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10/16/2008
New Hydration and Non-Chemo Drug Administration Codes for 2009
In order to organize the drug administration codes numerically, the AMA has assigned new CPT codes for the hydration and therapeutic, diagnostic, and prophylactice drug administration codes.
The new CPT codes will be effective January 01, 2008. Click here to access ASCO's cross reference sheet for the new 2009 CPT codes and 2008 CPT codes.
5/16/2008
Medicare ESA Requirements
In response to requests for clarification on the reporting requirements for ESAs and other anti-anemia drugs, and to reports of incorrect denials on these drugs I have summarized the billing requirements and included an ESA Required Information Reference Chart.
Remember, the information in the link below pertains to the CMS requirements, your Medicare Contractor may have additional billing and reporting requirements. Refer to your Medicare Contractors Web site and bulletins for updated information.
Summary of ESA Billing & Reporting Requirements and Reference Chart
If your ESA claims are being incorrectly denied:
1. Verify that you are including all of the required information on your claims in the right format and in the right field see the Reference Chart below and review your Carriers guidelines.
2.
Contact your software vendor to make sure the information is being mapped properly to Loop 2400 MEA segment on the electronic form 837P or item 19 of the paper CMS 1500 for the hct/hgb, and the correct line item corresponding to the ESA HCPCS for the ESA modifiers.
3.
Verify that the information is being transmitted properly from your practice management billing system or billing service to the clearinghouse.
4. Verify that the information is being transmitted properly from the clearinghouse (or your software system if you are transmitting directly to Medicare) to your Medicare Contractor. Remember the recent issue where CMS reported that some clearinghouses were inadvertently removing the NPI before transmitting the claim to Medicare.
5. Verify that the Medicare Contractor is receiving the required information – you can call your Contractor’s EDI support line to verify that the information is going over properly in the correct field.
Finally, if all of the information is in the correct format and field and is being transmitted properly to your Medicare Contractor the problem may be a systems problem with your Medicare Contractor. If you find this to be the case, contact your state oncology society to make them aware of the problem.
This communication is for informational purposes only. Medicare regulations are constantly evolving, consult your Medicare carrier, contracted insurers & state laws for specific guidelines on billing and reimbursement.
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