2005, April 2005, July 2005, and October 2005
Quarterly Average Sales Price Medicare Part B
Drug Pricing Files.
747.................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction.
748.................... New G Code for Power Mobility Devices.
Power Mobility Devices Code G0372.
749.................... Reasonable Charge Update for 2006 for Splints,
Casts, Dialysis Supplies, Dialysis Equipment,
and Certain Intraocular Lenses.
750.................... 2006 Annual Update for Clinical Laboratory Fee
Schedule and Laboratory Services Subject to
Reasonable Charge Payment.
751.................... National Monitoring Policy for EPO and Aranesp
for End-Stage Renal Disease.
Patients Treated in Renal Dialysis Facilities.
Chapter 8, Section 60.4, Epoetin Alfa.
Chapter 8, section 60.7, Darbepoetin Alfa for
End-Stage Renal Disease Patients.
752.................... Eliminate the Use of Surrogate Unique
Physicians Identification Numbers (OTH000) on
Medicare Claims.
753.................... Update of Contact Information for the Do Not
Forward Reports.
Reporting Requirements--Carriers.
754.................... Supplying Fee and Inhalation Drug Dispensing
Fee Revisions and Clarifications.
Pharmacy Supplying Fee and Inhalation Drug
Dispensing Fee.
755.................... Common Working File Updates for Carrying
National Provider Identifier.
756.................... Issued to a specific audience, not posted to
Internet/Intranet due to Sensitivity of
Instruction.
757.................... Resubmission of Inpatient Psychiatric Facility
Prospective Payment System.
Claims with Chronic Renal Failure Comorbid
Condition.
758.................... Changes to the Laboratory National Coverage
Determination Edit Software for January 2006.
759.................... Therapy Caps to be Effective January 1, 2006.
The Financial Limitation.
Discipline Specific Outpatient Rehabilitation
Modifiers--All Claims.
760.................... Instructions for Downloading the Medicare Zip
Code File.
761.................... This Transmittal is rescinded and replaced by
Transmittal 777.
762.................... Ambulance Inflation Factor for CY 2006.
763.................... Update to Repetitive Billing--Manualization.
Frequency of Billing to Fiscal Intermediaries
for Outpatient Services Hospital and Community
Mental Health Center Reporting Requirements
for Services Performed on the Same Day.
764.................... Update to the Prospective Payment System for
Home Health Agencies for Calendar Year 2006.
765.................... Instructions for Downloading the Medicare Zip
Code File.
766.................... This Transmittal is rescinded and replaced by
Transmittal 776.
767.................... Skilled Nursing Facility Prospective Payment
System Revisions to IOM 100-4--Manualization.
Physician's Services and Other Professional
Services Excluded From Part A.
Prospective Payment System Payment and the
Consolidated Billing Requirement.
Billing Skilled Nursing Facility Prospective
Payment System Services.
Billing Procedures for a Composite Skilled
Nursing Facility or a Change in Provider
Number.
Billing for Services After Termination of
Provider Agreement, or After Payment is Denied
for New Admission.
General Rules.
Billing for Covered Services.
Part B Billing.
[[Page 14909]]
768.................... Lung Volume Reduction Surgery.
769.................... Surrogate Unique Provider Identification
Numbers Reported on Independent Diagnostic
Testing Facility Claims.
770.................... Fee Schedule Update for 2006 for Durable
Medical Equipment, Prosthetics, Orthotics, and
Supplies.
771.................... Revisions to Pub. 100-04, Medicare Claims
Processing Manual in Preparation for the
National Provider Identifier.
Fiscal Intermediary Consistency Edits.
Identifying Institutional Providers.
Payment Under Prospective Payment System
Diagnosis-Related Groups.
Payment to Hospitals and Units Excluded From
Inpatient Prospective Payment System for
Direct Graduate Medical Education and Nursing
and Allied Health.
Education for Medicare Advantage Enrollees.
Requirements for Critical Access Hospital
Services, Critical Access Hospital.
Skilled Nursing Care Services and Distinct Part
Units.
Payment for Post-Hospital Skilled Nursing
Facility Care Furnished by a Critical Access
Hospital.
Swing-Bed Services.
Outlier Payments: Cost-to-Charge Ratios.
Affected Medicare Providers.
Billing Requirements Under Long Term Care
Hospital Prospective Payment System.
Coinsurance Election.
Maryland Waiver Hospitals.
Zip Code Files.
Special Partial Hospitalization Billing
Requirements for Hospitals, Community Mental
Health Centers, and Critical Access Hospitals.
Bill Review for Partial Hospitalization
Services Provided in Community Mental Health
Centers.
Part B Outpatient Rehabilitation and
Comprehensive Outpatient Rehabilitation
Facility Services--General.
Dialysis Provider Number Series.
Shared Systems Changes for Medicare Part B
Drugs for End-Stage Renal Disease Independent
Dialysis Facilities.
Federally Qualified Health Centers.
Request for Anticipated Payment.
Home Health Prospective Payment System Claims.
Completing the Uniform (Institutional Provider)
Bill (Form CMS-1450) for Hospice Election.
Care Plan Oversight.
772.................... Fiscal Intermediary Shared System Edit Updates
for Epoetin Alfa and Darbepoetin Alfa
Healthcare Common Procedure Coding System
Changes Effective January 1, 2006.
773.................... Announcement of the Medicare Federally
Qualified Health Center Supplemental Payment.
Billing for Supplemental Payments for Federally
Qualified Health Centers Under Contract With
Medicare Advantage Plans.
774.................... Implementation of Changes in End-Stage Renal
Disease Payment for Calendar Year 2006.
Required Information for In-Facility Claims
Paid Under the Composite Rate.
775.................... Home Care and Domiciliary Care Visits (Codes
99324-99350).
776.................... Stem Cell Transplantation.
777.................... Competitive Acquisition Program for Part B
Drugs.
778.................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality of
Instruction.
779.................... New Waived Tests.
780.................... Common Working File Database Extract into Next
Generation Desktop Data Mart.
781.................... Revised Manual Instructions for Processing End-
Stage Renal Disease Exceptions Under the
Composite Rate Reimbursement System.
General Instructions for Processing Requests
Under the Composite Rate Reimbursement System.
Criteria for Approval of End-Stage Renal
Disease Exception Requests.
Procedures for Requesting Exceptions to End-
Stage Renal Disease Payment Rates.
Period of Approval: Payment Exception Request.
Criteria for Re-filing a Denied Exception
Request.
Responsibility of Intermediaries.
Payment Exception: Pediatric Patient Mix.
Payment Exception: Self Dialysis Training Costs
in Pediatric Facilities.
782.................... This Transmittal is rescinded and replaced by
Transmittal 788.
783.................... January 2006 Non-Outpatient Prospective Payment
System Outpatient Code Editor Specifications
Version 21.1.
784.................... January 2006 Outpatient Prospective Payment
System Code Editor Specifications Version 7.0.
785.................... January 2006 Update of the Hospital Outpatient
Prospective Payment System.
Manual Instruction: Changes to Coding and
Payment for Drug Administration--Manulization.
Coding and Payment for Drug Administration.
Administration of Drugs via Implantable or
Portable Pumps.
Chemotherapy Drug Administration.
Non-Chemotherapy Drug Administration.
786.................... January 2006 Update of the Hospital Outpatient
Prospective Payment System: Summary of Payment
Policy Changes, Outpatient Prospective Payment
System Pricer Logic Changes, and Instructions
for Updating the Outpatient Provider Specific
File.
787.................... January 2006 Update of the Hospital Outpatient
Prospective Payment System.
Manual Instruction: Changes to Coding and
Payments for Observation.
Observation Services Overview.
General Billing Requirements for Observation
Services.
Revenue Code Reporting.
[[Page 14910]]
Reporting Hours of Observation.
Billing and Payment for Observation Services
Furnished Prior to January 1, 2006.
Billing and Payment for Packaged Observation
Services Furnished Between August 1, 2000 and
December 31, 2005.
Billing and Payment for Separately Payable
Observation Services Furnished Between April
1, 2002 and December 31, 2005.
Billing and Payment for Direct Admission to
Observation Services Furnished Between January
1, 2003 and December 31, 2005.
Billing and Payment for Observation Services
Furnished On or After January 1, 2006.
Billing and Payment for All Hospital
Observation Services Furnished on or After
January 1, 2006.
Separate and Package Payment for Direct
Admission to Observation.
Separate and Package Payments for Observation.
Services Not Covered as Observation Services.
788.................... Consultation Services (Codes 99241-99255).
789.................... Ambulance Fee Schedule--Medical Conditions
List: Manualization.
790.................... List of Medicare Telehealth Services.
Payment Methodology for Physician/Practitioner
at the Distant Site.
Originating Site Facility Fee Payment
Methodology.
Submission of Telehealth Claims for Distant
Site Practitioners.
