[Federal Register Volume 60, Number 143 (Wednesday, July 26, 1995)]
[Notices]
[Pages 38344-38352]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-18333]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration
[BPO-131-N]


Medicare and Medicaid Programs; Quarterly Listing of Program 
Issuances and Coverage Decisions--First Quarter 1995

AGENCY: Health Care Financing Administration (HCFA), HHS.

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: This notice lists HCFA manual instructions, substantive and 
interpretive regulations and other Federal Register notices, and 
statements of policy that were published during January, February, and 
March of 1995 that relate to the Medicare and Medicaid programs. 
Section 1871(c) of the Social Security Act requires that we publish a 
list of Medicare issuances in the Federal Register at least every 3 
months. Although we are not mandated to do so by statute, for the sake 
of completeness of the listing, we are including all Medicaid issuances 
and Medicare and Medicaid substantive and interpretive regulations 
(proposed and final) published during this timeframe. We are also 
providing the content of revisions to the Medicare Coverage Issues 
Manual published between January 1 and March 31, 1995. On August 21, 
1989, we published the content of the Manual (54 FR 34555) and 
indicated that we will publish quarterly any updates. Adding to this 
listing the complete text of the changes to the Medicare Coverage 
Issues Manual allows us to fulfill this requirement in a manner that 
facilitates identification of coverage and other changes in our 
manuals.

FOR FURTHER INFORMATION CONTACT:
Margaret Cotton, (410) 786-5255 (For Medicare instruction information). 
Pat Prete, (410) 966-3246 (For Medicaid instruction information). After 
July 21, 1995, (410) 786-3246. Nancy Ranels, (410) 966-8928 (For all 
other information). After August 4, 1995, (410) 786-8928.

SUPPLEMENTARY INFORMATION:

I. Program Issuances

    The Health Care Financing Administration (HCFA) is responsible for 
administering the Medicare and Medicaid programs, which pay for health 
care and related services for 38 million Medicare beneficiaries and 36 
million Medicaid recipients. Administration of these programs involves 
(1) Providing information to Medicare beneficiaries and Medicaid 
recipients, health care providers, and the public; and (2) effective 
communications with regional offices, State governments, State Medicaid 
Agencies, State Survey Agencies, various providers of health care, 
fiscal intermediaries and carriers who process claims and pay bills, 
and others. To implement the various statutes on which the programs are 
based, we issue regulations under authority granted the Secretary under 
sections 1102, 1871, and 1902 and related provisions of the Social 
Security Act (the Act) and also issue various manuals, memoranda, and 
statements necessary to administer the programs efficiently.
    Section 1871(c)(1) of the Act requires that we publish in the 
Federal Register at least every 3 months a list of all Medicare manual 
instructions, interpretive rules, statements of policy, and guidelines 
of general applicability not issued as regulations. We published our 
first notice June 9, 1988 (53 FR 21730). Although we are not mandated 
to do so by statute, for the sake of completeness of the listing of 
operational and policy statements, we are continuing our practice of 
including Medicare substantive and interpretive regulations (proposed 
and final) published during the 3-month timeframe. Since the 
publication of our quarterly listing on June 12, 1992 (57 FR 24797), we 
decided to add Medicaid issuances to our quarterly listings. 
Accordingly, we are listing in this notice Medicaid issuances and 
Medicaid substantive and interpretive regulations published from 
January 1 through March 31, 1995.

II. Medicare Coverage Issues

    We receive numerous inquiries from the general public about whether 
specific items or services are covered under Medicare. Providers, 
carriers, and intermediaries have copies of the Medicare Coverage 
Issues Manual, which identifies those medical items, services, 
technologies, or treatment procedures that can be paid for under 
Medicare. On August 21, 1989, we published a notice in the Federal 
Register (54 FR 34555) that contained all the Medicare coverage 
decisions issued in that manual.
    In that notice, we indicated that revisions to the Coverage Issues 
Manual will be published at least quarterly in the Federal Register. We 
also sometimes issue proposed or final national coverage decision 
changes in separate Federal Register notices. Readers should find this 
an easy way to identify both issuance changes to all our manuals and 
the text of changes to the Coverage Issues Manual.
    Revisions to the Coverage Issues Manual are not published on a 
regular basis but on an as-needed basis. We publish revisions as a 
result of technological changes, medical practice changes, responses to 
inquiries we receive seeking clarifications, or the resolution of 
coverage issues under Medicare. If no Coverage Issues Manual revisions 
were published during a particular quarter, our listing will reflect 
that fact.
    Not all revisions to the Coverage Issues Manual contain major 
changes. As with any instruction, sometimes minor clarifications or 
revisions are made within the text. We have reprinted manual revisions 
as transmitted to manual holders. The new text is shown in italics. We 
will not reprint the table of contents, since the table of contents 
serves primarily as a finding aid for the user of the manual and does 
not identify items as covered or not.
III. How to Use the Addenda

