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Additional Information for 2006 OPPS Drug Administration
In February, CMS published on its website Questions and Answers related to the 2006 Drug Administration coding changes.
View the Questions and Answers
Colorectal Cancer
March is National Colorectal Cancer Awareness Month. CMS issued MedLearn Matters Number SE0613 to review Medicare coverage and billing processes for colorectal cancer screening.
The following HCPCS codes should be used when billing colorectal cancer screening:
HCPCS
Code |
HCPCS Code Descriptor |
| G0104 |
Colon cancer screening; flexible sigmoidoscopy |
| G0105* |
Colon cancer screening; colonoscopy on individual at high risk |
| G0106 |
Colon cancer screening; barium enema as an alternative to G0104 |
| G0107 |
Colon cancer screening; FOBT, 1-3 simultaneous determinations |
| G0120 |
Colon cancer screening; barium enema as an alternative to
G010 |
| G0121 |
Colon cancer screening; colonoscopy for individuals not meeting criteria for high risk |
| G0122** |
Colon cancer screening; barium enema (non-covered) |
| G0328 |
Colon cancer screening; as an alternative to G0107; fecal occult blood test, immunoassay, 1-3 simultaneous determinations |
*When billing for the “high risk” beneficiary, the screening diagnosis code on the claim must reflect at least one of the high-risk conditions.
**Code G0122 should be used when a screening barium enema is performed not as an alternative to either to G0104 or G0105. This service is denied as non-covered because it fails to meet the requirements of the benefit.
The beneficiary is liable for payment. Reporting of this non-covered code will also allow claims to be billed and denied for beneficiaries who need a Medicare denial for other insurance purposes.
The appropriate HCPCS code, revenue code and corresponding ICD-9-CM diagnosis codes must be listed on the UB-92 (or the electronic claim record). Be sure your facility’s CDM is accurate and current!
2006 Payment Change to Medicare Physician Fee Schedule
Congress passed the Deficit Reduction Act (DRA) of 2005, which changes the update to the 2006 conversion factor for services paid under the Medicare Physician Fee Schedule (i.e., physical therapy, occupational therapy, speech therapy and screening/diagnostic mammography).
This change replaces the previously announced -4.4% reduction with a 0% increase for services paid under the physician fee schedule. This change is effective retroactive for services rendered on or after January 1, 2006.
Claims that were paid with the -4.4% rate will be automatically reprocessed with the new rates and adjustments will be made. The necessary adjustments will be completed no later than July 1, 2006. If the claims have not been adjusted, contact your fiscal intermediary to bring it to their attention and appropriate adjustments will be made.
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