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NOTE: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material that is copyrighted by the American Medical Association. You are forbidden to download the files unless you read, agree to, and abide by the provisions of the copyright statement. Read the copyright statement now and you will be linked back to here.
RAILROAD MEDICARE ADVISORY September 2021
Volume 2021, Issue 9
Latest Part B News for Railroad Medicare
What’s Inside...
Administration
Tell Us What You Think of Our Service .................................................................................. 3
eServices and Google Authenticator ........................................................................................4
Get Your Railroad Medicare News Electronically ................................................................... 6
Medicare Learning Network® (MLN) ....................................................................................7
ePass is Now Available in the Railroad Medicare Interactive Voice Response (IVR) Unit .8
CMS Quarterly Provider Update .............................................................................................9
Provider Customer Service Center Training and Closure Dates ............................................10
“PTAN Lookup and Request Tool”........................................................................................ 11
How Can I Tell if a Patient Has Railroad Medicare? ............................................................12
Help Us to Help You: Have Your Provider and Patient Information Ready When You Call
Customer Service ...............................................................................................................14
eServices: COVID-19 Transition ...........................................................................................15
Medicine
Internet Only Manual Updates to Publication (Pub.) 100-02 to Implement Updates to Policy
and Correct Errors and Omissions (Inpatient Rehabilitation Facility (IRF)).....................16
National Coverage Determination (NCD) Removal..............................................................18
Hospice
Modifications/Improvements to Value-Based Insurance Design (VBID) Model –
Implementation...................................................................................................................20
Laboratory
New Waived Tests .................................................................................................................. 22
Oncology
National Coverage Determination (NCD 110.24): Chimeric Antigen Receptor (CAR) T-cell
Therapy - This CR Rescinds and Fully Replaces CR 11783 ................................................23
Continued >>
palmettogba.com/rr
The Medicare Advisory contains coverage, billing and other information for Railroad Medicare. This
information is not intended to constitute legal advice. It is our official notice to those we serve concerning
their responsibilities and obligations as mandated by Medicare regulations and guidelines. This information
is readily available at no cost on the Palmetto GBA website. It is the responsibility of each facility to obtain
this information and to follow the guidelines. The Railroad Medicare Advisory includes information provided
by the Centers for Medicare & Medicaid Services (CMS) and is current at the time of publication. The
information is subject to change at any time. This bulletin should be shared with all health care practitioners
and managerial members of the provider staff. Bulletins are available at no-cost from our website at https://
www.PalmettoGBA.com/rr.
CPT only copyright 2020 American Medical Association. All rights reserved. CPT is a registered trademark
of the American Medical Association. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee
schedules, relative value units, conversion factors and/or related components are not assigned by the AMA,
and are not part of CPT®, and the AMA is not recommending their use. The AMA does not directly or indirectly
practice medicine or dispense medical services. The AMA assumes no liability for data contained or not con-
tained herein. The Code on Dental Procedures and Nomenclature is published in Current Dental Terminology
(CDT), Copyright © 2020 American Dental Association (ADA). All rights reserved.
Skilled Nursing Facility (SNF)
Internet Only Manual Updates to Pub. 100-01, 100-02, and 100-04 to Implement Consolidated Appropriations Act
Changes and Correct Errors and Omissions (SNF) ...................................................................................................27
Etcetera
MLN ConnectsTM ........................................................................................................................................................30
Do You Have a Question Regarding eServices? We Can Help!
Palmetto GBA has dedicated representatives available to provide technical assistance and answer
questions about our secure online portal — eServices. Our Provider Contact Center (PCC) representatives
can be reached at 888-355-9165 (Monday – Friday, 8:30 a.m. to 4:30 p.m. ET for all time zones with the
exception of PT, which receives services from 8 a.m. to 4 p.m.).
To connect with an eServices representative:
• Press 2 for EDI/eServices, then
• Press 1 for eServices inquiries
CMS Provider Minute Videos
The Medicare Learning Network has a series of CMS Provider Minute Videos
(https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/MLN-
Multimedia) on a variety of topics, such as psychiatry, preventive services, lumbar spinal fusion, and much
more. The videos offer tips and guidelines to help you properly submit claims and maintain sufficient supporting
documentation. Check the site often as CMS adds new videos periodically to further help you navigate the
Medicare program.
CPT codes, descriptors and other data only are copyright 2020 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data
contained therein) is copyright by the American Dental Association. ©2020 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.
2 9/2021
Tell Us What You Think of Our Service
If your experience with Railroad Medicare was awesome or not, we’d like to hear from you! Telling us what
we do well lets us know what we should keep doing, and telling us how we can improve gives us room to grow.
Just visit our website and take our Palmetto GBA/Railroad Medicare Provider Experience survey at
https://www.surveymonkey.com/r/JPYHTDN. Here you can provide feedback on your most recent interaction
with Railroad Medicare that occurred via telephone, chat, email, mail or social media (Facebook, Twitter or
LinkedIn). We value your comments and opinions, and we look forward to a culture of continuous improvement
in the way we conduct business and serve our customers.
Our survey has eight easy questions and takes about three minutes to complete (if that). Those three minutes
can help us coach a Palmetto GBA team member to give a customer an awesome experience every time they
contact Railroad Medicare.
We thank you in advance for your participation!
CPT codes, descriptors and other data only are copyright 2020 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data
contained therein) is copyright by the American Dental Association. ©2020 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.