    This notice is organized so that a reader may review the subjects 
of all manual issuances, memoranda, substantive and interpretive 
regulations, or coverage decisions published during the timeframe to 
determine whether any are of particular interest. We expect it to be 
used in concert with previously published notices. Most notably, those 
unfamiliar with a description of our Medicare manuals may wish to 
review Table I of our first three notices June 9, 1988 (53 FR 21730), 
September 22, 1988 (53 FR 36891), December 16, 1988 (53 FR 50577) and 
the notice published March 31, 1993 (58 FR 16837), and those desiring 
information on the Medicare Coverage Issues Manual may wish to review 
the August 21, 1989 publication (54 FR 34555).
    To aid the reader, we have organized and divided this current 
listing into five addenda. Addendum I identifies updates that changed 
the Coverage Issues Manual. We published notices in the Federal 
Register that included the text of changes to the Coverage Issues 

[[Page 38345]]
Manual. These updates, when added to material from the manual published 
on August 21, 1989 constitute a complete manual as of March 31, 1995. 
Parties interested in obtaining a copy of the manual and revisions 
should follow the instructions in section IV of this notice.
    Addendum II identifies previous Federal Register documents that 
contain a description of all previously published HCFA Medicare and 
Medicaid manuals and memoranda.
    Addendum III of this notice lists, for each of our manuals or 
Program Memoranda, a HCFA transmittal number unique to that instruction 
and its subject matter. A transmittal may consist of a single 
instruction or many. Often it is necessary to use information in a 
transmittal in conjunction with information currently in the manuals.
    Addendum IV sets forth the revisions to the Medicare Coverage 
Issues Manual that were published during the quarter covered by this 
notice. For the revisions, we give a brief synopsis of the revisions as 
they appear on the transmittal sheet, the manual section number, and 
the title of the section. We present a complete copy of the revised 
material, no matter how minor the revision, and identify the revisions 
by printing in italics the text that was changed. If the transmittal 
includes material unrelated to the revised section, for example, when 
the addition of revised material causes other sections to be 
repaginated, we do not reprint the unrelated material.
    Addendum V lists all substantive and interpretive Medicare and 
Medicaid regulations and general notices published in the Federal 
Register during the quarter covered by this notice. For each item, we 
list the date published, the Federal Register citation, the title of 
the regulation, the parts of the Code of Federal Regulations (CFR) 
which have changed (if applicable), the agency file code number, the 
ending date of the comment period (if applicable), and the effective 
date (if applicable).

IV. How to Obtain Listed Material

A. Manuals

    An individual or organization interested in routinely receiving any 
manual and revisions to it may purchase a subscription to that manual. 
Those wishing to subscribe should contact either the Government 
Printing Office (GPO) or the National Technical Information Service 
(NTIS) at the following addresses:

Superintendent of Documents, Government Printing Office, ATTN: New 
Order, P.O. Box 371954, Pittsburgh, PA 15250-7954, Telephone (202) 512-
1800, Fax number (202) 512-2250 (for credit card orders); or
National Technical Information Service, Department of Commerce, 5825 
Port Royal Road, Springfield, VA 22161, Telephone (703) 487-4630.

    In addition, individual manual transmittals and Program Memoranda 
listed in this notice can be purchased from NTIS. Interested parties 
should identify the transmittal(s) they want. GPO or NTIS can give 
complete details on how to obtain the publications they sell.

B. Regulations and Notices

    Regulations and notices are published in the daily Federal 
Register. Interested individuals may purchase individual copies or 
subscribe to the Federal Register by contacting the GPO at the address 
indicated above. When ordering individual copies, it is necessary to 
cite either the date of publication or the volume number and page 
number.

C. Rulings

    Rulings are published on an infrequent basis by HCFA. Interested 
individuals can obtain copies from the nearest HCFA Regional Office or 
review them at the nearest regional depository library. We also 
sometimes publish Rulings in the Federal Register.

D. HCFA's Compact Disk-Read Only Memory (CD-ROM)

    HCFA's laws, regulations, and manuals are now available on CD-ROM, 
which may be purchased from GPO or NTIS on a subscription or single 
copy basis. The Superintendent of Documents list ID is HCLRM, and the 
stock number is 717-139-00000-3. The following material is contained on 
the CD-ROM disk:
     Titles XI, XVIII, and XIX of the Act.
     HCFA-related regulations.
     HCFA manuals and monthly revisions.
     HCFA program memoranda.
    The titles of the Compilation of the Social Security Laws are 
current as of January 1, 1993. The remaining portions of CD-ROM are 
updated on a monthly basis.
    The CD-ROM disk does not contain Appendix M (Interpretative 
Guidelines for Hospices). Copies of this appendix may be reviewed at a 
Federal Depository Library (FDL).
    Any cost report forms incorporated in the manuals are included on 
the CD-ROM disk as LOTUS files. LOTUS software is needed to view the 
reports once the files have been copied to a personal computer disk.

