05-24023. Medicare and Medicaid Programs; Quarterly Listing of Program Issuances-July Through September 2005  

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    AGENCY:

    Centers for Medicare & Medicaid Services (CMS), HHS.

    ACTION:

    Notice.

    SUMMARY:

    This notice lists CMS manual instructions, substantive and interpretive regulations, and other Federal Register notices that were published from July 2005 through September 2005, relating to the Medicare and Medicaid programs. This notice provides information on national coverage determinations (NCDs) affecting specific medical and health care services under Medicare. Additionally, this notice identifies certain devices with investigational device exemption (IDE) numbers approved by the Food and Drug Administration (FDA) that potentially may be covered under Medicare. This notice also includes listings of all approval numbers from the Office of Management and Budget for collections of information in CMS regulations. Finally, this notice includes a list of Medicare-approved carotid stent facilities.

    Section 1871(c) of the Social Security Act requires that we publish a list of Medicare issuances in the Federal Register at least every 3 months. Although we are not mandated to do so by statute, for the sake of completeness of the listing, and to foster more open and transparent collaboration efforts, we are also including all Medicaid issuances and Medicare and Medicaid substantive and interpretive regulations (proposed and final) published during this 3-month time frame.

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    FOR FURTHER INFORMATION CONTACT:

    It is possible that an interested party may have a specific information need and not be able to determine from the listed information whether the issuance or regulation would fulfill that need. Consequently, we are providing information contact persons to answer general questions concerning these items. Copies are not available through the contact persons. (See Section III of this notice for how to obtain listed material.)

    Questions concerning items in Addendum III may be addressed to Timothy Jennings, Office of Strategic Operations and Regulatory Affairs, Centers for Medicare & Medicaid Services, C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-2134.

    Questions concerning Medicare NCDs in Addendum V may be addressed to Patricia Brocato-Simons, Office of Clinical Standards and Quality, Centers for Medicare & Medicaid Services, C1-09-06, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-0261.

    Questions concerning FDA-approved Category B IDE numbers listed in Addendum VI may be addressed to John Manlove, Office of Clinical Standards and Quality, Centers for Medicare & Medicaid Services, C1-13-04, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-6877.

    Questions concerning approval numbers for collections of information in Addendum VII may be addressed to Bonnie Harkless, Office of Strategic Operations and Regulatory Affairs, Regulations Development and Issuances Group, Centers for Medicare & Medicaid Services, C5-14-03, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-5666.

    Questions concerning Medicare-approved carotid stent facilities may be addressed to Sarah J. McClain, Office of Clinical Standards and Quality, Centers for Medicare & Medicaid Services, C1-09-06, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-2994.

    Questions concerning all other information may be addressed to Gwendolyn Johnson, Office of Strategic Operations and Regulatory Affairs, Regulations Development Group, Centers for Medicare & Medicaid Services, C5-14-03, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-6954.

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    SUPPLEMENTARY INFORMATION:

    I. Program Issuances

    The Centers for Medicare & Medicaid Services (CMS) is responsible for administering the Medicare and Medicaid programs. These programs pay for health care and related services for 39 million Medicare beneficiaries and 35 million Medicaid recipients. Administration of the two programs involves (1) furnishing information to Medicare beneficiaries and Medicaid recipients, health care providers, and the public and (2) maintaining effective communications with regional offices, State governments, State Medicaid agencies, State survey agencies, various providers of health care, all Medicare contractors that process claims and pay bills, and others. To implement the various statutes on which the programs are based, we issue regulations under the authority granted to the Secretary of the Department of Health and Human Services under sections 1102, 1871, 1902, and related provisions of the Social Security Act (the Act). We also issue various manuals, memoranda, and statements necessary to administer the programs efficiently.

    Section 1871(c)(1) of the Act requires that we publish a list of all Medicare manual instructions, interpretive rules, statements of policy, and guidelines of general applicability not issued as regulations at least every 3 months in the Federal Register. We published our first notice June 9, 1988 (53 FR 21730). Although we are not mandated to do so by statute, for the sake of completeness of the listing of operational and policy statements, and to foster more open and transparent collaboration, we are continuing our practice of including Medicare substantive and interpretive regulations (proposed and final) published during the respective 3-month time frame.

    II. How To Use the Addenda

    This notice is organized so that a reader may review the subjects of manual issuances, memoranda, substantive and interpretive regulations, NCDs, and FDA-approved IDEs published during the subject quarter to determine whether any are of particular interest. We expect this notice to be used in concert with previously published notices. Those unfamiliar with a description of our Medicare manuals may wish to review Table I of our first three notices (53 FR 21730, 53 FR 36891, and 53 FR 50577) published in 1988, and the notice published March 31, 1993 (58 FR 16837). Those desiring information on the Medicare NCD Manual (NCDM, formerly the Medicare Start Printed Page 76291Coverage Issues Manual (CIM)) may wish to review the August 21, 1989, publication (54 FR 34555). Those interested in the revised process used in making NCDs under the Medicare program may review the September 26, 2003, publication (68 FR 55634).

    To aid the reader, we have organized and divided this current listing into eight addenda:

    • Addendum I lists the publication dates of the most recent quarterly listings of program issuances.
    • Addendum II identifies previous Federal Register documents that contain a description of all previously published CMS Medicare and Medicaid manuals and memoranda.
    • Addendum III lists a unique CMS transmittal number for each instruction in our manuals or Program Memoranda and its subject matter. A transmittal may consist of a single or multiple instruction(s). Often, it is necessary to use information in a transmittal in conjunction with information currently in the manuals.
    • Addendum IV lists all substantive and interpretive Medicare and Medicaid regulations and general notices published in the Federal Register during the quarter covered by this notice. For each item, we list the—

    ○ Date published;

    Federal Register citation;

    ○ Parts of the Code of Federal Regulations (CFR) that have changed (if applicable);

    ○ Agency file code number; and

    ○ Title of the regulation.

    • Addendum V includes completed NCDs, or reconsiderations of completed NCDs, from the quarter covered by this notice. Completed decisions are identified by the section of the NCDM in which the decision appears, the title, the date the publication was issued, and the effective date of the decision.
    • Addendum VI includes listings of the FDA-approved IDE categorizations, using the IDE numbers the FDA assigns. The listings are organized according to the categories to which the device numbers are assigned (that is, Category A or Category B), and identified by the IDE number.
    • Addendum VII includes listings of all approval numbers from the Office of Management and Budget (OMB) for collections of information in CMS regulations in title 42; title 45, subchapter C; and title 20 of the CFR.
    • Addendum VIII includes listings of Medicare-approved carotid stent facilities. All facilities listed meet CMS standards for performing carotid artery stenting for high risk patients.

    III. How To Obtain Listed Material

    A. Manuals

    Those wishing to subscribe to program manuals should contact either the Government Printing Office (GPO) or the National Technical Information Service (NTIS) at the following addresses: Superintendent of Documents, Government Printing Office, ATTN: New Orders, P.O. Box 371954, Pittsburgh, PA 15250-7954, Telephone (202) 512-1800, Fax number (202) 512-2250 (for credit card orders); or National Technical Information Service, Department of Commerce, 5825 Port Royal Road, Springfield, VA 22161, Telephone (703) 487-4630.

    In addition, individual manual transmittals and Program Memoranda listed in this notice can be purchased from NTIS. Interested parties should identify the transmittal(s) they want. GPO or NTIS can give complete details on how to obtain the publications they sell. Additionally, most manuals are available at the following Internet address: http://cms.hhs.gov/​manuals/​default.asp.

    B. Regulations and Notices

    Regulations and notices are published in the daily Federal Register. Interested individuals may purchase individual copies or subscribe to the Federal Register by contacting the GPO at the address given above. When ordering individual copies, it is necessary to cite either the date of publication or the volume number and page number.

    The Federal Register is also available on 24x microfiche and as an online database through GPO Access. The online database is updated by 6 a.m. each day the Federal Register is published. The database includes both text and graphics from Volume 59, Number 1 (January 2, 1994) forward. Free public access is available on a Wide Area Information Server (WAIS) through the Internet and via asynchronous dial-in. Internet users can access the database by using the World Wide Web; the Superintendent of Documents home page address is http://www.gpoaccess.gov/​fr/​index.html, by using local WAIS client software, or by telnet to swais.gpoaccess.gov, then log in as guest (no password required). Dial-in users should use communications software and modem to call (202) 512-1661; type swais, then log in as guest (no password required).

    C. Rulings

    We publish rulings on an infrequent basis. Interested individuals can obtain copies from the nearest CMS Regional Office or review them at the nearest regional depository library. We have, on occasion, published rulings in the Federal Register. Rulings, beginning with those released in 1995, are available online, through the CMS Home Page. The Internet address is http://cms.hhs.gov/​rulings.

    D. CMS' Compact Disk-Read Only Memory (CD-ROM)

    Our laws, regulations, and manuals are also available on CD-ROM and may be purchased from GPO or NTIS on a subscription or single copy basis. The Superintendent of Documents list ID is HCLRM, and the stock number is 717-139-00000-3. The following material is on the CD-ROM disk:

    • Titles XI, XVIII, and XIX of the Act.
    • CMS-related regulations.
    • CMS manuals and monthly revisions.
    • CMS program memoranda.

    The titles of the Compilation of the Social Security Laws are current as of January 1, 2003. (Updated titles of the Social Security Laws are available on the Internet at http://www.ssa.gov/​OP_​Home/​ssact/​comp-toc.htm.) The remaining portions of CD-ROM are updated on a monthly basis.

    Because of complaints about the unreadability of the Appendices (Interpretive Guidelines) in the State Operations Manual (SOM), as of March 1995, we deleted these appendices from CD-ROM. We intend to re-visit this issue in the near future and, with the aid of newer technology, we may again be able to include the appendices on CD-ROM.

    Any cost report forms incorporated in the manuals are included on the CD-ROM disk as LOTUS files. LOTUS software is needed to view the reports once the files have been copied to a personal computer disk.

    IV. How To Review Listed Material

    Transmittals or Program Memoranda can be reviewed at a local Federal Depository Library (FDL). Under the FDL program, government publications are sent to approximately 1,400 designated libraries throughout the United States. Some FDLs may have arrangements to transfer material to a local library not designated as an FDL. Contact any library to locate the nearest FDL.

    In addition, individuals may contact regional depository libraries that receive and retain at least one copy of most Federal Government publications, either in printed or microfilm form, for use by the general public. These libraries provide reference services and interlibrary loans; however, they are not Start Printed Page 76292sales outlets. Individuals may obtain information about the location of the nearest regional depository library from any library. For each CMS publication listed in Addendum III, CMS publication and transmittal numbers are shown. To help FDLs locate the materials, use the CMS publication and transmittal numbers. For example, to find the Medicare NCD publication titled “Cochlear Implantation,” use CMS—Pub. 100-03, Transmittal No. 42.

    (Catalog of Federal Domestic Assistance Program No. 93.773, Medicare—Hospital Insurance, Program No. 93.774, Medicare—Supplementary Medical Insurance Program, and Program No. 93.714, Medical Assistance Program)

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    Dated: December 7, 2005.

    Jacquelyn Y. White,

    Director, Office of Strategic Operations and Regulatory Affairs.

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    Addendum I

    This addendum lists the publication dates of the most recent quarterly listings of program issuances.

    June 27, 2003 (68 FR 38359)

    September 26, 2003 (68 FR 55618)

    December 24, 2003 (68 FR 74590)

    March 26, 2004 (69 FR 15837)

    June 25, 2004 (69 FR 35634)

    September 24, 2004 (69 FR 57312)

    December 30, 2004 (69 FR 78428)

    February 25, 2005 (70 FR 9338)

    June 24, 2005 (70 FR 36620)

    September 23, 2005 (70 FR 55863)

    Addendum II—Description of Manuals, Memoranda, and CMS Rulings

    An extensive descriptive listing of Medicare manuals and memoranda was published on June 9, 1988, at 53 FR 21730 and supplemented on September 22, 1988, at 53 FR 36891 and December 16, 1988, at 53 FR 50577. Also, a complete description of the former CIM (now the NCDM) was published on August 21, 1989, at 54 FR 34555. A brief description of the various Medicaid manuals and memoranda that we maintain was published on October 16, 1992, at 57 FR 47468.