Contractor Editing of Telehealth Claims.
791.................... This Transmittal is rescinded and replaced by
Transmittal 793.
792.................... Nursing Facility Services (Codes 99304-99318).
793.................... Revision to Chapter 31--Addition of Hospice
Data HIPAA 270/271 Eligibility.
Eligibility Extranet Workflow.
794.................... Announcement of Medicare Supplemental Payments
to Federally Qualified Health Centers Under
Contract with Medicare Advantage Plans.
Billing for Supplemental Payments for Federally
Qualified Health Centers Under Contract with
Medicare Advantage Plans.
795.................... Redefined Type of Bill 14X for Non-Patient
Laboratory Specimens--Change.
Request 3835 Manualization.
Type of Bill.
Packaging.
General Rules for Reporting Outpatient Hospital
Services.
Bill Types Subject to Outpatient Prospective
Payment System.
Standard Method--Cost-Based Facility Services,
With Billing of Carrier for Professional
Services.
Optional Method for Outpatient Services: Cost-
Based Facility Services Plus 115.
Percentage Fee Schedule Payment for
Professional Services.
Certified Registered Nurse Anesthetist Services
(Certified Registered Nurse Anesthetist Pass-
Through Exemption of 115 Percent Fee Schedule
Payments for Certified Registered Nurse
Anesthetist Services).
Optional Method for Outpatient Services: Cost-
Based Facility Services Plus 115.
Percent Fee Schedule Payment for Professional
Services.
Hospital and Skilled Nursing Facility Patients.
Special Billing Instructions for Rural Health
Centers and Federally Qualified Health
Centers.
Payment Requirements.
Payment Methodology and Healthcare Common
Procedure Coding System Coding.
General Explanation of Payment.
Method of Payment for Clinical Laboratory
Tests--Place of Service Variation.
Hospital Billing Under Part B.
Critical Access Hospital Outpatient Laboratory
Service.
Computer-Aided Detection Add-On Codes.
Payment Method for Rural Health Centers and
Federally Qualified Health Centers.
Healthcare Common Procedure Coding System Codes
for Billing.
Type of Bill and Revenue Codes for Form CMS-
1450.
Revenue Code and Health Common Procedure Coding
System Codes for Billing.
Payment Method--Fiscal Intermediaries and
Carriers.
Healthcare Common Procedure Coding System,
Revenue, and Type of Service Codes.
Ambulatory Blood Pressure Monitoring Billing
Requirements.
Fiscal Intermediary Billing Requirements.
Bill Types.
796.................... Announcement of Medicare Rural Health Clinics
and Federally Qualified Health Centers Payment
Rate.
797.................... Full Replacement of CR 4095, Diagnosis Code
Requirements for Method II.
Home Dialysis Claims CR 4095 Is Rescinded.
Supplier Documentation Required.
798.................... Emergency Update to the 2006 Medicare Physician
Fee Schedule Database.
799.................... Reminder Notice of the Implementation of
Ambulance Transition Schedule.
800.................... Clinical Diagnostic Laboratory Date of Service
for Archived Specimens.
801.................... Instructions for Reporting New HCPCS Code V2788
for Presbyopia-Correcting Intraocular Lenses.
Presbyopia-Correcting Intraocular Lenses
(General Policy Information).
Payment for Physician Services and Supplies.
Coding and General Billing Requirements.
Provider Notification Requirements.
Beneficiary Liability.
[[Page 14911]]
802.................... Termination of the Medicare HIPAA Incoming
Claim Contingency Plan, Addition of a Self-
Assessable Unusual Circumstance, Modification
of the Obligated to Accept as Payment in Full
Exception, and Modification of Administrative
Simplification Compliance Act Exhibit Letters
A, B and C General HIPAA Electronic Data
Interchange Requirements.
Continued Support of Pre-HIPAA Electronic Data
Interchange Formats.
National Council Prescription Drug Plans
Narrative Portion of Prior Authorization
Segment.
A/X12 837 Coordination of Benefits.
C/Legacy Formats.
Use of Imaging, External Keyshop, and In-House
Keying for Entry of Transaction Data Submitted
on Paper.
Electronic Data Interchange Receiver Testing by
Carriers, Durable Medical Equipment Regional
Carriers and Intermediaries.
Carrier, Durable Medical Equipment Regional
Carrier, and Fiscal Intermediary Submitter/
Receiver Testing with Legacy Formats during
the HIPAA Contingency Period.
Discontinuation of Use of Coordination of
Benefit Claim Legacy Formats Following
Successful HIPAA Format Testing.
Free Claim Submission Software.
Key Shop and Image Processing.
Mandatory Electronic Submission of Medicare
Claims.
Exceptions.
Unusual Circumstance Waivers.
Unusual Circumstance Waivers Subject to
Provider Self-Assessment.
------------------------------------------------------------------------
Medicare Secondary Payer
(CMS Pub. 100-05)
------------------------------------------------------------------------
37..................... Manualizing Long-Standing Medicare Secondary
Payer Policy in Chapter 3 of the Medicare
Secondary Payer Internet Only Manual.
Limitation on Right To Charge a Beneficiary
Where Services Are Covered by a Group Health
Plan.
Right of Providers to Charge Beneficiary Who
Has Received Primary Payment From a Group
Health Plan.
Right of Physicians and Other Suppliers To
Charge Beneficiary Who Has Received Primary
Payment From a Group Health Plan.
Payment When Proper Claim Not Filed.
Situations in Which Medicare Secondary Payer
Billing Applies.
Provider, Physician, and Other Supplier
Responsibility When a Request is Received From
an Insurance Company or Attorney.
Provider, Physician, and Other Supplier
Responsibility When Duplicate Payments Are
Received.
Incorrect Group Health Plan Primary Payments.
Retroactive Application.
General Policy.
Provider, Physician, and Other Supplier
Billing.
Provider Billing Where Services Are Covered by
a Group Health Plan.
Provider Billing Where Services Are Accident-
Related and No-Fault Insurance May Be
Available.
Provider Bills No-Fault Insurance First.
No-Fault Insurance Does Not Pay.
Liability Claim Also Involved.
Responsibility of Provider Where Benefits May
Be Payable Under Workers' Compensation.
Responsibility of Provider Where Benefits May
Be Payable Under the Federal Black Lung
Program.
Provider Billing Medicare for Secondary
Benefits Where Services Are Covered by a Group
Health Plan.
Instructions to Providers on How To Submit
Claims to a Contractor When There Are Multiple
Payers.
Instructions to Physicians and Other Suppliers
on How to Submit Claims to Contractors When
There Are One or More Primary Payers.
Completing the Form CMS 1450 in Medicare
Secondary Payer Situations by Providers.
Inpatient Services.
Outpatient Bills, Part B Inpatient Services,
and Home Health Agency Bills.
Partial Payment by Primary Payer for Inpatient
Services, Outpatient Services, Part B
Inpatient Services and Home Health Agency
Bills.
Partial Payment by Primary Payer That Applies
to Medicare Covered Services.
Annotation of Claims Denied by Group Health
Plans, Liability or No-Fault Insurers.
Annotation of Claims to Request Conditional
Payments.
Completing the Form CMS 1500 in MSP Situations
by Physicians and Other Suppliers of Services.
38..................... Hospital Audit Workload Updates.
Hospital Review Protocol for Medicare Secondary
Payer.
Reviewing Hospital Files.
Frequency of Reviews and Hospital Selection
Criteria.
Methodology for Review of Admission and Bill
Processing Procedures.
Selection of Bill Sample.
Methodology for Review of Hospital Billing
Data.
Review of Form CMS-1450.
Use of Systems Files for Review.
Assessment of Hospital Review.
39..................... Request to Change Lead Contractor.
Coordination with the Coordination of Benefits
Contractor.
Contractors Medicare Secondary Payer Auxiliary
File Update Responsibility.
Coordination of Benefit Contractor Electronic
Correspondence Referral System.
[[Page 14912]]
Providing Written Documents to the Coordination
of Benefit Contractor.
Contractor Record Retention.
Notification to Contractor of Medicare
Secondary Payer Auxiliary File Updates.
Referring Calls to Coordination of Benefit
Contractor.
Changes in Contractor Initial Medicare
Secondary Payer Development Activities.
Additional Activities Arranged by Non-Group
Health Plan Medicare Secondary Payer.
Coordination of Benefit Contractors Numbers.
40..................... Updates to the Group Health Plan Demand
Letters.
Recovery From the Provider, Physician or Other
Supplier.
Recovery From the Beneficiary That Has Received
Payment From Both Medicare And a Group Health
Plan.
Provider, Physician or Other Supplier Group
Health Plan Demand Letter.
Beneficiary Group Health Plan Demand Letter.
Recovery Management & Accounting System/
Healthcare Integrated General Ledger
Accounting System Group Health Plan General
Information.