3 9/2021
eServices and Google Authenticator
To enhance the security of Medicare information, the Centers for Medicare & Medicaid Services (CMS) requires
the use of multi-factor authentication (MFA) each time you log in to eServices. We're excited to announce a
new option to protect your account - Google Authenticator.
You now have three options to receive an MFA code:
• Email
• Text
• Google Authenticator
Are you new to eServices? Or maybe you already have an eServices account...no worries! In just a few quick
steps, you can set up Google Authenticator. This two-step verification is available when initially registering
for eServices or if you already have an existing eServices account.
Initial Registration
Upon initial registration to eServices, you must complete the fields on the MFA Setup screen.
The information entered on this screen will be saved in your profile. Select Authenticator Setup for Google
Authenticator option.
After selecting the Authenticator Setup button, you'll see instructions for installing Google Authenticator. These
steps are based on your device - iPhone or Android:
• iPhone users must access iTunes
• Android users must access Google Play
A successful installation prompts this screen showing your device is now linked. Select Submit to save the
changes.
At your initial login to eServices, you are asked to choose your preferred method for receiving your MFA code.
Select the Use the app button to receive the MFA code via the Google Authenticator app.
Continued >>
CPT codes, descriptors and other data only are copyright 2020 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data
contained therein) is copyright by the American Dental Association. ©2020 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.
4 9/2021
After selecting Use the app, the verification code will appear in your Google Authenticator app. This code will
renew every 30 seconds.
Enter the code in the available field and select the Submit button.
Existing Account
At your next login to eServices, you are asked to choose your preferred method for receiving your MFA code.
You must choose from the text or email options since you haven’t set up the Google Authenticator option yet.
After verification, go to the My Account tab to change your account settings.
From the My Account tab, scroll down until you see the MFA Setup options.
The information entered on this screen will be saved in your profile. Select Authenticator Setup for Google
Authenticator option.
After selecting the Authenticator Setup button, you'll see instructions for installing Google Authenticator. These
steps are based on your device - iPhone or Android:
• iPhone users must access iTunes
• Android users must access Google Play
A successful installation prompts this screen showing your device is now linked. Select Submit to save the
changes.
At your next login to eServices, you are again asked to choose your preferred method for receiving your MFA
code. But not you’ll notice you can also choose to receive your code with the Google Authenticator app.
Select the Use the app button to receive the MFA code via the Google Authenticator app.
After selecting Use the app, the verification code will appear in your Google Authenticator app. This code will
renew every 30 seconds.
Enter the code in the available field and select the Submit button.
CPT codes, descriptors and other data only are copyright 2020 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data
contained therein) is copyright by the American Dental Association. ©2020 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.
5 9/2021
Get Your Railroad Medicare News Electronically
Register now to receive customized daily or weekly emails on the latest Medicare news and Palmetto GBA
features.
How to register to receive Palmetto GBA Railroad Medicare email updates:
Subscribing to our email updates is quick, easy and free! Go to https://tinyurl.com/RailroadMedicareEmailUpdates.
Enter your email address and select the topics you are interested in receiving updates about. Complete the
CAPTCHA equation and submit.
Note: After you click “Submit”, a confirmation email will be sent to your email address. Please use the link
provided in the email to confirm your registration.
eServices Eligibility
eServices, by Palmetto GBA, allows you to search for patient eligibility. The eServices eligibility functions
are based on CMS’ HIPAA Eligibility Transaction System (HETS). See options below:
• Medicare ID Number, Last Name, First Name, Birth Date
• Medicare ID Number, Last Name, Birth Date
• Medicare ID Number, Last Name, First Name
For more information about eServices and the many services it offers, see our eServices User Manual at
http://www.PalmettoGBA.com/eServicesuserguide.
CPT codes, descriptors and other data only are copyright 2020 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data
contained therein) is copyright by the American Dental Association. ©2020 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.
6 9/2021Medicare Learning Network® (MLN)
Want to stay informed about the latest changes to the Medicare Program? Get
connected with the Medicare Learning Network® (MLN) – the home for education,
information, and resources for health care professionals.
The Medicare Learning Network® is a registered trademark of the Centers for
Medicare & Medicaid Services (CMS) and the brand name for official CMS education
and information for health care professionals. It provides educational products on
Medicare-related topics, such as provider enrollment, preventive services, claims
processing, provider compliance, and Medicare payment policies. MLN products are offered in a variety of
formats, including articles, educational tools, booklets, fact sheets, web-based training courses (many of which
offer continuing education credits) – all available to you free of charge!
You can find links to the following resources on the CMS MLN web page at:
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNGenInfo
• Publications & Multimedia
• Events & Training
• News & Updates
• Association Continuing Education Credit
MLN Connects Electronic Mailing List
Subscribe to the MLN Connects weekly email newsletter for all national Fee-for-Service (FFS) program news,
including MLN Matters Article and MLN product updates.
To subscribe to the service:
1. Go to https://public.govdelivery.com/accounts/USCMS/subscriber/new?pop=t&topic_id=USCMS_7819.
Enter you email address and select Submit.
2. Follow the instructions to set up an account and start receiving updates immediately – it’s that easy!
If you would like to contact the MLN, please email CMS at MLN@cms.hhs.gov.
CPT codes, descriptors and other data only are copyright 2020 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data
contained therein) is copyright by the American Dental Association. ©2020 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.
