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CMS Manual SystemDepartment of Health &Human Services (DHHS)Pub 100-04 Medicare Claims ProcessingCenters for Medicare &Medicaid Services (CMS)Transmittal 1661Date: January 2, 2009Change Request 6351Subject: Emergency Update to the 2009 Medicare Physician Fee Schedule Database (MPFSDB)I. SUMMARY OF CHANGES: Payment files were issued to contractors based upon the 2009 MedicarePhysician Fee Schedule (MPFS) Final Rule. This change request amends those payment files.New / Revised MaterialEffective Date: January 1, 2009Implementation Date: January 5, 2009Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicizedmaterial. Any other material was previously published and remains unchanged. However, if this revisioncontains a table of contents, you will receive the new/revised information only, and not the entire table ofcontents.II. CHANGES IN MANUAL INSTRUCTIONS: (N/A if manual is not updated)R REVISED, N NEW, D DELETED-Only One Per Row.R/N/DChapter / Section / Subsection / TitleN/AIII. FUNDING:SECTION A: For Fiscal Intermediaries and Carriers:No additional funding will be provided by CMS; Contractor activities are to be carried out within theiroperating budgets.SECTION B: For Medicare Administrative Contractors (MACs):The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as definedin your contract. CMS does not construe this as a change to the MAC Statement of Work. The contractor isnot obligated to incur costs in excess of the amounts allotted in your contract unless and until specificallyauthorized by the Contracting Officer. If the contractor considers anything provided, as described above, tobe outside the current scope of work, the contractor shall withhold performance on the part(s) in questionand immediately notify the Contracting Officer, in writing or by e-mail, and request formal directionsregarding continued performance requirements.IV. ATTACHMENTS:One-Time Notification*Unless otherwise specified, the effective date is the date of service.

Attachment – One-Time NotificationPub. 100-04Transmittal: 1661Date: January 2, 2009Change Request: 6351SUBJECT: Emergency Update to the 2009 Medicare Physician Fee Schedule Database (MPFSDB)Effective Date: January 1, 2009Implementation Date: January 5, 2009I.GENERAL INFORMATIONA.Background: Payment files were issued to contractors based upon the 2009 Medicare Physician FeeSchedule (MPFS) Final Rule. This change request amends those payment files.B.Policy: Section 1848(c)(4) of the Social Security Act authorizes the Secretary to establish ancillarypolicies necessary to implement relative values for physicians’ services.II.BUSINESS REQUIREMENTS TABLEUse“Shall" to denote a mandatory requirementNumberRequirement6351.1Contractors shall manually end-date code G0394effective December 31, 2008.Contractors shall manually remove code G0394from the 2009 MPFSDB File.Contractors shall manually update their systems toreflect the following changes effective for dates ofservice on or after September 29, ity (place an “X” in eachapplicable column)A D F C R SharedOTH/ M I A H SystemERB ER H MaintainerR I sM MIF M V CA AEI C M WC CRS S S FSXX XXXX XXXXX X- Status Indicator N- Status Indicator N- Status Indicator N- Status Indicator NThis change is due to the National CoverageDetermination for Thermal Intradiscal Procedures(TIPs).6351.3Contractors shall manually update their systems toreflect 5 base units for CPT code 01916, effective

Number6351.4Requirementfor dates of service on or after January 1, 2009.Contractors shall manually update the procedurecode file for the following codes with an effectivedate of January 1, 2009:XXContractors need not search their files to eitherXretract payment for claims already paid or toretroactively pay claims. However, contractorsshall adjust claims brought to their attention.Contractors shall retrieve the corrected paymentXfiles, as identified in Attachment 2, from the CMSMainframe Telecommunications System. Files willbe available for retrieval on December 11, 2008.Notification of successful receipt shall be sent viaXe-mail to price file receipt@cms.hhs.gov statingthe name of the file received and the entity forwhich it was received (e.g., MedicareX F3510F3511F6351.56351.66351.7Responsibility (place an “X” in eachapplicable column)A D F C R SharedOTH/ M I A H SystemERB ER H MaintainerR I sM MIF M V CA AEI C M WC CRS S S 1F4320FX XX X

