| Issue Name: |
Blood Transfusions |
| Description: |
CPT codes 36430, 36440, 36450, and 36455 (excluding claims with any modifiers) should be billed as one (1) per session, regardless of the number of units transfused on that date of service.
Provider Types Affected: Outpatient Hospital and Physician. |
| Date of Service: |
10/01/2007 - Open |
| States Affected: |
South Carolina |
| Additional Information: |
Additional information can be found in the following manuals/publications:
Federal Register, Volume 67, No.212, page2
Program Memorandum Intermediaries, Transmittal A-01-50, April 12, 2001, page 1
CMS Pub 100-04, Ch. 4, § 231.8
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| Issue Name: |
Untimed Codes |
| Description: |
CPT Codes (excluding modifiers KX, and 59) where the procedure is not defined by a specific timeframe (untimed codes), the provider should enter a one (1) in the units billed column per date of service.
Provider Types Affected: Outpatient Hospital and Physician |
| Date of Service: |
10/01/2007 - Open |
| States Affected: |
South Carolina |
| Additional Information: |
Additional information can be found in the following manuals/publications:
CMS Pub 100-04, Transmittal 1019, dated 8.3.06, pages 7-11
CMS Pub 100-04, Ch. 5, § 20.2
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| Issue Name: |
IV Hydration Therapy |
| Description: |
Based on the definition of CPT 90760 (excluding claims modifier-59 ), the maximum number of units should be one (1) per patient per date of service. Beginning 1.1.09, code 90760 was replaced with code 96360.
Provider Types Affected: Outpatient Hospital and Physician. |
| Date of Service: |
10/01/2007 - Open |
| States Affected: |
South Carolina |
| Additional Information: |
Additional information can be found in the following manuals/publications:
CMS Pub 100-4 Ch. 12, pages 31-32
CMS Pub 100-20, Transmittal 419, page 7
MLN Matters, MM6349 R/T RC Realease Date 12.19.08, page 4
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| Issue Name: |
Bronchoscopy Services |
| Description: |
CPT Codes 31625, 31628 and 31629 should be billed with a maximum number of units of one (1) per patient per date of service (excluding claims with modifier 59) should only be reported with one unit per date of service.
Provider Types Affected: Outpatient Hospital and Physician. |
| Date of Service: |
10/01/2007 - Open |
| States Affected: |
South Carolina |
| Additional Information: |
Additional information can be found on the following website(s):
American Medical Association's (AMA) Current Procedural Terminology (CPT) for 2007, 2008 and 2009.
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| Issue Name: |
Once in a lifetime procedures |
| Description: |
By virtue of the description of the CPT code, these codes can be performed only once per patient lifetime.
Provider Types Affected: Outpatient Hospital and Physician. |
| Date of Service: |
10/01/2007 - Open |
| States Affected: |
South Carolina |
| Additional Information: |
Additional information can be found on the following manuals/publications:
CMS Pub 100-08, Ch. 3, § 3.6
American Medical Association's (AMA) Current Procedural Terminology (CPT) for 2007, 2008 and 2009
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| Issue Name: |
Pediatric codes exceeding age parameters |
| Description: |
Newborn/Pediatric CPT codes being applied/billed for patients which exceed the age limit defined by the CPT code.
Provider Types Affected: Outpatient Hospital and Physician. |
| Date of Service: |
10/01/2007 - Open |
| States Affected: |
South Carolina |
| Additional Information: |
Additional information can be found on the following manual/publication:
American Medical Association's (AMA) Current Procedural Terminology (CPT) for 2007, 2008 and 2009
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| Issue Name: |
J2505: Injection, Pegfilgrastim, 6 mg. |
| Description: |
By definition HCPC Code J2505 represents 6 mg per unit. The code should be billed at one (1) unit per patient per date of service.
Provider Types Affected: Outpatient Hospital and Physician. |
| Date of Service: |
10/01/2007 - Open |
| States Affected: |
South Carolina |
| Additional Information: |
Additional information can be found in the following manuals/publications:
CMS Manual System, Publication 100-04 Medicare Processing Manual, Transmittal 949 (dated May 12, 2006
MLN Matters Number MM5912, Release Date: January 18, 2008
MLN Matters Number MM4380, Release Date: May 12, 2006 |