    Addendum III.—Medicare and Medicaid Manual Instructions

    [July through September 2005]

    Transmittal No.Manual/Subject/Publication No.
    Medicare General Information
    (CMS—Pub. 100-01)
    25Next Generation Desktop Testing Requirements Definitions
    Next Generation Desktop Maintainer Requirements
    26Implement New Medicare Plan ID and Carrier Number for the Single Testing Contractor
    Shared System Testing Requirements for Maintainers, Beta Testers, and Contractors
    27Provider Extract File
    28Conforming Changes for Change Request 3648 to Pub. 100-01
    Hospital Insurance (Part A) for Inpatient Hospital, Hospice, and Skilled Nursing Facility Services—A Brief Description Home Health Services
    Supplementary Medical Insurance (Part B)—A Brief Description
    Discrimination Prohibited
    Role of Part A Intermediaries
    Limitation on Physical Therapy, Occupational Therapy and Speech-Language Pathology Services
    Certification for Hospital Services Covered by the Supplementary Medical Insurance Program
    Content of the Physician's Certification
    Recertifications for Home Health Services
    Physician's Certification and Recertification for Outpatient Physical Therapy Occupational Therapy and Speech-Language Pathology Recertification
    Under Arrangements
    Term of Agreements
    Determining Payment for Services Furnished After Termination, Expiration, or Cancellation
    Home Health Agency Defined
    292005 Scheduled Release for October Updates to Software Programs and Pricing/Coding Files
    Medicare Benefit Policy
    (CMS—Pub. 100-02)
    37Conforming Changes for Change Request 3648 to Pub. 100-02
    Medical and Other Health Services Furnished to Inpatients of Participating Hospitals Outpatient Hospital Services
    Distinguishing Outpatient Hospital Services Provided Outside the Hospital Coverage of Outpatient Therapeutic Services
    Medical and Other Health Services Furnished by Home Health Agencies Skilled Services Defined
    Speech-Language Pathology
    Physical Therapy, Speech-Language Pathology, and Occupational Therapy Furnished by the Skilled Nursing Facility or by Others Under Arrangements With the Facility and Under Its Supervision
    Inpatient Physical Therapy, Occupational Therapy, and Speech-Language Pathology Services
    Services Furnished Under Arrangements With Providers
    Supplementary Medical Insurance Provisions
    Services Not Provided Within United States
    Medicare National Coverage Determinations
    (CMS—Pub. 100-03)
    42Cochlear Implantation
    Cochlear Implantation (Effective April 4, 2005)
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    Medicare Claims Processing
    (CMS—Pub. 100-04)
    601Cochlear Implantation
    Billing Requirements for Expanded Coverage of Cochlear Implantation
    Intermediary Billing Procedures
    Applicable Bill Types
    Special Billing Requirements for Intermediaries
    Intermediary Payment Requirements
    Carrier Billing Procedures
    Healthcare Common Procedure Coding System
    602Expansion of Various Alpha and Numeric Fields Within the Outpatient Prospective Payment System Outpatient Code Editor
    603Modification to the Appeals Language on the Medicare Summary Notice; Full Replacement of Change Request 3808
    Appeals Section
    Back of Medicare Summary Notice—Carriers and Intermediaries Carrier Spanish Medicare Summary Notices Back Intermediary Spanish Medicare Summary Notices Back
    604Issued to a specific audience, not posted to Internet/Intranet due to Confidentiality of Instruction
    605Frequency Instructions for Smoking and Tobacco-Use Cessation Counseling Services
    Remittance Advice Notices
    Medicare Summary Notices
    606Medicare Program-Update to the Hospice Payment Rates, Hospice Cap, Hospice Wage Index, and the Hospice Pricer for FY 2005
    Payment Rates
    607Issued to a specific audience, not posted to Internet/Intranet due to Confidentiality of Instruction
    608New Health Professional Shortage Area Modifier
    Zip Code Files
    Provider Education
    Claims Coding Requirements
    Services Eligible for Health Professional Shortage Area and Physician Scarcity Bonus Payments
    Post-payment Review
    Health Professional Shortage Area Incentive Payments for Physician Services Rendered in a Critical Access Hospital
    609Remittance Advice Remark Code and Claim Adjustment Reason Code Update
    610This Transmittal is rescinded and replaced by Transmittal 634
    611Payment Methodology for Rehabilitation Services in Indian Health Service/Tribally Owned and/or Operated Hospitals and Hospital Based Facilities
    Services Paid Under the Physician Fee Schedule
    612Abarelix for Treatment of Prostate Cancer
    613New Healthcare Common Procedure Coding System Codes and Systems Edits for Supplies and Accessories for Ventricular Assist Devices—Full Replacement of CR 3761
    614Medicare Physician Fee Schedule Database 2006 File Layout
    615Revision of Chapter 24, Electronic Data Interchange Support Requirements
    Electronic Data Interchange General Outreach Activities Carrier, Durable Medical Equipment Regional Carrier, and Fiscal Intermediary Analysis of Internal Information
    Systems Information
    Review of Provider Profiles
    Contact with New Providers
    Production and Distribution of Material to Increase Use of Electronic Data Interchange
    Electronic Data Interchange Enrollment
    New Enrollments and Maintenance of Existing Enrollments
    Submitter Number
    Release of Medicare Eligibility Data
    Network Service Vendor Agreement
    Electronic Data Interchange User Guidelines
    Directory of Billing Software Vendors and Clearinghouses
    Technical Requirements—Data, Media, and Telecommunications System Availability
    Media
    Telecommunications and Transmission Protocols
    Toll-Free Service
    Initial Editing
    Translators
    Required Electronic Data Interchange Formats
    General Health Insurance Portability and Accountability Act Electronic Data Interchange Requirements
    Continued Support of Pre-Health Insurance Portability and Accountability Act
    Electronic Data Interchange Formats
    National Council for Prescription Drug Program Claim Requirements
    Crossover Claim Requirements
    Direct Data Entry Screens
    Use of Imaging, External Key Shop, and In-House Keying for Entry of Transaction Data Submitted on Paper
    Electronic Funds Transfer
    Electronic Data Interchange Testing Requirements
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    Shared System and Common Working File Maintainers Internal Testing Requirements
    Carrier, Durable Medical Equipment Regional Carrier, and Intermediary Internal Testing Requirements
    Third-Party Certification Systems and Services
    Electronic Data Interchange Submitter/Receiver Testing by Carriers, Durable Medical Equipment Regional Carriers, and Fiscal Intermediaries
    Testing Accuracy
    Limitation on Testing of Multiple Providers That Use the Same Clearinghouse, Billing Service, or Vendor Software
    Carrier, Durable Medical Equipment Regional Carrier, and Fiscal Intermediary Submitter/Receiver Testing With Legacy Formats During the Health Insurance Portability and Accountability Act Contingency Period
    Discontinuation of Use of Claim Legacy Formats following Successful Health Insurance Portability and Accountability Act Format Testing
    Electronic Data Interchange Receiver Testing by Carriers, Durable Medical Equipment Regional Carriers, and Intermediaries
    Changes in Provider's System or Vendor's Software, and Use of Additional Electronic Data Interchange Formats
    Support of Electronic Data Interchange Trading Partners
    User Guidelines
    Technical Assistance to Electronic Data Interchange Trading Partners
    Training Content and Frequency
    Prohibition Against Requiring Use of Proprietary Software or Direct Data Entry
    Free Claim Submission Software
    Remittance Advice Print Software
    Medicare Remit Easy Print Software for Carrier and Durable Medical Equipment Regional Carrier Provider Use
    Medicare Standard Fiscal Intermediary PC-Print Software
    Newsletters/Bulletin Board/Internet Publication of Electronic Data Interchange Information
    Provider Guidelines for Choosing a Vendor
    Determining Goals/Requirements
    Vendor Selection
    Negotiating With Vendors
    Electronic Data Interchange Edit Requirements
    Carrier, Durable Medical Equipment Regional Carrier, and Fiscal Intermediary X12 Edit Requirements
    Supplemental Fiscal Intermediary-Specific Shared System Edit Requirements
    Fiscal Intermediary Health Insurance and Portability Accountability Act Claim
    Level Implementation Guide Edits
    Supplemental Carrier/Durable Medical Equipment Regional Carrier-Specific Shared System Implementation Guide Edit Requirements
    Keyshop and Image Processing
    Carrier, Durable Medical Equipment Regional Carrier, or Fiscal Intermediary Data Security and Confidentiality Requirements
    Carrier, Durable Medical Equipment Regional Carrier, and Fiscal Intermediary Electronic Data Interchange Audit Trails
    Security-Related Requirements for Carrier, Durable Medical Equipment
    Regional Carrier, or Fiscal Intermediary Arrangements with Clearinghouses And Billing Services
    Mandatory Electronic Submission of Medicare Claims
    Small Providers and Full-Time Equivalent Employee Self-Assessments
    Exceptions
    Unusual Circumstance Waivers
    Unusual Circumstance Waivers Subject to Provider Self-Assessment
    Unusual Circumstance Waivers Subject to Medicare Contractor Approval
    Unusual Circumstance Waivers Subject to Contractor Evaluation and CMS Decision
    Electronic and Paper Claims Implications of Mandatory Electronic Submission Enforcement
    Provider Education
    616Certified Registered Nurse Anesthetist Pass-Through Payments
    Anesthesia and Certified Registered Nurse Anesthetist Services in a Critical Access Hospitals
    Payment for Certified Registered Nurse Anesthetist Pass-Through Services
    Payment for Anesthesia Services by a Certified Registered Nurse Anesthetist (Method II Critical Access Hospital Only)
    617Administration of Drugs and Biologicals in a Method II Critical Access Hospital
    Coding for Administering Drugs in a Method II Critical Access Hospital
    Coding for Low Osmolar Contrast Material
    618Coding for the Administration of Other Drugs and Biologicals
    Clarification for Carriers and Durable Medical Equipment Regional Carriers About Correction and Recoupment of Previously Processed Claims
    619Late IRF-PAI Data Submission Penalty Protocol Within the Inpatient Rehabilitation Facility Prospective Payment System
    Payment Adjustment for Late Transmission of Patient Assessment Data
    620New Fiscal Intermediary (FI) Edit to Identify Potentially Excessive Medicare Payments
    Fiscal Intermediary Edits Affecting Multiple Bill Types
    Threshold Edit for Outpatient and Inpatient Part B Claims
    621Locality Codes for Purchased Diagnostic Tests
    622This Transmittal is rescinded and replaced by Transmittal 668
    623Durable Medical Equipment Regional Carrier Only—Corrections to the Billing Indicator Field for Adjusted Claims
    624This Transmittal is rescinded and replaced by Transmittal 686
    625Competitive Acquisition Program for Part B Drugs—Coding, Testing, and Implementation
    626Common Working File Expansion of Duplicate Claim Edit for Clinical Diagnostic Services
    627New Low Osmolar Contrast Material (LOCM) HCPCS Codes/Payment Criteria/Payment Level
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    Low Osmolar Contrast Media (HCPCS Codes Q9945-Q9951)
    Payment Criteria/Payment Level
    628Radiopharmaceutical Diagnostic Imaging Agents Codes Applicable to Positron Emission Tomography Scan Services Performed on or After January 28, 2005
    Appropriate Common Procedure Terminology Codes Effective for Positron Emission Tomography Scan Services Performed on or After January 28, 2005
    Tracer Codes Required for Positron Emission Tomography Scans
    629Certificate of Medical Necessity Claim Edits Workload Reporting
    Durable Medical Equipment Regional Carrier Systems
    630Medicare Part A Skilled Nursing Facility Prospective Payment System Pricer
    Update and Health Insurance Prospective Payment System Coding Update Effective January 1, 2006
    Health Insurance Prospective Payment System Rate Code
    Skilled Nursing Facility Prospective Payment System Rate Components
    Decision Logic Used by the Pricer on Claims
    631Claim Status Category Code and Claim Status Code Update
    632Billing and Claims Processing Instructions for Claims Subject to Expedited Determinations
    Limitation of Liability Notification and Coordination With Quality
    Improvement Organizations
    Limitation on Liability—Overview
    Hospital Claims Subject to Hospital Issued Notices of Noncoverage
    Scope of Issuance of Hospital Issued Notices of Noncoverage
    General Responsibilities of Quality Improvement Organizations and Fiscal Intermediaries Related to Hospital Issued Notices of Noncoverage
    Billing and Claims Processing Requirements Related to Hospital Issued Notices of Noncoverage
    Skilled Nursing Facility, Home Health Agency, Hospice, and Comprehensive Outpatient Rehabilitation Facility Claims Subject to Expedited Determinations
    Scope of Issuance of Expedited Determination Notices
    General Responsibilities of Quality Improvement Organizations and Fiscal Intermediaries Related to Expedited Determinations
    Billing and Claims Processing Requirements Related to Expedited Determinations
    Coordination With the Quality Improvement Organization
    633Guidelines for Payment of Vaccines (Pneumococcal Pneumonia Virus, Influenza Virus, and Hepatitis B Virus) and Their Administration Provided by Indian Health Service/Tribally-Owned and/or Operated Hospitals and Hospital Based Facilities
    Billing Requirements
    Bills Submitted to Fiscal Intermediaries
    Vaccines and Vaccine Administration
    634Guidelines for Payment of Vaccines (Pneumococcal Pneumonia Virus, Influenza Virus, and Hepatitis B Virus) and Their Administration at Renal Dialysis Facilities
    Vaccines Furnished to End-Stage Renal Disease Patients
    Fiscal Intermediary Payment for Pneumococcal Pneumonia, Influenza Virus, and Hepatitis B Vaccine
    Bills Submitted by Hospices and Payment for Renal Dialysis Facilities
    635Financial Liability for Services Subject to Home Health Consolidated Billing
    Home Health Prospective Payment System Consolidated Billing and Primary
    Home Health Agencies
    Home Health Prospective Payment System Consolidated Billing Beneficiary Notification and Payment Liability Under Home Health Consolidated Billing
    Responsibilities of Home Health Agencies
    Responsibilities of Providers/Suppliers of Services Subject to Consolidated Billing
    Responsibilities of Hospitals Discharging Medicare Beneficiaries to Home Health Care
    Home Health Consolidated Billing Edits in Medicare Systems
    Non-routine Supply Editing
    Therapy Editing
    Other Editing Related to Home Health Consolidated Billing
    Only Request for Anticipated Payment Received and Services Fall Within 60 Days After Request for Anticipated Payment Start Date
    No Request for Anticipated Payment Received and Therapy Services Rendered in the Home
    Health Insurance Eligibility Query to Determine Episode Status
