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CMS Manual System Department of Health & Human Services (DHHS) Pub. 100-04 Medicare Claims ProcessingCenters for Medicare & Medicaid Services (CMS) Transmittal 133 Date: APRIL 2, 2004 CHANGE REQUEST 3115 I. SUMMARY OF CHANGES: Billing non-covered charges to fiscal intermediaries summary and new instructions Clarification to Change Request 2634, Transmittal 25 to claims processing, dated October 31, 2003. REVISED MATERIAL - EFFECTIVE DATE: April 5, 2004. IMPLEMENTATION DATE: April 16, 2004. Disclaimer for Manual changes only: The revision date and transmittal number apply only to the red italicized material.

Claims R 1/60.4.5/Clarification of Liability for Preventive Screening Benefits Subject to Frequency Limits R 6/40.6.4/Bills with Covered and Noncovered Days R 6/40.6.5/Notification on Limitation of Liability Decisions R 6/40.7/Other Billing Situations III. FUNDING: *Medicare contractors only: These instructions should be implemented within your current operating budget.

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