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CPT codes, descriptors and other data only are copyright 1999
American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply.
General
1. When filing a paper claim for services rendered in place of service 33, Custodial Care, and that facility does not have a National Provider Identifier (NPI), how do you complete Items 32A and 32B on the CMS-1500 form? (Last Reviewed: July 16, 2008)
2. May an existing Medicare provider, who is joining an established group, submit his/her provider's application more than 30 days from the provider's start date? I believe that only new group/new provider's applications must be submitted within 30 days. (Last Reviewed: July 16, 2008)
3. What is the electronic loop for the "narrative" field? (Last Reviewed: April 4, 2008)
4. When a patient has Medicare coverage through a Medicare Advantage Plan and then enters a hospice, when does coverage convert to original Medicare? (Last Reviewed: July 16, 2008)
5. Where in writing does it state that a provider can or cannot charge a Medicare beneficiary for late fees or interest? (Last Reviewed: July 16, 2008)
6. Can Category III codes be used if they most accurately describe the service we are providing to the patient? (Last Reviewed: July 16, 2008)
7. What information do you need when we bill utilizing the 22 modifier? (Last Reviewed: July 16, 2008)
8. Is a service documented by a chiropractic intern and co-signed by the billing chiropractor a payable Medicare service? (Last Reviewed: July 16, 2008)
9. Some physicians are concerned that it is difficult to determine under what circumstances an advance beneficiary notice (ABN) should be completed. (Last Reviewed: July 16, 2008)
10. What happens if a physician makes a mistake and does not give an ABN to a beneficiary and then the Medicare contractor denies the claim? (Last Reviewed: July 16, 2008)
11. What is the difference between "Contractual Obligation" (CO) and "Patient Responsibility" (PR) as indicated on the explanation of benefits (EOB)? If PR is noted, should we bill the patient even if an ABN has not been signed? (Last Reviewed: July 16, 2008)
12. How do I check claim status and patient eligibility on the Upstate Medicare Division (UMD) Web site? (Last Reviewed: May 29, 2008)
13. Is there a limit or visit cap for chiropractic services? (Last Reviewed: July 16, 2008)
14. May we bill for an audiologist's services "incident to" a physician? (Last Reviewed: July 16, 2008)
15. What does the statement “Does the CPT 30% Coding Rule Apply?” mean when it appears in a local coverage determination (LCD)? (Last Reviewed: July 16, 2008)
16. Are the initial visit procedure codes (99221-99223) billed the first time the patient is seen for each provider specialty? (Last Reviewed: July 16, 2008)
17. If a radiologist supervises a physician assistant (PA) in a hospital, is that considered “incident to” and, therefore, be billed under the physician’s Provider Transaction Access Numner (PTAN)? (Last Reviewed: July 16, 2008)
18. Explain the billing of a consultation vs. an admission. (Last Reviewed: April 25, 2008)
19. How can we obtain Correct Coding Initiative (CCI) bundled code information? (Last Reviewed: April 25, 2008)
20. If an office has difficulty finding a CPT code for a procedure after thoroughly referencing the most current CPT coding books, how should the claim be coded? (Last Reviewed: April 25, 2008)
21. Can adjustment requests be done via email instead of fax? (Last Reviewed: May 29, 2008)
22. What are the documentation requirements for billing evaluation and management (E&M) services in teaching settings? (Last Reviewed: July 16, 2008)
23. Why are my erythropoiesis stimulating agents (ESA) claims being denied? (Last Reviewed: July 16, 2008)
1. When filing a paper claim for services rendered in place of service 33, Custodial Care, and that facility does not have a National Provider Identifier (NPI), how do you complete Items 32A and 32B on the CMS-1500 form?
(Last Reviewed: July 16, 2008)
"Under the NPI Final Rule (69 FR 3434), a health care provider who is a covered entity under HIPAA is required to obtain an NPI and to use it to identify itself as a health care provider in HIPAA transactions no later than May 23, 2007. Small health plans must use the NPI no later than May 23, 2008. A health care provider is a covered entity if it transmits any health information in electronic form in connection with a transaction for which the Secretary has adopted a standard. For example, any health care provider (individual or organization) who sends electronic health care claims to a health plan(s), is a covered provider and must obtain an NPI. Health care providers who are not covered providers may elect to apply for NPIs, but are not required to do so." Centers for Medicare & Medicaid Services (CMS) Web site Frequently Asked Questions #2622; http://questions.cms.hhs.gov.
