100-04 Medicare Claims Processing Manual: Chapter 12 Crosswalk

Medicare Claims Processing Manual
Chapter 12 - Physicians/Nonphysician Practitioners Crosswalk
Crosswalk
Chap. 	Sect. 	Int.
Pub. 13
Carrier
Pub. 14-3
PMs 	Description
12 	10 	B3-2020 	General
12 	20 	B3-15000 	Medicare Physicians Fee Schedule (MPFS)
12 	20.1 	B3-15006 	Method for Computing Fee Schedule Amount
12 	20.2 	Relative Value Units (RVUs)
12 	20.3 	B3-15010 	Bundled Services/Supplies
12 	20.4 	B3-15024 	Summary of Adjustments to Fee Schedule
Computations
12 	20.4.1 	B3-15032 	Participating Versus Nonparticipating Differential
12 	20.4.2 	B3-15036 	Site of Service Payment Differential
12 	20.4.3 	B3-15044 	Assistant at Surgery Services
12 	20.4.4 	B3-15900.2 	Supplies
12 	20.4.5 	B3-15055 	Allowable Adjustments
12 	20.4.6 	B3-15028 	Payment Change Due to Unusual Circumstances
(Modifier 52)

Chap. 	Sect. 	Int.
Pub. 13
Carrier
Pub. 14-3
PMs 	Description
(Modifier 52)
12 	20.5 	B3-15054 	No Adjustments in Fee Schedule Amounts
12 	20.6 	B3-15058 	B-03-007 	Update Factor for Fee Schedule Services
12 	20.7 	B3-15064 	Comparability of Payment Provision of Delegation of
Authority By CMS to Railroad Retirement Board
12 	30 	B3-15068 	Correct Coding Policy
12 	30.1 	B3-15100 	Digestive System (Codes 40000-49999)
12 	30.2 	B3-15200 	Urinary and Male Genital Systems (Codes 50010-
55899)
12 	30.3 	B3-15300 	Otolaryngology and Audiology/Speech/Language Tests
and Treatments (Codes V5299, V5362-V5364, 69000-
69979, and 92502-92599)
12 	30.4 	B3-15360 	Echocardiography Services (Codes 93303 - 93350)
12 	30.5 	B3-15400 	Chemotherapy Administration (Codes 96400-96549)
12 	30.6 	B3-15501-
B3-15501.1
Evaluation and Management Service Codes - General
(Codes 99201-99499)
12 	30.6.1 	Selection of Level of Evaluation and Management
Service
12 	30.6.2 	Billing for Medically Necessary Visit on Same
Occasion as Preventive Medicine Service

Chap. 	Sect. 	Int.
Pub. 13
Carrier
Pub. 14-3
PMs 	Description
12 	30.6.3 	B3-4820 - 4824 	Payment for Immunosuppressive Therapy Management
12 	30.6.4 	E and M Services Furnished Incident to Physician’s
Service by Nonphysician Practitioners
12 	Physicians in Group Practice
12 	30.6.6 	B3-4820 - 4824 	Payment for Evaluation and Management Services
Provided During Global Period of Surgery
12 	30.6.7 	B3-15502 	Payment for Office/Outpatient Visits (Codes 99201-
99215)
12 	30.6.8 	B3-15504 	Payment for Hospital Observation Services (Codes
99217-99220)
12 	30.6.9 	B3-15505 -
B3-15505.2
Payment for Inpatient Hospital Visits - General (Codes
99221 - 99239)
12 	30.6.9.1 	Payment for Initial Hospital Care Services (Codes
99221 - 99223)
12 	30.6.9.2 	Subsequent Hospital Visit and Hospital Discharge
Management (Codes 99231-99239)
12 	30.6.10 	B3-15506 	Consultations (Codes 99241 - 99275)
12 	30.6.11 	B3-15507 	Emergency Department Visits (Codes 99281-99288)
12 	30.6.12 	B3-15508 	Critical Care Visits and Neonatal Intensive Care
(Codes 99291-99292)

