New Medicare Preventive Services National Provider Call 8/15/12

Welcome to this video slideshow presentation from the new Medicare Preventive Services National Provider Call. Brought to you by the Medicare Learning Network, your source for official CMS information for Medicare Fee For Service Providers. This educational call was hosted by the CMS Provider Communications Group within the Center for Medicare on Wednesday August 15, 2012. Hello. Im Leah Nguyen from the Provider Communications Group here at CMS, and I will serve as your moderator for todays call, which is brought to you by the CMS Medicare Learning Network. I would like to welcome you to our National Provider Call on the Five New Medicare Preventive Services: 1. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse, 2. Screening for depression in adults, 3. Intensive behavioral therapy for cardiovascular disease, 4. Screening for sexually transmitted infections and high-intensity behavioral counseling to prevent STIs, and 5. Intensive behavioral therapy for obesity. CMS experts will provide an overview of these services, when to perform them, how to perform each service, who is eligible, and how to code and bill for each service. Before we get started, there are few items that I need to cover. The slide presentation for todays call was posted on the CMS Web site, and a link to the presentation was e-mailed to all registrants earlier this afternoon. The presentation can also be downloaded from the CMS Fee-for-Service National Provider Calls Web page at www.cms.gov/npc. Again, that URL is www.cms.gov/npc. At the left side of the Web page, select National Provider Calls and Events, and then select the August 15 call from the list. This call is being recorded and transcribed. An audio recording and written transcript will be posted soon to the National Provider Calls and Events section of the CMS Fee-for-Service National Provider Calls Web page. At this time, I would like to introduce our speakers for today. We are pleased to have with us Michelle Issa, Jamie Hermansen, and Deirdre OConnor from the Coverage and Analysis Group Center for Clinical Standards and Quality; Kathy Bryant from the Hospital Ambulatory Policy Group of the Center for Medicare; and Wil Gehne from the Provider Billing Group of the Center for Medicare. And now it is my pleasure to turn our call over to Michelle Issa for the first presentation on Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse. Thank you, Leah. Effective October 14, 2011, Medicare will cover annual alcohol screening, and for those that screen positive, Medicare covers up to four brief, face-to-face behavioral counseling interventions annually for Medicare beneficiaries, including pregnant women. Next slide. Slide 8 is the Description of the Service and Our Beneficiary Eligibility. * For those beneficiaries who screen positive, Medicare covers up to four face-to-face behavioral counseling interventions in a primary care setting. * For those who misuse alcohol but whose levels or patterns of alcohol consumption do not meet criteria for alcohol dependence. * For those who are competent and alert at the time that counseling is provided. * Whose counseling is furnished by a qualified primary care physician or other primary care practitioner in a primary care setting. CPT only copyright 2011 American Medical Association. All rights reserved. Next slide, number 9: Where Can Eligible Beneficiaries Receive These Services and Who Can Provide Them Screening and behavioral counseling intervention to reduce alcohol misuse must be furnished by a qualified primary care physician or other primary care practitioners in a primary care setting. Next slide, slide number 10. For the purposes of this covered service, a primary care practitioner is a physician with specialty designation of general practitioner, family practice practitioner, general internist, or obstetrician or gynecologist; a physician assistant; a nurse practitioner; and a clinical nurse specialist. Thank you. And Id like to turn this over to Kathy. Im on slide 11. Under the Medicare Program for Code G0442, which is what is used for annual alcohol misuse screening, the national payment rate for physicians in a nonfacility setting, such as a physicians office, would be $17.36. In a facility setting, it would be $9.19. And the hospital outpatient OPPS rate would be $35.69. For all of these services, there is no beneficiary co-insurance or deductible. For G0443, which is the code that is used for each of the brief face-to-face behavioral counseling sessions, the national payment rates are $25.19 for the physician nonfacility setting, $23.15 for the physician in a facility setting, and, again, $35.69 for the hospital outpatient department. Again, there is no beneficiary co-insurance or deductible. While we are on the call, I also wanted to point out to you, in slide number 12, a tool that is available on the Web site that youll be able to use any time to check on these or any other physician payment rates that you may be interested in. Its the Medicare Physician Fee Schedule Search Tool, which you have the link for there, and at this tool, you can put in any