Numbercontractor/fiscal intermediary name and number).CMS will send CWF two files to facilitateduplicate billing edits: 1) Purchased Diagnostic and2) Duplicative Radiology Editing. CWF shallinstall these files into their systems. CWF will benotified via e-mail when these files have been sentto them.6351.8III.RequirementResponsibility (place an “X” in eachapplicable column)A D F C R SharedOTH/ M I A H SystemERB ER H MaintainerR I sM MIF M V CA AEI C M WC CRS S S FSXPROVIDER EDUCATION TABLENumberRequirement6351.9A provider education article related to thisinstruction will be available y after the CR is released. You will receivenotification of the article’s release via theestablished "MLN Matters" listserv.Contractors shall post this article, or a direct link tothis article, on their Web site and includeinformation about it in a listserv message withinone week of the availability of the providereducation article. In addition, the providereducation article shall be included in your nextregularly scheduled bulletin. Contractors are freeto supplement MLN Matters articles with localizedinformation that would benefit their providercommunity in billing and administering theMedicare program correctly.Responsibility (place an “X” in eachapplicable column)A D F C R SharedOTH/ M I A H SystemERB ER H MaintainerR I sM MIF M V CA AEI C M WC CRS S S FSXX X

IV.SUPPORTING INFORMATIONA. For any recommendations and supporting information associated with listed requirements, use thebox below:Use "Should" to denote a ns or other supporting information:B. For all other recommendations and supporting information, use this space:V. CONTACTSPre-Implementation Contact(s): Gaysha Brooks, Gaysha.Brooks@cms.hhs.gov, (410) 786-9649Post-Implementation Contact(s): Appropriate Regional OfficeVI. FUNDINGA. For Fiscal Intermediaries and Carriers:No additional funding will be provided by CMS; contractor activities are to be carried out within their operatingbudgets.B. For Medicare Administrative Contractors (MAC) :The Medicare Administrative Contractor (MAC) is hereby advised that this constitutes technical direction asdefined in your contract. CMS does not construe this as changes to the MAC Statement of Work (SOW). Thecontractor is not obligated to incur costs in excess of the amounts specified in your contract unless and untilspecifically authorized by the contracting officer. If the contractor considers anything provided, as describedabove, to be outside the current scope of work, the contractor shall withhold performance on the part(s) inquestion and immediately notify the contracting officer, in writing or by e-mail, and request formal directionsregarding continued performance requirements.Attachments

Attachment 1Changes included in the Emergency Update to the 2009 Medicare Physician Fee ScheduleDatabase (MPFSDB) are as follows:CPT/HCPCS01916ACTIONBase Units 5.0020697Multiple Procedure Indicator 0Transitional Facility PE RVU 33.08Fully Implemented Facility PE RVU 33.0837205Transitional Non-Facility PE RVU 105.1537206Transitional Non-Facility PE RVU 64.264276FLong Descriptor: Potent antiretroviral therapy prescribed (HIV)Short Descriptor: Potent antivir thxpy rxdProcedure Status: MWRVU: 0.00Non-Facility PE RVU: 0.00Facility PE RVU: 0.00Malpractice RVU: 0.00PC/TC: 9Site of Service: 9Global Surgery: XXXMultiple Procedure Indicator: 9Bilateral Surgery Indicator: 9Assistant at Surgery Indicator: 9Co-Surgery Indicator: 9Team Surgery Indicator: 9Physician Supervision Diagnostic Indicator: 09Type of Service: 1Diagnostic Family Imaging Indicator: 9947525Transitional Non-Facility PE RVU 11.98Fully Implemented Non-Facility PE RVU 10.90Transitional Facility PE RVU 1.35Fully Implemented Facility PE RVU 0.86Global Period 00063650Global Period 01063685Global Period 010