Recovery Management & Accounting System/
Healthcare Integrated General Ledger
Accounting System Group Health Plan Demand
Process.
Recovery Management & Accounting System/
Healthcare Integrated General Ledger
Accounting System Group Health Plan Demand
Letter.
How To Resolve This Demand.
41..................... Full Replacement of and Rescinding Change
Request (CR) 3504--Modification to Online
Medicare Secondary Payer Questionnaire.
Admission Questions To Ask Medicare
Beneficiaries.
42..................... Updates to Medicare Secondary Payer Accounts
Receivable Write-Off Procedures.
Reclassification to Currently Not Collectible.
Write-Off Closed for Medicare Secondary Payer
Accounts Receivable.
Identification of Medicare Secondary Payer
Write-Off Closed Accounts.
Write-off Closed Definition.
Basis for Termination of Collection.
Criteria for Medicare Secondary Payer Based
Debts To Qualify for Write-Off Closed.
Data Requirements and Format for
Recommendations to the RO for Write-Off
Closed.
Write-Off Closed Notifications from Central
Officer for Debts Which Have Been Returned by
Treasury and Central Office Has Determined
That No Further Collection Attempts Are
Appropriate.
Write off closed Approval Process for section
70.3.3 Recommendations to the Regional Office.
Financial Reporting for Medicare Secondary
Payer Write off Closed Regional Office/Central
Office Responsibilities and Time-frames for
Approvals And/Or Recommendations.
Elimination of Automated Systems Write-Off
Closed Actions for Medicare Secondary Payer
Accounts Receivable; Reminder Zero Backend
Tolerance For Medicare Secondary Payer
Accounts Receivable.
Date for Establishment of Medicare Secondary
Payer Accounts Receivable.
Additional Instructions for ``Write-Off-
Closed'' for Debts of Less Than $25.00.
43..................... Expanding the Voluntary Data Sharing Agreement
Coordination of Benefit Contractor Numbers for
the Common Working File.
Definition of Medicare Secondary Payer/Common
Working File Terms.
44..................... This Transmittal is rescinded and replaced by
Transmittal 46.
45..................... Interest on Medicare Secondary Payment Debts.
Interest on Medicare Secondary Payment Recovery
Claims.
Medicare Secondary Payment Debt Interest
Calculation Methodology.
Medicare Secondary Payment Debt Interest
Accrual.
Medicare Secondary Payment Debt Interest
Accrual on Partial Payments.
Medicare Secondary Payment Debt Interest
Assessment.
Additional Rules with Regard to the Assessment
and Collection of Interest for Medicare
Secondary Payment Based Debts.
46..................... Updates to the Electronic Correspondence
Referral System User Guide v9.0 and Quick
Reference Card v9.0.
Coordination of Benefit Contractor Electronic
Referral System (includes the addition of
Attachments 1 and 2).
------------------------------------------------------------------------
Medicare Financial Management
(CMS Pub. 100-06)
------------------------------------------------------------------------
79..................... Discovery Code Indication for Recovery Audit
Contractor Non-Medicare Secondary Payer
Identified Overpayments.
80..................... Medicare Contractors' Monthly Cash Collections.
Medicare Contractor Monthly Cash Collections
Worksheet.
81..................... Recurring Update Notification for the Notice of
New Interest Rate for Medicare Overpayments
and Underpayments.
82..................... This Transmittal is rescinded and replaced by
Transmittal 85.
83..................... This Transmittal is rescinded and replaced by
Transmittal 84.
84..................... Revised Instructions on Contractor Procedures
for Provider Audit, and Clarification of
Continuing Education and Training Requirements
for Medicare Auditors.
Submission of Cost Report Data to CMS.
Audit Priority Consideration.
Pre-Exit Conference.
Finalization of Audit Adjustments.
Standards for Performing Medicare Audits.
Qualifications.
Due Professional Care.
[[Page 14913]]
Internal Quality Control.
Final Settlement of the Cost Report.
Timing and Completion of Home Office Audits.
Acceptance of Home Office Cost Statements.
85..................... Expansion of Form 5 of the Contractor Reporting
of Operational and Workload Data.
86..................... Development of New Report To Capture Benefit
Improvement Protection Act and Medicare
Modernization Act Appeals Data.
Monthly Statistical Report on Intermediary and
Carrier Part A and Part B Appeals Activity
Form (CMS-2592).
General.
Section I--Redeterminations.
Section II--Qualified Independent Contractor
Reconsiderations.
Section III--Administrative Law Judge Results.
Section IV--Department Appeals Board
Effectuations.
Clerical Error Reopenings.
Validation of Reports.
87..................... Update to Carrier Demand Letter Appeals
Language.
Provider Protests Its Liability.
------------------------------------------------------------------------
Medicare State Operations Manual
(Pub. 100-07)
------------------------------------------------------------------------
12..................... SOM Appendix PP--Guidance to Surveyors for Long
Term Care Facilities.
13..................... Revisions to Chapter 2, ``The Certification
Process,'' Appendix E--``Providers of
Outpatient Physical Therapy or Outpatient
Speech Language Pathology Services'' and
Appendix ``K--Comprehensive Outpatient
Rehabilitation Facilities''.
Types of Out Patient Therapy/Outpatient Speech
Language Pathology Providers.
Rehabilitation Agency.
Clinics and Public Health Agencies.
Sites of Service Provision.
Outpatient Physical Therapy/Outpatient Speech
Language Pathology Services Provided at More
Than One Location.
Outpatient Physical Therapy/Outpatient Speech
Language Pathology Services at Locations Other
Than Extension Locations.
State Agency Annual Report to Regional Office
on Locations of Extension Locations.
Survey of Outpatient Physical Therapy/
Outpatient Speech Language Pathology Extension
Locations.
Scope and Site of Services.
Shared Space With Another Provider or Supplier.
Sharing of Equipment.
14..................... This Transmittal is rescinded and replaced by
Transmittal 15.
15..................... Medical Director Guidance.
------------------------------------------------------------------------
Medicare Program Integrity
(CMS Pub.100-08)
------------------------------------------------------------------------
126.................... Implementation of Program Safeguard Contractor
Access to the VIPS Medicare Shared System at
All Durable Medical Equipment Carriers.
127.................... Complaint Screening Revisions.
128.................... Evidence of Medical Necessity: Wheelchair and
Power Operated Vehicle Claims.
129.................... Replacing the Use of Unique Physician
Identification Numbers With the National
Provider Identifiers.
130.................... Correction/Clarification of Chapter 11.
Medical Review Overview.
Routine Review Workload and Cost (Activity Code
21002).
Policy Reconsideration/Revision Activities
(Activity Code 21206).
New Policy Development Activities (Activity
Code 21208).
Complex Probe Review Workload and Cost
(Activity Code 21220).
Prepay Complex Review Workload and Cost
(Activity Code 21221).
Reporting LPET Workload and Cost Information
and Documentation in CAFM II.
Education Delivered to a Group of Providers
Workload and Cost (Activity Code 24117).
131.................... Medical Review Matching of Electronic Claims
and Additional Documentation in the Medical
Review Process.
Documentation Specifications for Areas Selected
for Prepayment or Postpayment Medical Review.
Prepayment Review of Claims for Medical Review
Purposes.
132.................... New Process for Web Maintenance of Provider
Enrollment Contractor Contact Information.
133.................... Enrolling Indian Health Service Facilities as
Durable Medical Equipment, Prosthetics,
Orthotics, and Supplies Suppliers.
134.................... Change in Provider Enrollment Timeliness
Standards.
Changes of Information.
Timeframes for Processing Enrollment
Applications.
------------------------------------------------------------------------
Medicare Contractor Beneficiary and Provider Communications
(CMS Pub. 100-09)
------------------------------------------------------------------------
14..................... Provider Inquiry Reporting Standardization.
15..................... Provider Customer Service Program.
Introduction.
Provider Services.
[[Page 14914]]
Guidelines for Telephone Service.
Toll Free Network Services.
Publication of Toll Free Numbers.
Call Handling Requirements.
Customer Service Assessment and Management
System Reporting Requirements.
Staff Development and Training.
Quality Call Monitoring.
Fraud and Abuse.
Provider Contact Center User Group.
Performance Improvements.
Written Inquiries.
Contractor Guidelines for High Quality
Responses to Written Inquiries.
Quality Written Correspondence Monitoring.
Quality Written Correspondence Monitoring
Program.
Quality Written Correspondence Monitoring
Calibration.
Quality Written Correspondence Monitoring
Performance Standards.
Disclosure of Information (Adherence to the
Privacy Act) Disclosure Desk.
Reference for Call Centers--Provider Portion.
Provider Communications--Program Elements.
Provider Service Plan.
Provider Inquiry Analysis.
Provider Claims Submission Error Analysis.
Provider Communication Advisory Group.
Bulletins/Newsletters/Educational Materials.
Seminars/Workshops/Trainings/Teleconferences.