V. How to Review Listed Material

    Transmittals or Program Memoranda can be reviewed at a local FDL. 
Under the FDL program, government publications are sent to 
approximately 1400 designated libraries throughout the United States. 
Interested parties may examine the documents at any one of the FDLs. 
Some may have arrangements to transfer material to a local library not 
designated as an FDL. To locate the nearest FDL, individuals should 
contact any library.
    In addition, individuals may contact regional depository libraries, 
which receive and retain at least one copy of most Federal government 
publications, either in printed or microfilm form, for use by the 
general public. These libraries provide reference services and 
interlibrary loans; however, they are not sales outlets. Individuals 
may obtain information about the location of the nearest regional 
depository library from any library. Superintendent of Documents 
numbers for each HCFA publication are shown in Addendum III, along with 
the HCFA publication and transmittal numbers. To help FDLs locate the 
instruction, use the Superintendent of Documents number, plus the HCFA 
transmittal number. For example, to find the Carriers Manual, Part 3--
Claims Process (HCFA-Pub. 14-3) transmittal entitled ``Medical 
Review,'' use the Superintendent of Documents No. HE 22.8/7 and the 
HCFA transmittal number 1508.

VI. General Information

    It is possible that an interested party may have a specific 
information need and not be able to determine from the listed 
information whether the issuance or regulation would fulfill that need. 
Consequently, we are providing information contact persons to answer 
general questions concerning these items. Copies are not available 
through the contact persons. Copies can be purchased or reviewed as 
noted above.
    Questions concerning Medicare items in Addenda III may be addressed 
to Margaret Cotton, Issuances Staff, Bureau of Program Operations, 
Health Care Financing Administration, S1-03-08, 7500 Security Blvd., 
Baltimore, MD 21244-1850, Telephone (410) 786-5255.
    Questions concerning Medicaid items in Addenda III may be addressed 
to Pat Prete, Medicaid Bureau, Office of Medicaid Policy, Health Care 
Financing Administration, (before July 21, 1995) Room 233 East High 
Rise, 6325 Security Blvd., Baltimore, MD 21207, Telephone (410) 966-
3246 or (after July 21, 1995) C4-25-02, 7500 Security Boulevard, 

[[Page 38346]]
Baltimore, MD 21244-1850, Telephone (410) 786-3246.
    Questions concerning all other information may be addressed to 
Nancy Ranels, Office of Regulations, Bureau of Policy Development, 
Health Care Financing Administration, (before August 4, 1995) Room 132 
East High Rise 6325 Security Blvd., Baltimore, MD 21207, Telephone 
(410) 966-8928 or (after August 4, 1995) C5-14-22, 7500 Security 
Boulevard, Baltimore, MD 21244-1850, Telephone (410) 786-8928.

(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance, Program No. 93.774, Medicare--
Supplementary Medical Insurance Program, and Program No. 93.714, 
Medical Assistance Program)

    Dated: July 19, 1995.
Bruce C. Vladeck,
Administrator, Health Care Financing Administration.
Addendum I

    This addendum lists the publication dates of the most recent 
quarterly listing of program issuances and coverage decision updates to 
the Coverage Issues Manual. For a complete listing of the quarterly 
updates to the Coverage Issues Manual published between March 20, 1990 
through November 14, 1994, please refer to the January 3, 1995 update 
(60 FR 134).

January 3, 1995 (60 FR 132)
April 6, 1995 (60 FR 17538)

Addendum II--Description of Manuals, Memoranda, and HCFA Rulings

    An extensive descriptive listing of Medicare manuals and memoranda 
was published on June 9, 1988, at 53 FR 21730 and supplemented on 
September 22, 1988, at 53 FR 36891 and December 16, 1988, at 53 FR 
50577. Also, a complete description of the Medicare Coverage Issues 
Manual was published on August 21, 1989, at 54 FR 34555. A brief 
description of the various Medicaid manuals and memoranda that we 
maintain was published on October 16, 1992, at 57 FR 47468.