Since a custodial care facility provides room, board, and other personal assistance services, generally on a long-term basis, which does not include a medical component, they are not required to have an NPI.
You should submit Item 32 (name, address, city, state, and zip) and leave Item 32A blank.
According to Pub. 100-04, Medicare Claims Processing Manual, Chapter 26, §10.4 effective May 23, 2008, Item 32B is not to be reported.
2. May an existing Medicare provider, who is joining an established group, submit his/her provider's application more than 30 days from the provider's start date? (Last Reviewed: July 16, 2008)
Yes, the Upstate Medicare Division (UMD) will only return applications for initial enrollments when they are submitted more than 30 days from the provider's start date. Applications to reassign a member to an existing group are not returned if submitted more than 30 days from the provider's start date. UMD is current with our inventory of existing reassignments and, therefore, will work these cases within 45 days, provided the application is complete and accurate and no development is necessary.
Pub. 100-08, Medicare Program Integrity Manual, Chapter 10 - Healthcare Provider/Supplier Enrollment, §3.2 - Returning the Application states:
"A. Immediate Returns
The contractor shall immediately return the enrollment application to the provider in the instances described below. This policy applies to all applications identified in sections 2.1 and 2.2 of this manual:
- The contractor received the application more than 30 days prior to the effective date listed on the application. (This does not apply to certified providers, ASCs, or portable x-ray suppliers.);"
3. What is the electronic loop for the "narrative" field? (Last Reviewed: April 4, 2008)
Extra narrative data may be entered in:
- The 2300 loop position 190 NTE02 - this applies to the entire claim, or
- The 2400 loop position 190 NTE02 - this applies to the line, such as a procedure code NOC which is a line note.
4. When a patient has Medicare coverage through a Medicare Advantage Plan and then enters a hospice, when does coverage convert to original Medicare? (Last Reviewed: July 16, 2008)
Pub. 100-04, Medicare Claims Processing Manual, Chapter 11 - Processing Hospice Claims, §40.2.2 - Claims from Medicare + Choice Organizations states:
"Medicare hospices will bill the RHHI for Medicare beneficiaries who have coverage through managed care just as they do for beneficiaries with fee-for-service coverage, beginning with a notice of election for an initial hospice benefit period, and followed by claims with types of bill 81X and 82X. If the beneficiary later revokes election of the hospice benefit, a final claim indicating revocation, through use of occurrence code 42, should be submitted as soon as possible so that the beneficiary's medical care and payment is not disrupted."
M + C organizations may bill the Medicare carrier for nonhospice services provided to M + C enrollees who elect hospice benefits. These claims should be submitted with a GV or GW (for services not related to the terminal condition) modifier as applicable. Carriers process these claims in accordance with regular claims processing rules.
Medicare physicians may also bill such services directly to carriers as long as all current requirements for billing for hospice beneficiaries are met. Revised requirements for such billing were set forth in Transmittal 1728 CR 1910 in Pub. 14-4 (Medicare Carriers Manual) effective April 2002 and specifies use of modifiers -GV and -GW. When these modifiers are used, carriers are instructed to use an override code to assure such claims have been reviewed and should be approved for payment by the Common Working File in Medicare claims processing systems.
As specified above, by regulation, the duration of payment responsibility by fee-for-service contractors extends through the remainder of the month in which hospice is revoked by hospice beneficiaries. Managed care enrollees that have elected hospice may revoke hospice election at any time, but claims will continue to be paid by fee-for-service contractors as if the beneficiary were a fee-for-service beneficiary until the first day of the month following the month in which hospice was revoked."
5. Where in writing does it state that a provider can or cannot charge a Medicare beneficiary for late fees or interest? (Last Reviewed: July 16, 2008)
It is a violation of the assignment for a physician to charge a beneficiary an amount in addition to the deductible and/or coinsurance amounts. Similarly, nonparticipating physicians who do not take assignment may charge no more than the limiting charge for the covered service. Medicare views the cost of collection of deductibles and coinsurance as part of the routine practice expense of doing business. If the physician was to charge interest or late fees to beneficiaries for the collection of deductible or coinsurance amount, that would be a violation of the assignment agreement or the limiting charge provisions.