New Technologies/Electronic Media.
Training of Providers in Electronic Claims
Submission.
Provider Education and Beneficiary Use of
Preventive Benefits.
Internal Development of Provider Issues.
Training of Provider Education Staff.
Partnering with External Entities.
Other Provider Education Subjects and
Activities.
Provider Education Material.
Provider/Supplier Service Plan Quarterly
Activity Report.
Charging Fees to Providers for Medicare
Education and Training Activities.
Provider/Supplier Communications--Program
Elements.
Provider/Supplier Service Plan.
Provider/Supplier Inquiry Analysis.
Provider/Supplier Claims Submission Error
Analysis.
Provider/Supplier Communications Advisory
Group.
Bulletins/Newsletters/Educational Materials.
Seminars/Workshops/Trainings/Teleconferences.
New Technologies/Electronic Media.
Training of Providers/Supplier in Electronic
Claims Submission.
Provider/Supplier Education and Beneficiary Use
of Preventive Benefits.
Internal Development of Provider/Supplier
Issues.
Training of Provider/Supplier Education Staff.
Partnering With External Entities.
Other Specific Provider/Supplier Education
Subjects and Activities.
Provider/Supplier Education Material.
Provider Customer Service Program.
------------------------------------------------------------------------
Medicare Managed Care
(CMS Pub. 100-16)
------------------------------------------------------------------------
74..................... Changes in Manual Instructions for Payment
Principles for Cost Based Health Maintenance
Organization/Comprehensive Medical Plan.
------------------------------------------------------------------------
Medicare Business Partners Systems Security
(CMS Pub. 100-17)
------------------------------------------------------------------------
06..................... Business Partners Systems Security Manual.
------------------------------------------------------------------------
Demonstrations
(CMS Pub. 100-19)
------------------------------------------------------------------------
29..................... Notification of New Value and Condition Codes
for Medicare Demonstrations.
30.................... The Medicare Chronic Care Improvement,
``Medicare Health Support,'' Program.
31..................... This Transmittal is rescinded and replaced by
Transmittal 35.
32..................... Issued to a specific audience, not posted to
Internet/Intranet due to Sensitivity of
Instruction.
[[Page 14915]]
33..................... Amendment to Rate for CPT 98943 for the Section
651 Expansion of Coverage of Chiropractic
Services Demonstration.
34..................... This Transmittal is rescinded and replaced by
Transmittal 36.
35..................... Physician's Voluntary Reporting Program.
36..................... 2006 Oncology Demonstration Project.
------------------------------------------------------------------------
One Time Notification
(CMS Pub. 100-20)
------------------------------------------------------------------------
182.................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality Of
Instruction.
183.................... This Transmittal is rescinded and replaced by
Transmittal 183
184.................... National Modifier and Condition Code To Be Used
To Identify Disaster Related Claims.
185.................... Payment Allowances for the Influenza Virus
Vaccine (CPT 90655, 90656, 90657, and 90658)
and the Pneumoccocal Vaccine (CPT 90732) When
Payment Is Based on 95 Percent of the Average
Wholesale Price.
186.................... Coverage by Medicare Advantage Plans for
Implantable Automatic Cardiac Defibrillator
Services Not Previously Included in MA
Capitation Rates.
187.................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality Of
Instruction.
188.................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality Of
Instruction.
189.................... Issued to a specific audience, not posted to
Internet/Intranet due to Sensitivity of
Instruction.
190.................... Stage 2 Requirements for Use and Editing of
National Provider Identifier Numbers Received
in Electronic Data Interchange Transaction,
via Direct Data Entry Screens, or Paper Claim
Forms.
191.................... Noridian North Dakota/South Dakota Carrier
Number Issue.
192.................... Issued to a specific audience, not posted to
Internet/Intranet due to Confidentiality Of
Instruction.
193.................... Change of Medicare Part B Contractor in the
State of Utah from Regence Blue Cross and Blue
Shield of Utah to Noridian Administrative
Services.
194.................... Calculation of the Interim Payment of Indirect
Medical Education Through The Inpatient
Prospective Payment System Pricer for
Hospitals That Received an Increase to Their
Full-Time Equivalent Resident Caps Under
Section 422 of the Medicare Modernization Act,
Pub. L. 108-173.
195.................... Change of Medicare Part A Contractor in the
States of Idaho, Oregon, and Utah From Regence
Blue Cross and Blue Shield to Noridian
Administrative Services.
196.................... Issued to a specific audience, not posted to
the Internet/Intranet due to Sensitivity of
Instruction.
197.................... Inpatient Prospective Payment System and
Skilled Nursing Facilities Wage Index
Corrections Fiscal Year 2006.
198.................... Termination of the Existing Eligibility-File
Based Crossover Process at All Medicare
Contractors.
199.................... New Medicare Summary Note Message Used for the
Physician's Voluntary Reporting Program.
------------------------------------------------------------------------
Addendum IV.--Regulation Documents Published in the Federal Register October Through December 2005
----------------------------------------------------------------------------------------------------------------
FR Vol. 70 CFR parts
Publication date page number affected File code Title of regulation
----------------------------------------------------------------------------------------------------------------
October 4, 2005............... 57785 405, 412, 413, CMS-1500-F2........... Medicare Program;
419, 422, and Changes to the
485. Hospital Inpatient
Prospective Payment
Systems and Fiscal
Year 2006 Rates;
Correcting
Amendment.
October 5, 2005............... 58260 431 and 457...... CMS-6026-IFC.......... Medicaid Program and
State Children's
Health Insurance
Program (SCHIP);
Payment Error Rate
Measurement.
October 7, 2005............... 58834 483.............. CMS-3198-F............ Medicare and Medicaid
Programs; Condition
of Participation:
Immunization
Standard for Long
Term Care
Facilities.
October 7, 2005............... 58649 421.............. CMS-6022-P............ Medicare Program;
Termination of Non-
Random Prepayment
Review.
October 11, 2005.............. 59182 411.............. CMS-1303-P............ Medicare Program;
Physicians'
Referrals to Health
Care Entities With
Which They Have
Financial
Relationships;
Exceptions for
Certain Electronic
Prescribing and
Electronic Health
Records
Arrangements.
October 28, 2005.............. 62124 ................. CMS-1316-N............ Medicare Program;
Meeting of the
Practicing
Physicians Advisory
Council, December 5,
2005.
October 28, 2005.............. 62065 483.............. CMS-3121-F............ Medicare and Medicaid
Program;
Requirements for
Long Term Care
Facilities; Nursing
Services; Posting of
Nursing Staffing
Information.
November 7, 2005.............. 67568 423.............. CMS-0011-F............ Medicare Program; E-
Prescribing and the
Prescription Drug
Program.
November 9, 2005.............. 68132 484.............. CMS-1301-F............ Medicare Program;
Home Health
Prospective Payment
System Rate Update
for Calendar Year
2006.
November 10, 2005............. 68516 419 and 485...... CMS-1501-FC........... Medicare Program;
Changes to the
Hospital Outpatient
Prospective Payment
System and Calendar
Year 2006 Payment
Rates.
[[Page 14916]]
November 21, 2005............. 70478 414.............. CMS-1325-IFC3......... Medicare Program;
Exclusion of Vendor
Purchases Made Under
the Competitive
Acquisition Program
(CAP) for Outpatient
Drugs and
Biologicals Under
Part B for the
Purpose of
Calculating the
Average Sales Price
(ASP).
November 21, 2005............. 70116 405, 410, 411, CMS1502-F and CMS-1325- Medicare Program;
413, 414, 424, F. Revisions to Payment
and 426. Policies Under the
Physician Fee
Schedule for
Calendar Year 2006
and Certain
Provisions Related
to the Competitive
Acquisition Program
of the Outpatient
Drugs and
Biologicals Under
Part B.
November 22, 2005............. 70532 418.............. CMS-1022-F............ Medicare Program;
Hospice Care
Amendments.
November 25, 2005............. 71163 ................. CMS-1294-N............ Medicare Program;
Coverage and Payment
of Ambulance
Services; Inflation
Update for CY 2006.
November 25, 2005............. 71020 144, 146, 148, CMS-4091-F............ Federal Enforcement
and 150. in Group and
Individual Health
Insurance Markets.
November 25, 2005............. 71008 424.............. CMS-0008-F............ Medicare Program;
Electronic
Submission of
Medicare Claims.
November 25, 2005............. 71006 403.............. CMS-1428-F3........... Medicare Program;
Changes to the
Hospital Inpatient
Prospective Payment
System and Fiscal
Year 2005 Rates:
Fire Safety
Requirements for
Religious Non-
Medical Health Care
Institutions:
Correction to
Reinstate
Requirements for
Written Fire Control
Plans and
Maintenance of
Documentation.
December 13, 2005............. 73623 405.............. CMS-1908-F............ Medicare Program;
Application of
Inherent
Reasonableness
Payment Policy to
Medicare Part B
Services (Other Than
Physician Services).
