8/17/2023 0 Comments Clip art paintbrush pngManual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. You may also contact us at National Coverage Policy To license the electronic data file of UB-04 Data Specifications, contact Tim Carlson at (312) 893-6816. Italicized font represents CMS national language/wording copied directly from CMS Manuals or CMS transmittals. Contractors are prohibited from changing national language. Title XVIII of the Social Security Act, Section 1862(a)(1)(A). This section allows coverage and payment of those services that are considered to be medically reasonable and necessary. Title XVIII of the Social Security Act section 1862 (a) (1) (D). This section states that no Medicare payment may be made under part A or part B for any expenses incurred for items or services that are investigational or experimental. Title XVIII of the Social Security Act, Section 1833(e). This section prohibits Medicare payment for any claim, which lacks the necessary information to process the claim.Ĥ2 CFR, Section 410.32 Diagnosis x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions. All diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests must be ordered by the physician who is treating the beneficiary, that is, the physician who furnishes a consultation or treats a beneficiary for a specific medical problem and who uses ther results in the management of the beneficiary’s specific medical problem. The billing and coding information in this article is dependent on the coverage indications, limitations and/or medical necessity described in the associated LCD Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring) 元4636 Tests not ordered by the physician who is treating the beneficiary are not reasonable and necessary.Ĥ2 CFR, Section 411.15(k)(1) states any services that are not reasonable and necessary are excluded from coverage. The HCPCS/CPT code(s) may be subject to Correct Coding Initiative (CCI) edits. This information does not take precedence over CCI edits. Please refer to CCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.ġ. These services may be reported globally with CPT codes 93224.The documentation in the progress notes must reflect medical necessity for the service.CPT codes for Holter monitoring services (CPT codes 93224-93227) are intended for up to 48 hours of continuous recording. Use the date of physician review as the date of service (DOS).
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