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Podiatry Comparative Billing Reports

Comparative Billing Reports

CBR201608 Recommended Links

http://www.cbrinfo.net/cbr201608-recommended-links.html

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