December 23, 2005............. 76317 ................. CMS-4112-N............ Medicare Program;
Meeting of the
Advisory Panel on
Medicare Education,
January 26, 2006.
December 23, 2005............. 76315 ................. CMS-1329-N............ Medicare Program;
Town Hall Meeting on
the Fiscal Year 2007
Applications for New
Medical Services and
Technologies Add-On
Payments Under the
Hospital Inpatient
Prospective Payment
System Scheduled for
February 16, 2006.
December 23, 2005............. 76313 ................. CMS-1289-N............ Medicare Program;
Meeting of the
Advisory Panel on
Ambulatory Payment
Classification (APC)
Groups--March 1, 2,
and 3, 2006.
December 23, 2005............. 76290 ................. CMS-9033-N............ Medicare and Medicaid
Programs; Quarterly
Listing of Program
Issuances--July
Through September
2005.
December 23, 2005............. 76199 484.............. CMS-3006-F............ Medicare and Medicaid
Programs; Reporting
Outcome and
Assessment
Information Set Data
as Part of the
Conditions of
Participation for
Home Health
Agencies.
December 23, 2005............. 76198 423.............. CMS-0011-CN........... Medicare Program; E-
Prescribing and the
Prescription Drug
Program; Correction.
December 23, 2005............. 76196 422.............. CMS-4069-F4........... Medicare Program;
Establishment of the
Medicare Advantage
Program.
December 23, 2005............. 76176 419 and 485...... CMS-1501-CN2.......... Medicare Program;
Changes to the
Hospital Outpatient
Prospective Payment
System and Calendar
Year 2006 Payment
Rates; Correction.
December 23, 2005............. 76175 418.............. CMS-1286-CN2.......... Medicare Program;
Hospice Wage Index
for Fiscal Year
2006.
----------------------------------------------------------------------------------------------------------------
Addendum V--National Coverage Determinations [October Through December
2005]
A national coverage determination (NCD) is a determination by
the Secretary with respect to whether or not a particular item or
service is covered nationally under Title XVIII of the Social
Security Act, but does not include a determination of what code, if
any, is assigned to a particular item or service covered under this
title, or determination with respect to the amount of payment made
for a particular item or service so covered. We include below all of
the NCDs that were issued during the quarter covered by this notice.
The entries below include information concerning completed decisions
as well as sections on program and decision memoranda, which also
announce pending decisions or, in some cases, explain why it was not
appropriate to issue an NCD. We identify completed decisions by the
section of the NCDM in which the decision appears, the title, the
date the publication was issued, and the effective date of the
decision. Information on completed decisions as well as pending
decisions has also been posted on the CMS Web site at http://cms.hhs.gov/coverage
.
[[Page 14917]]
National Coverage Determinations
[October through December 2005]
----------------------------------------------------------------------------------------------------------------
Title NCDM section TN No. Issue date Effective date
----------------------------------------------------------------------------------------------------------------
Lung Volume Reduction Surgery.......... 240.1 R44NCD................. 12/2/05 11/17/05
Stem Cell Transplantation.............. 110.8 R45NCD................. 12/6/05 11/28/05
----------------------------------------------------------------------------------------------------------------
Addendum VI--FDA-Approved Category B IDEs [October Through December
2005]
Under the Food, Drug, and Cosmetic Act (21 U.S.C. 360c) devices
fall into one of three classes. To assist CMS under this
categorization process, the FDA assigns one of two categories to
each FDA-approved IDE. Category A refers to experimental IDEs, and
Category B refers to non-experimental IDEs. To obtain more
information about the classes or categories, please refer to the
Federal Register notice published on April 21, 1997 (62 FR 19328).
The following list includes all Category B IDEs approved by FDA
during the fourth quarter, October through December 2005.
IDE/Category
G040190
G040194
G050048
G050092
G050116
G050118
G050140
G050151
G050187
G050191
G050192
G050193
G050195
G050198
G050200
G050202
G050204
G050205
G050206
G050207
G050208
G050210
G050214
G050217
G050221
G050222
G050223
G050224
G050228
G050230
G050231
G050232
G050234
G050235
G050236
G050239
G050244
G050245
Addendum VII--Approval Numbers for Collections of Information
Below we list all approval numbers for collections of
information in the referenced sections of CMS regulations in Title
42; Title 45, Subchapter C; and Title 20 of the Code of Federal
Regulations, which have been approved by the Office of Management
and Budget:
OMB Control Numbers
[Approved CFR Sections in Title 42, Title 45, and Title 20 (Note:
Sections in Title 45 are preceded by ``45 CFR,'' and sections in Title
20 are preceded by ``20 CFR'')]
------------------------------------------------------------------------
OMB No. Approved CFR Sections
------------------------------------------------------------------------
0938-0008.............. 414.40, 424.32, 424.44.
0938-0022.............. 413.20, 413.24, 413.106.
0938-0023.............. 424.103.
0938-0025.............. 406.28, 407.27.
0938-0027.............. 486.100-486.110.
0938-0034.............. 405.821.
0938-0035.............. 407.40.
0938-0037.............. 413.20, 413.24.
0938-0041.............. 408.6.
0938-0042.............. 410.40, 424.124.
0938-0045.............. 405.711.
0938-0046.............. 405.2133.
0938-0050.............. 413.20, 413.24.
0938-0062.............. 431.151, 435.151, 435.1009, 440.220, 440.250,
442.1, 442.10-442.16, 442.30, 442.40, 442.42,
442.100-442.119, 483.400-483.480, 488.332,
488.400, 498.3-498.5.
0938-0065.............. 485.701-485.729.
0938-0074.............. 491.1-491.11.
0938-0080.............. 406.13.
0938-0086.............. 420.200-420.206, 455.100-455.106.
0938-0101.............. 430.30.
0938-0102.............. 413.20, 413.24.
0938-0107.............. 413.20, 413.24.
0938-0146.............. 431.800-431.865.
0938-0147.............. 431.800-431.865.
0938-0151.............. 493.1-493.2001.
0938-0155.............. 405.2470.
0938-0193.............. 430.10-430.20, 440.167.
0938-0202.............. 413.17, 413.20.
0938-0214.............. 411.25, 489.2, 489.20.
0938-0236.............. 413.20, 413.24.
0938-0242.............. 416.44, 418.100, 482.41, 483.270, 483.470.
0938-0245.............. 407.10, 407.11.
0938-0251.............. 406.7.
0938-0266.............. 416.1-416.150.
0938-0267.............. 485.56, 485.58, 485.60, 485.64, 485.66.
0938-0269.............. 412.116, 412.632, 413.64, 413.350, 484.245.
[[Page 14918]]
0938-0270.............. 405.376.
0938-0272.............. 440.180, 441.300-441.305.
0938-0273.............. 485.701-485.729.
0938-0279.............. 424.5.
0938-0287.............. 447.31.
0938-0296.............. 413.170, 413.184.
0938-0301.............. 413.20, 413.24.
0938-0302.............. 418.22, 418.24, 418.28, 418.56, 418.58, 418.70,
418.74, 418.83, 418.96, 418.100.
0938-0313.............. 489.11, 489.20.
0938-0328.............. 482.12, 482.13, 482.21, 482.22, 482.27, 482.30,
482.41, 482.43, 482.45, 482.53, 482.56,
482.57, 482.60, 482.61, 482.62, 482.66,
485.618, 485.631.
0938-0334.............. 491.9, 491.10.
0938-0338.............. 486.104, 486.106, 486.110.
0938-0354.............. 441.50.
0938-0355.............. 442.30, 488.26.
0938-0358.............. 488.26.
0938-0359.............. 412.40-412.52.
0938-0360.............. 488.60.
0938-0365.............. 484.10, 484.11, 484.12, 484.14, 484.16, 484.18,
484.20, 484.36, 484.48, 484.52.
0938-0372.............. 414.330.
0938-0378.............. 482.60-482.62.
0938-0379.............. 442.30, 488.26.
0938-0382.............. 442.30, 488.26.
0938-0386.............. 405.2100-405.2171.
0938-0391.............. 488.18, 488.26, 488.28.
0938-0426.............. 480.104, 480.105, 480.116, 480.134.
0938-0429.............. 447.53.
0938-0443.............. 478.13, 478.34, 478.36, 478.42.
0938-0444.............. 1004.40, 1004.50, 1004.60, 1004.70.
0938-0445.............. 412.44, 412.46, 431.630, 476.71, 476.74,
476.78.
0938-0447.............. 405.2133.
0938-0448.............. 405.2133, 45 CFR 5, 5b; 20 CFR Parts 401, 422E.
0938-0449.............. 440.180, 441.300-441.310.
0938-0454.............. 424.20.
0938-0456.............. 412.105.
0938-0463.............. 413.20, 413.24, 413.106.