CPT or HCPCS code and get all kinds of information, including not only the payment but the payment policy indicators limiting charge, and we keep this updated at least quarterly so as when we change rates or new codes are added, you can always check here and get that information. Im sorry, and now Id like to turn the call over to Wil. Thanks, Kathy. On slide 14, we turn to Coding Professional Claims, and before I start, I want to define a couple of terms just for claritys sake. When the slide titles are referring to Professional Claims, thats referring to claim formats, so that means claims that will be submitted on a CMS 1500 paper claim form or an electronic 837 professional (837P) format. Each of my billing segments will talk about coding and editing of those professional claims, and then coding and editing of institutional claims, by which I mean claims submitted on the UB04 or the 837i electronic format, and then Ill talk a little bit about editing of all claims. So going back to professional claims, we are using the two HCPCS codes that Kathy mentioned, G0442 for screening and G0443 for behavioral counseling. And Michelle had mentioned primary care practitioners in a primary care setting, and we identify those things on professional claims using a set of provider specialty types for determining primary care practitioners, and theyre listed there on slide 14: general practice, family practice, internal medicine, obstetrics and gynecology, pediatric and geriatric medicine, certified nurse midwife, nurse practitioner, certified clinical nurse specialist, and physician assistant. Turning to slide 15: The place of service codes that are used to identify primary care settings for the service are: physicians office, outpatient hospital, independent clinic, federally qualified health center, public health clinic, and rural health clinic. In terms of how Medicare Systems will edit professional claims, well ensure that the two G codes are denied if theyre not billed with the appropriate place of service code, as was defined, and those denials will be identified on the remittance advicethe claim adjustment reason code 58, defined as treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service, and remittance advice remark code N428, service/procedure not covered when performed in certain settings. Similarly, when either code is not billed with one of the defined specialty provider specialties, the remittance advice for denials will be identified with reason code 185 (rendering provider is not eligible to perform this service billed), and remark code N95 (the provider type/provider specialty may not bill this service). Thats on slide 17. Turning to slide 18, we get the coding for institutional claims the same two HCPCS codes, G0442 and G0443. We use them on institutional claims. On institutional claims, we are identifying primary care setting by a specific list of types of bill: type of bill 13x for outpatient hospital, 71x for rural health clinic, 77x for federally qualified health centers, and 85x for critical access hospital outpatient. On slide 19, editing institutional claims were similarly ensuring that the two G codes are billed with one of the types of bill I just mentioned, and denials for using other types of bill will be identified under remittance advice with reason code 5 (the procedure code bill type is inconsistent with the place of service) and remark M77 (for invalid place of service). Next, slide 20. As the facilities in the audience will be familiar, the Medicare payment basis for institutional claims, you know, varies by the facility type: hospital outpatient claims, paid under the Outpatient Prospective Payment System; RHC and FQHC claims paid under all-inclusive payment rate; and critical access hospital claims paid based on the payment method thats selected by the hospital. If they select method I, we pay 101 percent of reasonable cost for technical component of the service, with the professional component able to be billed separately, and if they elect method II, 101 percent of the reasonable cost for the technical component plus 115 percent of the nonfacility rate for the professional component of those services. And any time we have payments that are covered by an all-inclusive rate, as in our RHC and FQHC settings, we have the question of what can be paid separately from an encounter or what is bundled into the payment for an encounter. So turning to slide 21, there are some special instructions for RHC/ FQHC payment, and that is that the alcohol screening and counseling is usually not separately payable with another encounter or visit on the same date. So on those claims, a separate service line is reported so that we can carve out the charges from the co-insurance and deductable, which Kathy mentioned dont apply to the service, but Medicare systems will bundle the line with the encounter and share that on the remittance advice with reason code 97, indicating that thee benefit for this service is included in the payment for another service. Turning to slide 22 a couple of terms, additional terms to define, when we talk about frequency editing in the slides that follow. By