CMS Manual System

1 CMS Manual System Department of Health & Human Services (DHHS)Pub. 100-04 Medicare Claims Processing Centers for Medicare & Medicaid Services (CMS)Transmittal 127 Date: MARCH 26, 2004 CHANGE REQUEST 3139 I. SUMMARY OF CHANGES: A spreadsheet containing an updated list of the HCPCS for durable medical equipment regional carrier (DMERC) and Part B local carrier jurisdictions is updated annually to reflect codes that have been added or discontinued (deleted) during each year. NEW/REVISED MATERIAL - EFFECTIVE DATE: May 26, 2004 *IMPLEMENTATION DATE: May 26, 2004 Disclaimer for Manual changes only: The revision date and transmittal number apply only to the red italicized material. Any other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will only receive the new/revised information, and not the entire table of contents.

2 II. CHANGES IN Manual INSTRUCTIONS: (R = REVISED, N = NEW, D = DELETED) R/N/D CHAPTER/SECTION/SUBSECTION/TITLE R 23 and Acceptance of HCPCS Codes and Modifiers *III. FUNDING: These instructions shall be implemented within your current operating budget. IV. ATTACHMENTS: Business Requirements X Manual Instruction Confidential Requirements One-Time Notification X Recurring Update Notification *Medicare contractors only Attachment Recurring Update Notification Pub. 100-04 Transmittal: 127 Date: March 26, 2004 Change Request 3139 SUBJECT: 2004 Jurisdiction List I. GENERAL INFORMATION A. Background: A spreadsheet containing an updated list of the HCPCS for durable medical equipment regional carrier (DMERC) and local carrier jurisdictions is updated annually to reflect codes that have been added or discontinued (deleted) during each year.

3 B. Policy: A recurring update notification will be published annually to notify DMERCs and Part B carriers that the list has been updated and is available on the CMS Web site. The jurisdiction list is an excel file and will be located at C. Provider Education: A provider education article related to this instruction will be available at shortly after the CR is released. You will receive notification of the article release via the established "medlearn matters" listserv. Contractors shall post this article to their Web site, and include it in a listserv message if applicable, within 1 week of the availability of the provider education article. In addition, the provider education article must be included in your next regularly scheduled bulletin. II. BUSINESS REQUIREMENTS Shall" denotes a mandatory requirement "Should" denotes an optional requirement Requirement # Requirements Responsibility Carriers shall download and publish the jurisdiction file.

4 Carrier, DMERC III. SUPPORTING INFORMATION AND POSSIBLE DESIGN CONSIDERATIONS A. Other Instructions: N/A X-Ref Requirement # Instructions B. Design Considerations: N/A X-Ref Requirement # Recommendation for Medicare System Requirements C. Interfaces: N/A D. Contractor Financial Reporting /Workload Impact: N/A E. Dependencies: N/A F. Testing Considerations: N/A IV. SCHEDULE, CONTACTS, AND FUNDING Effective Date: May 26, 2004 Implementation Date: May 26, 2004 Pre-Implementation Contact(s): Appropriate regional office Post-Implementation Contact(s): Appropriate regional office These instructions shall be implemented within your current operating budget. Attachment HCPCSDESCRIPTIONJURISDICTIONA0021 - A0999 Ambulance ServicesLocal CarrierA4206 - A4209 Medical, Surgical, and Self-Local Carrier if incident to a physician'sAdministered Injectionservice (not separately payable).

5 If otherSuppliesDME REGIONAL Free Injection DeviceDME REGIONAL CarrierA4211 Medical, Surgical, and Self-Local Carrier if incident to a physician'sAdministered Injectionservice (not separately payable). If otherSuppliesDME REGIONAL Coring Needle or StyletLocal Carrierwith or without CatheterA4213 - A4215 Medical , Surgical, and Self-Local Carrier if incident to a physician'sAdministered Injection Suppliesservice (not separately payable). If otherDME REGIONAL - A4217 SalineLocal Carrier if incident to a physician'sservice (not separately payable). If otherDME REGIONAL Kit for implantable PumpLocal CarrierA4221 - A4250 Medical, Surgical, and Self-Local Carrier if incident to a physician's Administered Injection Suppliesservice (not separately payable). If other DME REGIONAL - A4259 Diabetic SuppliesDME REGIONAL CarrierA4260 Levonorgestrel ImplantLocal CarrierA4261 Cervical Cap for Contraceptive Local CarrierUseA4262 - A4263 Lacrimal Duct ImplantsLocal CarrierA4265 ParaffinLocal Carrier if incident to a physician'sservice (not separately payable).

6 If otherDME REGIONAL - A4269 ContraceptivesLocal CarrierA4270 Endoscope SheathLocal CarrierA4280 Accessory for Breast ProsthesisDME REGIONAL CarrierA4281 - A4286 Accessory for Breast PumpDME REGIONAL CarrierA4290 Sacral Nerve Stimulation Test LeadLocal CarrierA4300 - A4301 implantable CatheterLocal CarrierA4305 - A4306 Disposable Drug DeliveryLocal Carrier if incident to a physician'sSystemservice (not separately payable). If otherDME REGIONAL - A4359 Incontinence Supplies/If provided in the physician's office for aUrinary Suppliestemporary condition, the item is incident to thephysician's service & billed to the LocalCarrier. If provided in the physician's office or other place of service for a permanentcondition, the item is a prosthetic device &billed to the DME REGIONAL - A4434 Ostomy SuppliesIf provided in the physician's office for atemporary condition, the item is incident to thephysician's service & billed to the LocalCarrier.