0938-0467.............. 431.17, 431.306, 435.910, 435.920, 435.940-
435.960.
0938-0469.............. 417.126, 422.502, 422.516.
0938-0470.............. 417.143, 422.6.
0938-0477.............. 412.92.
0938-0484.............. 424.123.
0938-0501.............. 406.15.
0938-0502.............. 433.138.
0938-0512.............. 486.304, 486.306, 486.307.
0938-0526.............. 475.102, 475.103, 475.104, 475.105, 475.106.
0938-0534.............. 410.38, 424.5.
0938-0544.............. 493.1-493.2001.
0938-0564.............. 411.32.
0938-0565.............. 411.20-411.206.
0938-0566.............. 411.404, 411.406, 411.408.
0938-0573.............. 412.256.
0938-0578.............. 447.534.
0938-0581.............. 493.1-493.2001.
0938-0599.............. 493.1-493.2001.
0938-0600.............. 405.371, 405.378, 413.20.
0938-0610.............. 417.436, 417.801, 422.128, 430.12, 431.20,
431.107, 440.170, 483.6, 483.10, 484.10,
489.102.
0938-0612.............. 493.801, 493.803, 493.1232, 493.1233, 493.1234,
493.1235, 493.1236, 493.1239, 493.1241,
493.1242, 493.1249, 493.1251, 493.1252,
493.1253, 493.1254, 493.1255, 493.1256,
493.1261, 493.1262, 493.1263, 493.1269,
493.1273, 493.1274, 493.1278, 493.1283,
493.1289, 493.1291, 394.1299.
0938-0618.............. 433.68, 433.74, 447.272.
0938-0653.............. 493.1771, 493.1773, 493.1777.
0938-0657.............. 405.2110, 405.2112.
0938-0658.............. 405.2110, 405.2112.
0938-0667.............. 482.12, 488.18, 489.20, 489.24
0938-0685.............. 410.32, 410.71, 413.17, 424.57, 424.73, 424.80,
440.30, 484.12.
0938-0686.............. 493.551-493.557.
0938-0688.............. 486.304, 486.306, 486.307, 486.310, 486.316,
486.318, 486.325.
0938-0691.............. 412.106.
0938-0692.............. 466.78, 489.20, 489.27.
0938-0701.............. 422.152.
[[Page 14919]]
0938-0702.............. 45 CFR 146.111, 146.115, 146.117, 146.150,
146.152, 146.160, 146.180.
0938-0703.............. 45 CFR 148.120, 134,122, 148.124, 148.126,
148.128.
0938-0714.............. 411.370-411.389.
0938-0717.............. 424.57.
0938-0721.............. 410.33.
0938-0723.............. 421.300-421.316.
0938-0730.............. 405.410, 405.430, 405.435, 405.440, 405.445,
405.455, 410.61, 415.110, 424.24.
0938-0732.............. 417.126, 417.470
0938-0734.............. 45 CFR 5b.
0938-0739.............. 413.337, 413.343, 424.32, 483.20.
0938-0749.............. 424.57.
0938-0753.............. 422.000-422.700.
0938-0754.............. 441.151, 441.152.
0938-0758.............. 413.20, 413.24.
0938-0760.............. 484.55, 484.205, 484.245, 484.250.
0938-0761.............. 484.11, 484.20.
0938-0763.............. 422.250, 422.252, 422.254, 422.256, 422.258,
422.262, 422.264, 422.266, 422.270, 422.300,
422.304, 422.306, 422.308, 422.310, 422.312,
422.314, 422.316, 422.318, 422.320, 422.322,
422.324, 423.251, 423.258, 423.265, 423.272,
423.286, 423.293, 423.301, 423.308, 423.315,
423.322, 423.329, 423.336, 423.343, 423.346,
423.350.
0938-0770.............. 410.2.
0938-0778.............. 422.111, 422.564.
0938-0779.............. 417.126, 417.470, 422.64, 422.210.
0938-0781.............. 411.404, 484.10.
0938-0786.............. 438.352, 438.360, 438.362, 438.364.
0938-0790.............. 460.12-460.210.
0938-0792.............. 491.8, 491.11.
0938-0798.............. 413.24, 413.65, 419.42.
0938-0802.............. 419.43.
0938-0818.............. 410.-141-410.146, 414.63.
0938-0829.............. 422.568.
0938-0832.............. Parts 489 and 491.
0938-0833.............. 483.350-483.376.
0938-0841.............. 431.636, 457.50, 457.60, 457.70, 457.340,
457.350, 457.431, 457.440, 457.525, 457.560,
457.570, 457.740, 457.750, 457.810, 457.940,
457.945, 457.965, 457.985, 457.1005, 457.1015,
457.1180.
0938-0842.............. 412.23, 412.604, 412.606, 412.608, 412.610,
412.614, 412.618, 412.626, 413.64.
0938-0846.............. 411.352-411.361.
0938-0857.............. Part 419.
0938-0860.............. Part 419.
0938-0866.............. 45 CFR Part 162.
0938-0872.............. 413.337, 483.20.
0938-0873.............. 422.152.
0938-0874.............. 45 CFR Parts 160 and 162.
0938-0878.............. Part 422 Subpart F and G.
0938-0887.............. 45 CFR 148.316, 148.318, 148.320.
0938-0897.............. 412.22, 412.533.
0938-0907.............. 412.230, 412.304, 413.65.
0938-0910.............. 422.620, 422.624, 422.626.
0938-0911.............. 426.400, 426.500.
0938-0915.............. 421.120, 421.122.
0938-0916.............. 483.16.
0938-0920.............. 438.6, 438.8, 438.10, 438.12, 438.50, 438.56,
438.102, 438.114, 438.202, 438.206, 438.207,
438.240, 438.242, 438.402, 438.404, 438.406,
438.408, 438.410, 438.414, 438.416, 438.604,
438.710, 438.722, 438.724, 438.810.
0938-0921.............. 414.804.
0938-0931.............. 45 CFR Part 142.408, 162.408, and 162.406.
0938-0933.............. 438.50.
0938-0934.............. 403.766.
0938-0936.............. 423.
0938-0939.............. 405.502.
0938-0944.............. 422.250, 422.252, 422.254, 422.256, 422.258,
422.262, 422.264, 422.266, 422.270, 422.300,
422.304, 422.306, 422.308, 422.310, 422.312,
422.314, 422.316, 422.318, 422.320, 422.322,
422.324, 423.251, 423.258, 423.265, 423.272,
423.279, 423.286, 423.293, 423.301, 423.308,
423.315, 423.322, 423.329, 423.336, 423.343,
423.346, 423.350.
0938-0950.............. 405.910.
0938-0951.............. 423.48.
0938-0953.............. 405.1200 and 405.1202.
0938-0954.............. 414.906, 414.908, 414.910, 414.914, 414.916.
------------------------------------------------------------------------
[[Page 14920]]
Addendum VIII--Medicare-Approved Carotid Stent Facilities [October
Through December 2005]
On March 17, 2005, we issued our decision memorandum on carotid
artery stenting. We determined that carotid artery stenting with
embolic protection is reasonable and necessary only if performed in
facilities that have been determined to be competent in performing
the evaluation, procedure, and follow-up necessary to ensure optimal
patient outcomes. We have created a list of minimum standards for
facilities modeled in part on professional society statements on
competency. All facilities must at least meet our standards in order
to receive coverage for carotid artery stenting for high risk
patients.