professional services, we mean any professional claim as I defined them earlier, plus any institutional claims thats billed with RHC or FQHC bill types, or institutional claims with the type of bill 85x that show institutional service revenue codes revenue codes 096x, 097x, or 098x. Facility fee claims will be, you know, pretty much anything thats left types of bill 13x and 85x, where the professional service revenue codes are not reported. Slide 23 turns to editing that applies to both professional and institutional claims. All claims for these services well be editing to ensure that G0442 is not billed more than once in a 12-month period, and G0443 is not billed more than four times in a 12-month period. And the remittance advice coding for those denials that exceed those maximums would be reason code 119, which is benefit maximum for this period has been reached, or the remark code N362, which is the number of days or units exceed our acceptable maximum. For each of those limits, a professional service or facility fee, as I described them, can be billed separately. Slide 24 describes editing to ensure that G0443 is not billed more than once on the same date of service for the same beneficiary, and denials for that reason will be identified on remittance advices with reason code 151, payment adjusted because the payer deems the information submitted does not support this many of the frequency of services and remark code M86, service denied because the payment is already made for a similar procedure within the set timeframe. And finally, turning to slide 25: We will also edit to ensure that the screening code G0442 is in the beneficiarys paid claims history before any claims for G0443 can be paid, and if that condition isnt met, the remittance advice will be coded with claim adjustment reason code B15, the service requires that qualifying service be received and covered, the qualifying service has not been received or adjudicated, and remark M16 with an alert to see the contractors Web site for the details, (inaudible), regarding this. Leah Thank you, Wil. Theres a list of resources for Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse on slide 26. And now I would like to turn the call back over to Michelle Issa, with our presentation on Screening for Depression in Adults. Thanks, Leah. Effective October 14, 2011, Medicare covers annual screening for adults for depression in a primary care setting that have staff-assisted depression care supports in place to assure accurate diagnosis, effective treatment, and followup. Next slide, number 29. Screening up to 15 minutes for depression screening for Medicare beneficiaries in a primary care setting when staff-assisted depression care supports are in place to assure accurate diagnosis, effective treatment, and followup. At a minimum level, staff-assisted supports consist of a clinical staff for example, a nurse or physician assistant in a primary care setting who can advise the physician of screening results and who can facilitate and coordinate referrals to mental health treatment. Various screening tools are available for screening for depression. CMS does not identify specific depression screening tools. Rather, the decision to use a specific tool is at the discretion of the clinician in a primary care setting. Next slide, number 30. For the purposes of this benefit, a primary care setting is a setting where there is provision of integrated, accessible healthcare services by clinicians who are accountable for addressing large majority of personal health care needs, development of sustained partnership with patients, and practicing in the context of family and community. Next slide, Coverage Limitations, slide 31. Screening for depression is not covered when performed more than one time in a 12-month period. It does not include treatment options for depression or any diseases, complications, or chronic conditions resulting from depression, nor does it address therapeutic interventions such as pharmacotherapy, combination therapy, counseling and medications, or other interventions for depression. Self-help materials, telephone calls, and Web-based counseling are not separately reimbursable by Medicare and are not part of this national coverage determination. Thank you. Now Id like to turn it over to Kathy. Thank you. For HCPCS code G0444 is the code used for annual depression screening. The national payment rates, again, starting with the physician nonfacility rate is $17.36. For the physician providing a service in the facility, $9.19. The hospital outpatient rate is $35.69. And there is no beneficiary co-insurance or deductible for this service. Now, Ill turn it over to Wil. Thanks, Kathy. For coding of depression screening on professional claims, you would use HCPCS Code G0444, and in this case the associated place of service code list is a little bit more limited limited to physicians office, outpatient hospital, independent clinic, or public health clinic. Similar to the other benefits, the Medicare system is going to edit to ensure that the correct place of service is reported, and if its not, the remittance advice will show that with reason code 58 