    Other Editing and Changes for Home Health Prospective Payment System Episodes
    Coordination of Home Health Prospective Payment System Claims and Episodes With Inpatient Claim Types
    636Instructions for Implementation of CMS Ruling 05-01; Presbyopia-Correcting Intraocular Lens
    637Issued to a specific audience, not posted to Internet/Intranet due to Confidentiality of Instruction
    638New Medicare Summary Notice Messages
    Adjustments
    Ajustes
    639Cessation of Additional $50 Payment for New Technology Intraocular Lenses
    Ambulatory Surgical Center Services on Ambulatory Surgical Center List
    Payment for Intraocular Lens
    640Medicare Part A Skilled Nursing Facility Prospective Payment System Pricer Update FY 2006
    641October 2005 Quarterly Update to Skilled Nursing Facility Consolidated Billing
    642New Waived Tests
    643Nature and Effect of Assignment on Carrier Claims
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    644October 2005 Non-Outpatient Prospective Payment System Code Editor Specifications Version 21
    645Issued to a specific audience, not posted to Internet/Intranet due to Confidentiality of Instruction
    646Update to the Inpatient Provider Specific File and the Outpatient Provider
    Specific File to Retain Provider Information
    647The Supplemental Security Income/Medicare Beneficiary Data for Fiscal Year 2004 for Inpatient Prospective Payment System Hospitals
    648Issued to a specific audience, not posted to Internet/Intranet due to Confidentiality of Instruction
    649Competitive Acquisition Program for Part B Drugs—Coding, Testing, and Implementation
    650This Transmittal is rescinded and replaced by Transmittal 673
    651Changes to the Laboratory National Coverage Determination Edit Software for October 2005
    652This Transmittal is rescinded and replaced by Transmittal 661
    653October 2005 Quarterly Average Sales Price Medicare Part B Drug Pricing File, Effective October 1, 2005 and Revisions to April 2005 and July 2005 Quarterly Average Sale Price Medicare Part B Drug Pricing File
    654Services Not Provided Within the United States
    Services Received by Medicare Beneficiaries Outside the United States Source of Part B Claims
    Appeals of Denied Charges for Physicians and Ambulance Services in Connection With Foreign Hospitalization
    Services Rendered in Nonparticipating Providers
    Coverage Requirements for Emergency Hospital Services in Foreign Countries
    Services Furnished in a Foreign Hospital Nearest to Beneficiary's U.S. Residence
    Coverage of Physician and Ambulance Services Furnished Outside U.S.
    Payment by the Railroad Retirement Beneficiaries for Services Furnished in Canada to Qualified Railroad Retirement Beneficiaries
    Foreign Religious Nonmedical Health Care Facility Claims
    Elections to Bill for Services Rendered at Nonparticipating Hospitals
    Processing Claims
    Appeals on Claims for Emergency and Foreign Services
    Payment for Services from Foreign Hospitals
    Full Denial—Foreign Claim—Beneficiary Filed
    655This Transmittal is rescinded and replaced by Transmittal 663
    656Full Replacement of Change Request 3607, Payment Edits in Applicable States For Durable Medical Equipment Prosthetics, Orthotics & Supplies
    Provider Billing for Prosthetics and Orthotic Services
    657Quarterly Update to Correct Coding Initiative Edits, Version V11.3, Effective October 1, 2005
    658Billing for Devices Under the Hospital Outpatient Prospective Payment System
    Billing for Devices Under the Outpatient Prospective Payment System
    Requirements that Hospitals Report Device Codes on Claims on Which They Report Specified Procedures
    Edits for Claims on Which Specified Procedures Are To Be Reported With Device Codes
    659Instructions for Downloading the Medicare Zip Code File
    660This Transmittal is rescinded and replaced by Transmittal 664
    661This Transmittal is rescinded and replaced by Transmittal 672
    662This Transmittal is rescinded and replaced by Transmittal 691
    663Update To The Hospice Payment Rates, Hospice Cap, Hospice Wage Index, and the Hospice Pricer for Fiscal Year 2006
    664This Transmittal is rescinded and replaced by Transmittal 683
    665October Quarterly Update for 2005 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Fees Schedule
    666Updates to the Coordination of Benefits Contractor Detailed Error
    Report File Layout
    Consolidation of the Claims Crossover Process
    Coordination of Benefits Agreement Detailed Error Notification Process
    667Home Care and Domiciliary Care Visits (Codes 99321-99350)
    668Enforcement of Hospital Inpatient Bundling: Carrier Denial of Ambulance Claims During an Inpatient Stay
    Hospital Inpatient Bundling
    General Coverage and Payment Policies
    Common Working File Editing of Ambulance Claims for Inpatients
    Intermediary Guidelines
    Provider/Intermediary Bill Processing Guidelines Effective April 1, 2002, as a Result of Fee Schedule Implementation
    669Schedule for Completing the Calendar Year 2006 Fee Updates and the Participating Physician Enrollment Procedures
    670Realignment of States and Medicare Claims Processing Workload From Durable Medical Equipment Regional Carrier Regions A, B, C, and D to the Durable Medical Equipment Major Ambulatory Jurisdictions A, B, C and D
    671Updated Manual Instructions for the Medicare Claims Processing Manual, Regarding Smoking and Tobacco-Use Cessation Counseling Services
    Healthcare Common Procedure Coding System and Diagnosis Coding
    Carrier Billing Requirements
    Fiscal Intermediary Billing Requirements
    Medicare Summary Notices
    672October Update to the 2005 Medicare Physician Fee Schedule Database
    673Manual Update on Medical Nutrition Therapy Services—Manualization
    Medicare Nutrition Therapy Services
    General Conditions and Limitations on Coverage
    Referrals for Medicare Nutrition Therapy Services
    Dietitians and Nutritionists Performing Medicare Nutrition Therapy Services
    Start Printed Page 76297
    Payment for Medicare Nutrition Therapy Services
    General Claims Processing Information
    Common Working File Edits
    674This Transmittal is rescinded and replaced by Transmittal 692
    675Changes to Appeals of Claims Decisions: Redeterminations and Reconsiderations (Implementation Date October 1, 2005)
    Workload Data Analysis Program
    Managing Appeals Workloads
    Standard Operating Procedures
    Execution of Workload Prioritization
    Workload Priorities
    6762006 Healthcare Common Procedure Coding System Annual Update Reminder
    677This Transmittal is rescinded and replaced by 687
    678This Transmittal is rescinded and replaced by 688
    679Medicare Redetermination Notice and Effect of the Redetermination Medicare Redetermination Notice (for partly or fully unfavorable redeterminations)
    Medicare Redetermination Notice (for fully favorable redeterminations) Effect of the Redetermination
    680Inpatient Rehabilitation Facility Annual Update: Prospective Payment System Pricer Changes for FY 2006
    681Guidelines For Payment of Vaccines (Pneumococcal Pneumonia Virus, Influenza Virus, And Hepatitis B Virus) and Their Administration Provided by Indian Health Services/Tribally-Owned and/or Operated Hospitals and Hospital Based Facilities
    Billing Requirements
    Bills Submitted to Fiscal Intermediaries
    Vaccines and Vaccine Administration
    682Issued to a specific audience, not posted to Internet/Intranet due to Confidentiality of Instruction
    683October 2005 Outpatient Prospective Payment System Code Editor Specifications Version
    684Correction to Chapter 17, Section 80.2.3, MSN/ANSI X12 Denial Messages for Anti-Emetic Drugs
    685Discontinuation of the Skilled Nursing Facility Healthcare Common Procedure Coding System Help File and Notification to Fiscal Intermediaries and Providers of the Redesigned Skilled Nursing Facility Consolidated Billing Annual Update File Posted on CMS Web site
    Services Included in Part A Prospective Payment System Payment Not Billable Separately by the Skilled Nursing Facility
    Services Beyond the Scope of the Part A Skilled Nursing Facility Benefit
    Billing for Medical and Other Health Services
    General Payment Rules and Application of Part B Deductible and Coinsurance
    686Common Working File Unsolicited Response Adjustments for Certain Claims Denied Due to an Open Medicare Secondary Payer Group Health Plan Record Where the Group Health Plan Record Was Subsequently Deleted
    687Appeals of Claims Decisions: Redeterminations and Reconsiderations (Implementation Dates for Fiscal Intermediary Initial Determination Issued On or After May 1, 2005 and Carrier Initial Determinations Issued on or After January 1, 2006)
    Filing a Request for Redetermination
    Appeal Rights for Dismissals
    Dismissal Letters
    Model Dismissal Notices
    Reconsideration—The Second Level of Appeal
    Filing a Request for a Reconsideration
    Time Limit for Filing a Request for a Reconsideration
    Contractor Responsibilities—General
    Qualified Independent Contractor Case File Development
    Qualified Independent Contractor Case File Preparation
    Forwarding Qualified Independent Contractor Case Files
    Qualified Independent Contractor Jurisdictions
    Tracking Cases
    Effectuation of Reconsiderations
    688Appeals of Claims Decisions: Redeterminations and Reconsiderations (Implementation Dates for All Requests for Redetermination Received by Fiscal Intermediary on or After May 1, 2005, and All Requests for Redetermination Received by Carriers on or After January 1, 2006)
    Redetermination—The First Level of Appeal
    The Redetermination
    The Redetermination Decision
    Dismissals
    Vacating a Dismissal
    689One Time Update to the National Council Prescription Drug Programs
    Companion Document Regarding Crossover Claims to Medicaid
    690Fiscal Year (FY) 2006 Payment for Services Furnished in Ambulatory Surgical Centers
    691October 2005 Update of the Hospital Outpatient Prospective Payment System
    692Fiscal Year 2006 Inpatient Prospective Payment System and Long Term Care Hospital Changes
    693Updates to the Inpatient Rehabilitation Facility and Skilled Nursing Facility
    Provider Specific File and Changes in Inpatient Rehabilitation Facility
    Prospective Payment System for FY 2006
    Provider-Specific File
    Case-Mix Groups
    Facility Level Adjustments
    Area Wage Adjustment
    Start Printed Page 76298
    Rural Adjustment
    Outlier
    Teaching Status Adjustment
    Full Time Equivalent Resident Cap
    Inpatient Rehabilitation Facility Prospective Payment System Pricer Software
    694Update to the Healthcare Provider Taxonomy Codes Version 5.1
    Medicare Secondary Payer
    (CMS—Pub. 100-05)
    31Full Replacement of Change Request 3770, Expanding the Number of Source Identifiers for Common Working File Medicare Secondary Payer Records
    Change Request 3770 Is Rescinded
    Definition of Medicare Secondary Payer/Common Working File Terms
    Medicare Secondary Payer Delete Transaction
    Identification of Reimbursement Advisory Committee Created Group Health Plan Records
    32Exception for Small Employers in Multi-Employer Group Health Plans Overview and General Responsibilities
    Introduction to the Coordination of Benefits Contractor
    Scope of the Coordination of Benefit Contractor in Relation to Contractors
    Contractors Claim Referrals to the Coordination of Benefit Contractors IRS/SSA/CMS Data Match
    Coordination of Benefit Contractors Discontinues Dissemination of the Right of Recovery Letters to Contractors
    Exception for Small Employers in Multi-Employer Group Health Plans
    Purpose
    Background
    Specific Information
    33Working Aged Exception for Small Employers in Multi-Employer Group Health Plans
    34Manualization: Long-Standing Medicare Secondary Payer Policy in Chapter 1 of the Medicare Secondary Payer Internet Only Manual
    General Provisions
    Working Aged
    End-Stage Renal Disease
    Workers' Compensation
    No-Fault Insurance
    Liability Insurance
    Conditional Primary Medicare Benefits
    When Conditional Primary Medicare Benefits May Be Paid When a Group Health Plan Is a Primary Payer to Medicare
    When Conditional Primary Medicare Benefits May Not Be Paid When a Group Health Plan Is a Primary Payer to Medicare
    When Medicare Secondary Payer Benefits Are Payable and Not Payable
    Multiple Insurers
    Definitions
    Crediting Deductible for Non-Inpatient Psychiatric Services
    Clarification of Current Employment Status for Specific Groups
    Actions Resulting From Group Health Plan or Large Group Health Plan
    Nonconformance
    Federal Government's Right to Sue and Collect Double Damages
    35Updates to the Group Health Plan Identification and Recovery Processes
    General
    IRS/SSA/CMS Data Match (Data Match) Group Health Plan Identified Cases
    Non-Data Match Group Health Plan Identified Cases
    Other Sources of Recovery Actions
    Group Health Plan Acknowledges Specific Debt (42 CFR 411.25)
    Recovery When a State Medicaid Agency Has Also Requested a Refund From the Group Health Plan
    Identification of Group Health Plan Mistaken Primary Payments Via the Recovery Management and Accounting System
    Progression of Recovery Management Accounting System Group Health Plan
    Lead Identification
    Progression of Recovery Management Accounting System History Search
    Contractor Recovery Case Files (Audit Trails)
    Group Health Plan Letters (Used for Recovery Management Accounting
    System/Healthcare Integrated General Ledger Accounting System (ReMAS/HIGLAS) When the Only Debtor Interfaced to Healthcare Integrated General Ledger Accounting System Is the Employer)
    Employer Group Health Plan Letter
    Important Information for Employers
    Insurer Group Health Plan Letter (Used for Recovery Management Accounting System/Healthcare Integrated General Ledger Accounting System When the Only Debtor Interfaced to Healthcare Integrated General Ledger Accounting System Is the Employer)
    Accountability Worksheet (Not Applicable to Recovery Management Accounting System/Healthcare Integrated General Ledger Accounting System Users)
    Summary Data Sheet (Not Applicable to ReMAS/HIGLAS Users)
    Field Description on the Medicare Secondary Payer Summary Data Sheet Payment Record Summary (Used with ReMAS/HIGLAS Users but in a Modified Format)
    Start Printed Page 76299
    Courtesy Copy of All Medicare Secondary Payer Group Health Plan-Based Recovery Demand Packages to the Employer's Insurer/Third Party Administrator
    Insurer/Third Party Administrator Courtesy Copy Letter
    Recovery Management Accounting System Error Reports
    Mistaken Group Health Plan Primary Payments
    Mistaken Primary Payment Activities and Record Layouts
    Contractor Actions Upon Receipt of the Data Match Cycle Tape or Other Notice of Non-Data Match Group Health Plan Mistaken Payments (for Contractor Not on ReMAS/HIGLAS for GHP Recovery) and Actions to Take for Those Contractors Using Recovery Management Accounting System/Health Integrated General Ledger Accounting System Group Health Plan Functions
    Coordination of Benefits Contractor Responsibility to Obtain Missing Medicare Secondary Payer Information
