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Medicare & Medicaid
Future Internet-Only Manual Updates

These issuances are future updates to the manuals based on the implementation date.  This update includes revisions communicated through March 19, 2004.  The specific sections in the manuals will be updated to reflect these changes on the implementation date.

Table of Contents

2004 Updates
January-March
April-June
July-September
October-December
2005 Updates
January-March

FILE Adobe PDF Icon COMM DATE PUB NO SUBJECT IMPL DATE CR NUM
January-March 2004 Updates
R108CP
(247 kb)
02/27/2004 100-04 Type of Service Corrections, Chapter 26, Section 10.7  CR 3018 03/29/2004 3018
R110CP
(241 kb)
02/27/2004 100-04 New Requirement for Payment of Drugs  CR 3078 03/29/2004 3078
R11MSP
(303 kb)
02/27/2004 100-05 MSP Policy for Certain Services  CR 3064 03/29/2004 3064
April-June 2004 Updates
R7BP
(139 kb)
03/05/2004 100-02 Policy Changes to Reflect Billing for Darbepoetin Alfa and Epoetin 04/01/2004 3119
R8NCD
(279 kb)
03/19/2004 100-03 Current Perception Threshold/Sensory Nerve Conduction Threshold Test (sNCT) 04/01/2004 2988
R13CP
(119 kb)






R13CP1
(99 kb)
R13CP2
(139 kb)
10/31/2003 100-04 Adjustments of Episode Payment-Confirming OASIS Assessment Items, Adjustment of Episode Payment-Therapy Threshold, Adjustment of Episode Payment-Hospitalization Within 14 Days of Start of Care

Attachment:
Business Requirements
Attachment:
Manual Instruction-Chapter 10
04/01/2004 2928
R23CP
(221 kb)


R23CP1
(127 kb)
R23CP2
(171 kb)
10/31/2003 100-04 Carriers Standard Systems would price the payment of referred services

Attachment:
Business Requirements
Attachment:
Manual Instruction-Chapter 16
04/01/2004 2193
R25CP
(112 kb)


R25CP1
(131 kb)
R25CP2
(82 kb)
R25CP3
(209 kb)
R25CP4
(239 kb)
R25CP5
(141 kb)
10/31/2003 100-04 Billing Non-Covered Charges to Fiscal Intermediaries - Summary and New Instructions

Attachment:
Business Requirements
Attachment A

Attachment B

Attachment:
Manual Instruction-Chapter 1
Manual Instruction-Chapter 10
04/01/2004 2634
R101CP
(258 kb)
02/20/2004 100-04 Restoring Composite Rate Exceptions for Pediatric Facilities 04/01/2004 3119
R121CP
(537 kb)
03/19/2004 100-04 Manualization of Place of Service Code Set Program Memorandum Revision to Group Home Code Description 04/01/2004 3087
R2MSP 10/17/2003 100-05 CONFIDENTIAL 04/01/2004 2252
R66PI
(261 kb)
02/20/2004 100-08 Progressive Corrective Action Program Memorandum and Providing Updated Instructions on How Contractors Must Identify, Verify, and Correct Billing Errors 04/02/2004 3124
R6BP
(264 kb)
01/23/2004 100-02 Intravenous Immune Globulin 04/05/2004 3059
R15CP
(283 kb)
10/31/2003 100-04 Implementation Guide Edits 04/05/2004 2819
R16CP
(119 kb)

R16CP1
(127 kb)
R16CP2
(56 kb)
10/31/2003 100-04 Payment Limit for Purchased Services

Attachment:
Business Requirements
Attachment:
Manual Instruction
04/05/2004 2919
R17CP
(104 kb)


R17CP1
(92 kb)
R17CP2
(97 kb)
10/31/2003 100-04 Correct Payments to terminated home health agencies under the Home Health Payment System