and the remark code N428. And for the place of service edits, the remittance advice coding is consistent across all five of these benefits. Well move through that a little bit more quickly as we go along. Regarding coding institutional claims, the same HCPCS would be used, and the same list of type of bills is allowable that we had seen in the previous benefits and Medicare systems (turning to slide 36) and, again, edit to ensure that. In this case, we have slightly different remittance advice coding for those denials using reason code 170, which is that payment is denied when performed or billed by this type of provider, and remark code N428, not covered when performed in this place of service. So for the institutional claim edits, the remittance advice coding varies slightly between the benefits. Once again, the payment basis on slide 37 varies by facility type. This is consistent across all five of the benefits. Well move through that a little bit more quickly as we go along as well. Turning to all claims again on slide 38: Medicare systems enforce that annual depression screening is billed no more than once within a 12-month period. Whenever there are time limitations like that its important to get the specific definition of how thats enforced, and were using 11 full months that must elapse following the month in which the last annual depression screening took place. On slide 39, you can see that when that edit is applied, the remittance advice will indicate it with reason code 119, benefit maximum for this time period or occurrence has been reached, and remark code N362, the number of days or units of service exceeds our acceptable maximum. And once again, professional and facility fees can be billed separately for the services just as we defined them back on slide 22. Leah Ill now turn the call over to Jamie Hermansen with our presentation on Intensive Behavioral Therapy for Cardiovascular Disease. Thank you, Leah. Effective November 8, 2011, Medicare covers intensive behavioral therapy for cardiovascular disease, which is also referred to as a CVD risk reduction visit. The visit consists of three components: 1. Encouraging aspirin use for primary prevention of cardiovascular disease, 2. Screening for high blood pressure, and 3. Intensive behavioral counseling to promote a healthy diet. Medicare covers one face-to-face CVD risk reduction visit each year. On slide 43, Medicare Part B covers the CVD risk reduction visit for Medicare beneficiaries who are competent and alert at the time counseling is provided and whose counseling is furnished by a qualified primary care physician or primary care practitioner and in a primary care setting. Slide 44. For purposes of this covered benefit, a primary care practitioner is a physician with a specialty designation of general practitioner, family practice practitioner, general internist, obstetrician or gynecologist, physician assistant, nurse practitioner, or clinical nurse specialist. Slide 45. For purposes of this covered benefit, a primary care setting is defined as one in which there is a provision of integrated, accessible healthcare services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing within the context of family and community. I would now like to hand the call over to Kathy Bryant. For the intensive behavioral therapy to reduce cardiovascular disease, individual, face-to-face counseling, you use code G0446. The national payment rates for the physician in an office or other nonfacility setting is $25.19, for a physician in a facility setting is $23.15, and for the hospital outpatient department is $35.69. There is no beneficiary co-insurance or deductible. Now, Ill turn it over to Wil. Thanks, Kathy. Turning to slide 47 regarding professional claims: Youd use the HCPCS code that Kathy just mentioned, G0446, and in this case, one of the provider specialty types from the longer list that we saw on the alcohol NCD I dont want to read the entire list again, but you have it there on slide 47. And on slide 48, the same list of place of service codes that we saw on the last benefit. Slide 49: Again, its very consistent. We have the same two edits for ensuring that those provider specialty types and places of service are reported, and the remittance advice coding for those two denials is identical to the two that we saw before. Regarding institutional claims on slide 50, use G0446 and one of the whats now a familiar looking list of types of bill, that you see there on slide 50. And on slide 51, well be editing to ensure that service is limited to those types of bill, and coding the remittance advice for any denials with reason code 170 and remark code N428. Slide 52: Once again, the payment varies, and the information there is similar to what you saw, or identical to what you saw, on the earlier slide. Slide 53, regarding editing of all claims for Medicare systems, well be editing to ensure that the G0446 is billed no more than once in a 12-month period using that same criterion of 11 full months following the service month, and well be coding remittance advice for denials in the same way that we did for the depression screening, with reason code 