        Addendum III.--Medicare and Medicaid Manual Instructions        
                      [January Through March 1995]                      
------------------------------------------------------------------------
 Trans. No.                     Manual/Subject/Publication Number       
------------------------------------------------------------------------
                                Medicare                                
                       Intermediary Manual--Part 2                      
                          Audits, Reimbursement                         
                 Program Administration (HCFA-Pub. 13-2)                
              (Superintendent of Documents No. HE 22.8/6-1)             
------------------------------------------------------------------------
402             Maximum Payment For Rural Health Clinics        
                        Maximum Payment For Federally Qualified Health  
                         Centers                                        
403             Contractor Performance Evaluation               
                        Fiscal Intermediary Performance Criteria--      
                         General                                        
                        The RHHI Performance Evaluation                 
                        RHHI Performance Criteria--General              
404             Beneficiary Services                            
                        Provider Services                               
------------------------------------------------------------------------
                                Medicare                                
                       Intermediary Manual--Part 3                      
                     Claims Process (HCFA-Pub. 13-3)                    
               (Superintendent of Documents No. HE 22.8/6)              
------------------------------------------------------------------------
1642            HCPCS for Hospital Outpatient Radiology Services
                         and Other Diagnostic Procedures                
                        Ambulatory Surgical Center Pricer Program       
1643            Billing for Durable Medical Equipment, Orthotic/
                         Prosthetic Devices and Surgical Dressings      
1644            Frequency of Billing                            
                        Requirement That Bills Be Submitted In-Sequence 
                         for a Continuous Inpatient Stay                
                        Need to Reprocess Inpatient Claims In-Sequence  
1645            PRO Reporting on Medical Review                 
1646            All-Inclusive Rate Providers                    
                        Billing for Parenteral and Enteral Nutrition    
                        Special Billing Instructions for Pneumococcal   
                         Pneumonia                                      
1647            On-Site CMRs                                    
                        Review Options                                  
------------------------------------------------------------------------
                                Medicare                                
                         Carriers Manual--Part 2                        
                 Program Administration (HCFA-Pub. 14-2)                
              (Superintendent of Documents No. HE 22.8/7-3)             
------------------------------------------------------------------------
130             The FY 1995 Contractor Performance Evaluation   
131             Beneficiary Services                            
                        Provider Services                               
------------------------------------------------------------------------
                                Medicare                                
                         Carriers Manual--Part 3                        
                     Claims Process (HCFA-Pub. 14-3)                    
               (Superintendent of Documents No. HE 22.8/7)              
------------------------------------------------------------------------
1508            Medical Review                                  
                        Local MR Policy                                 
                        The Carrier Advisory Committee                  

[[Page 38347]]
                                                                        
                        Data Analysis to Identify Aberrancies           
                        Aberrancies                                     
                        Taking Corrective Actions on Identified         
                         Aberrancies                                    
                        Conducting Evaluation of Effectiveness of       
                         Correction Action                              
                        Standard Postpayment Data Reports               
                        Categories of MR Screens                        
                        Provider Audit List                             
                        CMR Corrective Actions                          
                        Assessing an Overpayment or Potential           
                         Overpayment When the CMR was Based on a Limited
                         Sample/Subsample                               
                        Determination                                   
                        Consent Settlement Documents                    
1509            Participating Physician/Supplier Report         
                        Completion of Items on Participating Physician/ 
                         Supplier Report                                
                        Checking Reports                                
1510            Recovery From the Physician/Supplier--          
                         Overpayment Demand Letters                     
                        Initial Demand Letter to Physicians/Suppliers   
                        Follow-up Demand Letter to Physicians/Suppliers 
                        Overpayment Report                              
                        Optional Overpayment Customizing Paragraphs     
                        Sample Letter--Check Included For Correct Amount
                        Sample Letter--Check Included But Wrong Amount  
1511            Personal Computer EMC Software                  
1512            HCFA Common Procedure Coding System             
                        Use and maintenance of CPT-4 in HCPCS           
                        Local Codes at Regular Carriers                 
                        Use and Acceptance of HCPCS Codes and Modifiers 
                        HCPCS Update                                    
                        Payment Concerns While Updating Codes           
                        Payment, Utilization Review and Coverage        
                         Information on HCFA Tape File                  
                        Deleted HCPCS Codes/Modifiers                   
                        Claims Review and Adjudication Procedures       
                        HCPCS Release                                   
------------------------------------------------------------------------
                           Program Memorandum                           
                     Intermediaries (HCFA-Pub. 60A)                     
               (Superintendent of Document No. HE 22.8/7)               
------------------------------------------------------------------------
A-95-1          Hospital Outpatient Procedures: 1995 Update to  
                         the List of Radiology Procedures and Other     
                         Diagnostic Services Subject to Payment         
                         Limitation and Update to the List of HCPCS     
                         Codes to Be Grossed-Up                         
A-95-2          Submission of Form HCFA-2552-92 (Hospital and   
                         Hospital Health Care Complex Cost Report)      
A-95-3          Ambulatory Surgical Center--PRICER 9.1          
------------------------------------------------------------------------
                           Program Memorandum                           
                        Carriers (HCFA-Pub. 60B)                        
              (Superintendent of Documents No. HE 22.8/6-5)             
------------------------------------------------------------------------
B-95-1          Implementation of 1995 Physician Fee Schedule   
                         Payment Policy Changes                         
------------------------------------------------------------------------
                           Program Memorandum                           
                 Intemediaries/Carriers (HCFA-Pub. 60AB)                
              (Superintendent of Documents No. HE 22.8/6-5)             
------------------------------------------------------------------------
AB-95-1         Establishment of Standard Rates for Transmitting
                         Claims Information Between Medicare Contractors
                         and Complementary Insurers                     
AB-95-2         New Interest Rate Payable on Clean Claims Note  
                         Paid Timely                                    
AB-95-3         Implementation of ``Physician Ownership and     
                         Referral'' (Section 1877 of the Social Security
                         Act, as amended by Section 13562 of the Omnibus
                         Budget Reconciliation Act of 1993 (OBRA 93))   
AB-95-4         EDI Enrollment Form                             
AB-95-5         Temporary HCPCS Codes for Dexamethasone Acetate 
------------------------------------------------------------------------
                           Program Memorandum                           
                 Medicaid State Agencies (HCFA-Pub. 17)                 
              (Superintendent of Documents No. HE 22.8/6-5              
------------------------------------------------------------------------
95-1            Title XIX, Social Security Act, Transfers of    
                         Assets and Treatment of Trusts                 
------------------------------------------------------------------------

