Tuesday, January 24, 2017

Modifier CC, CG, CT, CS - Definition and Usage

Modifier CC - Procedure Code Change No impact on percentage

Procedure codes reported with modifier CC indicate that a corrected claim has beensubmitted, usually in response to a previously rejected claim. Claims history will be researched to determine the correct adjudication of the claim.

[This modifier is used when the submitted procedure code is changed either for administrative reasons or  because an incorrect code was filed.]

BU THE BENEFICIARY HAS BEEN INFORMED OF THE PURCHASE AND RENTAL OPTIONS AND AFTER 30 DAYS HAS NOT INFORMED THE SUPPLIER OF HIS/HER DECISION CC PROCEDURE CODE CHANGE (USE 'CC' WHEN THE PROCEDURE CODE SUBMITTED WAS CHANGED EITHER FOR ADMINISTRATIVE REASONS OR BECAUSE AN INCORRECT CODE WAS FILED). (SUPPLIERS SHOULD NOT SUBMIT MODIFIER CC.)

CG POLICY CRITERIA APPLIED (EFFECTIVE DATE 07/01/2008)

CR CATASTROPHE/DISASTER RELATED

CS ITEM OR SERVICE RELATED, IN WHOLE OR IN PART, TO AN ILLNESS, INJURY, OR CONDITION THAT WAS CAUSED BY OR EXACERBATED BY THE EFFECTS, DIRECT OR INDIRECT, OF THE 2010 OIL SPILL IN THE GULF OF MEXICO, INCLUDING BUT NOT LIMITED TO, SUBSEQUENT CLEAN-UP ACTIVITIES (EFFECTIVE 04/20/2010)


Codes for CC Modifier

Partial Quantity  Code Description

A4216 STERILE WATER, SALINE AND/OR DEXTROSE

A4217 STERILE WATER/SALINE, 500 ML

A4218 STERILE SALINE OR WATER

A4221 SUPPLIES FOR MAINTENANCE DRUG INFUS CATH

A4244 ALCOHOL OR PEROXIDE, PER PINT

A4245 ALCOHOL WIPES, EACH

A4246 BETADINE SOLUTION,PER PINT

A4247 BETADINE OR IODINE SWABS/WIPES, (EACH)

A4248 CHLORHEXIDINE CONTAINING ANTISEPTIC, 1 M

A4250 URINE TEST/REAGENT STRP/TABS,100

A4253 BLOOD GLUCOSE STRIPS/50

A4255 PLATFORMS FOR HOME GLUCOSE MON. 50/BOX

A4259 LANCETS, PER 100

A4265 PARAFIN

A4364 OSTOMY SKIN BOND OR CEMENT, PER OUNCE

A4369 OSTOMY SKIN BARRIER, LIQUID PER OZ

A4371 OSTOMY SKIN BARRIER, POWDER PER OZ

A4394 OST. DEODERANT FOR USE IN POUCH, LIQUID

A4402 OSTOMY LUBRICANT (EACH)

A4405 OSTOMY SKIN BARRIER NON-PECTIN PASTE

A4406 OSTOMY SKIN BARRIER, PECTIN BASED

A4450 TAPE,NON-WATERPROOF,PER 18 INCHES

A4452 TAPE WATERPROOF, PER 18 INCHES

A4455 ADHESIVE REMOVER OR SOLVENT (TAPE, CEMEN

A4556 ELECTRODES, (E.G. APNEA MONITOR)

A4557 LEAD WIRES, (E.G. APNEA MONITOR)

A4558 CONDUCTIVE PASTE OR GEL


SUBJECT: Payment Reduction for Computed Tomography (CT) Diagnostic Imaging Services

I. SUMMARY OF CHANGES: Effective January 1, 2016, a payment reduction of 5 percent applies to Computed Tomography (CT) services furnished using equipment that is inconsistent with the CT equipment standard and for which payment is made under the physician fee schedule. The payment reduction increases to 15 percent in 2017 and subsequent years.

EFFECTIVE DATE: January 1, 2016

*Unless otherwise specified, the effective date is the date of service.

IMPLEMENTATION DATE: January 4, 2016

Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. Any other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents.

II. CHANGES IN MANUAL INSTRUCTIONS: (N/A if manual is not updated)

R=REVISED, N=NEW, D=DELETED-Only One Per Row.

R/N/D CHAPTER / SECTION / SUBSECTION / TITLE

R 12/TOC

N 12/20.4.7 - Services That Do Not Meet the National Electrical Manufacturers

Association (NEMA) Standard XR-29-2013


III. FUNDING:

For Medicare Administrative Contractors (MACs):

The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined in your contract. CMS does not construe this as a change to the MAC Statement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the Contracting Officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions regarding continued performance requirements.

V. ATTACHMENTS:
Business Requirements

Manual Instruction
Attachment - Business Requirements

Pub. 100-04 Transmittal: 3402 Date: November 6, 2015 Change Request: 9250 NOTE: This Transmittal is no longer sensitive and is being re-communicated. This instruction may now be posted to the Internet.