    Time Limitations for Group Health Plan Recoveries
    Actual Notice
    Contractor History Search
    Aggregate Claims for Recovery
    Documentation of Debt
    Recovery Attempt Audit Trails
    Summary of Medicare Reimbursement
    Claim Facsimiles for Each Claim Mistakenly Paid
    IRS/SSA/CMS Mistaken Payment Recovery Tracking System
    Inpatient, Skilled Nursing Facility, and Religious Non-Medicare Health Care
    Outpatient Mistaken Payment Report Record Layout
    Home Health Agency Mistaken Payment Record Layout
    Communication Receive in Response to Recovery Actions
    36Update to the Healthcare Provider Taxonomy Codes Version 5.1
    Medicare Financial Management
    (CMS—Pub. 100-06)
    71Notice of New Interest Rate for Medicare Overpayments and Underpayments
    72Claims Accounts Receivable Update
    Intermediary Claims Accounts Receivable
    Financial Reporting for Intermediary Claims Accounts Receivable
    73This Transmittal is rescinded and replaced by Transmittal 75
    74Discovery Code Indication for Recovery Audit Contractor (RAC) Non-MSP Identified Overpayments
    75New Thresholds for 2nd Demand Letter for Physicians/Suppliers
    Part B Overpayment Demand Letters to Physicians/Suppliers
    76Development of New Report to Capture Benefits, Improvement and Protection Act and Medicare Prescription Drug, Improvement, and Modernization Act Appeals Data
    Monthly Statistical Report on Intermediary and Carrier Part A and Part B
    Appeals Activity Form
    Redeterminations
    Qualified Independent Contractor Reconsiderations
    Administrative Law Judge Results
    Department Appeals Board Effectuations
    Clerical Error Reopenings
    Validation of Reports
    77Non-Medicare Secondary Payer Debt Referral and Debt Collection Improvement Act of 1996 Activities
    Background
    Cross Servicing
    Treasury Offset Program
    Definition of Delinquent Debt
    Referral Requirements
    Exemptions to Referral
    Debt to be Referred
    Delinquent Non-Medicare Secondary Payer Fiscal Intermediary Debt, Including Debt on the Provider Overpayment Reporting System
    Delinquent Non-Medicare Secondary Payer Medicare Carrier Debt, Including Debt on the Physician/Supplier Overpayment Reporting System
    Delinquent Non-Medicare Secondary Payer Debt Previously Ineligible for Referral
    Debt Collection Improvement Act Language/Intent to Refer Letter
    Response to “Intent to Refer” Letter
    Provider Overpayment Reporting System Updates
    Physician/Supplier Overpayment Reporting System Updates
    Cross Servicing Collection Efforts
    Actions Subsequent to Debt Collection System Input
    Transmission of Debt
    Update to Debt Collection System After Transmission
    Financial Reporting for Debt Referred
    Financial Reporting for Non-Medicare Secondary Payer Debt
    Start Printed Page 76300
    78Coordination of Benefits Agreement Process for Contractor Financial Staff Notification
    Medicare State Operations Manual
    (CMS—Pub. 100-07)
    09Revision of Appendix P and Certain Exhibits of the State Operations Manual
    10Revisions—Appendix J—Interpretive Guidelines Intermediate Care Facilities With Mental Retardation
    11Revised Chapter 2—“The Certification Process,” Sections 2180E thru 2200F, and Appendix B—“Interpretive Guidelines: Home Health Agencies”
    Medicare Program Integrity
    (CMS—Pub. 100-08)
    115Program Integrity Manual Revision
    Affiliated Contractor/Full Program Safeguard Contractor Communication With the Comprehensive Error Rate Testing Contractor
    Overview of the Comprehensive Error Rate Testing Process
    Providing Sample Information to the Comprehensive Error Rate Testing Contractor
    Providing Review Information to the Comprehensive Error Rate Testing Contractor
    Providing Feedback Information to the Comprehensive Error Rate Testing Contractor
    Disputing/Disagreeing With a Comprehensive Error Rate Testing Decision Handling Overpayments and Underpayments Resulting From the Comprehensive Error Rate Testing Findings
    Handling Appeals Resulting From Comprehensive Error Rate Testing Initiated Denials
    Tracking Overpayments
    Tracking Appeals
    Potential Fraud
    Full Program Safeguard Contractor Requirements Involving Comprehensive Error Rate Testing Information Dissemination
    Full Program Safeguard Contractor Error Rate Reduction Plan
    Contacting Non-Responders
    Late Documentation Received by the Comprehensive Error Rate Testing Contractor
    Voluntary Refunds
    Local Coverage Determination/National Coverage Determination
    Comprehensive Error Rate Testing Review Contractor Review Guidelines
    116Revise the Fiscal Intermediary Shared System to Allow Reporting of Data for the Comprehensive Error Rate Testing Program Resolution File at a Line Level
    117Revise the Medicare Contractor System and the VIPS Medicare System To Allow Update of the Comprehensive Error Rate Testing Program Resolution File Within Five Business Days of a Comprehensive Error Rate Testing Request
    118Various Benefit Integrity Clarifications
    Goal of Medical Review Program
    Overpayment Procedures
    Disposition of the Suspension
    The Medicare Fraud Program
    Program Safeguard Contractor and Medicare Contractor Benefit Integrity Unit
    Organizational Requirements
    Training for Law Enforcement Organizations
    Procedural Requirements
    Requests for Information From Outside Organizations
    Sharing Fraud Referrals Between the Office of Inspector General and the Department of Justice
    Complaint Screening
    Investigations
    Conducting Investigations
    Disposition of Cases
    Reversed Denials by Administrative Law Judges on Open Cases
    Types of Fraud Alerts
    Coordination
    Investigation, Case, and Suspension Entries
    Update Requirements for Cases
    Closing Investigations
    Deleting Investigations, Cases, or Suspensions
    Access
    Harkin Grantees or Senior Medicare Patrol—Complaint Tracking System
    Harkin Grantees or Senior Medicare Patrol Project Description
    Harkin Grantees Tracking System Instructions
    System Access to Metaframe and Data Collection
    Data Dissemination/Aggregate Report
    Referral of Cases to the Office of the Inspector General/Office of Investigations
    Immediate Advisements to the Office of Inspector General/Office of Investigations
    Denial of Payments for Cases Referred to and Accepted by Office of Inspector General/Office of Investigations
    Take Administrative Action on Cases Referred to and Refused by Office of Inspector General /Office of Investigations
    Referral to State Agencies or Other Organizations
    Referral to Quality Improvement Organizations
    Start Printed Page 76301
    Referral Process to CMS
    Referrals to Office of Inspector General
    Breaches of Assignment Agreement by Physician or Other Supplier
    Annual Deceased-Beneficiary Postpayment Review
    Vulnerability Report
    119Issued to a specific audience, not posted to Internet/Intranet due to Confidentiality of Instruction
    120Correction to Change Request (CR) 3222: Local Medical Review Policy/Local Coverage Determination Medicare Summary Notice Message Revision Denials Notices
    121This Transmittal is rescinded and replaced by Transmittal 124
    122Medical Review Collection Number Requirements
    Overview of Prepayment and Postpayment Review for Medical Review Purposes
    123Chapter 3, Medicare Modernization Act Section 935
    Verifying Potential Errors and Setting Priorities
    Determining Whether the Problem Is Widespread or Provider Specific
    Overpayment Procedures
    “Probe” Reviews
    124Evidence of Medical Necessity: Wheelchair and Power Operated Vehicle Claims
    125Medical Review Additional Documentation Requests
    Additional Documentation Requests During Prepayment or Postpayment
    Medical Review
    Medicare Contractor Beneficiary and Provider Communications
    (CMS—Pub. 100-09)
    12Next Generation Desktop Testing Requirements
    13Provider Contact Centers Training Program
    Guidelines for Telephone Service
    Staff Development and Training
    Medicare Managed Care
    (CMS—Pub. 100-16)
    66Beneficiary Enrollment and Disenrollment Requirements for Medicare Advantage Plans
    Changes in Requirements for Periodic Surveys of Current and Former Enrollees, and in the CMS Method for Calculating Interest on Overpayment and Underpayments to Health Maintenance Organizations, Comprehensive Medical Plans and Health Care Prepayment Plans
    67Initial Publication of Chapter 1—General Provisions
    Introduction
    Definitions
    Types of Medical Assistance Plans
    Cost Sharing in Enrollment—Related Costs
    68Revisions to Chapter 12, “Effect of Change of Ownership,” and Chapter 14, “Contract Determination and Appeals”
    Effect of Change of Ownership
    What Constitutes a Change of Ownership
    Address for Sending Notifications to CMS
    When a Novation Agreement Is Required
    Acceptable Novation Agreements
    Contract Determination Notice
    Postponement of the Contract Determination's Effective Date
    Reconsiderations
    Time Frames for Filing a Reconsideration Request
    Parties to the Hearing
    Conduct and Record of a Hearing
    Reopening of Contract Reconsidered Determination or Decision of a Hearing Officer or the Administrator
    69Beneficiary Enrollment and Disenrollment Requirements for Medicare Advantage Plans
    70Deletion of MCM Chapter 19—The Enrollment and Payment User's Guide, and Chapter 20—Managed Care and Medical Assistance Business Requirements
    71Changes in Manual Instructions for Benefits and Beneficiary Protections
    Basic Rules
    Types of Benefits
    Availability and Structure of Plans
    CMS Review and Approval of M+C Benefit—rewritten and relocated to § 20
    Requirements Relating to Medicare Conditions of Participation—renumbered as § 4.10.7
    Provider Networks—renumbered as new § 10.8 and parts of the old § 20, “Original Medicare Covered Benefits”
    CMS Approval of Proposed Plan MA Benefits—old 10.7 revised and located here
    General Guidelines on Benefit Approval
    Screening Mammography, Influenza Vaccine, and Pneumococcal Vaccine
    Inpatient Hospital Rehabilitation Service
    Value-Added Items and Services
    Prescription Drug Discount Programs
    Start Printed Page 76302
    Waiting Periods and Exclusions That Are Not Present in Original Medicare
    Annual Beneficiary Out-of-Pocket Cap
    Drug Benefits
    Drugs That Are Covered Under Original Medicare
    Mid-Year Benefit Enhancements
    Multi-Year Benefits
    Return to Home Skilled Nursing Facility
    Guidance on Acceptable Cost-Sharing and Deductibles
    Homemaker Services
    Caregiver Resource Services
    Electronic Monitoring
    Dentures
    Chiropractic Services
    Cash
    Beauty Parlor
    Transportation
    Safety Items
    Travel for Transplants
    Meals
    Basic Benefits
    Cost-sharing Rules for Medical Assistance Regional Plans
    Supplemental Benefits and Mandatory Supplemental and Optional Supplemental
    Basic Versus Supplemental Benefits
    The Annual Deductible
    General Rule
    Accessing Plan Contracting Providers
    Enrollee Information and Disclosure
    Definitions
    Factors That Influence Service Area Approval
    The “County Integrity Rule”
    General Rule
    Employer Plans
    Basic Rule
    Medicare Benefits Secondary to Group Health Plans and Large Group Health Plans
    Medicare Secondary Payer Rules and State Laws
    Discrimination Against Beneficiaries Prohibited
    Disclosure Requirements at Enrollment (and Annually Thereafter)
    Information Pertaining to a Medical Assistance Organization Changing Their Rules or Provider Network
    Other Information That Is Disclosable Upon Request
    Access and Availability Rules for Coordinated Care Plans
    Emergency and Urgently Needed Services
    Post-Stabilization Care Services
    General Description
    Private Fee-for-Service Plan Terms and Conditions of Participation
    Provider Types—Direct Contracting, Deemed Contracting, Non-Contracting Access to Services
    Payments and Balance Billing
    Advance Notice of Coverage
    Prompt Payment Requirements
    Original Medicare vs. Estimated Payment Amounts
    Table Summarizing Private Fee-for-Service Plan Provider Types and Rules
    72Changes in Manual Instructions for Intermediate Sanctions
    Types of Intermediate Sanctions
    General Basis for Imposing Intermediate Sanctions on Medical Assistance Organizations
    Imposing Sanctions for Specific Medical Assistance Contract Violations
    Civil Monetary Penalties for Medical Assistance Organizations That Improperly Terminate the Medical Assistance Contract
    CMS Process for Suspending Marketing, Enrollment, and Payment
    Contract Termination by CMS
    Medicare Business Partners Systems Security
    (CMS—Pub. 100-17)
    00None
    Demonstrations
    (CMS—Pub. 100-19)
    26This Transmittal is rescinded and replaced by Transmittal 27
    27The Medicare Chronic Care Improvement, “Medicare Health Support,” Program
    28The Medicare Care Management for High Cost Beneficiaries Demonstration
    Start Printed Page 76303
    One-Time Notification
    (CMS—Pub. 100-20)
    161Kansas Blue Cross Blue Shield Carrier Numbering Issue
    162Instructions for Fiscal Intermediary Standard System and Multi-Carrier System
    Healthcare Integrated General Ledger Accounting System Changes
    163Qualified Independent Contractor Jurisdictions
    164Medicare HIPAA Electronic Claims Report—Third Reporting Timeframe Extension
    165Issued to a specific audience, not posted to Internet/Intranet due to Confidentiality of Instruction
    166This Transmittal is rescinded and replaced by Transmittal 173
    167Issued to a specific audience, not posted to Internet/Intranet due to Sensitivity of Instruction
    168Shared System Maintainer Hours for Resolution of Problems Detected During Health Insurance Portability and Accountability Act Transaction January 2006 Release Testing
    169Analysis of Systems Improvements to Streamline POS Code Set Updates
    170Updates to the Coordination of Benefits Agreement Insurance File for Use in the National Claims Crossover Program
    171Preliminary system updates in preparation for ending the Medicare contingency plan in October 2005
    172Issued to a specific audience, not posted to Internet/Intranet due to Confidentiality of Instruction
    173Overnight Oximetry Testing
    174Fiscal Intermediary Shared System Modification
    175Common Working File Calculation of Next Eligible Date for Preventive Services
    176Change of the CareFirst Part A Plan to Highmark in the State of Maryland and Washington, DC
    177Termination of Existing Crossover Agreements as Trading Partners
    Transition to the National Coordination of Benefits Agreement Program
    178Issued to a specific audience, not posted to Internet/Intranet due to Confidentiality of Instruction
    179Calculation of the Interim Payment of Indirect Medical Education Through the Inpatient Prospective Payment Pricer for Hospitals That Received an Increase to Their Full-Time Equivalent Resident Cap Under Section 422 of the Medicare Modernization Act, P.L. 108-173
    180Issued to a specific audience, not posted to Internet/Intranet due to Confidentiality of Instruction
    181National Modifier and Condition Code To Be Used To Identify Disaster Disaster Related Claims

