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Podiatry Comparative Billing Reports

Comparative Billing Reports

CBR201608 Recommended Links


eGT and Palmetto GBA referenced multiple policies and resources when drafting the language in CBR201608. The coverage and documentation guidelines for Podiatry: Nail Debridement and Evaluation and Management Services are listed below. Please follow the guidelines pertinent to your Medicare Administrative Contractor (MAC).

LCDs and LCAs – Active on 10/01/15:

Cahaba Government Benefit Administrators: L34944

CGS Administrators: L34246, A52372

First Coast Service Options: L33922, L33941

National Government Services: L33636, A52865

Novitas Solutions: L35013, L35138, A52996, A52998

Wisconsin Physicians Service Insurance Corporation: L36404

LCDs – Retired on 09/30/15:

Cahaba Government Benefit Administrators: L34368

CGS Administrators: L31896

First Coast Service Options: L29232, L29272

National Government Services: L26426

Novitas Solutions: L27486, L27487

Wisconsin Physician Service Insurance Corporation: N/A

Office of Inspector General: http://oig.hhs.gov

Medicare Payments for Nail Debridement Services, OEI–04–99–00460, June 2002

Use of Modifier 25, OEI-07-03-00470, November 2005

Centers for Medicare & Medicaid Services: https://www.cms.gov/

1995 Documentation Guidelines for Evaluation and Management Services

1997 Documentation Guidelines for Evaluation and Management Services

Medicare Manuals: https://www.cms.gov/regulations-and-guidance/guidance/manuals/internet-only-manuals-ioms.html

Medicare Benefit Policy Manual

  Chapter 15 – Covered Medical and Other Health Services

Medicare Claims Processing Manual

  Chapter 12 – Physician/Nonphysician Practitioners, Section 30.6.1

Medicare National Coverage Determinations Manual

  Chapter 1, Part 1 – Coverage Determinations

National Correct Coding Initiative (NCCI) Policy Manual

  Chapter 1 – General Correct Coding Policies

Medicare Learning Network (MLN®): https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlngeninfo/index.html

Medicare Podiatry Services: Information for Medicare Fee-for-Service Health Care Professionals, ICN 006948/October 2011

Evaluation and Management Services, ICN006764/August 2015

Medicare Administrative Contractors (MACs): https://www.cms.gov/medicare/medicare-contracting/medicare-administrative-contractors/medicareadministrativecontractors.html

Cahaba Government Benefit Administrators

  Medicare B Newsline, April 2016

CGS Administrators

  Podiatry Services and Evaluation & Management Codes

National Government Services, Inc.

  Medical Review Focus Area – Modifier 25 Service Specific Prepayment Review Interim Findings

Novitas Solutions, Inc.

  Upcoming Focus of Provider Specific Reviews – Medical Review Part B-JH

Palmetto GBA

  Widespread Review of Nail Debridement Services: First Quarter of FY2016

Wisconsin Physicians Service Insurance Corporation

  Class Findings Modifier Fact Sheet

Social Security Administration: https://www.ssa.gov

Title XVIII of the Social Security Act: Section 1862 (a) (1) (A), Section 1862 (a) (7), Section
1833 (e)

Federal Bureau of Investigations (FBI): http://www.fbi.gov

Brookfield Podiatrist Sentenced to 41 Months in Federal Prison for Defrauding Medicare, September 2013

Podiatrist Charged with Health Care Fraud and Identity Theft, October 2014

 American Medical Association (AMA): https://commerce.ama-assn.org/store/

CPT® 2015 Professional Edition

CPT® 2016 Professional Edition