[[Page 38348]]
                                                                        
                           Program Memorandum                           
                 Insurance Commissioners (HCFA-Pub. 80)                 
              (Superintendent of Documents No. HE 22.8/6-5)             
------------------------------------------------------------------------
95-1            Medigap Bulletin Series (Number Four)           
------------------------------------------------------------------------
                         State Operations Manual                        
                  Provider Certification (HCFA-Pub. 7)                  
              (Superintendent of Documents No. HE 22.8/12)              
------------------------------------------------------------------------
266             Survey Procedures for Swing-Bed Hospitals       
                        Model Letter--Swing Bed Applicants              
                        Nurse Aide Training/Nurse Aide Training and     
                         Competency Evaluation Program                  
                        Line-Item Justification for Direct and Indirect 
                         Costs                                          
                        Preparation of the State Survey Agency          
                         Certification Workload Report--HCFA-434        
                        Distribution of Approved Funds                  
                        Disbursement of Approved Funds                  
                        General                                         
                        Goods, Facilities, Services From Other Staff    
                         Agencies or From Local Agencies                
                        Personnel Services                              
                        State Agency Accounts                           
                        Determination of Necessary Staff                
                        Communications and Supplies                     
                        Equipment                                       
                        Training of State Agency Personnel              
                        Long Term Care Facility Workload (SNF/NF)       
                        Preparation of the State Agency Budget List of  
                         Positions--HCFA-1465A                          
                        Preparation of the State Agency Schedule for    
                         Equipment Purchases--HCFA-1466                 
                        Preparation of State Survey Agency Budget       
                         Request (Non-LTC)-HCFA-435                     
                        Preparation of State Survey Agency Budget       
                         Request--Long-Term Care, HCFA-435              
                        Submittal of Budget Request                     
                        Notification of Approval                        
                        Need For Additional Title XVIII and Title XIX   
                         Funds                                          
                        Financial Reporting                             
                        Limit on Expenditures                           
                        Periodic Analysis of Accounts                   
                        Cash Balances and Expenditure Authority         
                        Unliquidated Obligations                        
                        State Survey Agency Quarterly Expenditure       
                         Report, HCFA-435 and State Survey Agency       
                         Certification Workload Report HCFA-434--       
                         Submittal and Due Date                         
                        Preparation of State Survey Agency Non-TLC      
                         Quarterly Expenditure Report, HCFA-435         
                        Preparation of State Survey Agency Long-Term    
                         Care Quarterly Expenditure Report, HCFA-435    
                        State Survey Agency/Certification Workload      
                         Report                                         
267             Community Mental Health Centers--Citations and  
                         Description                                    
                        Certification Process                           
                        Model Letter to CMHCs                           
                        CMHC Crucial Data Extract                       
                        Public Health Service Act Requirements          
                        Health Insurance Benefit Agreement              
                        Conditions to Be Assessed Prior to Scheduling An
                         RHC Survey                                     
268               Assignment of Provider and Supplier             
                         Identification Numbers                         
                        Essential Access Community Hospital//Rural      
                         Primary Care Hospital (EACH/RPCH) Program--    
                         Citations and Description                      
                        Procedures for EACH Approval by the Regional    
                         Office (RO)                                    
                        Procedures for RPCH Approval by the RO          
                        Procedures for Processing RPCH Swing-Bed        
                         Applications                                   
                        Processing Complaints Against EACHs and RPCHs   
                        Processing Denials and Terminations for EACHs   
                         and RPCHs                                      
                        EACH Approval Letter                            
                        RPCH Approval Letter                            
                        EACH Denial Letter                              
                        RPCH Denial Letter                              
------------------------------------------------------------------------
                                Medicare                                
                     Hospital Manual (HCFA-Pub. 10)                     
               (Superintendent of Documents No. HE 22.8/2)              
------------------------------------------------------------------------
675             HCPCS for Hospital Outpatient Radiology Services
                         and Other Diagnostic Procedures                
676             Billing for Durable Medical Equipment, Orthotic/
                         Prosthetic Devices and Surgical Dressings      
677             Oral Cancer Drugs                               
                        Requirement That Bills Be Submitted In-Sequence 
                         for a Continuous Inpatient Stay                
678             Pneumococcal Pneumonia, Influenza Virus and     
                         Hepatitis B Vaccines                           
------------------------------------------------------------------------
                                Medicare                                
                Home Health Agency Manual (HCFA-Pub. 11)                
               (Superintendent of Documents No. HE 22.8/5)              
------------------------------------------------------------------------
274             Pneumococcal Pneumonia, Influenza Virus and     
                         Hepatitis B Vaccines                           
------------------------------------------------------------------------
                                Medicare                                
             Skilled Nursing Facility Manual (HCFA-Pub. 12)             
               (Superintendent of Documents No. HE 22.8/3)              
------------------------------------------------------------------------
334             Billing for Durable Medical Equipment, Orthotic/
                         Prosthetic Devices and Surgical Dressings      
335             Requirement That Bills Be Submitted In-Sequence 
                         For a Continuous Inpatient Stay                
336             Special Billing Instructions for Pneumococcal   
                         Pneumonia, Influenza Virus and Hepatitis B     
                         Vaccines                                       
------------------------------------------------------------------------
                                Medicare                                
                    Rural Health Clinic and Federally                   
             Qualified Health Centers Manual (HCFA-Pub. 27)             
            (Superintendent of Documents No. HE 22.8/19:985)            
------------------------------------------------------------------------
18              Rural Health Clinics                            
                        Federally Qualified Health Centers              
19              Billing of Pneumococcal Pneumonia, Influenza    
                         Virus and Hepatitis B Vaccines by Rural Health 
                         Clinics and Federally Qualified Health Centers 
------------------------------------------------------------------------
                                Medicare                                
                      Hospice Manual (HCFA-Pub. 21)                     
              (Superintendent of Documents No. HE 22.8/18)              
------------------------------------------------------------------------
45              Special Billing Instructions for Pneumococcal   
                         Pneumonia, Influenza Virus and Hepatitis B     
                         Vaccines                                       
------------------------------------------------------------------------
                                Medicare                                
          Provider Reimbursement Manual Part 1 (HCFA-Pub. 15-1)         
               (Superintendent of Documents No. HE 22.8/4)              
------------------------------------------------------------------------
380             Board Action on Request for Hearing             
381             Ancillary Services in SNFs                      
382             Principles                                      
                        Land (Non-Depreciable)                          
                        Historical Cost                                 
                        Purchase of Facility as Ongoing Operation       
                        Fair Market Value                               
                        Donated Assets                                  
                        Net Book Value                                  
                        Acquisitions                                    
                        Sale and Leaseback Agreements--Rental Charges   