    Addendum IV.—Regulation Documents Published in the Federal Register

    [July through September 2005]

    Publication dateFR Vol. 70 page numberCFR parts affectedFile codeTitle of regulation
    July 6, 200539022414CMS-3125-IFCMedicare Program; Competitive Acquisition of Outpatient Drugs and Biologicals Under Part B.
    July 8, 200539514CMS-1288-NMedicare Program; Meeting of the Advisory Panel on Ambulatory Payment Classification (APC) Groups—August 17, 18, and 19, 2005.
    July 12, 200540039CMS-2212-NMedicaid Program; Meeting of the Medicaid Commission—July 27, 2005.
    July 14, 200540788484CMS-1301-PMedicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2006.
    July 14, 200540709CMS-1288-CNMedicare Program; Meeting of the Advisory Panel on Ambulatory Payment Classification (APC) Groups—August 17, 18, and 19, 2005; Correction.
    July 22, 200542331CMS-3142-FNMedicare Program; Evaluation Criteria and Standards for Quality Improvement Program Contracts.
    July 22, 200542330CMS-1315-NMedicare Program; August 22, 2005, Meeting of Practicing Physicians Advisory Council and Request for Nominations.
    July 22, 200542329CMS-3153-NMedicare Program; Meeting of the Medicare Coverage Advisory Committee—October 6, 2005.
    July 22, 200542328CMS-4093-NMedicare Program; Request for Nominations for the Advisory Panel on Medicare Education.
    July 22, 200542327CMS-3158-NMedicare Program; Request for Nominations for Members for the Medicare Coverage Advisory Committee.
    July 22, 200542276146CMS-4094-F3Amendment to the Interim Final Regulation for Mental Health Parity.
    July 25, 200542674419 and 485CMS-1501-PMedicare Program; Proposed Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2006 Payment Rates.
    August 4, 200545130418CMS-1286-FMedicare Program; Hospice Wage Index for Fiscal Year 2006.
    Start Printed Page 76304
    August 4, 200545026409, 411, 424, and 489CMS-1282-FMedicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2006.
    August 4, 200544930CMS-2220-NMedicare Program; Meeting of the Medicaid Commission—August 17-18, 2005.
    August 4, 200544879402CMS-6019-PMedicare Program; Revised Civil Money Penalties, Assessments, Exclusions, and Related Appeals Procedures.
    August 8, 200545764405, 410, 411, 413, 414, and 426CMS-1502-PMedicare Program; Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2006.
    August 12, 200547278405, 412, 413, 415, 419, 422, and 485CMS-1500-FMedicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2006 Rates.
    August 15, 200547880412CMS-1290-FMedicare Program; Inpatient Rehabilitation Facility Prospective Payment System for FY 2006.
    August 15, 200547759483CMS-3198-PMedicare and Medicaid Programs; Condition of Participation: Immunization Standard for Long Term Care Facilities.
    August 26, 200550940410CMS-3017-IFCMedicare Program; Conditions for Payment of Power Mobility Devices, including Power Wheelchairs and Power-Operated Vehicles.
    August 26, 200550680419 and 485CMS-1501-CNMedicare Program; Proposed Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2006 Payment Rates; Correction.
    August 26, 200550375CMS-4111-NMedicare Program; Meeting of the Advisory Panel on Medicare Education, September 27, 2005.
    August 26, 200550374CMS-1330-NMedicare Program; Town Hall Meeting on the Medicare Provider Feedback Group (MPFG)—September 12, 2005.
    August 26, 200550373CMS-4106-PNMedicare Program; Changes in Medicare Advantage Deeming Authority.
    August 26, 200550372CMS-1309-NCMedicare and Medicaid Programs; Announcement of an Application From a Hospital Requesting Waiver for Organ Procurement Service Area.
    August 26, 200550358CMS-2209-NMedicaid Program; Fiscal Disproportionate Share Hospital Allotments and Disproportionate Share Hospital Institutions for Mental Disease Limits.
    August 26, 200550358CMS-1486-NMedicare Program; Announcement of New Members of the Advisory Panel on Ambulatory Payment Classification (APC) Groups.
    August 26, 200550262447 and 455CMS-2198-PMedicaid Program; Disproportionate Share Hospital Payments.
    August 26, 200550214433CMS-2210-IFCMedicaid Program; State Allotments for Payment of Medicare Part B Premiums for Qualifying Individuals: Federal Fiscal Year 2005.
    August 26, 200550214405CMS-4064-IFC3Medicare Program; Changes to the Medicare Claims Appeal Procedures: Correcting Amendment to a Correcting Amendment.
    August 30, 200551321410CMS-6024-PMedicare Program; Prior Determination for Certain Items and Services.
    September 1, 200552105CMS-1308-NCMedicare Program; Withdrawal of Ambulance Fee Schedule Issued in Accordance With Federal District Court Order in Lifestar Ambulance v. United States, No. 4:02-CV-127-1 (M.D. Ga., Jan. 16, 2003)—Medicare Covered Ambulance Services.
    September 1, 200552056405, 410, 411, 413, 414, and 426CMS-1502-CNMedicare Program; Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2006; Correction.
    September 1, 200552023422CMS-4069-F3Medicare Program; Establishment of the Medicare Advantage Program; Correcting Amendment; Partial Stay of Effectiveness.
    September 1, 200552019403CMS-4063-FMedicare Program; Medicare Prescription Drug Discount Card; Revision of Marketing Rules for Endorsed Drug Card Sponsors.
    September 6, 200552930414CMS-1325-IFC2Medicare Program; Competitive Acquisition of Outpatient Drugs and Biologicals Under Part B: Interpretation and Correction.
    Start Printed Page 76305
    September 16, 200554751CMS-5017-NMedicare Program; Medicare Health Care Quality (MHCQ) Demonstration Programs.
    September 23, 200555905CMS-3159-NMedicare Program; Meeting of the Medicare Coverage Advisory Committee—November 29, 2005.
    September 23, 200555903CMS-1269-N5Medicare Program; Emergency Medical Treatment and Labor Act (EMTALA) Technical Advisory Group (TAG) Meeting—October 26, 2005 Through October 28, 2005.
    September 23, 200555897CMS-8027-NMedicare Program; Medicare Part B Monthly Actuarial Rates, Premium Rate, and Annual Deductible for Calendar Year 2006.
    September 23, 200555896CMS-8025-NMedicare Program; Part A Premium for Calendar Year 2006 for the Uninsured Aged and for Certain Disabled Individuals Who Have Exhausted Other Entitlement.
    September 23, 200555887CMS-1307-GNCMedicare Program; Criteria and Standards for Evaluating Intermediary, Carrier, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Regional Carrier Performance During Fiscal Year 2006.
    September 23, 200555885CMS-8026-NMedicare Program; Inpatient Hospital Deductible and Hospital and Extended Care Services Coinsurance Amounts for Calendar Year 2006.
    September 23, 200555863CMS-9032-NMedicare and Medicaid Programs; Quarterly Listing of Program Issuances-April Through June 2005.
    September 23, 200555862CMS-2227-PNMedicare and Medicaid Programs; Application by the Accreditation Commission of Healthcare for Deeming Authority for Home Health Agencies.
    September 23, 200555812447 and 455CMS-2198-CNMedicaid Program; Disproportionate Share Hospital Payments.
    September 29, 200556901CMS-2230-FNState Children's Health Insurance Program (SCHIP); Redistribution of Unexpended SCHIP Funds From the Appropriation for Fiscal Year 2002.
    September 30, 200557376505CMS-1320-PMedicare Program; Health care Infrastructure Improvement Program; Forgiveness of Indebtness.
    September 30, 200557368505CMS-1287-IFCMedicare Program; Health Care Infrastructure Improvement Program; Selection Criteria of Loan Program for Qualifying Hospitals Engaged in Cancer-Related Health Care.
    September 30, 200557300CMS-1307-CNMedicare Program; Criteria and Standards for Evaluating Intermediary, Carrier, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Regional Carrier Performance During Fiscal Year 2006; Correction Notice.
    September 30, 200557297CMS-3144-NCMedicare Program; Calendar Year 2005 Review of Appropriateness of Payment Amounts for New Technology Intraocular Lenses (NTIOLs) Furnished by Ambulatory Surgical Centers (ASCs).
    September 30, 200557296CMS-1269-N6Medicare Program; Emergency Medical Treatment and Labor Act (EMTALA) Technical Advisory Group (TAG): Announcement of a New Member.
    September 30, 200557174418CMS-1286-CNMedicare Program; Hospice Wage Index for Fiscal Year 2006.
    September 30, 200557166412CMS-1290-CNMedicare Program; Inpatient Rehabilitation Facility Prospective Payment System for FY 2006; Correction.
    September 30, 200557164411 and 424CMS-1282-CNMedicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Correction.
    September 30, 200557161405, 412, 413, 415, 419, 422, and 485CMS-1500-CNMedicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2006 Rates; Correction.

    Addendum V—National Coverage Determinations

    [July Through September 2005]

    A national coverage determination (NCD) is a determination by the Secretary with respect to whether or not a particular item or service is covered nationally under Title XVIII of the Social Security Act, but does not include a determination of what code, if any, is assigned to a particular item or service covered under this title, or determination with respect to the amount of payment made for a particular item or service so covered. We include below all of the NCDs that were issued during the quarter covered by this notice. The entries below include information concerning completed decisions Start Printed Page 76306as well as sections on program and decision memoranda, which also announce pending decisions or, in some cases, explain why it was not appropriate to issue an NCD. We identify completed decisions by the section of the NCDM in which the decision appears, the title, the date the publication was issued, and the effective date of the decision. Information on completed decisions as well as pending decisions has also been posted on the CMS Web site at http://cms.hhs.gov/​coverage.

    National Coverage Determinations

    [July Through September 2005]

    There were no new NCDs posted during this time period.

    Addendum VI—FDA-Approved Category B IDEs

    [July Through September 2005]

    Under the Food, Drug, and Cosmetic Act (21 U.S.C. 360c) devices fall into one of three classes. To assist CMS under this categorization process, the FDA assigns one of two categories to each FDA-approved IDE. Category A refers to experimental IDEs, and Category B refers to non-experimental IDEs. To obtain more information about the classes or categories, please refer to the Federal Register notice published on April 21, 1997 (62 FR 19328).

