Major Changes to the Medicare Claims Processing Manual, Ch. 12

CMS issued Transmittal 10742 which brings about some unusual changes to the manual.

CMS is revising the following sections of the Centers for Medicare & Medicaid Services (“CMS”) Claims Processing Manual (Pub. 100-04), Chapter 12:

  • Section 30.6.1 Selection of Level of Evaluation and Management Service, (Rev. 3315, Issued: 08-06- 15, Effective: 01-01-16, Implementation: 01-04-16); B. Selection of Level of Evaluation and Management Service; Split/Shared E/M Service.
  • Section 30.6.12 Critical Care Visits and Neonatal Intensive Care (Codes 99291 – 99292) (Rev. 2997, Issued: 07-25-14, Effective: Upon implementation of ICD-10; 01-01- 2012 – ASC X12, Implementation: 08-25-2014 – ASC X12; Upon Implementation of ICD-10), Critical Care Services (Codes 99291-99292).
  • Section 30.6.13 Nursing Facility Services, (Rev. 2282, Issued: 08-26-11, Effective: 01-01-11, Implementation: 11-28-11); H. Split/Shared E/M Visit.

CMS plans to address the topics therein through the notice-and-comment rule-making process.

These sections will soon be removed from the Claims Processing Manual.  CMS does not keep historical versions available to the public.  The Claims Processing Manual has good information around Split/Shared and Critical Care.  It is suggested to save a current version of the PDF before it is updated with those sections removed for revisions.