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March 27, 2018


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Medical Coding News Archives

CMS Releases Updates to MPFS/Clinical Lab Fee Schedules

 
January 27, 2009:

On January 1, Medicare announced that there would be an emergency update to the physician fee schedule. The change affects all providers who file claims with Medicare contractors. 

Provider offices should make sure staff are aware of the changes noted in Medicare Transmittal 1661. Medicare contractors will not reprocess claims already paid but may adjust the claims if brought to their attention.

Below are some of the most significant revisions. For a complete list of the revisions included in the emergency update to the 2009 fee schedule, see attachment 1 of CR 6351, which can be found at http://www.cms.hhs.gov/Transmittals/downloads/R1661CP.pdf.

Status Indicator Revisions
Due to the national coverage determination for thermal intradiscal procedures (TIPs), the following codes will now have a status indicator of N (Noncovered).

22526
22527
0062T
0063T

RVU Revisions
The relative value units (RVUs) for the following codes have been revised.
20697
37025
47525
76775

Revisions of Physician Supervision Diagnostic Indicator
The following codes now have a physician supervision diagnostic indicator of 09, meaning that the concept does not apply.

93228 
93279   
93279 26 
93280   
93280 26 
93281   
93281 26 
93282   
93282 26 
93283   
93283 26 
93284   
93284 26 
93285   
93285 26 
93286   
93286 26 
93287   
93287 26 
93288   
93288 26 
93289   
93289 26 
93290   
93290 26 
93291   
93291 26 
93292   
93292 26 
93293   
93293 26 
93294 
93295 
93297 
93298

Note: Code 93293 TC has a physician supervision diagnostic indicator of 01, Procedure must be performed under the general supervision of a physician.

Descriptor Changes
The long and/or short descriptors have been revised for the following codes:

CPT© Code

Revised Long Descriptor

Revised Short Descriptor

4275F

Hepatitis B vaccine injection administered or previously received (HIV)

Hep b vac inj admin/ rcvd

D0486

Laboratory accession of brush biopsy sample, microscopic examination, preparation and transmission of written report

N/A

D1203

Topical application of fluoride—child

Topical app fluoride child

D1204

Topical application of fluoride—adult

Topical app fluoride adult

D3310

Endodontic therapy, anterior tooth (excluding final restoration)

End thxpy, anterior tooth

D3320

Endodontic therapy, bicuspid tooth (excluding final restoration)

End thxpy, bicuspid tooth

D3330

Endodontic therapy, molar (excluding final restoration)

End thxpy, molar

D4210

Gingivectomy or gingivoplasty—four or more contiguous teeth or tooth bounded spaces per quadrant

N/A

D4211

Gingivectomy or gingivoplasty—one to three contiguous teeth or tooth bounded spaces per quadrant

N/A

D4240

Gingival flap procedure, including root planing—four or more contiguous teeth or tooth bounded spaces per quadrant

N/A

D4241

Gingival flap procedure, including root planing—one to three contiguous teeth or tooth bounded spaces per quadrant

N/A

D4260

Osseous surgery (including flap entry and closure)—four or more contiguous teeth or tooth bounded spaces per quadrant

N/A

D4261

Osseous surgery (including flap entry and closure)—one to three contiguous teeth or tooth bounded spaces per quadrant

N/A

Q4114

Integra flowable wound matrix, injectable, 1 cc

N/A

Dental codes were also added with this 2009 update:
D0417
Long descriptor: Collection and preparation of saliva sample for laboratory diagnostic testing; 
Short descriptor: Collect & prep saliva sample  

D0418
Long descriptor: Analysis of saliva sample;
Short descriptor: Analysis of saliva sample

D3222
Long descriptor: Partial pulpotomy for apexogenesis—permanent tooth with incomplete root; development
Short descriptor: Part pulp for apexogenesis

D5991
Long descriptor: Topical medicament carrier;
Short descriptor: Topical medicament carrier

Lab Fee Schedule Update
Medicare released Transmittal 1660 on December 31, 2008. This transmittal announced that the annual update to payments made using the clinical laboratory fee schedule for calendar year 2009 is 4.5 percent; payments made on a reasonable charge basis for all other laboratory services is updated by 5.0 percent. Also the percentage in business requirement 6070.3 is changed from 4.5 percent to 5.0 percent. All other information in this RUN remains the same.

Nichole VanHorn
Clinical/Technical Editor

CPT is a registered trademark of the American Medical Association

 

 
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