    The following list includes all Category B IDEs approved by FDA during the second quarter, July through September 2005.

    IDE/Category

    G040204

    G050005

    G050016

    G050028

    G050035

    G050036

    G050041

    G050044

    G050069

    G050072

    G050082

    G050086

    G050103

    G050107

    G050108

    G050112

    G050113

    G050114

    G050117

    G050119

    G050120

    G050122

    G050123

    G050125

    G050127

    G050129

    G050130

    G050132

    G050133

    G050134

    G050135

    G050136

    G050141

    G050144

    G050145

    G050146

    G050147

    G050148

    G050149

    G050153

    G050155

    G050158

    G050160

    G050161

    G050163

    G050165

    G050166

    G050170

    G050172

    G050174

    G050177

    G050178

    G050180

    G050181

    G050182

    G050183

    Addendum VII—Approval Numbers for Collections of Information

    Below we list all approval numbers for collections of information in the referenced sections of CMS regulations in Title 42; Title 45, Subchapter C; and Title 20 of the Code of Federal Regulations, which have been approved by the Office of Management and Budget:

    OMB Control Numbers

    [Approved CFR Sections in Title 42, Title 45, and Title 20 (Note: Sections in Title 45 are preceded by “45 CFR,” and sections in Title 20 are preceded by “20 CFR”)]

    OMB numberApproved CFR sections
    0938-0008414.40, 424.32, 424.44
    0938-0022413.20, 413.24, 413.106
    0938-0023424.103
    0938-0025406.28, 407.27
    0938-0027486.100-486.110
    0938-0033405.807
    0938-0035407.40
    0938-0037413.20, 413.24
    0938-0041408.6, 408.22
    0938-0042410.40, 424.124
    0938-0045405.711
    0938-0046405.2133
    0938-0050413.20, 413.24
    0938-0062431.151, 435.1009, 440.220, 440.250, 442.1, 442.10-442.16, 442.30, 442.40, 442.42, 442.100-442.119, 483.400-483.480, 488.332, 488.400, 498.3-498.5
    0938-0065485.701-485.729
    0938-0074491.1-491.11
    0938-0080406.7, 406.13
    0938-0086420.200-420.206, 455.100-455.106
    0938-0101430.30
    0938-0102413.20, 413.24
    0938-0107413.20, 413.24
    0938-0146431.800-431.865
    0938-0147431.800-431.865
    0938-0151493.1357, 493.1363, 493.1405, 493.1406, 493.1411, 493.1417, 493.1423, 493.1443, 493.1449, 493.1455, 493.1461, 493.1462, 493.1469, 493.1483, 493.1489, 493.1491
    0938-0155405.2470
    0938-0170493.1269-493.1285
    0938-0193430.10-430.20, 440.167
    0938-0202413.17, 413.20
    0938-0214411.25, 489.2, 489.20
    0938-0236413.20, 413.24
    0938-0242442.30, 488.26
    0938-0245407.10, 407.11
    Start Printed Page 76307
    0938-0246431.800-431.865
    0938-0251406.7
    0938-0266416.41, 416.47, 416.48, 416.43
    0938-0267410.65, 485.56, 485.58, 485.60, 485.64, 485.66
    0938-0269412.116, 412.632, 413.64, 413.350, 484.245
    0938-0270405.376
    0938-0272440.180, 441.300-441.305
    0938-0273485.701-485.729
    0938-0279424.5
    0938-0287447.31
    0938-0296413.170, 413.184
    0938-0301413.20, 413.24
    0938-0302418.22, 418.24, 418.28, 418.56, 418.58, 418.70, 418.74, 418.83, 418.96, 418.100
    0938-0313489.11, 489.20
    0938-0328482.12, 482.13, 482.21, 482.22, 482.27, 482.30, 482.41, 482.43, 482.45, 482.53, 482.56, 482.57, 482.60, 482.61, 482.62, 485.618, 485.631
    0938-0334491.9, 491.10
    0938-0338486.104, 486.106, 486.110
    0938-0354441.60
    0938-0355442.30, 488.26
    0938-0357409.40-409.50, 410.36, 410.170, 411.4-411.15, 421.100, 424.22, 484.18, 489.21
    0938-0358412.20-412.30
    0938-0359412.40-412.52
    0938-0360488.60
    0938-0365484.10, 484.11, 484.12, 484.14, 484.16, 484.18, 484.20, 484.36, 484.48, 484.52
    0938-0372414.330
    0938-0378482.60-482.62
    0938-0379442.30, 488.26
    0938-0382442.30, 488.26
    0938-0386405.2100-405.2171
    0938-0391488.18, 488.26, 488.28
    0938-0426476.104, 476.105, 476.116, 476.134
    0938-0429447.53
    0938-0443473.18, 473.34, 473.36, 473.42
    0938-04441004.40, 1004.50, 1004.60, 1004.70
    0938-0445412.44, 412.46, 431.630, 456.654, 466.71, 466.73, 466.74, 466.78
    0938-0447405.2133
    0938-0448405.2133, 45 CFR 5, 5b; 20 CFR Parts 401, 422 Subpart E 0938-0449 440.180, 441.300-441.310
    0938-0454424.20
    0938-0456412.105
    0938-0463413.20, 413.24, 413.106
    0938-0467431.17, 431.306, 435.910, 435.920, 435.940-435.960
    0938-0469417.126, 422.502, 422.516
    0938-0470417.143, 417.800-417.840, 422.6
    0938-0477412.92
    0938-0484424.123
    0938-0501406.15
    0938-0502433.138
    0938-0512486.304, 486.306, 486.307
    0938-0526475.102, 475.103, 475.104, 475.105, 475.106
    0938-0534410.38, 424.5
    0938-0544493.1-493.2001
    0938-0564411.32
    0938-0565411.20-411.206
    0938-0566411.404, 411.406, 411.408
    0938-0573412.230, 412.256
    0938-0578447.534
    0938-0581493.1-493.2001
    0938-0599493.1-493.2001
    0938-0600405.371, 405.378, 413.20
    0938-0610484.10, 489.102
    0938-0612493.801, 493.803, 493.1232, 493.1233, 493.1234, 493.1235, 493.1236, 493.1239, 493.1241, 493.1242, 493.1249, 493.1251, 493, 1252, 493.1253, 493.1254, 493.1255, 493.1256, 493.1261, 493.1262, 493.1263, 493.1269, 493.1273, 493.1274, 493.1278, 493.1283, 493.1289, 493.1291, 493.1299
    0938-0618433.68, 433.74, 447.272
    0938-0653493.1771, 493.1773, 493.1777
    0938-0657405.2110, 405.2112
    0938-0658405.2110, 405.2112
    Start Printed Page 76308
    0938-0659456.700, 456.705, 456.709, 456.711, 456.712
    0938-0667482.12, 488.18, 489.20, 489.24
    0938-0679410.38
    0938-0685410.32, 410.71, 413.17, 424.57, 424.73, 424.80, 440.30, 484.12
    0938-0686493.551-493.557
    0938-0688486.304, 486.306, 486.307, 486.310, 486.316, 486.318, 486.325
    0938-0691412.106
    0938-0692466.78, 489.20, 489.27
    0938-0701422.152
    0938-070245 CFR 146.111, 146.115, 146.117, 146.150, 146.152, 146.160, 146.180
    0938-070345 CFR 148.120, 148.124, 148.126, 148.128
    0938-0713441.16, 489.66, 489.67
    0938-0714411.370-411.389
    0938-0717424.57
    0938-0721410.33
    0938-0723421.300-421.318
    0938-0730405.410, 405.430, 405.435, 405.440, 405.445, 405.455, 410.61, 415.110, 424.24
    0938-0732417.126, 417.470
    0938-073445 CFR 5b
    0938-0739413.337, 413.343, 424.32, 483.20
    0938-0742422.300-422.312
    0938-0749424.57
    0938-0753422.000-422.700
    0938-0754441.151, 441.152
    0938-0758413.20, 413.24
    0938-0760484 Subpart E, 484.55, 484.205, 484.245, 484.250
    0938-0761484.11, 484.20
    0938-0763422.1-422.10, 422.50-422.80, 422.100-422.132, 422.300-422.312, 422.400-422.404, 422.560-422.622
    0938-0770410.2
    0938-0778422.64, 422.111
    0938-0779417.126, 417.470, 422.64, 422.210
    0938-0781411.404-411.406, 484.10
    0938-0786438.352, 438.360, 438.362, 438.364
    0938-0783422.66, 422.562, 422.564, 422.568, 422.570, 422.572, 422.582, 422.584, 422.586, 422.590, 422.594, 422.602, 422.612, 422.618, 422.619, 422.620, 422.622
    0938-0787406.28, 407.27
    0938-0790460.12, 460.22, 460.26, 460.30, 460.32, 460.52, 460.60, 460.70, 460.71, 460.72, 460.74, 460.80, 460.82, 460.98, 460.100, 460.102, 460.104, 460.106, 460.110, 460.112, 460.116, 460.118, 460.120, 460.122, 460.124, 460.132, 460.152, 460.154, 460.156, 460.160, 460.164, 460.168, 460.172, 460.190, 460.196, 460.200, 460.202, 460.204, 460.208, 460.210
    0938-0792491.8, 491.11
    0938-0798413.24, 413.65, 419.42
    0938-0802419.43
    0938-0818410.141, 410.142, 410.143, 410.144, 410.145, 410.146, 414.63
    0938-0829422.568
    0938-0832Parts 489 and 491
    0938-0833483.350-483.376
    0938-0841431.636, 457.50, 457.60, 457.70, 457.340, 457.350, 457.431, 457.440, 457.525, 457.560, 457.570, 457.740, 457.750, 457.810, 457.940, 457.945, 457.965, 457.985, 457.1005, 457.1015, 457.1180
    0938-0842412.23, 412.604, 412.606, 412.608, 412.610, 412.614, 412.618, 412.626, 413.64
    0938-0846411.352-411.361
    0938-0857Part 419
    0938-0860413.65, 419.42
    0938-086645 CFR Part 162
    0938-0872413.337, 483.20,
    0938-0873422.152
    0938-087445 CFR Parts 160 and 162
    0938-0878Part 422 Subpart F & G
    0938-088345 CFR Parts 160 and 164
    0938-0884405.940
    0938-088745 CFR 148.316, 148.318, 148.320
    0938-0897412.22, 412.533
    0938-0907412.230, 412.304, 413.65
    0938-0910422.620, 422.624, 422.626
    0938-0911426.400, 426.500
    0938-0916483.16
    Start Printed Page 76309
    0938-0920438.6, 438.8, 438.10, 438.12, 438.50, 438.56, 438.102, 438.114, 438.202, 438.206, 438.207, 438.240, 438.242, 438.402, 438.404, 438.406, 438.408, 438.410, 438.414, 438.416, 438.710, 438.722, 438.724, 438.810
    0938-0921414.804
    0938-093145 CFR Part 142.408, 162.408, and 162.406
    0938-0933438.50
    0938-0934403.766
    0938-0936423
    0938-0940484 and 488
    0938-0944422.250, 422.252, 422.254, 422.256, 422.258, 422.262, 422.264, 422.266, 422.270, 422.300, 422.304, 422.306, 422.308, 422.310, 422.312, 422.314, 422.316, 422.318, 422.320, 422.322, 422.324, 423.251, 423.258, 423.265, 423.272, 423.279, 423.286, 423.293, 423.301, 423.308, 423.315, 423.322, 423.329, 423.336, 423.343, 423.346, 423.350
    0938-0950405.910
    0938-0951423.48
    0938-0953405.1200 and 405.1202
    0938-0954414.906, 414.908, 414.914, 414.916
    0938-0957Part 423 Subpart R

    Addendum VIII—Medicare-Approved Carotid Stent Facilities [July Through September 2005]

    On March 17, 2005, we issued our decision memorandum on carotid artery stenting. We determined that carotid artery stenting with embolic protection is reasonable and necessary only if performed in facilities that have been determined to be competent in performing the evaluation, procedure, and follow-up necessary to ensure optimal patient outcomes. We have created a list of minimum standards for facilities modeled in part on professional society statements on competency. All facilities must at least meet our standards in order to receive coverage for carotid artery stenting for high risk patients.