7 9/2021ePass is Now Available in the Railroad Medicare Interactive
Voice Response (IVR) Unit
Provider authentication by Provider Transaction Access Number (PTAN), National Provider Identifier (NPI) and
Tax Identification Number (TIN) is required before the Palmetto GBA Interactive Voice Response (IVR) Unit
is authorized to release Railroad Medicare claim status information, financial information, patient eligibility
information, or to order a copy of a remittance advice.
An “ePass” is an eight-digit code you will be prompted to receive or enter each time you choose the IVR options
for claims, finance, eligibility or duplicate remittance advice. When you choose option 2 to receive an ePass,
you will be assigned an ePass code for the provider’s PTAN/NPI/TIN combination you enter. You can then
enter that ePass in the IVR for the remainder of the day in order to authenticate that provider. This eliminates
the need to repeatedly enter the same PTAN, NPI and TIN into the IVR.
The goal of the ePass is to ease provider burden by eliminating the need to repeatedly authenticate the same
provider each time you contact the IVR in a given day.
We hope this service will be effective and helpful to you. We encourage you to give us feedback about ePass
through our website satisfaction survey. Your input helps us create new tools (like ePass) to make interacting
with Railroad Medicare smooth and easy. To access the survey, access the “Topics” in the drop down menu
at the top of this web page. The last item on the preview says “You Do Make a Difference,” which is the link
to the survey.
We look forward to hearing from you!
CPT codes, descriptors and other data only are copyright 2020 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data
contained therein) is copyright by the American Dental Association. ©2020 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.
8 9/2021CMS Quarterly Provider Update
The Quarterly Provider Update is a comprehensive resource published by the Centers for Medicare & Medicaid
Services (CMS) on the first business day of each quarter. It is a listing of all non-regulatory changes to Medicare
including program memoranda, manual changes and any other instructions that could affect providers.
Regulations and instructions published in the previous quarter are also included in the update. The purpose of
the Quarterly Provider Update is to:
• Inform providers about new developments in the Medicare program
• Assist providers in understanding CMS programs and complying with Medicare regulations and instructions
• Ensure that providers have time to react and prepare for new requirements
• Announce new or changing Medicare requirements on a predictable schedule
• Communicate the specific days that CMS business will be published in the ‘Federal Register’
To receive notification when regulations and program instructions are added throughout the quarter, sign up
for the Quarterly Provider Update listserv (electronic mailing list) at
https://public.govdelivery.com/accounts/USCMS/subscriber/new?pop=t&qsp=566.
We encourage you to bookmark the Quarterly Provider Update Web site at
www.cms.gov/Regulations-and-Guidance/Regulations-and-Policies/QuarterlyProviderUpdates/index and
visit it often for this valuable information.
eServices Extends Administrator Unlock Feature
Beyond 30 Days
Palmetto GBA has implemented new “Disable User” functionality in eServices that will disable a user that has
been inactive for 30 days instead of terminating the User ID. Administrators will now be able to enable the
user up to 120 days after 30 days of inactivity. If the user ID is not enabled within this time, the account will
be terminated. We will send notifi cation to providers through a series of periodic emails (up to the 120-day
limit) to remind the user of their status and provide instructions to re-enable eServices IDs.
In short, provider administrators can now simply unlock users as well as other administrators. This is a signifi
cant change from past guidelines. Previously:
• Provider Administrators and users were required to login at least once every 30 days
• Accounts in which users did not login past 30 days were deactivated/terminated
• If the provider admin did not login, all user accounts associated with the provider admin were also
deactivated/terminated
• This created additional work for administrators as they were required to create new accounts for deactivated/
terminated users
The Provider Contact Center eServices Helpdesk is also able to assist if the provider administrator is unable to
complete this task. Provider Contact Center (PCC) representatives can be reached at 888-355-9165 (Monday
– Friday, 8:30 a.m. to 4:30 p.m. ET for all time zones with the exception of PT, which receives services from
8 a.m. to 4 p.m.). To connect with an eServices representative:
• Press 2 for EDI/eServices, then
• Press 1 for eServices inquiries
CPT codes, descriptors and other data only are copyright 2020 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data
contained therein) is copyright by the American Dental Association. ©2020 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.
9 9/2021Provider Customer Service Center Training
and Closure Dates
The Centers for Medicare & Medicaid Services (CMS) and the Railroad Retirement
Board (RRB) have approved the RRB Specialty Medicare Administrative Contractor
(RRB SMAC) to close up to eight hours per month for provider Customer Service
Advocates (CSAs) training and/or staff development. The goal is to help CSAs
improve the consistency and accuracy of their responses to provider questions;
enhance their awareness and understanding of Medicare policies and issues; and
facilitate CSAs’ retention of the facts of their training by increasing its frequency.
When our CSAs participate in training and developmental sessions on Thursdays
of each month, you may use our online provider portal called eServices. eServices
provides claim status, duplicate remittances, patient eligibility and much more. Register now at
https://www.PalmettoGBA.com/eServices. Please refer to the training schedule below for specific closure
dates and times.