119 and remark code N362. And once again, professional and facility fees can be billed separately for the service. Leah Thank you, Wil. Theres a list of resources for intensive behavioral therapy for cardiovascular disease on slide 54. I will now turn the call over to Deirdre OConnor for our presentation on screening for sexually transmitted infections and high-intensity behavioral counseling to prevent STIs. Hi. On slide 56, there is the description of the service. So, effective for dates of service on or after November 8, 2011, CMS will cover screening for sexually transmitted infections specifically chlamydia, gonorrhea, syphilis, and hepatitis B with the appropriate Food and Drug Administrationapproved/cleared laboratory tests when ordered by the primary care provider. The tests must be used consistent with FDA-approved labeling and in compliance with the Clinical Laboratory Improvement Act regulations and performed by an eligible Medicare provider for these services. Who is covered and frequency Screening for chlamydia and gonorrhea: Pregnant women who are 24 years old or younger when the diagnosis of pregnancy is known, and then repeat screening during the third trimester if high-risk *** behavior has occurred since the initial screening test, Pregnant women who are at increased risk for STIs when the diagnosis of pregnancy is known, and then repeat screening during the third trimester if high-risk *** behavior has occurred since the initial screening test, and Women at increased risk for STIs, annually. For syphilis: Pregnant women when the diagnosis of pregnancy is known, and then repeat screening during the third trimester and at delivery if high-risk *** behavior has occurred since the previous screening tests, Also, men and women at increased risk for STIs annually. For hepatitis B: Pregnant women at the first prenatal visit when the diagnosis of pregnancy is known, and then re-screening at the time of delivery for those with new or continuing risk factors. The coverage policy for the high intensity behavioral counseling is effective for dates of service on or after November 8, 2011. CMS will cover individual, 20- to 30-minute, face-to-face counseling sessions for Medicare beneficiaries for high-intensity behavioral counseling to prevent STIs, if referred for this service by a primary care provider and provided by a Medicare-eligible primary care provider in a primary care setting. Slide 61, Description of Primary Care Practitioner. Primary care practitioner is described as a physician with a specialty designation of general practitioner, family practice practitioner, general internist, or obstetrician or gynecologist; physician assistant, nurse practitioner, or clinical nurse specialist. A setting where there is a primary care setting is described as provision of integrated, accessible healthcare services by clinicians who are accountable for addressing a large majority of personal health care needs, development of sustained partnership with patients, and practicing in context of family and community. Slide 63 is high-intensity behavioral counseling is defined as a program intended to promote *** risk reduction or risk avoidance, which includes each of these broad topics, allowing flexibility for appropriate patient-focused elements: education, skills training, and guidance on how to change *** behavior. The medical record should be a reflection of the service provided, and I would refer you to the MLN Matters article on National Coverage Determination on slide 80 for a complete description of who is considered at high or increased risk. CMS will cover up to two individual, 20- to 30-minute, face-to-face counseling sessions annually for all sexually active adolescents and for adults at increased risk for STIs. And now, Ill hand it over to Kathy. Thank you. For the high-intensity behavioral counseling to prevent sexually transmitted infections, you use code G0445, and that code includes education, skills training, and guidance on how to change *** behavior. The national payment rates for each of those services: for a physician in a nonfacility setting, $25.19; for a physician in a facility setting, $23.15; and the OPP hospital outpatient rate is $35.69. There is no beneficiary co-insurance or deductible for these services. Now, Ill turn it over to Wil. Oh wait, Im sorry. I wont turn it over to Wil. I also wanted to mention that for the screening, the clinical lab tests are also covered for chlamydia, gonorrhea, syphilis, and hepatitis B. Those are paid under the clinical lab fee schedule, and on slide 66 weve provided you with the link to get that exact information, depending upon the (inaudible) you would be using. And now, Ill turn it over to Wil. Thanks, Kathy. Starting at slide 67, regarding coding professional claims, youd use the G0445 code that Kathy mentioned, and for this service we have an additional requirement, that the reporting HCPCS code needs to be supported by a specific ICD-9 diagnosis code, and that is code V69.8. At the bottom of slide 67, you see the now-familiar list of provider specialty types that are required, and again on slide 60 Im sorry, on 67 you see that, and