    Effective Date—July 7, 2005

    Antelope Valley Hospital, 1600 West Avenue J, Lancaster, CA 93534

    Medicare Provider #050056

    Baptist St. Anthony's Hospital, 1600 Wallace Boulevard, Amarillo, TX 79106

    Medicare Provider #450231

    Dayton Heart Hospital, 707 S. Edwin Moses Boulevard, Dayton, OH 45408

    Medicare Provider #360253

    Duke Health Raleigh Hospital, 3400 Wake Forest Road, Raleigh, NC 27609

    Medicare Provider #340073

    East Pasco Medical Center, 7050 Gall Boulevard, Zephyrhills, FL 33541-1399

    Medicare Provider #100046

    FirstHealth Moore Regional Hospital, 1555 Memorial Drive, P.O. Box 3000 Pinehurst, NC 28374

    Medicare Provider #340115

    The George Washington University Hospital, 900 23rd Street, NW., Washington, DC 20037

    Medicare Provider #090001

    Heart Hospital of Lafayette, 1105 Kaliste Saloom Road, Lafayette, LA 70508

    Medicare Provider #190263

    Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287-1629

    Medicare Provider #210009

    Kingman Regional Medical Center, 3269 Stockton Hill Road, Kingman, AZ 86401

    Medicare Provider #030055

    Lafayette General Medical Center, 1214 Coolidge Street, P.O. Box 52009, Lafayette, LA 70505

    Medicare Provider #190002

    Manatee Memorial Hospital and Health Systems, 206 2nd Street East, Bradenton, FL 34208

    Medicare Provider #100035

    Mercy Health System, 1000 Mineral Point Avenue, P.O. Box 5003, Janesville, WI 53547-5003

    Medicare Provider #520066

    The Methodist Hospital, 6565 Fannin Street, Houston, TX 77030

    Medicare Provider #450358

    Mohawk Valley Vascular Center of Faxton, St. Luke's Healthcare, 1656 Champlain Avenue, Utica, NY 13502

    Medicare Provider #330044

    Northwest Medical Center, 2801 North State Road 7, Margate, FL 33063-9002

    Medicare Provider #100189

    Oakwood Hospital and Medical Center, 18101 Oakwood Boulevard, P.O. Box 2500, Dearborn, MI 48123-2500

    Medicare Provider #230020

    Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903

    Medicare Provider #041007

    Scripps Green Hospital, 10666 North Torrey Pines Road, La Jolla, CA 92037-9100

    Medicare Provider #050424

    St. Cloud Hospital, 1406 Sixth Avenue North, St. Cloud, MN 56303-1901

    Medicare Provider #240036

    St. Joseph's Regional Medical Center, 703 Main Street, Paterson, NJ 07530

    Medicare Provider #310019

    St. Luke's Hospital, 5901 Monclova Road, Maumee, OH 43537-1899

    Medicare Provider #360090

    St. Vincent Hospital, 835 S. Van Buren Street, P.O. Box 13508, Green Bay, WI 54307-3508

    Medicare Provider #520075

    St. Vincent's Medical Center, 1800 Barrs Street, Jacksonville, FL 32204

    Medicare Provider #100040

    Stormont-Vail HealthCare, 1500 S.W. 10th Avenue, Topeka, KS 66604-1353

    Medicare Provider #170086

    Tomball Regional Hospital, 605 Holderrieth Street, Tomball, TX 77375

    Medicare Provider #450670

    Trinity Mother Frances Health System, 800 E. Dawson, Tyler, TX 75701

    Medicare Provider #450102

    Effective Date—July 15, 2005

    Allen Memorial Hospital, 1825 Logan Avenue, Waterloo, IA 50703-1999

    Medicare Provider #160110

    Alta Bates Summit Medical Center, Alta Bates Campus, 2450 Ashby Avenue Berkley, CA 94705

    Medicare Provider #050305

    Alta Bates Summit Medical Center, Summit Campus, 350 Hawthorne Avenue, Oakland, CA 94609

    Medicare Provider #050043

    Banner Baywood Heart Hospital, 6750 East Baywood Avenue, Mesa, AZ 85206

    Medicare Provider #030105

    Battle Creek Health System, 300 North Avenue, Battle Creek, MI 49016 Start Printed Page 76310

    Medicare Provider #230075

    Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215

    Medicare Provider #220086

    BryanLGH Medical Center, 1600 South 48th Street, Lincoln, NE 68506-1299

    Medicare Provider #280003

    Deborah Heart & Lung Center, 200 Trenton Road, Browns Mills, NJ 08015

    Medicare Provider #310031

    Erie County Medical Center Corporation, 462 Grinder Street, Buffalo, NY 14215

    Medicare Provider #330219

    Fairview Southdale Hospital, 6401 France Avenue, Edina, MN 55435

    Medicare Provider #240078

    Gratiot Medical Center, 300 East Warwick Drive, Alma, MI 48801-1096

    Medicare Provider #230030

    Harbor Hospital, 3001 South Hanover Street, Baltimore, MD 21225-1290

    Medicare Provider #210034

    Holmes Regional Medical Center, 1350 South Hickory Street, Melbourne, FL 32901

    Medicare Provider #100019

    Holy Cross Hospital, 4725 North Federal Highway, Fort Lauderdale, FL 33308

    Medicare Provider #100073

    Marion General Hospital, 1000 McKinley Park Drive, Marion, OH 43301

    Medicare Provider #360011

    Mease Countryside Hospital, 3231 McMullen Booth Road, Safety Harbor, FL 34695

    Medicare Provider #100265

    Mercy General Hospital, 4001 J Street, P.O. Box 19245, Sacramento, CA 95819-9990

    Medicare Provider #050017

    OU Medical Center, 1200 Everett Drive, Oklahoma City, OK 73104

    Medicare Provider #370093

    Pennsylvania Hospital of the University of Pennsylvania Health System, 800 Spruce Street, Philadelphia, PA 19071-6192

    Medicare Provider #390226

    Provena Mercy Medical Center, 1325 North Highland Avenue, Aurora, IL 60506

    Medicare Provider #140174

    Reading Hospital and Medical Center, P.O. Box 16052, Reading, PA 19612-6052

    Medicare Provider #390044

    Regional Medical Center of Hopkins County, 900 Hospital Drive, Madisonville, KY 42431

    Medicare Provider #180093

    Sacred Heart Medical Center, 101 West 8th Avenue, P.O. Box 2555, Spokane, WA 99220-2555

    Medicare Provider #500054

    Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA 92103

    Medicare Provider #050077

    Sisters of Charity Providence Hospitals, 2435 Forest Drive, Columbia, SC 29204

    Medicare Provider #420026

    Tucson Medical Center, 5301 East Grant Road, Tucson, AZ 85712

    Medicare Provider #030006

    UCLA Medical Center, 10833 Le Conte Avenue, Los Angeles, CA 90095-1730

    Medicare Provider #050262

    University of Colorado Hospital, 4200 East 9th Avenue, Denver, CO 80262

    Medicare Provider #060024

    Effective Date—July 20, 2005

    Christus St. Patrick Hospital, 524 South Ryan Street, Lake Charles, LA 70601

    Medicare Provider #190027

    Condell Medical Center, 801 South Milwaukee Avenue, Libertyville, IL 60048

    Medicare Provider #140202

    Florida Hospital Ormond Memorial, 875 Sterthaus Avenue, Ormond Beach, FL 32174

    Medicare Provider #100169

    Lakewood Hospital, 14519 Detroit Avenue, Lakewood, OH 44107

    Medicare Provider #360212

    Loma Linda University Medical Center, 11234 Anderson Street, P.O. Box 2000, Loma Linda, CA 92354

    Medicare Provider #050327

    Miami Valley Hospital, Medical Imaging, One Wyoming Street, Dayton, OH 45409-2793

    Medicare Provider #360051

    National Park Medical Center, 1910 Malvern Avenue, Hot Springs, AR 71901

    Medicare Provider #040078

    Newark Beth Israel Medical Center, 201 Lyons Avenue, Newark, NJ 07112

    Medicare Provider #310002

    Salina Regional Health Center, P.O. Box 5080, Salina, KS 67402-5080

    Medicare Provider #170012

    Scott and White Memorial Hospital and Scott, Sherwood and Brindley Foundation, 2401 South 31st Street, Temple, TX 76508

    Medicare Provider #450054

    Sentra Norfolk General Hospital, 600 Gersham Drive, Norfolk, VA 23507

    Medicare Provider #490007

    Spartanburg Regional Medical Center, 101 East Wood Street, Spartanburg, SC 29303

    Medicare Provider #420007

    St. Francis Hospital, 3237 South 16th Street, Milwaukee, WI 53215-4592

    Medicare Provider #520078

    St. Vincent Indianapolis Hospital, 2001 West 86th Street, Indianapolis, IN 46260

    Medicare Provider #150084

    Tulsa Regional Medical Center, 744 West 9th, Tulsa, OK 74127

    Medicare Provider #370078

    University Hospital, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210

    Medicare Provider #330241

    UT Southwestern University Hospitals—Zale Lipshy, 5151 Harry Hines Boulevard, Dallas, TX 75390

    Medicare Provider #450766

    UT Southwestern University Hospitals—St. Paul, 5909 Harry Hines Boulevard, Dallas, TX 75390

    Medicare Provider #450044

    Effective Date—July 22, 2005

    Forrest General Hospital, 6051 Highway 49, Hattiesburg, MS 39401-7243

    Medicare Provider #250078

    Hamilton Medical Center, P.O. Box 1168, Dalton, GA 30722-1168

    Medicare Provider #110001

    Heritage Valley Health System, The Medical Center, 100 Dutch Ridge Road, Beaver, PA 15009-9700

    Medicare Provider #390036

    Northeast Georgia Medical Center, 743 Spring Street, Gainesville, GA 30501

    Medicare Provider #110029

    Wishard Health Services, 1001 West Tenth Street, Indianapolis, IN 46202

    Medicare Provider #150024

    Effective Date—July 27, 2005

    East Texas Medical Center Athens, 2000 South Palestine, Athens, TX 75751

    Medicare Provider #450389

    Glendale Adventist Medical Center, 1509 Wilson Terrace, Glendale, CA 91206

    Medicare Provider #050239

    Lahey Clinic Medical Center, Inc., 41 Mall Road, Burlington, MA 01805

    Medicare Provider #220171

    Saint Joseph Hospital, One Saint Joseph Drive, Lexington, KY 40504

    Medicare Provider #180010

    St. Mary's Medical Center, 2900 First Avenue, Huntington, WV 25702

    Medicare Provider #510007

    Yakima Regional Medical and Cardiac Center, 110 South 9th Avenue, Yakima, WA 98902

    Medicare Provider #500012

    Effective Date—August 1, 2005

    Alegent Health Bergan Mercy Medical Center, 7500 Mercy Rd., Omaha, NE 68124-9832

    Medicare Provider #280060

    Bon Secours DePaul Medical Center, 150 Kingsley Ln., Norfolk, VA 23505

    Medicare Provider #490011

    Hendrick Medical Center, 1900 Pine St., Abilene, TX 79601-2316

    Medicare Provider #450229

    Nebraska Heart Hospital, 7500 S. 91st St., Lincoln, NE 68526 Start Printed Page 76311

    Medicare Provider #280128

    Singing River Hospital System, 3109 Bienville Blvd., Ocean Springs, MS 39564

    Medicare Provider #250040

    St. Peter's Hospital,315 South Manning Blvd., Albany, NY 12208

    Medicare Provider #330057

    University of California San Francisco Medical Center, 500 Parnassus Ave., San Francisco, CA 94143-0296

    Medicare Provider #050454

    Effective Date—August 4, 2005

    Bowling Green Warren County Community Hospital Corp. d/b/a The Medical Center, 250 Park Street, P.O. Box 90010, Bowling Green, KY 42102-9010

    Medicare Provider #180013

    Carson-Tahoe Hospital, 775 Fleischmann Way, P.O. Box 2168, Carson City, NV 89702-2168

    Medicare Provider #290010

    Heart Hospital of Austin, 3801 N. Lamar Boulevard, Austin, TX 78756

    Medicare Provider #450824

    Indiana Heart Hospital, 8040 Clearvista Parkway, Suite 200, Indianapolis, IN 46256

    Medicare Provider #150154

    JFK Medical Center, 5301 South Congress Avenue, Atlantis, FL 33462

    Medicare Provider #100080

    Sierra Vista Regional Medical Center, 1010 Murray Avenue, San Luis Obispo, CA 93405

    Medicare Provider #050506

    St. Joseph Hospital, 1100 West Stewart Drive, P.O. Box 5600 Orange, CA 92863-5600

    Medicare Provider #050069

    St. Luke's Cornwall Hospital, 70 Dubois Street, Newburgh, NY 12550

    Medicare Provider #330264

    UCI Medical Center, 101 The City Drive South, Orange, CA 92868

    Medicare Provider #050348

    Effective Date—August 8, 2005

    Lynchburg General Hospital, 1920 Atherholt Road, Lynchburg, VA 24501-1104

    Medicare Provider #490021

    Mercy Hospitals Bakersfield, 2215 Truxtun Avenue, P.O. Box 119, Bakersfield, CA 93302

    Medicare Provider #050295

    Virginia Regional Medical Center, 901 Ninth Street North, Virginia, MN 55792

    Medicare Provider #240084

    Effective Date—August 9, 2005

    Columbia Hospital, 2201 45th Street, West Palm Beach, FL 33407

    Medicare Provider #100234

    Fairview Hospital, 14519 Detroit Avenue, Fairview, OH 44107

    Medicare Provider #360077

    Forum Health-Northside Medical Center, Cardiovascular Administration, 500 Gypsy Lane, Youngstown, OH 44501

    Medicare Provider #360141

    Mercy Hospital, 144 State Street, Portland, ME 04101

    Medicare Provider #020008

    New Hanover Regional Medical Center, 2131 South 17th Street, P.O. Box 9000, Wilmington, NC 28402-9000