Date Phones Closed
August 26, 2021 PCC closed for training / 2:30 to 4:30 PM ET
September 2, 2021 PCC closed for training / 2:30 to 4:30 PM ET
September 6, 2021 Office closed / Labor Day
September 16, 20201 PCC closed for training / 2:30 to 4:30 PM ET
September 23, 2021 PCC closed for training / 2:30 to 4:30 PM ET
September 30, 2021 PCC closed for training / 2:30 to 4:30 PM ET
November 25, 2021 Office closed / Thanksgiving Day
November 26, 2021 Office closed / Day After Thanksgiving
December 23, 2021 Office closed / Christmas Eve
December 24, 2021 Office closed / Christmas Day
December 31, 2021 Office closed / New Year’s Day
Please note that we will attempt to provide advance notice of any changes to the above training schedule via
the website, IVR features and automatic email notices.
If you have not already done so, we encourage you to sign up for automatic email notices of updates to our
website. Subscribing to the email update is the fastest way to find out about Medicare changes that may affect
you. There is no charge for the service, and we will not share your email address with others. To register, go
to Email Updates at https://www.palmettogba.com/registration.nsf/Push+Mail+Archive+Home?OpenForm.
Continued >>
CPT codes, descriptors and other data only are copyright 2020 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data
contained therein) is copyright by the American Dental Association. ©2020 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.
10 9/2021If you have questions, please call our Provider Contact Center at 888-355-9165 and select Option 5. Customer
Service Advocates are available between the hours of 8:30 a.m. to 4:30 p.m. for all time zones, with the exception
of PT, which receives service from 8 a.m. to 4 p.m. PT. Our eServices portal is available 24/7 with the exception
of claims, remittance, and financial data, which is available from 8 a.m. to 7 p.m. Monday through Friday. You
may access eServices at http://www.PalmettoGBA.com/eServices.
eDelivery Reminder: Are You Getting Your Greenmail?
Palmetto GBA would like to remind providers that you have the option to receive letters electronically
through eServices. Gaining access to these letters is a simple process! To start receiving your Medicare letters,
such as Medical Review Additional Documentation Request (ADR) letters and first level appeal Medicare
Redetermination Notices (MRNs) electronically, you must be signed up for our eServices online provider portal.
Once you have signed into eServices, select the Admin tab, next you can choose your eDelivery preferences.
Just click the drop down box to choose eDelivery of the letters you would like to receive via greenmail. You
can also select “User Email Notification” to start receiving emails when your letters are available in eServices
for you. Selecting this choice is so easy and allows you to receive your letters faster!
Once you have chosen the eDelivery option, all of the letters you selected will come to you electronically, even
if you sent in your request via fax or mail.
Railroad Medicare’s online
“PTAN Lookup and Request Tool”
Providers can now obtain their existing Railroad Medicare Provider Transaction Access Number (PTAN) or
request a new Railroad Medicare PTAN through our “PTAN Lookup and Request Tool” at
https://www.PalmettoGBA.com/RR/PTAN.
Please review the following resources before using the PTAN Tool:
• Using Railroad Medicare’s online “PTAN Lookup and Request Tool”
https://www.palmettogba.com/palmetto/rr.nsf/DID/AK7K447304
• Railroad Medicare PTAN Lookup and Request Tool FAQs
https://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Railroad-Medicare~AXCNMG2662
CPT codes, descriptors and other data only are copyright 2020 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data
contained therein) is copyright by the American Dental Association. ©2020 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.
11 9/2021How Can I Tell if a Patient Has Railroad Medicare?
Railroad Medicare beneficiaries historically have had unique Medicare numbers, which made them easily
distinguishable from Social Security Medicare patients. With today’s Medicare Beneficiary Identifiers (MBIs),
the you can’t tell the difference by the MBI. Instead, the difference lies in the design of the Medicare card.
The Medicare card of a person with Railroad Medicare is unique. The Railroad Retirement Board (RRB) issues
Railroad Medicare cards with the RRB logo in the upper left corner, and ‘Railroad Retirement Board’ at the
bottom, as shown here. Railroad Medicare cards also have a QR code on the front lower right-hand corner of
the cards, while Medicare cards will have a QR code on the back of the card. Make sure to ask your patients for
their new cards and program your system to identify Railroad Medicare patients based on their cards, if possible.
If you verify your patient’s eligibility electronically, CMS will return a message on the eligibility transaction
response for a Fee-For-Service (FFS) Railroad Medicare MBI inquiry that will read “Railroad Retirement
Medicare Beneficiary” in 271 Loop 2110C, Segment MSG.
If you verify a patient’s eligibility using an MBI in the Palmetto GBA eServices online provider portal, the
portal will return the “Railroad Retirement Medicare Beneficiary” message in the Additional Information field
of the Eligibility sub-tab, as shown below.
Continued >>
CPT codes, descriptors and other data only are copyright 2020 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data
contained therein) is copyright by the American Dental Association. ©2020 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.
12 9/2021For more information on the new Medicare cards and using the MBIs, see the following Medicare Learning
Network (MLN) resources:
• MBI website: https://www.cms.gov/Medicare/New-Medicare-Card/index
• MLN SE18006 - New Medicare Beneficiary Identifier (MBI) Get It, Use It: https://tinyurl.com/SE18006
CPT codes, descriptors and other data only are copyright 2020 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data
contained therein) is copyright by the American Dental Association. ©2020 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.
13 9/2021Help Us to Help You: Have Your Provider and Patient
Information Ready When You Call Customer Service
Having the required provider and beneficiary authentication elements available when you call Customer Service
will save you time and help us handle your inquiry more efficiently.
