CMS Medicare MNT Update

CMS Medicare MNT Update

Several important benefit regulations include:

  • As of April 2003, Medicare MNT for diabetes and non-dialysis kidney disease can be billed on the CMS-1450 (also called UB92) form in hospital outpatient settings. This is an additional way to bill outpatient Medicare MNT, it does not change requirements where you can bill on the CMS-1500 form. CMS has issued a program memorandum today describing this change. Access the document from CMS' Web page at  www.cms.hhs.gov/Transmittals/downloads/A02115.pdf

 

  • CMS indicated RDs must enroll and get their provider identification numbers, and practitioners could start providing MNT to qualifying beneficiaries according to the effective date that was indicated on the enrollment form. However, the facility would hold these claims until April, when they can be submitted to your fiscal intermediary on the CMS-1450 form.

 

  • As of January 2003, where there is medical necessity for additional hours of coverage after the completion of the three hours of MNT, two new MNT codes must be used. These codes, one for individual MNT and one for group MNT, would be used for reassessment and subsequent intervention following a second referral in the same calendar year for a change in diagnosis, medical condition, or treatment regimen. Additional details on the new Medicare MNT regulations will be posted on ADA's Web site, or view the recent CMS program memorandum that describes the new codes. The memorandum is accessible on ADA's Web site in the Medicare Provider section or from the CMS web at www.cms.hhs.gov/Transmittals/downloads/AB02151.pdf    

                                                                   

  • Despite earlier information on the start date for providing MNT for diabetes and non-dialysis kidney disease, CMS has now indicated the Medicare MNT benefit is based on a calendar year. CMS explains this further in their 10/25 program memorandum (web address above) and indicates that Medicare covers three hours of MNT in the beneficiary's initial calendar year. There will be no carrying over of initial hours to the next calendar year. For example, if a physician gives a referral to a beneficiary for three hours of MNT but a beneficiary only uses two hours in November, the calendar year ends in December and if the third hour is not used, it cannot be carried over into the following year. The following year, a beneficiary is eligible for two follow-up hours (with a physician referral). Every calendar year a beneficiary must have a new referral for follow-up hours.

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