7 If provided in the physician's office or other place of service for a permanentcondition, the item is a prosthetic device &billed to the DME REGIONAL - A4455 Tape;Adhesive RemoverLocal Carrier if incident to a physician'sservice (not separately payable). If otherDME REGIONAL BagDME REGIONAL CarrierA4462 Abdominal DressingLocal Carrier if incident to a physician'sservice (not separately payable). If otherDME REGIONAL Binder for ExtremityDME REGIONAL CarrierA4470 Gravlee Jet WasherLocal CarrierA4480 Vabra AspiratorLocal CarrierA4481 Tracheostomy SupplyLocal Carrier if incident to a physician'sservice (not separately payable). If otherDME REGIONAL ExchangerDME REGIONAL CarrierA4490 - A4510 Surgical StockingsDME REGIONAL CarrierA4521 - A4538 DiapersDME REGIONAL CarrierA4550 Surgical TraysLocal CarrierA4554 Disposable UnderpadsDME REGIONAL CarrierA4556 - A4558 Electrodes; Lead Wires; Con-Local Carrier if incident to a physician'sductive Pasteservice (not separately payable).

8 If otherDME REGIONAL - A4562 PessaryLocal CarrierA4565 SlingLocal CarrierA4570 SplintLocal CarrierA4575 Topical Hyperbaric OxygenDME REGIONAL CarrierChamber, DisposableA4580 - A4590 Casting Supplies & MaterialLocal CarrierA4595 TENS SuppliesLocal Carrier if incident to a physician'sservice (not separately payable). If otherDME REGIONAL Probe for OximeterDME REGIONAL CarrierA4608 Transtracheal Oxygen CatheterDME REGIONAL CarrierA4609 - A4610 Tracheal Suction CatheterDME REGIONAL CarrierA4611 - A4613 Oxygen Equipment Batteries and DME REGIONAL CarrierSuppliesA4614 Peak Flow Rate MeterLocal Carrier if incident to a physician'sservice (not separately payable). If otherDME Regional - A4629 Oxygen & Tracheostomy Supplies Local Carrier if incident to a physician'sservice (not separately payable). If otherDME REGIONAL - A4640 DME SuppliesDME REGIONAL CarrierA4641 - A4646 Imaging Agent; Contrast Material Local CarrierA4647 Contrast MaterialLocal CarrierA4649 Miscellaneous Surgical SuppliesLocal Carrier if incident to a physician'sservice (not separately payable).

9 If otherDME REGIONAL - A4932 Supplies for ESRDDME REGIONAL CarrierA5051 - A5093 Additional Ostomy SuppliesIf provided in the physician's office for atemporary condition, the item is incident to thephysician's service & billed to the LocalCarrier. If provided in the physician's office or other place of service for a permanentcondition, the item is a prosthetic device &billed to the DME REGIONAL - A5200 Additional Incontinence andIf provided in the physician's office for aOstomy Suppliestemporary condition, the item is incident to thephysician's service & billed to the LocalCarrier. If provided in the physician's office or other place of service for a permanentcondition, the item is a prosthetic device &billed to the DME REGIONAL - A5511 Therapeutic ShoesDME REGIONAL CarrierA6000 Non-Contact Wound WarmingDME REGIONAL CarrierCover2 HCPCSDESCRIPTIONJURISDICTIONA6010-A6024 Surgical DressingLocal Carrier if incident to a physician'sservice (not separately payable) or if supply for implanted prosthetic device or implantedDME.

10 If other DME REGIONAL Gel SheetLocal Carrier if incident to a physician'sservice (not separately payable) or if supply for implanted prosthetic device or implantedDME. If other DME REGIONAL - A6411 Surgical DressingLocal Carrier if incident to a physician'sservice (not separately payable) or if supply for implanted prosthetic device or implantedDME. If other DME REGIONAL PatchLocal Carrier if incident to a physician'sservice (not separately payable) or if supply for implanted prosthetic device or implantedDME. If other DME REGIONAL - A6512 Surgical DressingsLocal Carrier if incident to a physician'sservice (not separately payable) or if supply for implanted prosthetic device or implantedDME. If other DME REGIONAL - A6551 Supplies for Negative PressureDME REGIONAL CarrierWound Therapy Electrical PumpA7000 - A7039 Accessories for Nebulizers,DME REGIONAL CarrierAspirators, and VentilatorsA7042 - A7043 Pleural CatheterLocal CarrierA7044 - A7046 Respiratory AccessoriesDME REGIONAL CarrierA7501-A7526 Tracheostomy SuppliesDME REGIONAL CarrierA9150 Non-Prescription DrugsLocal CarrierA9270 Noncovered Items or ServicesDME REGIONAL CarrierA9280 Alarm DeviceDME REGIONAL CarrierA9300 Exercise EquipmentDME REGIONAL CarrierA9500 - A9700 Supplies for Radiology Procedures Local CarrierA9900 Miscellaneous DME Supply or Local Carrier if used with implanted DME.