You will be asked for the following information about the provider:
• The provider’s National Provider Identifier (NPI)
• The provider’s Railroad Medicare Provider Transaction Access Number (PTAN)
• The provider’s Tax Identification Number (TIN): last five digits
The Centers for Medicare & Medicaid Services (CMS) requires authentication of these provider elements
whenever a request would involve the disclosure of personally-identifiable information (PII) or protected health
information (PHI). If you are not able to provide the required elements, our Customer Service Advocates may
ask you to obtain the information and call back.
Don’t have your Railroad Medicare PTAN? Providers can use our PTAN Lookup and Request Tool to lookup
their Railroad Medicare PTAN. If you are employed by a clearinghouse or third-party biller, you must contact
the provider to obtain the Railroad Medicare PTAN. See our Using Railroad Medicare’s Online PTAN Lookup
and Request Tool article for details https://www.palmettogba.com/palmetto/rr.nsf/DID/AK7K447304.
You will be asked to provide the following information about the beneficiary:
• The beneficiary’s Medicare Beneficiary Identifier (MBI)
• The beneficiary’s last name
• The beneficiary’s first name or initial, and either
• The claim date(s) of service (for post-claim inquiries, such as reason for denial or rejection) or
• The beneficiary’s date or birth (for pre-claim inquiries, such as entitlement requests/issues)
The CMS requires authentication of these beneficiary elements prior to disclosing PII or PHI about a Medicare
beneficiary to an authenticated provider. All information must match. If you are not able to provide the required
elements, our Customer Service Advocates may ask you to obtain the information and call back.
Don’t have the patient’s MBI? There are three ways you and your office staff can get MBIs:
1. Ask your patient
2. Use the MBI Look-up tool on the Palmetto GBA eServices portal or your local Medicare Administrative
Contractor’s portal
• You can look up MBIs for your Medicare patients when they don’t or can’t give them. You must have
your patient’s first name, last name, date of birth and Social Security Number (SSN) to search. If a patient
doesn’t want to release their SSN to you, the patient will need to provide you with their MBI.
3. Check a remittance advice
• If you previously saw a patient and got a claim payment decision based on a claim submission with a
HICN before January 1, 2020, look at that remittance advice. We returned the MBI on every remittance
advice when a provider submitted a claim with a valid and active HICN from October 1, 2018 through
December 31, 2019.
Resource: MLN SE18006 — New Medicare Beneficiary Identifier (MBI) Get It, Use It at
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/
Downloads/SE18006.pdf
CPT codes, descriptors and other data only are copyright 2020 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data
contained therein) is copyright by the American Dental Association. ©2020 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.
14 9/2021eServices: COVID-19 Transition
In light of the COVID-19 pandemic, organizations are proactively transitioning employees across the health
care industry back into the office.
Palmetto GBA is providing a quick reference eServices guide to assist with common issues you may experi-
ence if you have not logged into your eServices account in the past 30-60 days.
If you are not currently registered to use eServices, we have also included some resources to get you started.
Railroad Medicare:
https://www.palmettogba.com/internet/PCIDN.nsf/R?OpenAgent&DID=BRKJM375&url=yes
CPT codes, descriptors and other data only are copyright 2020 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data
contained therein) is copyright by the American Dental Association. ©2020 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.
15 9/2021Internet Only Manual Updates to Publication (Pub.) 100-
02 to Implement Updates to Policy and Correct Errors and
Omissions (Inpatient Rehabilitation Facility (IRF))
MLN Matters Number: MM12353
Related CR Release Date: August 6, 2021
Related CR Transmittal Number: R10892BP
Related Change Request (CR) Number: 12353
Effective Date: November 8, 2022
Implementation Date: November 8, 2022
Provider Types Affected
This MLN Matters® Article is for IRFs that bill Medicare Administrative Contractors (MACs) for services
they provide to Medicare patients.
Provider Action Needed
This Article tells you about updates to Chapter 1, Section 110 of the Medicare Benefit Policy Manual. These
updates:
• Clarify some existing content related to IRFs
• Correct various omissions and minor technical errors
• Provide information on new, finalized IRF policies
• Explain waivers and flexibilities issued during the public health emergency for COVID-19
Make sure your billing staff is aware of these changes. CR 12353
https://www.cms.gov/files/document/r10892BP.pdf includes the relevant manual content.
Background
CMS bases CR 12353 https://www.cms.gov/files/document/r10892BP.pdf on IRF policies we finalized in the
Fiscal Year (FY) 2021 IRF Prospective Payment System (PPS) final rule (85 FR 48424
https://www.govinfo.gov/content/pkg/FR-2020-08-10/pdf/2020-17209.pdf).
We summarize the key Chapter 1 changes to the manual as follows:
Section 110: Adds clarifying language regarding an IRF patient’s ability to participate actively in a therapy
program upon admission to the IRF. This allows CMS to consider the IRF claim reasonable and necessary.
Section 110.1.1: Adds regulatory citations to the required preadmission screening.
Section 110.1.2: Removes all policy guidance regarding the post-admission physician evaluation.
Section 110.1.3: Adds regulatory citations for the individualized plan of care.
Section 110.1.4: Adds regulatory citations for the require admission orders.
Continued >>
CPT codes, descriptors and other data only are copyright 2020 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data
contained therein) is copyright by the American Dental Association. ©2020 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.
16 9/2021Section 110.1.5: Reminds IRFs that the patient assessment instrument should be in the patient’s medical record
at the IRF.