This information can be found in the Medicare Participating Physician or Supplier Agreement (number 1) and the Federal Register, 42 CFR 489.20, 489.21, and 489.30.
6. Can Category III codes be used if they most accurately describe the service we are providing to the patient? (Last Reviewed: July 16, 2008)
Category III codes are for data collection and are available for emerging technologies. Category III codes for which coverage is allowed by this Part B carrier are either added to a local coverage determination (LCD) or noted in a published article.
7. What information do you need when we bill utilizing the 22 modifier? (Last Reviewed: July 16, 2008)
The information needed when making a decision when the 22 modifier is used is the same as the information needed when using any of the unlisted codes or the 52 modifier. It is important to identify the portions of the documentation (such as operative note) which describes the unlisted procedure or reason(s) the modifier is being utilized. It is necessary to provide sufficient identified clinical information to allow judgment of medical necessity of the procedures and payment modifications.
8. Is a service documented by a chiropractic intern and co-signed by the billing chiropractor a payable Medicare service? (Last Reviewed: July 16, 2008)
No. Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, §100, Teaching Physician Services, provides Medicare guidelines for teaching physician services. It states, “Payment under the MPFSDB may be made for the professional services rendered to a beneficiary by his/her attending physician where the attending physician provides personal and identifiable direction to interns or residents who are participating in the care of the patient.”
“B - Definitions
For purposes of this section, the following definitions apply.
Resident - An individual who participates in an approved graduate medical education (GME) program or a physician who is not in an approved GME program but who is authorized to practice only in a hospital setting. The term includes interns and fellows in GME programs recognized as approved for purposes of direct GME payments made by the FI.
The fact that an individual hospital does not choose to include an eligible individual in its full-time equivalency count of residents does not change that individual’s status as a resident in an approved GME program.
A medical student is never considered to be a resident. Any contribution of a medical student to the performance of a service or billable procedure (other than the taking of a history in the case of an E/M service) must be performed in the physical presence of a physician or jointly with a resident in a service meeting the requirements set forth below for teaching physician billing.
Teaching Physician - A physician (other than another resident) who involves residents in the care of his or her patients.
Direct Medical and Surgical Services - Services to individual beneficiaries that are either personally furnished by a physician or furnished by a resident under the supervision of a physician in a teaching hospital making the reasonable cost election for physician services furnished in teaching hospitals. All payments for such services are made by the FI for the hospital.
Teaching Hospital - A hospital engaged in an approved GME residency program in medicine, osteopathy, dentistry, or podiatry.
Teaching Setting - Any provider, hospital-based provider, or nonprovider setting in which Medicare payment for the services of residents is made by the FI under the direct graduate medical education payment methodology or freestanding SNF or HHA in which such payments are made on a reasonable cost basis.”
9. Some physicians are concerned that it is difficult to determine under what circumstances an advance beneficiary notice (ABN) should be completed. (Last Reviewed: July 16, 2008)
ABNs are designed to be given when the provider expects (or is certain) that Medicare will deny payment for an item or service, either on the basis of the exclusion for lack of medical necessity (section 1862(a)(1) of the Act) or on one of the few other statutory bases that trigger ABNs (custodial care, a hospice patient determined not to be terminally ill, a home health patient who is not homebound or requiring intermittent skilled nursing care, and DMEPOS in the case of unsolicited telephone calls, lack of a supplier number, and failure to get an advance determination of noncoverage). Guidelines for using the ABN can be found in Pub. 100-04, Medicare Claims Processing Manual, Chapter 30 - Financial Liability Protections. Physicians are also expected to be knowledgeable about Medicare coverage rules on the basis of Medicare publications and professional relations activities, as well as on the bases of their experience with the Medicare program and their local medical standards of practice. For more information regarding ABNs, access the Centers for Medicare & Medicaid Services (CMS) publication, "What Doctors Need to Know About the Advance Beneficiary Notice."