[[Page 38350]]
                                                                        
                        Lease Purchase Agreements--Rental Charges       
                        Assets Partially or Fully Depreciated on        
                         Provider's Books When Provider Enters Program  
                        Transfer of Governmental Facilities             
                        Assets Donated to Provider                      
                        Useful Life of Depreciable Assets               
------------------------------------------------------------------------
                                Medicare                                
                      Provider Reimbursement Manual                     
 Part II--Provider Cost Reporting Forms and Instructions (HCFA-Pub. 15- 
                                  11AF)                                 
               (Superintendent of Documents No. HE 22.8/4)              
------------------------------------------------------------------------
1               Home Health Agency Cost Report, Form HCFA-1728- 
                         94                                             
2               Rounding Standards for Fractional Computations  
                        Method of Payment                               
                        Worksheet S--Independent Renal Dialysis Facility
                         Cost Report Certification                      
                        Worksheet A--Reclassification and Adjustments of
                         Trial Balance of Expenses                      
                        Worksheet A-2--Adjustments to Expenses          
                        Worksheet B, Cost Allocation--General Service   
                         Costs and Worksheet B-1--Cost Allocation--     
                         Statistical Basis                              
------------------------------------------------------------------------
                                Medicare                                
                      Provider Reimbursement Manual                     
                 Part II--Provider Cost Reporting Forms                 
              and Instructions (General) (HCFA-Pub. 15-11A)             
               (Superintendent of Documents No. HE 22.8/4)              
------------------------------------------------------------------------
17              Submission of Cost Reports                      
------------------------------------------------------------------------
                                Medicare                                
                     Outpatient Physical Therapy and                    
            Comprehensive Outpatient Rehabilitation Facility            
                          Manual (HCFA-Pub. 9)                          
               (Superintendent of Documents No. HE 22.8/9)              
------------------------------------------------------------------------
120             Billing for Durable Medical Equipment, Orthotic/
                         Prosthetic Devices and Surgical Dressing       
121             Pneumococcal Pneumonia, Influenza Virus and     
                         Hepatitis B Vaccines                           
122             Pneumococcal Pneumonia, Influenza Virus and     
                         Hepatitis B Vaccines                           
------------------------------------------------------------------------
                     Peer Review Organization Manual                    
                             (HFCA-Pub. 19)                             
              (Superintendent of Documents No. HE 22.8/15)              
------------------------------------------------------------------------
44              Introduction                                    
                        HCFA-Provided Data                              
                        PRO-Selected Data                               
                        Confidentiality of PRO Data                     
45              Training                                        
46              Objectives of the Internal Quality Control      
                         Program                                        
                        IQC Program Requirements                        
                        IQC Control Process                             
                        Analysis and Reporting Requirements             
47              Introduction                                    
                        Uses for PDC                                    
                        Conducting PDC                                  
                        Concerns Identified During PDC                  
                        Confidentiality                                 
                        Reports to HCFA                                 
                        Required HCFA Notification/Approval             
                        Office of Management and Budget Clearance       
                        Related Activities Through PRO/Carrier          
                         Intermediary/ESRD Network Cooperation          
                        Timeline for PDC Process                        
48              Statutory Basis                                 
                        Grounds for Termination                         
                        Recommendation to Initiate Termination          
                        Notice of Intent to Terminate Contract          
                        Termination Panel                               
                        Termination Decision                            
------------------------------------------------------------------------