Sections 110.2 and 110.2.4: Adds CMS requirements for the minimum number of rehabilitation visits to the
patient. It also shows when non-physician practitioners may conduct these visits.
Section 110.2.2: Adds regulatory citations for the intensive level of rehabilitation services.
Section 110.2.6: IRF Waivers and Flexibilities During the Public Health Emergency for the COVID-19
Pandemic: This Section restates the waivers and flexibilities during the COVID-19 Public Health Emergency
(PHE).
More Information
We issued CR 12353 (https://www.cms.gov/files/document/r10892BP.pdf) to your MAC as the official
instruction for this change. The manual revisions are part of the CR, including miscellaneous sections that
aren’t in the above summary.
For more information, contact your MAC http://go.cms.gov/MAC-website-list.
Document History
Date of Change Description
August 9, 2021 Initial article released.
CPT codes, descriptors and other data only are copyright 2020 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data
contained therein) is copyright by the American Dental Association. ©2020 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.
17 9/2021National Coverage Determination (NCD) Removal
MLN Matters Number: MM12254 Revised
Related CR Release Date: August 2, 2021
Related CR Transmittal Number: R10927NCD
Related Change Request (CR) Number: 12254
Effective Date: January 1, 2021
Implementation Date: June 22, 2021; October 4, 2021
Note: We revised this Article to reflect a revised CR 12254. The CR revision didn’t impact the
substance of the Article. We did change the CR release date, transmittal number, and the web
address of the CR. All other information is the same.
Provider Types Affected
This MLN Matters Article is for physicians, providers, and suppliers billing Medicare Administrative Contractors
(MACs) for services provided to Medicare patients.
Provider Action Needed
This Article tells you CMS removed 6 National Coverage Determinations (NCDs) from the Medicare NCD
Manual, Pub. 100-03, as a result of an NCD removal process through rulemaking in the Calendar Year (CY)
2021 Medicare Physician Fee Schedule (85 FR 84472
https://www.govinfo.gov/content/pkg/FR-2020-12-28/pdf/2020-26815.pdf#page=326, December 28, 2020).
Please be sure your billing staffs are aware of these updates.
Background
The final rule https://www.govinfo.gov/content/pkg/FR-2020-12-28/pdf/2020-26815.pdf#page=326 contains a
summary of the NCD removal process and explicitly removes the following 6 NCDs from the NCD Manual:
• NCD 20.5 Extracorporeal Immunoadsorption (ECI) Using Protein A Columns
• NCD 30.4 Electrosleep Therapy
• NCD 100.9 Implantation of Gastrointestinal Reflux Devices
• NCD 110.19 Abarelix for the Treatment of Prostate Cancer
• NCD 220.2.1 Magnetic Resonance Spectroscopy
• NCD 220.6.16 FDG PET for Inflammation and Infection
The final rule https://www.govinfo.gov/content/pkg/FR-2020-12-28/pdf/2020-26815.pdf#page=326 also makes
a non-substantive conforming change to NCD 220.6 Positron Emission Tomography (PET) Scans, which will
be reflected in the NCD Manual.
In the absence of an NCD, the MACs and adjudicators will consider whether any Medicare claims for these
items or services are reasonable and necessary under Section 1862(a)(1)(A) () of
https://www.ssa.gov/OP_Home/ssact/title18/1862.htm the Social Security Act, consistent with the existing
guidance for making such decisions when there isn’t an NCD. Therefore, coverage of the above 6 NCDs revert
to MAC discretion effective for claims with dates of service on and after January 1, 2021.
Continued >>
CPT codes, descriptors and other data only are copyright 2020 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data
contained therein) is copyright by the American Dental Association. ©2020 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.
18 9/2021More Information
We issued CR 12254 https://www.cms.gov/files/document/r10927NCD.pdf to your MAC as the official
instruction for this change.
For more information, contact your MAC http://go.cms.gov/MAC-website-list.
Document History
Date of Change Description
August 3, 2021 We revised this Article to reflect the revised CR 12254. The CR revision didn’t
impact the substance of the Article. We did change the CR release date, transmittal
number, and the web address of the CR. All other information is the same.
July 19, 2021 We revised this Article to reflect the revised CR 12254. The CR revision didn’t
impact the substance of the Article. We did change the CR release date, transmittal
number, and the web address of the CR. All other information is the same.
June 16, 2021 We revised this Article to reflect the revised CR 12254. The CR revision didn’t
impact the substance of the Article. We did change the CR release date, transmittal
number, and the web address of the CR. All other information is the same.
May 24, 2021 Initial article released.
CPT codes, descriptors and other data only are copyright 2020 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data
contained therein) is copyright by the American Dental Association. ©2020 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.
19 9/2021Modifications/Improvements to Value-Based Insurance
Design (VBID) Model – Implementation
MLN Matters Number: MM12349
Related CR Release Date: August 6, 2021
Related CR Transmittal Number: R10894DEMO
Related Change Request (CR) Number: 12349
Effective Date: January 1, 2022
Implementation Date: January 3, 2022
Provider Types Affected
This MLN Matters Article is for hospice care and other providers for services they provide to Medicare patients
who elected hospice and enrolled in Medicare Advantage (MA) plans participating in the voluntary VBID
Model’s Hospice Benefit Component.
Provider Action Needed
This Article tells you about modifications to CR 11754 https://www.cms.gov/files/document/r10170demo.pdf.