63688Global Period 01075557 GlobalBilateral Indicator 076775 GlobalTransitional Facility PE RVU 2.3976775 26Transitional Facility PE RVU 0.2396360PC/TC 596361PC/TC 596365PC/TC 596366PC/TC 596367PC/TC 596368PC/TC 596369PC/TC 596370PC/TC 596371PC/TC 596372PC/TC 596373PC/TC 596374PC/TC 596375PC/TC 593228Physician Supervision Diagnostic Indicator 0993279 GlobalPhysician Supervision Diagnostic Indicator 0993279 26Physician Supervision Diagnostic Indicator 0993280 GlobalPhysician Supervision Diagnostic Indicator 0993280 26Physician Supervision Diagnostic Indicator 0993281 GlobalPhysician Supervision Diagnostic Indicator 09

93281 26Physician Supervision Diagnostic Indicator 0993282 GlobalPhysician Supervision Diagnostic Indicator 0993282 26Physician Supervision Diagnostic Indicator 0993283 GlobalPhysician Supervision Diagnostic Indicator 0993283 26Physician Supervision Diagnostic Indicator 0993284 GlobalPhysician Supervision Diagnostic Indicator 0993284 26Physician Supervision Diagnostic Indicator 0993285 GlobalPhysician Supervision Diagnostic Indicator 0993285 26Physician Supervision Diagnostic Indicator 0993286 GlobalPhysician Supervision Diagnostic Indicator 0993286 26Physician Supervision Diagnostic Indicator 0993287 GlobalPhysician Supervision Diagnostic Indicator 0993287 26Physician Supervision Diagnostic Indicator 0993288 GlobalPhysician Supervision Diagnostic Indicator 0993288 26Physician Supervision Diagnostic Indicator 0993289 GlobalPhysician Supervision Diagnostic Indicator 0993289 26Physician Supervision Diagnostic Indicator 0993290 GlobalPhysician Supervision Diagnostic Indicator 0993290 26Physician Supervision Diagnostic Indicator 0993291 GlobalPhysician Supervision Diagnostic Indicator 0993291 26Physician Supervision Diagnostic Indicator 0993292 GlobalPhysician Supervision Diagnostic Indicator 0993292 26Physician Supervision Diagnostic Indicator 09

93293 GlobalPhysician Supervision Diagnostic Indicator 0993293 TCPhysician Supervision Diagnostic Indicator 0193293 26Physician Supervision Diagnostic Indicator 0993294Physician Supervision Diagnostic Indicator 0993295Physician Supervision Diagnostic Indicator 0993297Physician Supervision Diagnostic Indicator 0993298Physician Supervision Diagnostic Indicator 0993352Global Period ZZZG0394Removed from the MPFSDB effective December 31, 2008; see BR 6351.1and 6351.1.1Noncovered ServicesDue to the National Coverage Determination for Thermal Intradiscal Procedures (TIPs), effectiveSeptember 29, 2008, CPT codes 22526, 22527, 0062T and 0063T became noncovered servicesfor Medicare purposes. Contractors shall manually update their systems to reflect the followingchange effective for dates of service on or after September 29, 2008:22526225270062T0063TStatus Indicator NStatus Indicator NStatus Indicator NStatus Indicator NDescriptor ChangesThe long and/or short descriptor has been revised for the following codes:CPT Code4275FD0486D1203D1204D3310D3320Revised Long DescriptorHepatitis B vaccine injection administeredor previously received (HIV)Laboratory accession of brush biopsysample, microscopic examination,preparation and transmission of writtenreportTopical application of fluoride - childTopical application of fluoride – adultEndodontic therapy, anterior tooth(excluding final restoration)Endodontic therapy, bicuspid tooth(excluding final restoration)Revised Short DescriptorHep b vac inj admin/ rcvdN/ATopical app fluoride childTopical app fluoride adultEnd thxpy, anterior toothEnd thxpy, bicuspid tooth