October 2005
10/4/05
Firelands Regional Medical Center, 1101 Decatur Street, Sandusky, OH
44870
Medicare Provider 360025
qMeritCare Hospital, 720 4th Street N, P.O. Box MC, Fargo, ND 58122
Medicare Provider 350011
Presbyterian Healthcare, 200 Hawthorne Lane, Charlotte, NC 28204
Medicare Provider 340053
Regions Hospital, 640 North Jackson Street, St. Paul, MN 55101
Medicare Provider 240106
Saint Agnes Medical Center, 1303 East Herndon Avenue, Fresno, CA
93720
Medicare Provider 050093
Saint Francis Medical Center, 211 Saint Francis Drive, Cape
Girardeau, MO 63703-8399
Medicare Provider 260183
Staten Island University Hospital, 475 Seaview Avenue, Staten
Island, NY 10305-3498
Medicare Provider 330160
Baptist Medical Center, 111 Dallas Street, San Antonio, TX 78205-
1230
Medicare Provider 450058
Bayonne Medical Center, 29th Street at Avenue E, Bayonne, NJ 07002
Medicare Provider 310025
Memorial Medical Center, 1086 Franklin Street, Johnstown, PA 15905-
4398
Medicare Provider 390110
NorthEast Medical Center, 920 Church Street, North, Concord, NC
28025
Medicare Provider 340001
St. Francis Medical Center, 309 Jackson Street, P.O. Box 1901,
Monroe, LA 71210-1901
Medicare Provider 190125
UHHS University Hospitals of Cleveland, 11100 Euclid Avenue,
Cleveland, OH 44106-5006
Medicare Provider 360137
10/11/05
St. Catherine Hospital, 4321 Fir Street, East Chicago, IN 46312
Medicare Provider 015008
University Hospital, 234 Goodman ML 700, Cincinnati, OH 45219
Medicare Provider 360003
Frankford Hospital, Frankford Avenue & Wakeling Street,
Philadelphia, PA 19124
Medicare Provider 390115
Memorial Hospital of South Bend, 615 North Michigan Street, South
Bend, IN 46601
Medicare Provider 150058
Mills-Peninsula Health Services, 1783 El Camino Real, Burlingame, CA
94010
Medicare Provider 050007
Mount Clemens General Hospital, 1000 Harrington Boulevard, Mount
Clemens, MI 48043
Medicare Provider 230227
SouthCrest Hospital, 8801 South 101st East Avenue, Tulsa, OK 74133
Medicare Provider 370202
St. Mary Medical Center, 1500 South Lake Park Avenue, Hobart, IN
46342
Medicare Provider 150034
St. Mary's Health System, 900 E. Oak Hill Avenue, Knoxville, TN
37917
Medicare Provider 440120
University of Illinois Medical Center at Chicago, 1740 West Taylor
Street, Suite 1400, Chicago, IL 60612
Medicare Provider 140150
Wuesthoff Health System Rockledge, 110 Longwood Avenue, P.O. Box
565002 Rockledge, FL 32956-5002
Medicare Provider 010092
10/14/05
Baylor Regional Medical Center at Grapevine, 1650 West College
Street, Grapevine, TX 76051
Medicare Provider 450563
Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104-2499
Medicare Provider 500064
Hendrico Doctors' Hospital,
Forest Campus--Administration, 1602 Skipwith Road, Richmond, VA
23229
Medicare Provider 049118
Methodist Dallas Medical Center, P.O. Box 655999, Dallas, TX 75265-
5999
Medicare Provider 450051
North Kansas City Hospital, 2800 Clay Edwards Drive, Kansas City, MO
64116
Medicare Provider 260096
University Community Hospital, Inc., 3100 East Fletcher Avenue,
Tampa, FL 33613
Medicare Provider 100173
10/21/05
AtlantiCare Regional Medical Center, 65 Jimmie Leeds Road, Pomona,
NJ 08240
Medicare Provider 310064
Boston Medical Center Corporation, One Boston Medical Center Place,
Boston, MA 02118
Medicare Provider 220031
Robert Wood Johnson University Hospital, One Robert Wood Johnson
Place, P.O. Box 2601, New Brunswick, NJ 08903-2601
Medicare Provider 210038
University Hospital, 1350 Walton Way, Augusta, GA 30901-2629
Medicare Provider 110028
Via Christi Regional Medical Center, 929 N. St. Francis, Wichita, KS
67214-3882
Medicare Provider 170122
10/24/05
Advocate South Suburban Hospital, 17800 South Kedzie Avenue, Hazel
Crest, IL 60429-0989
Medicare Provider 140250
Baptist Health Medical Center-Little Rock, 9601 Interstate 630, Exit
7, Little Rock, AR 72205-7299
Medicare Provider 040114
Bassett Healthcare, One Atwell Road, Cooperstown, NY 13326-1394
Medicare Provider 330136
Bay Regional Medical Center, 1900 Columbus Avenue, Bay City, MI
48708
Medicare Provider 230041
Mercy Medical Center, 500 S. Oakwood Road, P.O. Box 3370, Oshkosh,
WI 54904-3370
Medicare Provider 520048
Sharp Chula Vista Medical Center, 751 Medical Center Court, Chula
Vista, CA 91911-6699
Medicare Provider 050222
The Miriam Hospital, 164 Summit Avenue, Providence, RI 02906
Medicare Provider 410012
The University of California San Diego Medical Center, 200 W. Arbor
Drive, San Diego, CA 92103
Medicare Provider 050025
USC University Hospital, 1500 San Pablo Street, Los Angeles, CA
90033
Medicare Provider 050696
10/27/05
Baylor Heart & Vascular Hospital, 621 North Hall Street, Dallas, TX
75226
Medicare Provider 450851
Columbus Regional Healthcare System, 710 Center Street P.O. Box 951,
Columbus, GA 31902
Medicare Provider 110064
Deaconess Billings Clinic, 2800 Tenth Avenue North, P.O. Box 37000,
Billings, MT 59107-7000
Medicare Provider 270004
Kaiser Permanente San Diego Medical Center, Kaiser Foundation
Hospital, 4647 Zion Avenue, San Diego, CA 92120
Medicare Provider 050515
Kaweah Delta District Hospital, 400 West Mineral King, Visalia, CA
93291-6263
Medicare Provider 050057
Lexington County Health Services District, Inc. d/b/a Lexington
Medical Center, 2720 Sunset Boulevard, West Columbia, SC 29169
Medicare Provider 420073
Nazareth Hospital, 2601 Holme Avenue, Philadelphia, PA 19152
Medicare Provider 390204
Sharp Memorial Hospital, 7901 Frost Street, San Diego, CA 92123
Medicare Provider 050100
St. Vincent Medical Center, 2800 Main Street, Bridgeport, CT 06606
Medicare Provider 070028
Summa Health Systems, 525 E. Market Street, Akron, OH 44304-1698
Medicare Provider 360020
The Health Network of The Chester County Hospital, 701 E. Marshall
Street, West Chester, PA 19380
Medicare Provider 390179
The Toledo Hospital, 2124 N. Cove Boulevard, Toledo, OH 43606
Medicare Provider 360068
November 2005
11/1/05
Brandon Regional Hospital, 119 Oakfield Drive, Brandon, FL 33511
Medicare Provider 100243
Cape Cod Hospital, P.O. Box 640, 27 Park
[[Page 14921]]
Street, Hyannis, MA 02601
Medicare Provider 220012
St. Elizabeth Hospital, 1506 South Oneida Street, Appleton, WI 54915
Medicare Provider 520009
11/3/05
Athens Regional Medical Center, 1199 Prince Avenue, Athens, GA 30606
Medicare Provider 110074
Foote Hospital, 205 North East Avenue, Jackson, MI 49201
Medicare Provider 230092
Memorial Herman Southwest Hospital, 7600 Beechnut, Houston, TX 77074
Medicare Provider 450184
Regional Medical Center of San Jose, 225 North Jackson Avenue, San
Jose, CA 95116-1691
Medicare Provider 050125
St. Luke Hospital, 7380 Turfway Road, Florence, KY 41042
Medicare Provider 180045
11/4/05
Arlington Memorial Hospital, 800 West Randol Mill Road, Arlington,
TX 76012
Medicare Provider 450064
Calvert Memorial Hospital, 100 Hospital Road, Prince Frederick, MD
20678
Medicare Provider 210039
Community Memorial Hospital of San Buenaventura, 147 North Brent
Street, Ventura, CA 93003-2854
Medicare Provider 050394
Lancaster General Hospital, 555 North Duke Street, P.O. Box 3555,
Lancaster, PA 17604-3555
Medicare Provider 390100
St. Clair Hospital, 1000 Bower Hill Road, Pittsburgh, PA 15243
Medicare Provider 390228
11/10/05
Banner Thunderbird Medical Center, 5555 West Thunderbird Road,
Glendale, AZ 85306
Medicare Provider 030089
CHRISTUS Spohn Hospital Corpus Christi Shoreline, 600 Elizabeth
Street, Corpus Christi, TX 78404
Medicare Provider 450046
Cooper University Hospital, One Cooper Plaza, Camden, NJ 08103-1489
Medicare Provider 310014
Maine Medical Center, 22 Bramhall Street, Portland, ME 04102-3175
Medicare Provider 200009
Northeast Alabama Regional Medical Center, Post Office Box 2208,
Anniston, AL 36202
Medicare Provider 010078
Virginia Hospital Center, 1701 N. George Mason Drive, Arlington, VA
22205-3698
Medicare Provider 490050
