Healthcare Common Procedure Coding System (HCPCS)

Question: Which Healthcare Common Procedure Coding System (HCPCS) codes will be used for claims-based reporting of Physician Quality Reporting Initiative (PQRI) quality measure data?
Answer : The majority of PQRI quality-data codes (numerator codes) are CPT Category II codes, although some measures may use G-codes. Detailed specifications for each quality measure are available on the CMS PQRI website as a download from the Measures/Codes page (http://www.cms.hhs.gov/PQRI). The PQRI Code Master Single Source, a numerical listing of all codes included in PQRI for the current program year, is available on the CMS PQRI website as a download from the Resources and Tools section. This document is an Excel file intended for professionals' use in setting up their billing/coding systems to capture all PQRI codes and modifiers for each measure.


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fiscal intermediaries

Question: What is the new Current Procedural Terminology (CPT) code that carriers and fiscal intermediaries (FIs) must use for services previously billed under CPT code 90718?
Answer : Effective July 1, 2005, Medicare carriers and intermediaries must use the new CPT code 90714 (Tetanus and diphtheria toxoids (Td) absorbed, preservative free, for use in individuals seven years or older, for intramuscular use) for services previously billed under CPT code 90718.

Reference: http://www.cms.hhs.gov/mlnmattersarticles/downloads/MM4222.pdf

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What will happen if Current Procedural Terminology (CPT) code 95992 is bill alone?

Answer : If billed alone, this code will be denied. On remittance advice notices for claims so denied, Medicare contractors will use group code CO and claim adjustment reason code 97 ("Payment is included in the allowance for another service/procedure.") Alternatively, reason code B15, which has the same intent may also be used by your Medicare contractor.


Reference: http://www.cms.hhs.gov/mlnmattersarticles/downloads/MM6407.pdf

http://www.cms.hhs.gov/transmittals/downloads/R1706CP.pdf

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Can CPT codes 99341 – 99350 be used to report Medicare Part B physician services for a patient in an assisted living facility (POS 13) or a group h

Answer : No. The CPT codes 99341 – 99350 (Home Services) may be used only when Medicare Part B physician services are provided in the private residence of the patient.


Reference: http://www.cms.hhs.gov/transmittals/downloads/R667CP.pdf

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Who assigns NPIs to health care providers?

Answer : The Department of Health and Human Services selected Fox Systems, Inc., known as the Enumerator, does this work. In addition to receiving and processing paper National Provider Identifier (NPI) applications and updates and notifying health care providers of their NPIs, the Enumerator resolves issues related to NPI applications and updates that contain errors, investigates situations in which applications for NPIs match or closely match health care providers who already have been assigned NPIs, investigates situations in which updates are unable to match any enumerated health care provider, and operates and maintains a Call Center and an electronic mailbox in order to receive and respond to questions about obtaining NPIs.

Do the finger and toe modifiers apply to radiology CPT codes?

Answer : Yes, the finger and toe modifiers apply to radiology CPT Codes. Specifically, the finger modifiers would apply to CPT code 73140 and the toe modifiers would apply to CPT code 73660.

What is Current Procedural Terminology (CPT) code 90718 used for?

Effective July 1, 2005, CPT code 90718 is used for the tetanus and diphtheria toxoids (Td) vaccine absorbed for use in an individual seven years or older, for intramuscular use.

Reference: http://www.cms.hhs.gov/mlnmattersarticles/downloads/MM4222.pdf

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