CGI Federal (Region B RAC): CMS Approved Audit Issues
Released 8/26/09, updated
Name
Number
Blood Transfusions
B000052009
Description
Blood Transfusions – should be billed with a maximum of (1)
unit per patient per date of service (outpatient/physician)
Claim Type
Outpatient Hospital, Physician
Codes Affected
Overpayment or
Underpayment
Dates of Service
States
Overpayment
10/1/2007 - Open
IL, IN, KY, MI, MN, OH, WI
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
Policy Related Links
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Date Approved
Name
Number
CMS Pub 100-04, Ch. 4, § 231.8
Program Memorandum Intermediaries, Transmittal A01-50, April 12, 2001, page 1
Federal Register, Vol73, No 223, page 69016
8/14/2009
Bronchoscopy Services
B000062009
Description
Bronchoscopy Services - should be billed with a maximum of (1)
unit per patient per date of service (outpatient hospital/physician)
Claim Type
Outpatient Hospital, Physician
Codes Affected
Overpayment or
Underpayment
Dates of Service
States
Overpayment
10/1/2007 - Open
IL, IN, KY, MI, MN, OH, WI
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Policy Related Links
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Date Approved
Name
American Medical Association (AMA), Current
Procedural Terminology (CPT)
Federal Register, Volume 67, No. 251 (12/31/02), page
80072.
American Thoracic Society Coding 2005 Update
8/14/2009
IV-Hydration
B000072009
Number
Description
IV-Hydration- should be billed with a maximum number of
units (1) per patient per date of service
Claim Type
Outpatient Hospital, Physician
Codes Affected
Overpayment or
Underpayment
Overpayment
10/1/2007 - Open
Dates of Service
IL, IN, KY, MI, MN, OH, WI
States
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

Policy Related Links
Date Approved
Name
Number
CMS Pub 100-4 Ch. 12, pages 31-32
CMS Pub100-20, Transmittal 419, page 7
MLN Matters, MM6349 R/T CR Release Date
12.19.08, page 4
8/14/2009
Neulasta
B0000352009
Description
Neulasta - HCPC code J2505 represents 6 mg per unit. The code
should be billed (1) unit per patient per date of service.
Claim Type
Outpatient Hospital, Physician
Codes Affected
Overpayment or
Underpayment
Dates of Service
States
Overpayment
10/1/2007 - Open
IL, IN, KY, MI, MN, OH, WI
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
Policy Related Links
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
Date Approved
Name
CMS Manual System, Publication 100-04 Medicare
Claims Processing Manual, Transmittal 949 (dated May
12, 2006) CM_C0220_2
MLN Matters Number MM5912, Release Date : January
18, 2008 CM_C0220_3
MLN Matters Number MM4380, Release Date : May 12,
2006 CM_C0220_4
MLN Matters Number MM4380, Release Date : May 12,
2006 CM_C0220_4
9/30/2009
Once in a Lifetime Procedures
B000022009
Number
Description
Once in a Lifetime Procedures – Specified procedures that can
only be performed once in a lifetime per beneficiary.
Claim Type
Outpatient Hospital, Physician
Codes Affected
Overpayment or
Underpayment
Overpayment
10/1/2007 - Open
Dates of Service
IL, IN, KY, MI, MN, OH, WI
States
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
Policy Related Links
Date Approved
Name
Number
CMS Pub 100-08, Ch. 3, § 3.6.
NULLCahaba GBA Medicare B Newline Article
(January 2007)
9/30/2009
Untimed Codes
B000042009
Description
Untimed Codes – CPT codes (excluding modifiers KX, and 59)
where the procedure is not defined by a specific timeframe
(untimed codes), the provider should enter a one (1) in the units
billed column per date of service.
Claim Type
Outpatient Hospital, Physician
Codes Affected
Overpayment or
Overpayment
Underpayment
Dates of Service
States
10/1/2007 - Open
IL, IN, KY, MI, MN, OH, WI

Policy Related
Links
Date Approved
Name
Number
Description
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CMS Pub 100-04, Transmittal 1019, dated 8.3.06, pages 711.
CMS Pub 100-04, Ch. 5, § 20.2.
9/30/2009
Wheelchair Bundling
B000092009
Billing guidelines for certain wheelchair bases, options, and
accessories indicate that certain items are components and
therefore, not separately payable.
Claim Type
DME
Codes Affected
Overpayment or
Underpayment
Dates of Service
States
Overpayment
10/1/2007 - Open
IL, IN, KY, MI, MN, OH, WI
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
Policy Related Links
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
Date Approved
National Government Services (NGS) Policy Article for
Wheelchair Options/Accessories (A47229)
National Government Services LCD for Wheelchair
Options/Accessories (L27223)
Noridian LCD Policy A19846
CMS Pub 100-03, Ch 1, § 280.1 & 280.3
11/12/2009