Beginning March 3, 2008, providers (including independent laboratories), physicians, practitioners, and suppliers may use the revised ABN for all situations where Medicare payment is expected to be denied. The revised ABN replaces the existing ABN-G (Form CMS-R-131G), ABN-L (Form CMS-R-131L), and NEMB (Form CMS-20007). CMS will allow a 6-month transition period from the date of implementation for use of the revised form and instructions. Thus, all providers and suppliers must begin using the revised ABN (CMS-R-131) no later than September 1, 2008. The revised form and instructions may be found on the Beneficiary Notices Initiative (BNI) page of CMS' Web site located at www.cms.hhs.gov/BNI/02_ABNGABNL.asp#TopOfPage.
10. What happens if a physician makes a mistake and does not give an ABN to a beneficiary and then the Medicare contractor denies the claim? (Last Reviewed: July 16, 2008)
There are other protections for physicians under the Limitation of Liability provision (§1879 of the Act) besides the use of ABNs. In any denial for medical necessity (or one of the other statutory bases that trigger ABNs), the physician may appeal the denial on the basis that the service should be covered and, if the physician prevails, the claim will be paid as covered. Additional physician documentation of the medical necessity of the service for the individual patient may result in a reversal of a denial. The physician also can appeal on the basis that the physician did not know and could not reasonably have been expected to know that payment would be denied by Medicare. If the physician is found not liable on the basis that he/she did not know of the likelihood of Medicare denial, the claim may be paid under §1879 as if it were covered. Please refer to Limitation of Liability guidelines in Pub. 100-04, Medicare Claims Processing Manual, Chapter 30 - Financial Liability Protections.
11. What is the difference between "Contractual Obligation" (CO) and "Patient Responsibility" (PR) as indicated on the explanation of benefits (EOB)? If PR is noted, should we bill the patient even if an ABN has not been signed? (Last Reviewed: July 16, 2008)
Pub. 100-04, Medicare Claims Processing Manual, Chapter 22 states:
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 instructs health plans to be able to conduct standard electronic transactions adopted under HIPAA using valid standard codes. Medicare policy states that Claim Adjustment Reason Codes (CARCs) are required in the remittance advice and coordination of benefits transactions. Medicare policy further states that Remittance Advice Remark Codes (RARCs) are required in the remittance advice transaction. Payers communicate the reason for any adjustment (when the payment differs from the amount billed) using these 2 sets of codes along with a group code. The group codes identify who is financially responsible for the amount that the payer is not reimbursing.
Medicare uses the following group codes:
CO - Contractual Obligation (Provider is financially responsible)
PR - Patient Responsibility (Provider can collect the amount from patient)
Chapter 30 of this manual addresses the use of the Advance Beneficiary Notice (ABN).
12. How do I check claim status and patient eligibility on the Upstate Medicare Division (UMD) Web site? (Last Reviewed: May 29, 2008)
Due to limitations set by the Privacy Act and the Centers for Medicare & Medicaid Services (CMS), sensitive materials such as Social Security numbers, personal medical information, and other confidential data cannot be transmitted over the Internet unless it is encrypted. Therefore, UMD is not able to provide claim status and patient eligibility through our Web site at this time. You can, however, check claim status and patient eligibility by using our Interactive Voice Response (IVR) Unit. Claim status and patient eligibility information is available Monday through Friday from 6 a.m. to 6 p.m. by calling our toll-free provider line at 877-567-7173.
To check patient eligibility, press 1. You will need to supply your National Provider Identifier (NPI), Provider Transaction Access Number (PTAN), the beneficiary's Medicare number, the beneficiary's date of birth, the beneficiary's first name, the beneficiary's last name, and the date of service.
To check claim status information, press 2. You will need to supply your NPI, PTAN (group providers should enter the group PTAN; individual providers should enter the individual PTAN), the beneficiary's Medicare number, and the date of service.
For more information regarding our IVR, please read our "Interactive Voice Response (IVR) Unit Guide  ."
Addition information regarding eligibility inquiries can be access by visiting the "Electronic Billing & EDI Transactions" section of the CMS Web site and Pub. 100-04, Medicare Claims Processing Manual, Chapter 31.
13. Is there a limit or visit cap for chiropractic services? (Last Reviewed: July 16, 2008)
There are no caps/limits in Medicare for covered chiropractic care rendered by chiropractors who meet Medicare's licensure and other requirements as specified in Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §30.5.