again on 68, you see the list of place of service codes that are accepted. Slide 69 indicates that, once again, were editing to ensure that those specialty types and places of service are reported accurately on the claim, and the remittance advice coding is consistent with what weve talked about before. Regarding coding institutional claims, on slide 70, the same HCPCS code is used, and the same ICD-9 code requirement for V69.8 applies. The familiar list of types of bill is in effect here as well, and on slide 71, you see that the remittance advice coding for any denials for other types of bill uses reason code 170 and remark code N428. Once again, on slide 72, the payment varies by facility type, and the special instructions for RHCs and FQHCs apply. For editing of all claims, we ensure that the G0445 is billed with the diagnosis code V69.8, and denials for the absence of that diagnosis code will be reported with reason code 50. Theyre not these are noncovered services because this is not deemed a medical necessity by the payer, and remark code N386, indicating that this physician was based on a national coverage determination. Well also be editing to ensure that G0445 is billed no more two sessions in a 12-month period, and any denials for that reason will be coded using the benefit maximum codes that weve seen earlier in the presentation. And once again, facilities are professional services and facility fees can be billed separately when applying those frequency limitations. For this service, as Kathy mentioned, we have coding for laboratory billing as well, and I dont want to read the long list of HCPCS codes that are shown on slide 75, but note that there are nine different codes for chlamydia testing, four for gonorrhea, three for syphilis, two for hepatitis B, and those HCPCS code can be supported by ICD-9 codes V74.5, V73.89, V69.8, V22.0, V22.1, or V23.9. A list of valid ordering provider specialties for those lab codes is similar to the list of identical to the list of provider specialties that weve seen on several of the other services and shown on slide 76. Medicare systems edits to the laboratory billing will be ensuring that the STIs are billed with the appropriate ICD-9 diagnosis code that I just mentioned, and denials for the lack of these diagnostic codes would use reason code 50 and remark code N386. On slide 78, well be ensuring that the ordering physician specialty is appropriate for screenings for STIs, and those denials would be indicated on remittance advice with reason code 184, the prescribing or ordering provider is not eligible to prescribe or order the service billed. On slide 79 notes that well also be editing to ensure that those screenings for STIs do not exceed coverage frequency limitations as they had noted with coverage frequency differs based on the test performed, patient gender, high-risk diagnosis, and pregnancy status, and the benefit maximum remittance advice coding that weve seen on earlier slides applies to these services as well. Leah Thank you, Wil. And again, theres a list of resources for screening for sexually transmitted infections and high-intensity behavioral counseling to prevent STIs on slide 80. I will now turn the call over to Jamie Hermansen for our final presentation on intensive behavioral therapy for obesity. Thank you, Leah. On slide 82: Effective November 29, 2011, Medicare covers intensive behavioral therapy for obesity for beneficiaries with a body mass index greater than or equal to 30. Intensive behavioral therapies for obesity consist of the following: a screening for obesity in adults using measurement of BMI calculated by dividing weight in kilograms by the square of height in meters, dietary nutritional assessment, and intensive behavioral counseling and behavioral therapy to promote sustained weight loss through high-intensity interventions on diet and exercise. On slide 83: For Medicare beneficiaries with obesity who are competent and alert at the time that counseling is provided and whose counseling is furnished by a qualified primary care physician or other primary care practitioner and in a primary care setting, CMS covers one face-to-face visit every week for the first month, one face-to-face visit every other week for months 2 through 6, and one face-to-face visit every month for months 7 through 12, if the beneficiary meets the 3 kg weight loss requirement during the first six months. For slide 84: At the six-month visit, a reassessment of obesity and a determination of the amount of weight loss must be performed. Beneficiaries must lose 3 kg during the first six months of counseling to be eligible for counseling for an additional six months. Beneficiaries who do not achieve a weight loss of 3 kg or more may undergo reassessment of their readiness to change and BMI after an additional six months period. On slide 85: This service must be furnished in a primary care setting by a primary care practitioner. For slide 86: For purposes of this covered benefit, a primary care practitioner is a physician with specialty designation of general practitioner, family practice practitioner, general internist, obstetrician or gynecologist; a