Attachment:
Business Requirements
Attachment:
Manual Instruction-Chapter 10
04/05/2004 2927
R28CP
(245 kb)
11/07/2003 100-04 Consolidation of the Claims Crossover Process & the Adding of CWF Crossover Disposition Indicators 04/05/2004 2962
R49CP
(248 kb)
12/19/2003 100-04 HIPAA X12N 837 Health Care Claim Transaction Must be rejected by the FI 04/05/2004 2879
R50CP
(271 kb)
12/19/2003 100-04 New K Codes 04/05/2004 2967
R57CP
(292 kb)
01/02/2004 100-04 Implementation of the HIPAA Interchange Control Header 04/05/2004 3001
R58CP
(241 kb)
01/02/2004 100-04 April Quarterly DMEPOS Fee Schedule Update 04/05/2004 3014
R63CP
(303 kb)
01/16/2004 100-04 Chapter 4, Section(s) 250, 250.1 250.2 and 250.6 04/05/2004 3051
R66CP
(232 kb)
01/16/2004 100-04 Quarterly Update to Correct Coding Initiative Edits, Version 10.1, Effective April 1, 2004 04/05/2004 2997
R67CP
(280 kb)
01/16/2004 100-04 Coding/Testing Phases of CR 2631 04/05/2004 3039
R68CP
(270 kb)
01/16/2004 100-04 Chapter 3, Section(s) 30.1, 30.1.1 04/05/2004 3052
R71CP
(322 kb)
01/23/2004 100-04 Changes to the Laboratory National Coverage Determination Edit Software 04/05/2004 3032
& 3072
R74CP
(253 kb)
01/23/2004 100-04 Intravenous Immune Globulin 04/05/2004 3060
R92CP
(366 kb)
02/06/2004 100-04 Apr. Qtrly Update to Jan. 2004 Annual Update of HCPCS Codes Used for SNF Consolidated Billing Enforcement 04/05/2004 3070
R93CP
(171 kb)
02/06/2004 100-04 Reason Codes 04/05/2004 3122
R102CP
(94 kb)
02/20/2004 100-04 New CLIA Waived Tests - April 1, 2004 04/05/2004 3061
R104CP
(247 kb)
02/20/2004 100-04 DMERCS & VIPS & NCD #s 04/05/2004 3141
R105CP
(258 kb)
02/20/2004 100-04 First Update to the 2004 Medicare Physician Fee Schedule Database 04/05/2004 3128
R109CP
(318 kb)
02/27/2004 100-04 Updated Policy and Claims Processing Instructions for ABPM CR 2726 04/05/2004 2726
R112CP
(263 kb)
02/27/2004 100-04 04/04 Changes to OPPS CR 3144 04/05/2004 3144
R113CP
(192 kb)
02/27/2004 100-04 Claims Requiring Adjustment as a Result of April 2004 Changes to the OPPS CR 3145 04/05/2004 3145
R116CP
(293 kb)
03/05/2004 100-04 ESRD Miscellaneous Code Processing Clarification 04/05/2004 3019
R117CP
(199 kb)
03/05/2004 100-04 Instructions for downloading the Medicare zip code file 04/05/2004 3160
R118CP
(537 kb)
03/05/2004 100-04 Policy Changes to Reflect Billing for Darbepoetin Alfa and Epoetin 04/05/2004 2984
R119CP
(183 kb)
03/19/2004 100-04 MMA Drug Pricing Update-Drug Exceptions 04/05/2004 3161
R120CP
(255 kb)
03/19/2004 100-04 January Medicare OCE Specifications  Version 19.1R1 04/05/2004 3155
R24FM
(81 kb)
10/31/2004 100-06 Update of the Provider Statistical and Reimbursement Reporting System for Version 32.0 04/05/2004 2953
R53PI
(105 kb)
R53PI1
(107 kb)
R53PI2
(134 kb)
R53PI3
(74 kb)
10/31/2003 100-08 Prepayment Edits

Attachment:
Business Requirements
Attachment:
Manual Instruction-Chapter 3
Attachment:
CR 2916 Qs&As
04/05/2004 2916
R54PI
(105 kb)
R54PI1
(107 kb)
R54PI2
(100 kb)
10/31/2003 100-08 Denials

