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.

CR5304 originally stated the following regarding CPT Code 90736:

Payment Rate for CPT 90736, Zoster (Shingles) Vaccine, Live, for Subcutaneous Injection, Becomes Effective on its Date of FDA Approval.

Currently, CPT Code 90736 is not payable under OPPS and is assigned to status indicator ‘E’. The product described by this code was approved by the Food and Drug Administration (FDA) on May 25, 2006. Therefore, in the October 2006 OCE update, the status indicator for CPT 90736 will be changed from ‘E’ to ‘K’ to become payable under OPPS effective May 25, 2006.

CPT 90736 will map to APC 0745. The payment rate for APC 0745 can be found in the October 2006 update of OPPS Addendum A and Addendum B, which will posted on the CMS Web site at the end of September.

Update:

CMS has determined that CPT Code 90736 is not covered at this time and should be “rejected” if billed on an OPPS or Non-OPPS claim.

If CPT code 90736 is submitted on a claim, it will be rejected. The Beneficiary will be liable if there is an Occurrence Code 32 present on the claim. Otherwise, 90736 will reject as Provider liable.

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