That CR is testing the inclusion of the Medicare hospice benefit into MA through the VBID Model (Hospice
Benefit Component) for Calendar Year (CY) 2022. Unless otherwise stated, all requirements in CR 11754
remain the same. CMS will test the Hospice Benefit Component of the Model through 2024.
Background
Through the Hospice Benefit Component, we are testing the impact on payment and service delivery of adding
the Medicare Part A hospice benefit with the goal of creating a seamless care continuity in the MA program for
Part A and Part B services. For Medicare Advantage Organizations (MAOs) that volunteer to be part of the VBID
Model, we will evaluate the impact on cost and quality of care for MA enrollees, including how the Model:
• Improves quality and timely access to the hospice benefit
• Enables innovation through fostering partnerships between MAOs and hospice providers
While participating in this component of the Model, MAOs will incorporate the current Medicare hospice benefit
into MAO-covered benefits. This is in combination with offering palliative care services outside the hospice
benefit for enrollees with serious illness and providing individualized transitional concurrent care services.
Currently, when an enrollee in an MA plan elects hospice, Fee-for-Service (FFS) Medicare is financially
responsible for most services, while the MAO is responsible for certain services (such as supplemental benefits).
Under the Hospice Benefit Component of the VBID Model, participating MAOs retain responsibility for all
Original Medicare services, including hospice care.
Eligibility Check
Beginning CY 2022, here is how to determine if your patient has enrolled in a plan of an MAO that is participating
in the VBID Model Hospice Benefit Component:
STEP ONE: Confirm your patient’s Medicare eligibility and check for MA enrollment using either your normal
process or any of the following online tools or services to check for MA enrollment:
Continued >>
CPT codes, descriptors and other data only are copyright 2020 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data
contained therein) is copyright by the American Dental Association. ©2020 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.
20 9/2021• MAC Portal
• Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS)
• Billing agencies, clearinghouses or software vendors
STEP TWO: If the patient is in an MA plan and the hospice election date is on or after January 1, 2021, identify
the MA contract number and plan benefit package identification information on the MA enrollment card or by
using one of the online tools or services in Step 1.
It will look like this: H#######. For example, H1234-001.
Note: Check the effective and termination dates to ensure the patient’s enrollment in the participating plan is
for 2022.
STEP THREE: Compare the patient’s plan information to the list of plans participating in the Hospice Benefit
Component of the VBID Model
(https://innovation.cms.gov/media/document/vbid-cy2021-hoospice-contact-info-geo). This list will be updated
in Fall 2021 to reflect plans participating in CY 2022. If their plan is part of the Model, follow the directions
for submitting claims (https://innovation.cms.gov/innovation-models/vbid-hospice-benefit-billing-payment).
More Information
We issued CR 12349 (https://www.cms.gov/files/document/r10894DEMO.pdf) to your MAC as the official
instruction for this change.
For more information, contact your MAC http://go.cms.gov/MAC-website-list.
Document History
Date of Change Description
August 9, 2021 Initial article released.
CPT codes, descriptors and other data only are copyright 2020 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data
contained therein) is copyright by the American Dental Association. ©2020 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.
21 9/2021New Waived Tests
MLN Matters Number: MM12381
Related CR Release Date: August 6, 2021
Related CR Transmittal Number: R10897CP
Related Change Request (CR) Number: 12381
Effective Date: October 1, 2021
Implementation Date: October 4, 2021
Provider Types Affected
This MLN Matters Article is for providers billing Medicare Administrative Contractors (MACs) for Clinical
Laboratory Improvement Amendments (CLIA)
https://www.congress.gov/bill/100th-congress/house-bill/5471/text waived laboratory tests they provide to
Medicare patients.
Provider Action Needed
Make sure your billing staff is aware of these changes.
Background
The Clinical Laboratory Improvement Amendments of 1988 (CLIA)
https://www.congress.gov/bill/100th-congress/house-bill/5471/text regulations require a facility to be
appropriately certified for each test it performs. CMS edits laboratory claims at the CLIA certificate level to
make sure that Medicare & Medicaid only pay for laboratory tests categorized as waived complexity under
CLIA in facilities with a CLIA certificate of waiver.
Listed below are the latest tests the FDA approved as waived tests under CLIA. The CPT codes for the following
new tests must have the modifier QW to be recognized as a waived test.
CPT Code Effective Date Description
80305QW October 9, 2020 American Screening LLC Discover Panel Dip Card Tests MOR 2000
80305QW October 9, 2020 American Screening LLC OneScreen Plus Panel Dip Card Tests
MOR300
80305QW October 9, 2020 American Screening LLC OneScreen Plus Panel Dip Card Tests
MOR2000
80305QW October 9, 2020 American Screening LLC Reveal Panel Dip Card Tests MOR300
80305QW May 3, 2021 Lendas UAB EXPLORO Highly Sensitive THC test
80305QW May 5, 2021 Clinical Reference Laboratory CRLStat Multi-Drug Urine Test Cup
More Information
We issued CR 12381 (https://www.cms.gov/files/document/r10897cp.pdf) to your MAC as the official instruction
for this change. We’ve attached the complete list of Tests Granted Waived Status Under CLIA to this CR.
For more information, contact your MAC http://go.cms.gov/MAC-website-list.
Document History
Date of Change Description
August 9, 2021 Initial article released.