There may be review screens (numbers of visits at which the Medicare carrier or Part A/B Medicare Administrative Contractor (A/B MAC) may require a review of documentation), but caps/limits are not allowed.
The Social Security Act (§1862(a)(1)) provides that Medicare will only pay for items or services it determines to be "reasonable and necessary," and if those items or services can be shown to be "reasonable and necessary," then those items or services are covered and will be paid by Medicare.
14. May we bill for an audiologist's services "incident to" a physician? (Last Reviewed: July 16, 2008)
It depends on the service the audiologist is providing. As of April 1, 2008, Change Request (CR) 5717 clearly states that:
"Audiological diagnostic tests are not covered under the benefit for incident to a physician (described in Pub. 100-02, chapter 15, section 60), because they have their own benefit as "other diagnostic tests". See Pub. 100-04, chapter 13 for diagnostic test policies."
"Coverage and Payment for Audiological Services. Diagnostic services performed by a qualified audiologist and meeting the requirements at §1861(ll)(3)(B) are payable as "other diagnostic tests." Audiological diagnostic tests are not covered as services incident to physician’s services or as services incident to audiologist’s services."
However, "Services that are not diagnostic tests and are also not "always" therapy (according to the list and the policy in Pub.100-04, chapter 5, section 20) and are provided by qualified personnel (who may be audiologists), may be billed "incident to" when all other appropriate requirements are met. (See policies in Pub. 100-02, chapter 15, sections 60, 200, and 230.)"
15. What does the statement “Does the CPT 30% Coding Rule Apply?” mean when it appears in a local coverage determination (LCD)? (Last Reviewed: July 16, 2008)
This statement is in relation to the American Medical Association’s copyright regulations for the CPT coding manual. If any given LCD contains 30%, or more, of the CPT codes from a section of the CPT manual, the shortened version of each code descriptor must be used in the LCD. The only impact this has on users of the LCD is that the full CPT description of the codes may need to be reviewed in the current CPT manual rather than in the LCD.
16. Are the initial visit procedure codes (99221-99223) billed the first time the patient is seen for each provider specialty? (Last Reviewed: July 16, 2008)
The 2008 CPT Code Book section on initial hospital care for a new or established patient states, "The following codes (99221-99223) are used to report the first hospital inpatient encounter with the patient by the admitting physician. For initial inpatient encounters by physicians other than the admitting physician, see initial inpatient consultation codes (99251-99255) or subsequent hospital care codes (99231-99223) as appropriate." Please remember, if consultation services are billed, the requirements per Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, §30.6.10 must be met.
In the Initial Hospital Visits local coverage determination (LCD) (EM007E01) (Database # L4837), under coding guidelines, it states, "Only one (1) initial visit code may be billed per beneficiary per hospitalization."
Per Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, §30.6.9.1(F), "Physicians use the initial hospital care codes (99221-99223) to report the first hospital inpatient encounter with the patient when he or she is the admitting physician. Carriers consider only one M.D. or D.O. to be the admitting physician and permit only the admitting physician to use the initial hospital care codes. Physicians that participate in the care of a patient but are not the admitting physician of record should bill the inpatient evaluation and management services codes that describe their participation in the patient’s care (i.e., subsequent hospital visit or inpatient consultation)."
17. If a radiologist supervises a physician assistant (PA) in a hospital, is that considered “incident to” and, therefore, be billed under the physician’s Provider Transaction Access Number (PTAN)? (Last Reviewed: July 16, 2008)
“Incident to” is not applicable to inpatient or outpatient hospital place of service (POS) 21, 22, and 23. In MLN Matters article SE0441, under “Background,” it states, “The following paragraphs discuss the various care settings, which are important to note because the processes for billing vary somewhat depending on the care site.” Under the “Hospital or SNF” section, it states, “For inpatient or outpatient hospital services and services to residents in a Part A covered stay in a SNF the unbundling provision (1862(a)14) provides that payment for all services are made to the hospital or SNF by a Medicare intermediary (except for certain professional services personally performed by physicians and other allied health professionals). Therefore, incident to services are not separately billable to the carrier or payable under the physician fee schedule.”