Transmittal 3299, dated August 6, 2015, is being rescinded and replaced by Transmittal 3402, dated November 6, 2015, to remove MCS from requirement 9250.5 and because the CR is no longer “sensitive/controversial.” All other information remains the same.


SUBJECT: Payment Reduction for Computed Tomography (CT) Diagnostic Imaging Services EFFECTIVE DATE: January 1, 2016
*Unless otherwise specified, the effective date is the date of service.

IMPLEMENTATION DATE: January 4, 2016


I. GENERAL INFORMATION

A. Background: Section 218(a) of the Protecting Access to Medicare Act of 2014 (PAMA) is titled “Quality Incentives To Promote Patient Safety and Public Health in Computed Tomography Diagnostic Imaging.” It amends the Social Security Act (SSA) by reducing payment for the technical component (and the technical component of the global fee) of the Physician Fee Schedule service (5 percent in 2016 and 15 percent in 2017 and subsequent years) for computed tomography (CT) services identified by CPT codes 70450-70498, 71250-71275, 72125-72133, 72191-72194, 73200-73206, 73700-73706, 74150-74178, 74261-74263, and 75571-75574 furnished using equipment that does not meet each of the attributes of the National Electrical Manufacturers Association (NEMA) Standard XR-29-2013, entitled “Standard Attributes on CT Equipment Related to Dose Optimization and Management.”

The statutory provision requires that information be provided and attested to by a supplier and a hospital outpatient department that indicates whether an applicable CT service was furnished that was not consistent with the NEMA CT equipment standard, and that such information may be included on a claim and may be a modifier. The statutory provision also provides that such information shall be verified, as appropriate, as part of the periodic accreditation of suppliers under SSA section 1834(e) and hospitals under SSA section 1865(a). Any reduced expenditures resulting from this provision are not budget neutral. To implement this provision, the Centers for Medicare and Medicaid Services (CMS) will create modifier “CT” (Computed tomography services furnished using equipment that does not meet each of the attributes of the National Electrical Manufacturers Association (NEMA) XR-29-2013 standard). Beginning in 2016, claims for CT scans described by above-listed CPT codes (and any successor codes) that are furnished on non-NEMA Standard XR-29-2013-compliant CT scans must include modifier “CT” that will result in the applicable payment reduction.

B. Policy: Beginning January 1, 2016, a payment reduction of 5 percent applies to the technical component (and the technical component of the global fee) for Computed Tomography (CT) services furnished using equipment that is inconsistent with the CT equipment standard and for which payment is made under the physician fee schedule. This payment reduction becomes 15 percent for 2017 and succeeding years.

Background

The Protecting Access to Medicare Act (H.R. 4302; P.L. 113-93), also known as PAMA, enacted in 2014, amended the Social Security Act (the Act) to extend Medicare payments to physicians and other providers of the Medicare and Medicaid program.

Section 218(a) of the Protecting Access to Medicare Act (PAMA) requires that ADI suppliers and hospital outpatient areas providing CT services must meet safety requirements under NEMA Standard XR-29-2013 beginning on January 1, 2016. ADI suppliers and hospital outpatient departments that are non-compliant with these safety requirements must use a Current Procedural Terminology (CPT) code modifier on their Medicare billing to attest to non-compliance. These non-compliant ADI suppliers will receive a decrease in their Medicare payment of 5% in 2016 with a further reduction to 15% in 2017 and thereafter.

Memorandum Summary

• Information Only: The Centers for Medicare & Medicaid Services (CMS) is sharing this clarification with State and Federal Surveyors as information only. Surveyors will not be expected to determine compliance with Advanced Diagnostic Imaging (ADI) suppliers or hospital outpatient department requirements. Accrediting Organizations (AOs) will be evaluating compliance on a periodic basis. State Agency and Regional Office Staffs have no role to play in this process.

• Clarifications: The CMS is providing compliance and payment clarifications based on stakeholder questions regarding National Electrical Manufacturers Association (NEMA) XR-29 Standard.

• Frequently Asked Questions (FAQs): The FAQs attached with this policy memorandum aim to clarify stakeholder uncertainty and to include aspects of payment reductions if CT systems are found non-compliant.



Clarification

In late 2015, stakeholders which included radiologists, hospital administrators, medical physicists, and individual institutions raised concern regarding the uncertainty of determination and documentation of compliance to the NEMA XR-29 “Standard Attributes on CT Equipment Related to Dose Optimization and Management” (MITA SmartDose) Standard.

Additionally, third party vendor claims of “XR-29 Solutions” may or may not actually upgrade a CT scanner to full compliance within the law has raised concern among the health care industry.

Therefore, CMS has compiled the attached FAQ document to clarify reimbursement changes for non-compliant systems and information regarding billing, coding and payment rates.

Effective Date: This memorandum is provided as information only. If providers have questions about this topic, they should be referred to this email box: [email protected]

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