General
The following FAQs were retired in July 2007.
- Do we need to include the electronic cost-report (ECR) file?
- What should a Certified Transplant Center (CTC) be billing an Organ Procurement Organization (OPO) for when the CTC provides an organ to an OPO?
- When will the amount for our tentative / LSA / NPR be included in our remittance?
- Will I need to re-enroll and send a new 855A Enrollment Form to Highmark Medicare Services due to the transition of the Part A Medicare contract for Maryland/DC?
- Can I use my existing Medicare Provider Identification Number when Highmark Medicare Services takes over the Part A Medicare contract for Maryland/DC?
- Why was my claim rejected with reason code C7122?
- Can a Registered Nurse (RN) in Pennsylvania (PA) administer sedation and analgesia in the gastrointestinal endoscopy setting?
- Is there a post-operative period for surgical procedures under Part A Medicare?
- What is Anodyne ® Therapy?
- Is Anodyne ® Therapy a covered treatment by Highmark Medicare Services for treatment of diabetic peripheral neuropathy?
- Does this non-coverage policy apply to all revenue codes?
- What is the CPT code used for Anodyne ® Therapy?
Do we need to include the electronic cost-report (ECR) file?
Yes. Current regulations require all provider types (with the exception of Home Offices (Form CMS–287-05) to file electronically
Date Posted: 09/01/2000, Date Reviewed/Revised: 07/27/2007
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Due to a recently discovered discrepancy between the Provider Reimbursement Manual 15-1, Section 2771 and the Medicare Intermediary Manual 13-2, Section 3612, CMS is instructing intermediaries to allow either the standard acquisition charge (SAC) which reflects the average cost associated with acquiring each type of organ or their departmental charges by a CTC to an OPO for organ retrieval services.
CTCs must still bill the SAC third party payers, including Medicare, for organs acquired and transplanted. Departmental charges cannot be billed for this purpose.
Date Posted: 10/10/2003, Date Reviewed/Revised: 07/27/2007
When will the amount for our tentative / LSA / NPR be included in our remittance?
As soon as the transaction is processed in the FISS system, usually within ten days of notification.
Date Posted: 09/01/2000, Date Reviewed/Revised: 07/27/2007
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No, you will not need to re-enroll as a result of the transition.
Date Reviewed/Revised: 07/30/2007
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Yes, you may continue to use your existing Medicare Provider Identification Number when billing Highmark Medicare Services for Medicare Part A services.
Date Reviewed/Revised: 07/30/2007
Why was my claim rejected with reason code C7122?
Reason code C7122 is defined as follows:
This inpatient non-pps claim has an admission date equal to or one day after the through date (or, if present, the occurrence span code 72 through date) on an outpatient history claim for the same provider. The outpatient claims contains therapeutic revenue codes, which should be bundled in with the inpatient charges.
The system incorrectly applied the payment window to your claim(s). This error was corrected in the April release. CAHs are exempt from the payment window.
Date Posted: 07/08/2003, Date Reviewed/Revised: 07/31/2007
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Services provided by an RN are determined by the State based on the licensure. To establish whether a RN in PA can administer sedation and analgesia in the gastrointestinal endoscopy setting, you should contact the State Department of Health at 717-783-1380. (Question based on July 2006 top written inquiries)
Date Posted: 09/01/2006, Date Reviewed/Revised: 07/31/2007
Is there a post-operative period for surgical procedures under Part A Medicare?
Post-operative periods are implemented under Medicare Part B. Medicare Part A does not have post-operative periods for surgical procedures. (Question based on July 2006 top written inquiries)
Date Posted: 09/01/2006, Date Reviewed/Revised: 07/31/2007
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Anodyne ® Therapy System, also known as monochromatic near-infrared photo energy (MIRE), delivers monochromatic, near-infrared photo energy through contact with the skin. The light is emitted by an array of 60 superluminous gallium aluminum diodes located on a flexible pad. The Anodyne ® Therapy System has been proposed as a treatment modality for several indications, including peripheral neuropathy. The benefit is claimed to be a temporary increase in sensitivity (a decrease in hypoesthesia) experienced by those with diabetes and other causes of peripheral neuropathy.
Date Posted: 09/06/2006, Date Reviewed/Revised: 07/31/2007
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According to Highmark Medicare Services LCD 06-032, effective 2-15-06. There has been insufficient evidence in the peer-reviewed, evidence-based literature to support providing coverage for this service. At this time, Anodyne® therapy for the treatment of diabetic peripheral neuropathy is not recognized as a standard of care, therefore is considered experimental and investigational, and not reimbursable by Medicare. There is currently no circumstance for which Medicare covers Anodyne® Therapy.
Date Posted: 09/06/2006, Date Reviewed/Revised: 07/31/2007
Does this non-coverage policy apply to all revenue codes?
Yes, complete absence of all Revenue Codes in the policy indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
Date Posted: 09/06/2006, Date Reviewed/Revised: 07/31/2007
What is the CPT code used for Anodyne ® Therapy?
Anodyne ® Therapy is reported under the CPT code 97026 - Application of a modality to one or more areas; infrared. 97026 is also used for other services, however the 97026 billed for the use of Anodyne ® Therapy is not reimbursable.
Date Posted: 09/06/2006, Date Reviewed/Revised: 07/31/2007