Attachment:
Business Requirements
Attachment:
Manual Instruction
04/05/2004 2936
R62PI
(166 kb)
01/23/2004 100-08 FMR Report 04/05/2004 3062
R4COM
(862 kb)
03/05/2004 100-09 Provider/Supplier Communications 04/05/2004 3118
R4SS
(5683 kb)
03/05/2004 100-17 Federal Laws 04/05/2004 3106
R13MSP
(2996 kb)
03/19/2004 100-05 Update to the ECRS User Guide v7.0 and Quick Reference Card v7.0 04/19/04 3174
R5ESRD
(493 kb)
03/12/2004 100-14 Chapter 4 - Information Management 04/26/2004 n/a
R6ESRD
(237 kb)
03/12/2004 100-14 Chapter 6 - Community Information and Resources 04/26/2004 n/a
R7ESRD
(635 kb)
03/12/2004 100-14 Chapter 7 - Sanctions and ESRD Complaints and Grievances 04/26/2004 n/a
July-September 2004 Updates
R103CP
(272 kb)
02/20/2004 100-04 Chapter 4, Section 250.2, Optional Method for Outpatient Services: Cost-Based Facility Services Plus 115 Percent 07/01/2004 3114
R88CP
(507 kb)
02/06/2004 100-04 Implementation of Changes to Payment for Ambulance Services Required by Section 414 of MMA 07/05/2004 3099
R37FM
(187 kb)
03/19/2004 100-06 Update of the PS&R Reporting System 07/05/2004 3131
R7NCD
(184 kb)
03/19/2004 100-03 Electrical Stimulation and Electromagnetic Therapy for the Treatment of Wounds 07/06/2004 3149
R78CP
(329 kb)
02/06/2004 100-04 Medicare Incentive Payments for Physician Care 07/06/2004 3108
R79CP
(299 kb)
02/06/2004 100-04 ESRD Reimbursement for AMCC Tests 07/06/2004 2813
R80CP
(332 kb)
02/06/2004 100-04 Extend Medicare Coverage for Certain Colorectal Cancer Screenings at SNF 07/06/2004 2874
R81CP
(2141 kb)
02/06/2004 100-04 Update of UB-92 Codes 07/06/2004 3012
R82CP
(341 kb)
02/06/2004 100-04 ESRD Data for Use In Adjudicating Claims 07/06/2004 3066
R83CP
(225 kb)
02/06/2004 100-04 New "K" Codes for Wheelchair Cushions 07/06/2004 3069
R84CP
(238 kb)
02/06/2004 100-04 Chapter 24, Section 40.7.3 07/06/2004 3095
R85CP
(472 kb)
02/06/2004 100-04 Processing of Claims for Referred Services for a Independent Clinical Diagnostic Laboratory 07/06/2004 3090
R86CP
(267 kb)
02/06/2004 100-04 Health Insurance Portability and Accountability Act (HIPAA) X12N837 Professional II 07/06/2004 3050
R87CP
(284 kb)
02/06/2004 100-04 Expansion of Transfer Policy Under Inpatient Payment Prospective System (IPPS) 07/06/2004 2934
R89CP
(362 kb)
02/06/2004 100-04 The Elimination of the 90-day Grace Period for HCPCS Codes 07/06/2004 3093
R90CP
(248 kb)
02/06/2004 100-04 Bundled Services for SNF 07/06/2004 2944
R91CP
(264 kb)
02/06/2004 100-04 Processing Non-covered HH PPS Charges 07/06/2004 3077
R94CP
(368 kb)
02/06/2004 100-04 More Info on MSNs About SNFs 07/06/2004 3098
R97CP
(291 kb)
02/06/2004 100-04 Implementation of New Medicare Redetermination Notice 07/06/2004 2620
R98CP
(645 kb)
02/06/2004 100-04 Consolidation of the Claims Crossover Process-Additional CWF Functionality 07/06/2004 3109
R99CP
(257 kb)
02/09/2004 100-04 HIPAA X12N 837 Coordination of Benefits Gap Fill Additional 07/06/2004 3100
R100CP
(257 kb)
02/13/2004 100-04 Outpatient Clinical Laboratory/Tests Furnished by Hospitals With Fewer Than 50 Beds 07/06/2004 3130
R107CP
(503 kb)
02/24/2004 100-04 HIPAA X12N 837 Health Care Claim Implementation Guide Editing Additional Instruction CR 3031 07/06/2004 3031
R114CP
(347 kb)
02/27/2004 100-04 Changes in Payment Floor Calculation for Claims Submitted Electronically in a non-HIPAA CR 2981 07/06/2004 2981
R115CP
(200 kb)
03/05/2004 100-04 DMERCs and VIPS, Processing NDC Number - Clarification to CR 3141 07/06/2004 3148
R7MSP
(214 kb)
02/06/2004 100-05 MSP FOR HH PPS 07/06/2004 2954
R8MSP
(316 kb)
02/06/2004 100-05 Common Working File MSP Modifications 07/06/2004 2775
R9MSP
(276 kb)
02/06/2004 100-05 Converting HIPAA Individual Relation 07/06/2004 3116
R10MSP
(160 kb)
02/13/2004 100-05 Update to the Shared Systems to Send the Appropriate Medicare Fee Schedule Amounts to the Updated MSPPAY Software 07/06/2004 2955
R32FM
(229 kb)
02/06/2004 100-06 Expanded Identification and Working load Reporting for CMS Medicare Systems 07/06/2004 3023
R33FM
(207 kb)
02/06/2004 100-06 Coordination of Medicare and Complementary Insurance Programs 07/06/2004 3109
R68PI 02/25/2004 100-08 Program Requirements to Support Medical Review of HH PPS  CR 2519 07/06/2004 2519
October-December 2004 Updates
R35FM
(364 kb)
02/09/2004 100-06 Unsolicited/Voluntary Refund Requirements 10/04/2004 1444
January-March 2005 Updates
R3GI
(319 kb)
03/12/2004 100-01 New Part B Annual Deductible 01/01/2005 3121



View the latest actions taken by CMS to implement
The Medicare Prescription Drug, Improvement and Modernization Act of 2003

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Last Modified on Thursday, September 16, 2004