[[Page 38351]]
                                                                        
                                Medicare                                
                  Coverage Issues Manual (HCFA-Pub. 6)                  
               (Superintendent of Documents No. 22. 8/14)               
------------------------------------------------------------------------
74              Bladder Stimulators (Pacemakers)                
------------------------------------------------------------------------
                          State Medicaid Manual                         
                  Part 3--Eligibility (HCFA-Pub. 45-6)                  
              (Superintendent of Documents No. HE 22.8/10)              
------------------------------------------------------------------------
65              Persons with Drug Addition or Alcoholism        
------------------------------------------------------------------------
                          State Medicaid Manual                         
              Part 6--Payment for Services (HCFA-Pub. 45-6)             
              (Superintendent of Documents No. HE 22.8/10)              
------------------------------------------------------------------------
27              Physician Services to Children Under 21         
                        Physican Services to Pregnant Women             
------------------------------------------------------------------------
                         End Stage Renal Disease                        
               Network Organizations Manual (HCFA-Pub. 81)              
               (Superintendent of Documents No. HE 22.9/4)              
------------------------------------------------------------------------
2               Introduction                                    
                        Board of Directors                              
                        Network Staff                                   
                        Network Council                                 
                        Patient Involvement                             
                        Medical Review Board                            
                        Other Committees                                
                        Meetings                                        
                        Goals                                           
                        Internal Quality Control System                 
                        Continuous Quality Improvement                  
                        Medicare Benefits for ESRD Patients             
                        Hospital Insurance for Persons Needing Kidney   
                         Transplant or Dialysis                         
                        When ESRD Coverage Begins                       
                        When ESRD Coverage Ends                         
                        Supplemental Medical Insurance                  
                        Organizational Conflicts of Interest Among      
                         Governing Body of ESRD Network Organizations,  
                         Facilities, and Patients                       
                        Conflict of Interest--Private Arrangements      
                         Prohibited                                     
                        Organizational Conflicts of Interest            
                        Permitted Activities                            
------------------------------------------------------------------------
                                Medicare                                
              Renal Dialysis Facility Manual (HCFA-Pub. 29)             
               (Superintendent of Document No. HE 22.8/13)              
------------------------------------------------------------------------
71              Pneumococcal Pneumonia, Influenza Virus and     
                         Hepatitis B Vaccines                           
------------------------------------------------------------------------
                            Medicare/Medicaid                           
                      Sanction/Reinstatement Report                     
------------------------------------------------------------------------
95-1            Report of Physicians/Practitioners, Providers   
                         and/or Other Health Care Suppliers Excluded/   
                         Reinstated                                     
95-2            Report of Physicians/Practitioners, Providers   
                         and/or Other Health Care Suppliers Excluded/   
                         Reinstated                                     
95-3            Report of Physicians/Practitioners, Providers   
                         and/or Other Health Care Suppliers Excluded/   
                         Reinstated                                     
------------------------------------------------------------------------


Addendum IV--Medicare Coverage Issues Manual

    (For the reader's convenience, new material and changes to 
previously published material are in italics. If any part of a sentence 
in the manual instruction has changed, the entire line is shown in 
italics. The transmittal includes material unrelated to revised 
sections. We are not reprinting the unrelated material.)

Transmittal No. 74; sections 65-10.1-65-11 Bladder Stimulators 
(Pacemakers) CHANGED IMPLEMENTING INSTRUCTIONS--EFFECTIVE DATE: For 
services performed on or after 03-01-95.