Chap. 	Sect. 	Int.
Pub. 13
Carrier
Pub. 14-3
PMs 	Description
12 	30.6.13 	B3-15509 -
B3-15509.1
Nursing Facility Visits (Codes 99301-99313)
12 	30.6.14 	B3-15510 	Home Care and Domiciliary Care Visits (Codes 99348-
99349)
12 	30.6.15 	B3-15511 -
B3-15511.3
Prolonged Services and Standby Services (Codes
99354-99360)
12 	30.6.15.1 	Prolonged Services (Codes 99354 – 99359) (ZZZ
codes)
12 	30.6.15.2 	Prolonged Services Without Face-to-Face Service
(Codes 99358-99359)
12 	30.6.15.3 	Physician Standby Service (Code 99360)
12 	30.6.16 	B3-15512 	Case Management Services (Codes 99362 and 99371-
99373)
12 	30.6.17 	B3-15515,
B3-15066
Home Services (Codes 99341 - 99350)
12 	40 	B3-4820 	Surgeons and Global Surgery
12 	40.1 	B3-4821,
B3-15900.2,
B3-15011,
B3-4820- B3-4831
Definition of a Global Surgical Package
12 	40.2 	B3-4822 	Billing Requirements for Global Surgeries

Chap. 	Sect. 	Int.
Pub. 13
Carrier
Pub. 14-3
PMs 	Description
12 	40.3 	B3-4823 	Claims Review for Global Surgeries
12 	40.4 	B3-4824, B3-4825,
B3-7100-B3-7120.7
Adjudication of Claims for Global Surgeries
12 	40.5 	B3-4825 	Postpayment Issues
12 	40.6 	B3-4826, B3-15038,
B3-15056, B3-4826
Claims for Multiple Surgeries
12 	40.7 	B3-4827, B3-15040 	Claims for Bilateral Surgeries
12 	40.8 	B3-4828, B3-15046 	Claims for Co-Surgeons and Team Surgeons
12 	40.9 	B3-4829 	Procedures Billed With Two or More Surgical
Modifiers
12 	50 	B3-4830, B3-15018.
B3-15018.K,
B3-4830C,
B3-4830D
Payment Conditions for Anesthesiology Services
12 	60 	B3-15020 	AB-01-47
(CR1499)
Payment Conditions for Pathology Services
12 	70 	B3-15022 	Payment Conditions for Radiology Services
12 	80 	B3-15014 	Services of Physicians Furnished in Providers or to
Patients of Providers
12 	80.1 	B3-2220 	Coverage of Physicians' Services Provided in
Comprehensive Outpatient Rehabilitation Facility

Chap. 	Sect. 	Int.
Pub. 13
Carrier
Pub. 14-3
PMs 	Description
Comprehensive Outpatient Rehabilitation Facility
12 	80.2 	B3-2260- B3-2260.3 	Rural Health Clinic and Federally Qualified Health
Center Services
12 	80.3 	B3-15026 	Unusual Travel (CPT Code 99082)
12 	90 	Physicians Practicing in Special Settings
12 	90.1 	B3-2020.5 	Physicians in Federal Hospitals
12 	90.2 	Physician Billing for End-Stage Renal Disease Services
12 	90.2.1 	B3-1506.2 -
B3-15062.1
Inpatient Hospital Visits with Dialysis Patients
12 	90.3 	B3-2265,
B3-2265.4
Physicians' Services Performed in Ambulatory Surgical
Centers (ASC)
12 	90.4 	B3-3350,
B3-15052
Billing and Payment in a Health Professional Shortage
Areas (HPSAs)
12 	90.4.1 	B3-3350.1 	Informing the Physician Community
12 	90.4.2 	B3-3350.2 	Detailing HPSA Locations
12 	90.4.3 	B3-3350.3 	Claims Coding Requirements
12 	90.4.4 	B3-3350.4 	Payment
12 	90.4.5 	B3-3350.5 	Services Eligible for HPSA Bonus Payments

Chap. 	Sect. 	Int.
Pub. 13
Carrier
Pub. 14-3
PMs 	Description
12 	90.4.6 	B3-3350.6 	Remittance Messages
12 	90.4.7 	B3-3350.7 	Postpayment Review
12 	90.4.8 	B3-3350.8,
B3-13320,
B3-13320.1,
B3-13322.3
Reporting
12 	100 	B3-2020.7, B3-8201,
B3-15016
Teaching Physician Services
12 	100.1 	Payment for Physician Services in Teaching Settings
Under the MPFS
12 	100.1.1 	Evaluation and Management (E/M) Services
12 	100.1.2 	Surgical Procedures
12 	100.1.3 	Psychiatry
12 	100.1.4 	Time-Based Codes
12 	100.1.5 	Other Complex or High-Risk Procedures
12 	100.1.6 	Miscellaneous
12 	100.1.7 	B3-15016 	Assistants at Surgery in Teaching Hospitals
12 	100.1.8 	B3-8204, B3-15016 	Physician Billing in the Teaching Setting

