Ambulatory Surgical Center Payment Indicator (ASCPI) File Error; and Reiteration of Centers for Medicare & Medicaid Services (CMS) Policy Regarding Beneficiary Liability for V2787 and V2788
MLN Matters® Number: MM6630
Related Change Request (CR) #: 6630
Related CR Release Date: August 28, 2009
Effective Date: January 1, 2009
Related CR Transmittal #: R546OTN
Implementation Date: September 29, 2009
Provider Types Affected
Physicians and other providers who bill Medicare Carriers or Medicare Administrative Contractors (MAC) for providing intraocular lens replacement services in ambulatory surgical centers.
What You Need to Know
CR 6630, from which this article is taken, corrects the Ambulatory Surgical Center Payment Indicator (ASCPI) file payment indicator assigned to Healthcare Common Procedure Coding System (HCPCS) codes V2787 (Astigmatism correcting function of intraocular lens) and HCPCS code V2788 (Presbyopia correcting function of intraocular lens). It notifies your carrier or MAC that the correct payment indicator (‘Y5’) previously assigned to these codes is incorrect and instructs them to download files containing the corrected payment indicator (‘E5’).
You should make sure that your billing staffs are aware of this correction, and that your carrier or MAC will search for, and adjust, affected claims with dates of service on/after January 1, 2009. Please see the Background section, below, for more information.
Background
CR 6630, from which this article is taken, alerts your carriers and MACs that the payment indicator (‘Y5’) assigned to HCPCS code V2787 Astigmatism correcting function of intraocular lens and HCPCS code V2788 (Presbyopia correcting function of intraocular lens) in earlier Change Requests (CR 6184 issued on October 17, 2008; CR 6424 issued on March 13, 2009; and CR 6496 issued on May 22, 2009) was incorrect and results in incorrect beneficiary liability assignment and messaging on Medicare Summary Notices (MSNs). CR 6630 notifies the carriers and MACs that the corrected payment indicator assigned to these codes is ‘E5.’
Your carrier or MAC will install replacement ASCPI files for January, 2009, April 2009, and July 2009 (which have been corrected to reflect payment indicator of ‘E5’ for both HCPCS codes V2787 and V2788). They will search for, and adjust, affected claims to trigger the correct beneficiary liability message for HCPCS codes V2787 and V2788 for dates of service on or after January 1, 2009.
Additional Information
You can find the official instruction, CR 6630, issued to your carrier or MAC by visiting www.cms.hhs.gov/Transmittals/downloads/R546OTN.pdf (PDF, 112 KB) on the CMS Web site
If you have questions, please contact our Provider Contact Center at our toll-free number (866) 332-7025 (Ohio and West Virginia) or (888) 828-2092 (South Carolina Part B).
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents. CPT only copyright 2008 American Medical Association.