This bulletin should be shared with all health care practitioners and managerial members of the provider/supplier staff.  Additional copies may be downloaded from our website at www.highmarkmedicareservices.com.

Countdown has begun; do you have your NPI? Don’t risk disruption to your cash flow – Get your NPI now! National Provider Identifiers (NPIs) will be required on claims sent on or after May 23, 2007. Every healthcare provider needs to get an NPI! Learn more about NPI and how to apply by visiting www.cms.hhs.gov/NationalProvIdentStand/ on the CMS website.

This page also contains a section for Medicare Fee-For-Service (FFS) providers with helpful information on the Medicare NPI implementation.  A Countdown Clock is now available on this page to remind health care providers of the number of days left before the compliance date; bookmark this page as new information and resources will continue to be posted.

For more information on private industry NPI outreach, visit the Workgroup for Electronic Data Interchange (WEDI) NPI Outreach Initiative website at http://www.wedi.org/npioi/index.shtml on the web.

Providers shall report modifier -FB when they report replacement of an implanted device with a device for which they incurred no cost or when they are replacing an implanted device with a device for which they received a credit in the amount of the cost of the replaced device. Payment for replacement procedure is reduced by the offset amount applicable to the ambulatory payment classification (APC) group for the year in which the service was furnished. These offset amounts are displayed on the OPPS CMS Web site at: http://www.cms.hhs.gov/HospitalOutpatientPPS/.

Hospitals paid under OPPS are to report HCPCS modifier -FB with the HCPCS code for a procedure that requires a device for which neither the hospital, nor the beneficiary, has an obligation to pay.

Hospitals are to report the FB modifier when the hospital is given credit towards a replacement device in the amount of the cost of the device being replaced.

Hospitals paid under OPPS are to charge less than $1.01 for the applicable device when they replace a device furnished without cost by the manufacturer

Hospitals paid under OPPS are to charge the difference between the hospital’s usual charge for the replacement device, and the usual charge for the device being replaced when they receive credit for the device being replaced but implant a more costly device.

Please review MM5263 for a complete overview.

If you have any questions regarding this bulletin, please contact the appropriate Customer Contact Center at:

Maryland/DC Providers: 1-866-488-0545

Pennsylvania Providers: 1-800-560-6170