Medicare News

March 2, 2011: Alert for Faslodex (J9395) Claims Processing Issue

A Medically Unlikely Edit (MUE) value for HCPCS code J9395, which does not align with recently revised higher doses of this medication approved by the FDA, is causing services to be denied. The Centers for Medicare and Medicaid Services (CMS) will modify the MUE value for this code on April 1, 2011 retroactive to dates of service January 1, 2011. Please refer to the article in our newsroom for more information on filing of claims and reopenings related to this issue.

March 1, 2011: Medical Policy Article Update

The J12 MAC article, called A49325 - NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Oncologic Conditions, been revised.

Updates on Medicare policies from the Philadelphia Regional Office

News from Spring 2010 (PDF)
News from Winter 2010 (PDF)

Medicare Carrier Advisory Committee

CtOA has a representative and an alternate representative on the Medicare Carrier Advisory Committee (CAC). They are xxxxxxxxxxxx and xxxxxxxxxxx  respectively. The purpose of CAC is to provide:

• A formal mechanism for physicians to participate in the development of Local Coverage Decisions (LCD) in an advisory capacity;
• A mechanism for members, in an advisory capacity, to discuss and improve administrative policies that are within the discretion of HGS Administrators;
• A forum for information exchange and identification of issues between the HSG Administrators and members’ constituencies.