18. Explain the billing of a consultation vs. an admission. (Last Reviewed: April 25, 2008)
The intent of a consultation service is that a physician or qualified nonphysician practitioner (NPP) or other appropriate source is asking another physician or qualified NPP for advice, opinion, a recommendation, suggestion, direction, or counsel, etc., in evaluating or treating a patient because that individual has expertise in a specific medical area beyond the requesting professional's knowledge.
If the physician has been called in to give his/her opinion, and is giving his/her opinion back to the primary physician, then this would constitute a consultation.
Physicians use the initial hospital care codes (codes 99221-99223) to report the first hospital inpatient encounter with the patient when he or she is the admitting physician. Carriers consider only one M.D. or D.O. to be the admitting physician and permit only the admitting physician to use the initial hospital care codes. Physicians that participate in the care of a patient but are not the admitting physician of record should bill the inpatient evaluation and management services codes that describe their participation in the patient's care (i.e., subsequent hospital visit or inpatient consultation). Please refer to Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, §§30.6.9.1 and 30.6.10.
19. How can we obtain Correct Coding Initiative (CCI) bundled code information? (Last Reviewed: April 25, 2008)
Information regarding CCI is available on the Centers for Medicare & Medicaid Service (CMS) Web site at www.cms.hhs.gov/NationalCorrectCodInitEd/.
20. If an office has difficulty finding a CPT code for a procedure after thoroughly referencing the most current CPT coding books, how should the claim be coded? (Last Reviewed: April 25, 2008)
If there is no code assigned to the procedure, the unlisted code should be submitted. Upon receipt of the claim, Medicare will ask for medical documentation. Medical review staff will review the documentation and make a determination.
21. Can adjustment requests be done via email instead of fax? (Last Reviewed: May 29, 2008)
No, the Privacy Act of 1974 mandates that beneficiary-specific information cannot be disclosed electronically via email, which would include Medicare numbers, Social Security numbers, personal medical information, or other confidential items in email inquiries. Since these items are required to conduct a redetermination or reopening, using email is not appropriate. Please see the Privacy Act or Pub.100-09, Medicare Contractor Beneficiary and Provider Communications Manual, Chapter 3, §30.2.2D - Special Note about Inquiries Received Via Email and Fax, at www.cms.hhs.gov/manuals/downloads/com109c03.pdf.
22. What are the documentation requirements for billing evaluation and management (E&M) services in teaching settings? (Last Reviewed: July 16, 2008)
Refer to Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, §§100-100.2 for information regarding teaching physician services.
For purposes of payment, E&M services billed by teaching physicians require that they personally document at least the following:
- That they performed the service or were physically present during the key or critical portions of the service when performed by the resident; and
- The participation of the teaching physician in the management of the patient.
Students may document services in the medical record. However, the documentation of an E&M service by a student that may be referred to by the teaching physician is limited to documentation related to the review of systems and/or past family/social history. The teaching physician may not refer to a student's documentation of physical exam findings or medical decision making in his or her personal note. If the medical student documents E&M services, the teaching physician must verify and redocument the history of present illness as well as perform and redocument the physical exam and medical decision making activities of the service.
Documentation by the resident of the presence and participation of the teaching physician is not sufficient to establish the presence and participation of the teaching physician. On medical review, the combined entries into the medical record by the teaching physician and the resident constitute the documentation for the service and together must support the medical necessity of the billed service and the level of the service billed by the teaching physician.
23. Why are my erythropoiesis stimulating agents (ESA) claims being denied? (Last Reviewed: July 16, 2008)
This is a claim specific question which should be directed to our toll-free provider line at 877-567-7173. However, before making that call you should confirm that you are following the requirements found in:
- Pub. 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 2, §110.21 - "The Use of ESAs in Cancer and Other Neoplastic Conditions," which lists coverage criteria for the use of ESAs in patients who have cancer and experience anemia as a result of chemotherapy or as a result of the cancer itself, and
- Pub. 100-04, Medicare Claims Processing Manual, Chapter 17, §§80 - 80.12.
One common issue is providers submitting claims that do not follow the claims processing rules for ESAs administered to cancer patients for anti-anemia therapy found in Pub. 100-04, Medicare Claims Processing Manual, Chapter 17, §80.12. The implementation date was April, 7, 2008.
It is important that you read these publications, and follow the requirements.
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General