D3330D4210D4211D4240D4241D4260D4261Q4114Endodontic therapy, molar (excluding finalrestoration)Gingivectomy or gingivoplasty - four ormore contiguous teeth or tooth boundedspaces per quadrantGingivectomy or gingivoplasty - one tothree contiguous teeth or tooth boundedspaces per quadrantGingival flap procedure, including rootplaning - four or more contiguous teeth ortooth bounded spaces per quadrantGingival flap procedure, including rootplaning - one to three contiguous teeth ortooth bounded spaces per quadrantOsseous surgery (including flap entry andclosure) - four or more contiguous teeth ortooth bounded spaces per quadrantOsseous surgery (including flap entry andclosure) - one to three contiguous teeth ortooth bounded spaces per quadrantIntegra flowable wound matrix, injectable, 1ccEnd thxpy, molarN/AN/AN/AN/AN/AN/AN/ANew Dental Codes for 2009D0417Long Descriptor: Collection and preparation of saliva sample forlaboratory diagnostic testingShort Descriptor: Collect & prep saliva sampleProcedure Status: NWRVU: 0.00Non-Facility PE RVU: 0.00Facility PE RVU: 0.00Malpractice RVU: 0.00PC/TC: 9Site of Service: 9Global Surgery: XXXMultiple Procedure Indicator: 9Bilateral Surgery Indicator: 9Assistant at Surgery Indicator: 9Co-Surgery Indicator: 9Team Surgery Indicator: 9Physician Supervision Diagnostic Indicator: 09Type of Service: 1Diagnostic Family Imaging Indicator: 99

D0418Long Descriptor: Analysis of saliva sampleShort Descriptor: Analysis of saliva sampleProcedure Status: NWRVU: 0.00Non-Facility PE RVU: 0.00Facility PE RVU: 0.00Malpractice RVU: 0.00PC/TC: 9Site of Service: 9Global Surgery: XXXMultiple Procedure Indicator: 9Bilateral Surgery Indicator: 9Assistant at Surgery Indicator: 9Co-Surgery Indicator: 9Team Surgery Indicator: 9Physician Supervision Diagnostic Indicator: 09Type of Service: 1Diagnostic Family Imaging Indicator: 99D3222Long Descriptor: Partial pulpotomy for apexogenesis - permanent toothwith incomplete root developmentShort Descriptor: Part pulp for apexogenesisProcedure Status: NWRVU: 0.00Non-Facility PE RVU: 0.00Facility PE RVU: 0.00Malpractice RVU: 0.00PC/TC: 9Site of Service: 9Global Surgery: XXXMultiple Procedure Indicator: 9Bilateral Surgery Indicator: 9Assistant at Surgery Indicator: 9Co-Surgery Indicator: 9Team Surgery Indicator: 9Physician Supervision Diagnostic Indicator: 09Type of Service: 2Diagnostic Family Imaging Indicator: 99D5991Long Descriptor: Topical medicament carrierShort Descriptor: Topical medicament carrierProcedure Status: NWRVU: 0.00

Non-Facility PE RVU: 0.00Facility PE RVU: 0.00Malpractice RVU: 0.00PC/TC: 9Site of Service: 9Global Surgery: XXXMultiple Procedure Indicator: 9Bilateral Surgery Indicator: 9Assistant at Surgery Indicator: 9Co-Surgery Indicator: 9Team Surgery Indicator: 9Physician Supervision Diagnostic Indicator: 09Type of Service: 9Diagnostic Family Imaging Indicator: 99Note: File will also contain OPPS payment amounts for CPT code 51798

Attachment 2Filenames for Revised Payment FilesThe revised filenames for the Emergency Update to the 2009 Medicare Physician FeeSchedule Database for carriers sed Diagnostic FileMU00.@BF12390.MPFS.CY09.RV1.PURDIAG.V1211The revised filenames for the Emergency Update to the 2009 Medicare Physician FeeSchedule Database for intermediaries are:SNF Abstract y/CORF Abstract ography Abstract apy/CORF Supplemental ice ent Indicator FileMU00.@BF12390.MPFS.CY09.RV1.PAYIND.V1211

93298 Physician Supervision Diagnostic Indicator 09 93352 Global Period ZZZ G0394 Removed from the MPFSDB effective December 31, 2008; see BR 6351.1 and 6351.1.1 Noncovered Services Due to the National Coverage Determination for Thermal Intradiscal Procedures (TIPs), effective September 29, 2008, CPT codes 22526, 22527, 0062T and 0063T .

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