Wuestoff Health System Melbourne, 250 North Wickham Road, Melbourne,
FL 32935
Medicare Provider 100291
11/14/05
Anne Arundel Medical Center, 2001 Medical Parkway, Annapolis, MD
21401
Medicare Provider 210023
CHRISTUS Schumpert Health System, One St. Mary Place, Shreveport, LA
71121
Medicare Provider 190041
Eisenhower Medical Center, 39000 Bob Hope Drive, Rancho Mirage, CA
92270
Medicare Provider 050573
Methodist Healthcare-Memphis Hospitals, 1211 Union Avenue, Memphis,
TN 38104
Medicare Provider 440049
Waukesha Memorial Hospital, 725 American Avenue, Waukesha, WI 53188
Medicare Provider 520008
11/18/05
Ashtabula County Medical Center, 2420 Lake Avenue, Ashtabula, OH
44004
Medicare Provider 360125
Carle Foundation Hospital, 611 S. Park Street, Urbana, IL 61801
Medicare Provider 140091
New York Methodist Hospital, 506 Sixth Street, Brooklyn, NY 11215-
9008
Medicare Provider 330236
Rush-Copely Medical Center, 2000 Ogden Avenue, Aurora, IL 60504
Medicare Provider 140029
Saint Clare's Hospital, 25 Pocono Road, Denville, NJ 07834
Medicare Provider 310050
Sherman Health, 934 Center Street, Elgin, IL 60120
Medicare Provider 140030
The Hospital at Westlake Medical Center, 5656 Bee Caves Road, Ste M-
302, Austin, TX 78746
Medicare Provider 670006
11/21/05
CentraState Medical Center, 901 W. Main Street, Freehold, NJ 07728
Medicare Provider 310111
Doctors' Hospital of Opelousas, 3983 I-49 South Service Road,
Opelousas, LA 70570
Medicare Provider 190191
Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202
Medicare Provider 230053
LaPorte Regional Health Systems, 1007 Lincolnway, P.O. Box 250,
LaPorte, IN 46352-0250
Medicare Provider 150006
Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030
Medicare Provider 450068
Morton Plant North Bay Hospital, 6600 Madison Street, New Port
Richey, FL 34652
Medicare Provider 100063
Santa Barbara Cottage Hospital, Post Office Box 689, Pueblo at Bath
Street, Santa Barbara, CA 93102-0689
Medicare Provider 050396
St. John Medical Center, 1923 South Utica Avenue, Tulsa, OK 74104
Medicare Provider 370114
Kaiser Foundation Hospital, Hawaii Region, 3288 Moanalua Road,
Honolulu, HI 96819
Medicare Provider 120011
King County Public Hospital District 1, DBA: Valley Medical
Center, 400 South 43rd Street, P.O. Box 50010, Renton, WA 98058-5010
Medicare Provider 500088
Medical Center East, 50 Medical Park East Drive, Birmingham, AL
35235
Medicare Provider 010011
11/28/05
Mercy Hospital, 2601 Electric Avenue, Port Huron, MI 48060-6518
Medicare Provider 230031
Northwest Community Hospital, 800 West Central Road, Arlington
Heights, IL 60005-2392
Medicare Provider 140252
St. Joseph's Healthcare, 15855 Nineteen Mile Road, Clinton Township,
MI 48038
Medicare Provider 230047
11/29/05
Alegent Health Immanuel Medical Center, 6901 North 72nd Street,
Omaha, NE 68122-1799
Medicare Provider 099398
Desert Valley Hospital, 16850 Bear Valley Road, Victorville, CA
92395
Medicare Provider 050709
MedCentral Health System, 335 Glessner Avenue, Mansfield, OH 44903-
2265
Medicare Provider 360118
Memorial Hospital of Carbondale, 405 West Jackson Street, P.O. Box
10000, Carbondale, IL 62902-9000
Medicare Provider 140164
Providence Medical Center, 8929 Parallel Parkway, Kansas City, KS
66112
Medicare Provider 170009
St. Mary Medical Center, 18300 Highway 18, Apple Valley, CA 92307
Medicare Provider 05300
Sutter Medical Center Santa Rosa, 3325 Chanate Road, Santa Rosa, CA
95404
Medicare Provider 050291
Tucson Heart Hospital, 4888 North Stone Avenue, Tucson, AZ 85704
Medicare Provider 030100
United Hospital Center, Post Office Box 1680, Clarksburg, WV 26302-
1680
Medicare Provider 510006
December 2005
12/1/05
All Saints Healthcare System, 3801 Spring Street, Racine, WI 53405
Medicare Provider 520096
Beaufort Memorial Hospital, 955 Ribaut Road, Beaufort, SC 29902-5454
Medicare Provider 420067
Self Regional Healthcare, 1325 Spring Street, Greenwood, SC 29646
Medicare Provider 420071
12/5/05
Citrus Memorial Health Foundation, Inc., 502 W. Highland Blvd,
Inverness, FL 34452-4754
Medicare Provider 100023
Poudre Valley Hospital, 1024 South Lemay Avenue, Fort Collins, CO
80524
Medicare Provider 060010
St. Joseph's Hospital Health Center, 301 Prospect Avenue, Syracuse,
NY 13203-1898
Medicare Provider 330140
UNC Hospitals, 101 Manning Drive, Chapel Hill, NC 27514
Medicare Provider 340061
12/6/05
O'Connor Hospital, 2105 Forest Avenue, San Jose, CA 95128
Medicare Provider 050153
University of Minnesota Medical Center
[[Page 14922]]
Fairview, 2450 Riverside Avenue, Minneapolis, MN 55424
Medicare Provider 240080
Wyoming Medical Center, 1233 E. 2nd Street, Casper, WY 82601
Medicare Provider 530012
12/12/05
Chesapeake General Hospital, 736 Battlefield Boulevard, North,
Chesapeake, VA 23320
Medicare Provider 490120
Exempla Lutheran Medical Center, 8300 West 38th Avenue, Wheat Ridge,
CO 80033
Medicare Provider 060009
Gaston Memorial Hospital, 2525 Court Drive, Gastonia, NC 28054,
Medicare Provider 340032
Parkridge Medical Center, 2333 McCallie Avenue, Chattanooga, TN
37404, Medicare Provider 440156
12/19/05
Baton Rouge General Medical Center, 3600 Florida Boulevard, Baton
Rouge, LA 70806, Medicare Provider 190065
Broward General Medical Center, 1600 South Andrews Avenue, Ft.
Lauderdale, FL 33316, Medicare Provider 100039
Good Samaritan Medical Center, 1309 Flagler Drive, West Palm Beach,
FL 33401, Medicare Provider 100287
Largo Medical Center, 201 14th Street SW, Mail P.O. Box 2905, Largo,
FL 33770, Medicare Provider 100248
Memorial Hermann Baptist Hospital-Beaumont, 3080 College Street,
Beaumont, TX 77701, Medicare Provider 450346
The Nebraska Medical Center, 987400 Nebraska Medical Center, Omaha,
NE 68198-7400, Medicare Provider 280013
Providence Everett Medical Center, 1321 Colby Avenue, Everett, WA
98201, Medicare Provider 500014
Roper Hospital, 316 Calhoun Street, Charleston, SC 29401, Medicare
Provider 420087
Santa Clara Valley Medical Center, 751 South Bascom Avenue, San
Jose, CA 95128, Medicare Provider 050038
Stanford Hospital & Clinics, 300 Pasteur Drive, Stanford, CA 94305,
Medicare Provider 050441
The University of Chicago Hospitals, AMB W-606 MC 6091, 5841 South
Maryland Avenue, Chicago, IL 60637-1470, Medicare Provider
140088
University of Utah Hospitals and Clinics, 50 North Medical Drive,
Salt Lake City, UT 84132, Medicare Provider 460009
12/21/05
Community Medical Center Healthcare System, 1800 Mulberry Street,
Scranton, PA 18510, Medicare Provider 390001
Mercy General Health Partners in Muskegon, Michigan, 1500 East
Sherman Boulevard, Muskegon, MI 49444, Medicare Provider
230004
St. Luke's Medical Center, 190 East Bannock Street, Boise, ID 83712,
Medicare Provider 130006
12/28/05
Riverside Healthcare Systems, LP, Dba Riverside Community Hospital,
4445 Magnolia Avenue, Riverside, CA 92501, Medicare Provider
050022
Santa Rosa Memorial Hospital, 1165 Montgomery Drive, Santa Rosa, CA
95405-4801, Medicare Provider 050174
San Joaquin Community Hospital, 2615 Eye Street, P.O. Box 2615,
Bakersfield, CA 93303-2615, Medicare Provider 050455
United Hospital, 333 North Smith Avenue, St. Paul, MN 55102,
Medicare Provider 240038
12/30/05
Georgetown University Hospital, 3800 Reservoir Road, NW, Washington,
DC 20007-2113, Medicare Provider 090004
Memorial Health Care System, 2525 de Sales Avenue, Chattanooga, TN
37404-1102, Medicare Provider 440091
Mercy Medical Center, 1343 Fountain Boulevard, P.O. Box 1380,
Springfield, OH 45501-1380, Medicare Provider 360086
Munson Medical Center, 1105 Sixth Street, Traverse City, MI 49684-
2386, Medicare Provider 230097
Salem Hospital, 665 Winter Street SE, Post Office Box 14001, Salem,
OR 97309-5014, Medicare Provider 380051
University of Mississippi Medical Center, 2500 North State Street,
Jackson, MS 39216, Medicare Provider 250001
[FR Doc. 06-2807 Filed 3-23-06; 8:45 am]
BILLING CODE 4120-01-P