Chap. 	Sect. 	Int.
Pub. 13
Carrier
Pub. 14-3
PMs 	Description
12 	100.2 	B3-2020.8, B3-8030 	Interns and Residents
12 	110 	B3-16001, B3-2156,
B3-15004, B3-4112,
B3-15024
Physician Assistant (PA) Services Payment
Methodology
12 	110.1 	B3-16001 	Limitations for Assistant-at-Surgery Services
12 	110.2 	B3-4112, B3-2472.4 	Mental Health Limitation
12 	110.3 	B3-16001, B3-15044,
B3-2156
PM-B-99-16 	PA Billing to Carrier
12 	120 	B3-16002,
B3-2158- B3-2160,
B3-4112, B3-2472-2472.4
Nurse Practitioner (NP) And Clinical Nurse Specialist
(CNS) Services
12 	120.1 	B3-2158E, B3-2160E,
B3-3040.4
Direct Billing and Payment
12 	130 	B3-16004, B3-5257 	Nurse-Midwife Services
12 	130.1 	B3-16004A, B3-16004B,
B3-5257B,
B3-3040.4, B3-17001.1
Payment for Services
12 	130.2 	B3-16004C, B3-5257C 	Global Allowances
12 	140 	B3-16003, B3-16003 A,
B3-3040.4, B3-4172
Certified Registered Nurse Anesthetist (CRNA)
Services

Chap. 	Sect. 	Int.
Pub. 13
Carrier
Pub. 14-3
PMs 	Description
12 	140.1 	B3-16003, B3-4172.1 	Qualified Anesthetists
12 	140.1.1 	B3-4172.2 	Issuance of UPINs
12 	140.1.2 	B3-4172.3 	Annual Review of CRNA Certifications
12 	140.2 	B3-16003C, B3-4830A 	Entity or Individual to Whom CRNA Fee Schedule is
Payable
12 	140.3 	B3-16003D and E 	CRNA Fee Schedule Payment
12 	140.3.1 	B3-16003F 	CRNA Conversion Factors Used on or After January 1,
1997
12 	140.3.2 	B3-15018G 	Anesthesia Time and Calculation of Anesthesia Time
Units
12 	140.3.3 	Billing Modifiers
12 	140.3.4 	B3-4172.5 	General Billing Instructions
12 	140.4 	CRNA Special Billing and Payment Situations
12 	140.4.1 	An Anesthesiologist and CRNA Work Together
12 	140.4.2 	B3-4172.6 	CRNA and an Anesthesiologist in a Single Anesthesia
Procedure
12 	140.4.3 	B3-16003H 	Payment for Medical or Surgical Services Furnished by
CRNAs

Chap. 	Sect. 	Int.
Pub. 13
Carrier
Pub. 14-3
PMs 	Description
12 	140.4.4 	B3-16003I, 	PM B-01-69 	Conversion Factors for Anesthesia Services of CRNAs
Furnished on or After January 1, 1992
12 	150 	B3-2152, B3-17000 	Clinical Social Worker (CSW) Services
12 	160 	B3-2150, B3-2070.2 	Independent Psychologist Services
12 	160.1 	Payment
12 	170 	B3-2150 	Clinical Psychologist Services
12 	170.1 	B3-2150, B3-17001.1 	Payment
12 	180 	B3-15513 	B-00-65 	Care Plan Oversight Services
12 	180.1 	B3-15513 	B-00-65 	Care Plan Oversight Billing Requirements
12 	190 	A3-3497,
A3-3660.2
B3-4159, B3-15516 	AB-01-69,
AB-02-05
Medicare Payment for Telehealth Services
12 	190.1 	Background
12 	190.2 	Eligibility Criteria
12 	190.3 	List of Medicare Telehealth Services
12 	190.4 	Conditions of Payment
12 	190.5 	Payment Methodology for Physician/Practitioner at the
Distant Site
12 	190.6 	Originating Site Facility Fee Payment Methodology

Chap. 	Sect. 	Int.
Pub. 13
Carrier
Pub. 14-3
PMs 	Description
12 	190.6.1 	Submission of Telehealth Claims for Distant Site
Practitioners
12 	190.6.2 	Exception for Sotre and Forward (Non-interactive)
Telehealth
12 	190.7 	Carrier Editing of Telehealth Claims
12 	200 	B3-15050 	Allergy Testing and Immunotherapy
12 	210 	B3-2470 	Outpatient Mental Health Limitation
12 	210.1 	B3-2472-B3-2472.5 	Application of the Limitation