    Medicare Provider #340141

    Sharp Grossmont Hospital, P.O. Box 158, La Mesa, CA 91944-0158

    Medicare Provider #050026

    Torrance Memorial Medical Center, 3330 Lomita Boulevard, Torrance, CA 90505-5073

    Medicare Provider #050351

    Effective Date—August 16, 2005

    Englewood Hospital and Medical Center, 350 Engle Street, Englewood, NJ 07631

    Medicare Provider #310045

    Mobile Infirmary Medical Center, Five Mobile Infirmary Circle, Mobile, AL 36607

    Medicare Provider #010113

    Ocean Medical Center, 425 Jack Martin Boulevard, Brick, NJ 08724

    Medicare Provider #310052

    OSF St. Joseph Medical Center, 200 East Washington Street, Bloomington, IL 61701

    Medicare Provider #140162

    St. Luke's Medical Center, LP, 1800 East Van Buren Street, Phoenix, AZ 85006

    Medicare Provider #030037

    Effective Date—August 19, 2005

    Inova Alexandria Hospital, 4320 Seminary Road, Alexandria, VA 22304

    Medicare Provider #490040

    Inova Fairfax Hospital, Inova Fairfax Hospital for Children and Inova Heart and Vascular Institute, 3300 Gallows Road, Falls Church, VA 22042-3300

    Medicare Provider #490063

    Milford Hospital, 300 Seaside Avenue, P.O. Box 3015, Milford, CT 06460-0815

    Medicare Provider #070019

    Our Lady of the Lakes Regional Medical Center, 5000 Hennessy Boulevard, Baton Rouge, LA 70808

    Medicare Provider #190064

    Summit Hospital, 17000 Medical Center Drive, Baton Rouge, LA 70816

    Medicare Provider #190202

    University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0060

    Medicare Provider #230046

    Effective Date—August 22, 2005

    Baptist Hospital of Miami, 8900 North Kendall Drive, Miami, FL 33176

    Medicare Provider #100008

    Camden-Clark Memorial Hospital, 800 Garfield Avenue, P.O. Box 718, Parkersburg, WV 26102

    Medicare Provider #510058

    HCA Dauterive Hospital, 600 North Lewis Avenue, New Iberia, LA 70563

    Medicare Provider #190003

    Kadlec Medical Center, 888 Swift Boulevard, Richland, WA 99352

    Medicare Provider #500058

    Lancaster Community Hospital, 43830 10th Street West, Lancaster, CA 93534

    Medicare Provider #050204

    Mercy Hospital, 4050 Coon Rapids Boulevard, Coon Rapids, MN 55433

    Medicare Provider #240115

    Montefiore Medical Center, 111 East 210th Street, New York, NY 10467

    Medicare Provider #330059

    Morristown Memorial Hospital, 100 Madison Avenue, Morristown, NJ 07962-1956

    Medicare Provider #310015

    Palmetto Health Richland, 5 Richland Medical Park Drive, Columbia, SC 29203-6897

    Medicare Provider #420018

    Saint Elizabeth Regional Medical Center, 555 South 70th Street, Lincoln, NE 68510

    Medicare Provider #280020

    Springhill Medical Center, 3710 Dauphine Street, Mobile, AL 36608

    Medicare Provider #010144

    Unity Hospital, 550 Osborne Road, Fridley, MN 55432

    Medicare Provider #240132

    Wilson Memorial Regional Medical Center, 33-57 Harrison Street, Johnson City, NY 13790

    Medicare Provider #330394

    Effective Date—August 23, 2005

    Jackson Madison County General Hospital, 708 West Forest Avenue, Jackson, TN 38301-3956

    Medicare Provider #044002

    Leesburg Regional Medical Center, 600 E. Dixie Avenue, Leesburg, FL 34748

    Medicare Provider #100084

    Meriter Hospitals, Inc., 202 South Park Street, Madison, WI 53715

    Medicare Provider #520089

    Poplar Bluff Regional Medical Center, 2620 North Westwood Boulevard, Poplar Bluff, MO 63901

    Medicare Provider #260119

    Saint Francis Hospital, 241 North Road, Poughkeepsie, NY 12601-1399

    Medicare Provider #330067

    The Western Pennsylvania Hospital, 4800 Friendship Avenue, Pittsburg, PA 15224

    Medicare Provider #390090

    Effective Date—August 24, 2005

    Halifax Medical Center, 303 N. Clyde Morris Start Printed Page 76312Boulevard, Daytona Beach, FL 32114

    Medicare Provider #100017

    Jackson Hospital, 1725 Pine Street, Montgomery, AL 36106-1117

    Medicare Provider #010024

    Marietta Memorial Hospital, 401 Matthew Street, Marietta, OH 45750

    Medicare Provider #360147

    Meadowcrest Hospital, 2500 Belle Chasse Highway, Gretna, LA 70056

    Medicare Provider #190152

    Medical Center Hospital, P.O. Box 7239, Odessa, TX 79760-7239

    Medicare Provider #450132

    REX Healthcare, 4420 Lake Boone Trail, Raleigh, NC 27607

    Medicare Provider #340114

    St. John's Mercy Medical Center, 615 South New Ballas Road, St. Louis, MO 63141

    Medicare Provider #260020

    Effective Date—August 26, 2005

    Candler Hospital, 5353 Reynolds Street, Savannah, GA 31405

    Medicare Provider #110024

    CHRISTUS Santa Rosa, 333 North Santa Rosa Street, San Antonio, TX 78207-3198

    Medicare Provider #450237

    Durham Regional Hospital, 3643 North Roxboro Road, Durham, NC 27704

    Medicare Provider #344155

    Hillcrest Medical Center, 1120 South Utica Avenue, Tulsa, OK 74104

    Medicare Provider #370001

    Houston Northwest Medical Center, 710 FM 1960 West, Houston, TX 77090

    Medicare Provider #450638

    Mercy Hospital, 3663 South Miami Avenue, Miami, FL 33133

    Medicare Provider #100061

    Saint Barnabas Medical Center, Old Short Hills Road, Livingston, NJ 07039

    Medicare Provider #310076

    Effective Date—August 31, 2005

    Columbia St. Mary's Hospital Milwaukee, Inc., 2323 North Lake Drive, Milwaukee, WI 53211

    Medicare Provider #520051

    Franklin Square Hospital Center, 9000 Franklin Square Drive, Baltimore, MD 21237-9986

    Medicare Provider #210015

    The Griffin Hospital, 130 Division Street, Derby, CT 06418

    Medicare Provider #070031

    Gwinnett Medical Center, 1000 Medical Center Boulevard, Lawrenceville, GA 30045

    Medicare Provider #110087

    Louis A. Weiss Memorial Hospital, 4646 North Marine Drive, Chicago, IL 60640

    Medicare Provider #140082

    The North Shore Medical Center, 81 Highland Avenue, Salem, MA 01970

    Medicare Provider #220006

    South Pointe Hospital, 20000 Harvard Road, Warrensville Hts., OH 44122

    Medicare Provider #360144

    Southwest Medical Center—Lafayette, 2810 Ambassador Caffery, Lafayette, LA 70506

    Medicare Provider #190205

    St. Mary's Hospital Ozaukee, Inc., 13111 North Port Washington Road, Mequon, WI 53097

    Medicare Provider #520027

    St. Tammany Parish Hospital, 1202 South Tyler Street, Covington, LA 70433

    Medicare Provider #190045

    Trinity Medical Center Terrace Park, 4500 Utica Ridge Road, Bettendorf, IA 52722

    Medicare Provider #160104

    UAMS Medical Center, 4301 West Markham, Little Rock, AK 72205-7199

    Medicare Provider #040016

    Valley Baptist Medical Center—Harlingen, P.O. Drawer 2588, 2101 Pease Street, Harlingen, TX 78551

    Medicare Provider #450033

    Effective Date—September 6, 2005

    Carilion Roanoke Memorial Hospital, 1906 Belleview Avenue, Roanoke, VA 24014

    Medicare Provider #490024

    Midland Memorial Hospital, 2200 West Illinois Avenue, Midland, TX 79701-6499

    Medicare Provider #450133

    Provena Saint Joseph Medical Center, 333 North Madison Street, Joliet, IL 60435-6595

    Medicare Provider #140007

    Salinas Valley Memorial Healthcare System, 450 E. Romie Lane, Salinas, CA 93901

    Medicare Provider #050334

    UHHS Geauga Regional Hospital, 13207 Ravenna Road, Chardon, OH 44024

    Medicare Provider #360192

    Effective Date—September 8, 2005

    Howard Regional Health System, 3500 South Lafountain Street, P.O. Box 9011, Kokomo, IN 46904-9011

    Medicare Provider #150007

    Luther Hospital, 1221 Whipple Street, P.O. Box 4105, Eau Claire, WI 54702-4105

    Medicare Provider #520070

    Our Lady of Fatima Hospital, 200 High Service Avenue, No. Providence, RI 02904

    Medicare Provider #041005

    Pitt County Memorial Hospital, Inc., P.O. Box 6028, Greenville, NC 27835-6028

    Medicare Provider #340040

    Effective Date—September 12, 2005

    Baylor All Saints Medical Center, 1400 Eighth Avenue, Fort Worth, TX 76104

    Medicare Provider #450137

    St. Vincent's Hospital, Staten Island, 355 Bard Avenue, Staten Island, NY 10310

    Medicare Provider #330028

    SUNY Stony Brook University Hospital, Nicolls Road, Stony Brook, NY 11794

    Medicare Provider #330393

    The Washington Hospital, 155 Wilson Avenue, Washington, PA 15301

    Medicare Provider #390042

    Effective Date—September 15, 2005

    Abilene Regional Medical Center, 6250 Highway 83/84, Abilene, TX 79606

    Medicare Provider #450558

    Bon Secours Cottage Health Services, 468 Cadieux Road, Grosse Pointe, MI 48230

    Medicare Provider #230089

    HealthOne/HCA Rose Medical Center, 4567 E. 9th Avenue, Denver, CO 80220

    Medicare Provider #060032

    Providence Health Center, 6901 Medical Parkway, Waco, TX 76712

    Medicare Provider #450042

    St. Edward Mercy Medical Center, 7301 Rogers Avenue, P.O. Box 17000, Fort Smith, AR 72917-7000

    Medicare Provider #040062

    St. Joseph's Hospital, 3001 W. Dr. M.L. King Jr. Boulevard, Tampa, FL 33607

    Medicare Provider #100075

    Effective Date—September 22, 2005

    Baylor University Medical Center, Department of Radiology, 3500 Gaston Avenue, Dallas, TX 75246

    Medicare Provider #450021

    Delray Medical Center, 5352 Linton Boulevard, Delray Beach, FL 33484

    Medicare Provider #100258

    Desert Springs Hospital, 2075 East Flamingo Road, Las Vegas, NV 89119

    Medicare Provider #290022

    Ellis Hospital, 1101 Nott Street, Schenectady, NY 12308

    Medicare Provider #330153

    Ingham Regional Medical Center, 401 West Greenlawn Avenue, Lansing, MI 48910

    Medicare Provider #230167

    St. Joseph's Hospital, 11705 Mercy Boulevard, Savannah, GA 31419

    Medicare Provider #110043

    Mercy Hospital of Pittsburgh, 1400 Locust Street, Pittsburgh, PA 15219-5166

    Medicare Provider #390028

    The Pottsville Hospital and Warne Clinic, 420 South Jackson Street, Pottsville, PA 17901

    Medicare Provider #390030

    Southwest Mississippi Regional Medical Center, 215 Marion Avenue, McComb, MS 39648

    Medicare Provider #250097

    Sparks Regional Medical Center, 1311 South Start Printed Page 76313I Street, P.O. Box 17006, Fort Smith, AR 72917-7006

    Medicare Provider #040055

    Tampa General Hospital, 2 Columbia Drive, Tampa, FL 33606

    Medicare Provider #100128

    Wesley Medical Center, 550 N. Hillside, Wichita, KS 67214

    Medicare Provider #170123

    Effective Date—September 28, 2005

    Advocate Illinois Masonic Medical Center, 836 W. Wellington Avenue, Chicago, IL 60657-5193

    Medicare Provider #140182

    East Texas Medical Center-Tyler, 1000 South Beckham, Tyler, TX 75701

    Medicare Provider #450083

    Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219

    Medicare Provider #330914

    Mesa General Hospital, 515 North Mesa Drive, Mesa, AZ 85201

    Medicare Provider #030017

    Opelousas General Health System, 539 E. Prudhomme Street, P.O. Box 1389, Opelousas, LA 70570

    Medicare Provider #190017

    Southern Ohio Medical Center, 1895 27th Street, Portsmouth, OH 45662

    Medicare Provider #360008

    St. Joseph Hospital, 2901 Squalicum Parkway, Bellingham, WA 98264

    Medicare Provider #500030

    St. Lukes Hospital, 801 Ostrum Street, Bethlehem, PA 18015

    Medicare Provider #390049

    WakeMed Health and Hospitals, 3000 New Bern Avenue, Raleigh, NC 27610

    Medicare Provider #340069

    Yale-New Haven Hospital, 20 York Street, New Haven, CT 06504,

    Medicare Provider #070022

    End Supplemental Information

    [FR Doc. 05-24023 Filed 12-22-05; 8:45 am]

    BILLING CODE 4120-01-U

Document Information

Comments Received:
0 Comments
Published:
12/23/2005
Department:
Centers for Medicare & Medicaid Services
Entry Type:
Notice
Action:
Notice.
Document Number:
05-24023
Dates:
Prospective Payment System Pricer
Pages:
76290-76313 (24 pages)
Docket Numbers:
CMS-9033-N
PDF File:
05-24023.pdf