CPT codes, descriptors and other data only are copyright 2020 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data
contained therein) is copyright by the American Dental Association. ©2020 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.
22 9/2021National Coverage Determination (NCD 110.24): Chimeric
Antigen Receptor (CAR) T-cell Therapy - This CR Rescinds
and Fully Replaces CR 11783
MLN Matters Number: MM12177 Revised
Related CR Release Date: July 20, 2021
Related CR Transmittal Number: R10891CP and R10891NCD
Related Change Request (CR) Number: 12177
Effective Date: August 7, 2019
Implementation Date: September 20, 2021
Note: We revised the Article to reflect a revised CR that added CPT code C9076 (Breyanzi). You’ll
find the substantive content update in dark red font on page 3. We also revised the implementation date.
We revised the CR release date, transmittal number, and the web address of the transmittal. All other
information is the same.
Provider Types Affected
This MLN Matters Article is for physicians, hospitals, other providers, and suppliers billing Medicare
Administrative Contractors (MACs) for Chimeric Antigen Receptor (CAR) T-cell Therapy services provided
to Medicare patients.
What You Need to Know
This Article tells you that, effective for claims with dates of service on or after August 7, 2019, CMS covers
autologous treatment for cancer with T-cells expressing at least 1 CAR when administered at healthcare facilities:
Enrolled in the FDA Risk Evaluation and Mitigation Strategies (REMS)
Meets specified CMS/FDA criteria
Background
We reviewed the evidence for CAR T-cell therapy in patients with cancer and will cover FDA-approved CAR
T-cell therapy under the conditions specified in Publication 100-03, National Coverage Determination (NCD)
Manual, Section 110.24
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/ncd103c1_Part2.pdf.
Coverage and Diagnosis Requirements:
Effective for claims with dates of service on or after August 7, 2019, we cover autologous treatment for cancer
with T-cells expressing at least 1 CAR when administered at healthcare facilities enrolled in the FDA REMS
and used for a medically accepted indication as defined at Social Security Act, Section 1861(t)(2)
https://www.ssa.gov/OP_Home/ssact/title18/1861.htm (used for either an FDA-approved indication (according
to the FDA-approved label for that product)), or for other uses when the product has been FDA-approved and
the use is supported in 1 or more CMS-approved compendia.
The use of non-FDA-approved autologous T-cells expressing at least 1 CAR is non-covered. Autologous
treatment for cancer with T-cells expressing at least 1 CAR is non-covered when the requirements noted above
Continued >>
CPT codes, descriptors and other data only are copyright 2020 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data
contained therein) is copyright by the American Dental Association. ©2020 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.
23 9/2021aren’t met. The use of allogenic T-cells from healthy donors aren’t autologous CAR-T treatments and you
shouldn’t bill those as autologous CAR-T treatments.
We will cover routine costs in clinical trials that use CAR T-cell therapy as an investigational agent that meet
the requirements listed in NCD 310.1 effective August 7, 2019.
See the following websites for specific REMS facility information:
• Kymriah® https://www.us.kymriah.com/treatment-center-locator
• Yescarta® https://www.yescarta.com/find-a-treatment-center
• Tecartus™ https://www.tecartus.com/hcp/treatment-center-locator
• Breyanzi® https://www.breyanzihcp.com/treatment-centers
• ABECMA® https://www.abecmahcp.com/treatment-centers
The following are the applicable ICD-10-PCS procedure codes for CAR T-cell therapy coverage for
inpatient claims:
• XW033C3: Introduction of Engineered Autologous Chimeric Antigen Receptor T-cell Immunotherapy into
Peripheral Vein, Percutaneous Approach, New Technology Group 3
• XW043C3: Introduction of Engineered Autologous Chimeric Antigen Receptor T-cell Immunotherapy into
Central Vein, Percutaneous Approach, New Technology Group 3
• XW23346: Transfusion of Brexucabtagene Autoleucel Immunotherapy into Peripheral Vein, Percutaneous
Approach, New Technology Group 6
• XW24346: Transfusion of Brexucabtagene Autoleucel Immunotherapy into Central Vein, Percutaneous
Approach, New Technology Group 6
• XW23376 – Transfusion of lisocabtagene maraleucel immunotherapy into peripheral vein, percutaneous
approach, new technology group 6
• XW24376 – Transfusion of lisocabtagene maraleucel immunotherapy into central vein, percutaneous
approach, new technology 6
See Attachment 1 of the Transmittal R10796CP https://www.cms.gov/files/document/r10891CP.pdf#page=13
for a list of the primary ICD-10 diagnosis codes.
Payment Information for hospitals:
Inpatient
Billing requirements will allow for CAR T-cell therapy when you bill the services on Type of Bill (TOB) 11X.
Outpatient
We will pay for CAR T-cell therapy when you bill the services on TOBs 12X, 13X, or 85X. Type of facility
and setting determines the basis of payment. HOPDs may report CPT codes 0537T, 0538T, and 0539T to allow
tracking of these services furnished in the outpatient setting. Medicare will reject these lines as Medicare doesn’t
separately pay for these services under the OPPS.
Note: When the cells are collected in the physician office setting and the CAR-T is administered in the hospital
inpatient setting, inpatient providers should report the date that the CAR-T administration took place and not
the date the cells were collected.
Continued >>
CPT codes, descriptors and other data only are copyright 2020 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data
contained therein) is copyright by the American Dental Association. ©2020 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.
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