SNF CB - 2014 Annual Update of HCPCS Codes

MLN Matters® Number: MM8474
Related Change Request (CR) #: CR 8474
Related CR Release Date: October 25, 2013
Effective Date: January 1, 2014
Related CR Transmittal #: R2802CP
Implementation Date: January 6, 2014

Provider Types Affected
This MLN Matters® Article is intended for physicians, other providers, and suppliers submitting claims to Medicare contractors (carriers, Durable Medical Equipment Medicare Administrative Contractors (DME MACs), Fiscal Intermediaries (FIs), Medicare Administrative Contractors (A/B MACs), Regional Home Health Intermediaries (RHHI), and/or Home Health & Hospice (HH&H) MACs for services provided to Medicare beneficiaries who are in a Part A covered Skilled Nursing Facility (SNF) stay.

Provider Action Needed
If you provide services to Medicare beneficiaries in a Part A covered SNF stay, information in Change Request (CR) 8474 could impact your payments.

This article is based on CR 8474 which provides the 2014 annual update of HCPCS Codes for SNF CB and how the updates affect edits in Medicare claims processing systems. 

By the first week in December 2013: 

It is important and necessary for you to read the "General Explanation of the Major Categories" PDF file located at the bottom of each year's FI/A/B MAC update in order to understand the Major Categories, including additional exclusions not driven by HCPCS codes.

Background
Medicare's claims processing systems currently have edits in place for claims received for beneficiaries in a Part A covered SNF stay, as well as for beneficiaries in a non-covered stay. Changes to HCPCS codes and Medicare Physician Fee Schedule designations are used to revise these edits to allow carriers, A/B MACs, DME MACs, and FIs to make appropriate payments in accordance with policy for SNF CB contained in the "Medicare Claims Processing Manual," Chapter 6 (SNF Inpatient Part A Billing and SNF Consolidated Billing), Sections 20.6 (SNF CB Annual Update Process for Fiscal Intermediaries (FIs)/A/B MACs)) and 110.4.1 (Annual Update Process). You can find this manual at http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c06.pdf This link takes you to an external website. on the CMS website.

CPT codes 11042 (Debride skin/tissue), 11043 (Debride tissue/muscle), and 11044 (Debride tissue/muscle/bone) will be eliminated from the FI/A/B/MAC Minor Surgery INCLUSION list effective 12/31/2012. 

Also, note that these edits only allow services that are excluded from CB to be separately paid by Medicare contractors.

Additional Information
The official instruction, CR 8474 issued to your Medicare contractor regarding this change may be viewed at http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2802CP.pdf This link takes you to an external website. on the CMS website.

Last Updated Nov 04, 2013