physician assistant, nurse practitioner, or clinical nurse specialist. For slide 87: For purposes of this covered benefit of primary care setting is to find those one in which the provision of integrated, accessible healthcare services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing within the context of family and community. For slide 88 and 89: The decision the decision covers intensive behavioral therapy for obesity when furnished in primary care settings, as described in Section 210.12 of the Medicare National Coverage Determinations Manual. In the primary care office setting, Medicare may cover these services when billed by the primary care physician or practitioner and furnished by auxiliary personnel under the conditions specified under our regulation at 42 CFR section 410.26(b). In the primary care hospital outpatient setting, Medicare may cover these services when furnished and billed by the primary care physician or practitioner, as described in Section 210.12 of the Medicare National Coverage Determinations Manual. In addition, Medicare may cover these services when furnished by the hospital in outpatient hospital settings under the conditions specified under our regulation at 42 CFR 410.270. We believe that providing for coverage under these conditions will promote appropriate staff to furnish intensive behavioral therapy for obesity while ensuring that services are delivered within the primary care setting in order to provide a coordinated approach as part of each patients comprehensive prevention plan. I would now like to hand the call over to Kathy Bryant. Thank you. For the face-to-face behavioral counseling for obesity, use code G0447. For physician rates in a nonfacility setting, it is at $25.19; for the physician rate in a facility setting, its $23.15; and for the OPPS rate, it is $35.69. There is no beneficiary co-insurance or deductible for this service. Now, Ill turn it over to Wil. Thanks, Kathy. When coding professional claims using the G0447, once again there is a diagnosis coding requirement. In this case, a range of codes one of a range of codes must be used, all indicating body mass index is over 30 thats V85.30 through 39, or V85.41 through 45 and again those services the combination of procedure and diagnosis codes needs to be billed by one of the provider types I mean provider specialty types thats shown on slide 90, and by one of the places of services codes place of service codes, thats shown on slide 91. Well be editing to ensure the specialty types and place of service codes on slides 92 and 93 using the same remittance coding that has been consistently applied for all the benefits weve talked about today. On slide 94, Coding Institutional Claims: The same requirement for a HCPCS code and a code from the diagnosis range of V85.30 through 39 or V85.41 through 45 applies, and the familiar list of types of bill must be used. When Medicare systems are editing to ensure institutional claims are using the appropriate type of bill for this service, the remittance advice coding varies back to using adjustment reason code 5 and remark code M77. And once again on slide 96, the payment for the service varies by the type of bill. On slide 97: Medicare claim system edits that apply to all claims were ensuring that G0447 is billed with one of those specified diagnosis codes, and remittance advice codes for denial are reason code 167, these diagnosis codes are not covered, and remark code N386, indicating that the decision was based on a national coverage determination. Were also editing, on slide 98, to ensure the frequency limitation. Jamie described the frequency limitation varies over time by month, and because we cant be sure in Medicare systems that services are coming in sequentially, we cant enforce that requirement exactly, but we can sure enforce systematically that the absolute limit for a 12-month period is met, and so were ready to ensure that G0447 is billed no more than 22 times during a 12-month period, and if that condition is exceeded that limit is exceeded, using the benefit maximum remittance advice coding that weve seen several times in the earlier presentation. One last thing Id like to note, and this applies to all five of the benefits weve talked about today, next eligible dates for the services that have been described are viewable through standard inquiry methods. So if youre not certain whether a beneficiary is eligible on a given date, you can check through one of the standard inquiry methods and get the date that is appropriate. Thanks. Thank you, Wil. Theres a list of resources for intensive behavioral therapy for obesity on slide 100. On slide 101, we have information on how to submit comments for the calendar year 2013 Physician Fee Schedule proposed rule, and on slide 102 theres a list of general preventive services resources. Thank you for viewing this Medicare Preventive Services Video Slideshow Presentation. The information presented in this presentation was correct as of the date it was recorded. This presentation is not a legal document. Official Medicare program legal guidance is contained in the relevant statutes, regulations, and rulings.