    Section 65-10.1, Bladder Stimulators (Pacemakers).--This section is 
revised to reflect that pelvic floor stimulators, whether inserted into 
the vaginal canal or rectum or implanted in the pelvic area, used as a 
treatment for urinary incontinence either as a bladder pacer or a 
retraining mechanism are not covered for the reason that the safety 

[[Page 38352]]
and effectiveness of these devices are unproven.
    65-11 BLADDER STIMULATORS (PACEMAKERS)--NOT COVERED Pelvic floor 
stimulators, whether inserted into the vaginal canal or rectum or 
implanted in the pelvic area, used as a treatment for urinary 
incontinence either as a bladder pacer or a retraining mechanism are 
not covered for the reason that the safety and effectiveness of these 
devices are unproven.

                                           Addendum V.--Regulation Documents Published in the Federal Register                                          
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                                   End of               
Publication date   FR vol. 60 page      CFR part          File code                        Regulation title                       comment     Effective 
                                                                                                                                   period        date   
--------------------------------------------------------------------------------------------------------------------------------------------------------
01/03/95........  46-54...........  410,414.........  BPD-789-CN        Medicare Program; Refinements to Geographic Adjustment  ...........     01/01/95
                                                                         Factor Values, Revisions to Payment Policies,                                  
                                                                         Adjustments to the Relative Value Units (RVUs) Under                           
                                                                         the Physician Fee Schedule for Calendar Year 1995,                             
                                                                         and the 5-Year Refinement of RVUs.                                             
01/03/95........  130-132.........  ................  HSQ-224-N         CLIA Program: Approval of the Joint Commission on       ...........     01/03/95
                                                                         Accreditation of Healthcare Organizations As An                                
                                                                         Accrediting Organization.                                                      
01/03/95........  132-141.........  ................  BPO-129-N         Medicare and Medicaid Programs; Quarterly Listing of    ...........     01/03/95
                                                                         Program Issuances and Coverage Decisions--Third                                
                                                                         Quarter 1994.                                                                  
1/09/95.........  2325-2330.......  400, 405, 410,    BPD-798-FC        Medicare Program; Providers and Suppliers of               03/10/95     02/08/95
                                     484, 485, 486,                      Specialized Services: Technical Amendments.                                    
                                     498,.                                                                                                              
01/13/95........  3250-3253.......  ................  MB-089-N          Medicaid Program; Limitations on Aggregate Payments to  ...........     01/13/95
                                                                         Disproportionate Share Hospitals: Federal Fiscal Year                          
                                                                         1995.                                                                          
01/17/95........  3405-3410.......  ................  BPD-778-FN        Medicare Program; Special Payment Limits for Home       ...........     02/16/95
                                                                         Blood Glucose Monitors.                                                        
01/23/95........  4418-4423.......  ................  ORD-070-N         New and Pending Demonstration Project Proposals         ...........     01/23/95
                                                                         Submitted Pursuant to Section 1115(a) of the Social                            
                                                                         Security Act: November and December 1994.                                      
01/26/95........  5185-5204.......  ................  BPD-776-FNC       Medicare Program; Additions To and Deletions From the      03/27/95     02/27/95
                                                                         Current List of Covered Surgical Procedures for                                
                                                                         Ambulatory Surgical Centers.                                                   
02/02/95........  6537-6547.......  ................  BPD-812-NC        Medicare Program; Criteria for Medicare Coverage of        04/03/95     02/02/95
                                                                         Lung Transplants.                                                              
02/08/95........  7514............  482.............  BPD-826-N         Medicare Program; Hospice Wage Index..................  ...........     02/08/95
02/09/95........  7774-7780.......  ................  HSQ-223-N         CLIA Program: Approval of the College of American       ...........     02/09/95
                                                                         Pathologists.                                                                  
02/14/95........  8389-8406.......  ................  BPD-793-NC        Medicare Program; Schedule of Limits on Home Health        04/17/95     07/01/94
                                                                         Agency Costs Per Visit.                                                        
02/16/95........  8951-8955.......  410.............  BPD-424-F         Medicare Program; Medicare Coverage of Prescription     ...........     01/01/95
                                                                         Drugs Used in Immunosuppressive Therapy.                                       
02/24/95........  10395-10396.....  ................  OPL-004-N         Medicare Program; Meeting of the Practicing Physicians  ...........     02/24/95
                                                                         Advisory Council.                                                              
03/02/95........  11632-11633.....  485, 486........  BPD-798-CN        Medicare Program; Providers and Suppliers of            ...........     02/08/95
                                                                         Specialized Services-Technical Amendments;                                     
                                                                         Corrections.                                                                   
03/13/95........  13441...........  ................  BPD-833-N         Medicare Program; Hospice Wage Index..................  ...........     03/13/95
03/16/95........  14223-14224.....  410.............  BPD-724-F         Medicare Program; Medicare Coverage of Screening        ...........     10/01/94
                                                                         Mammography; Correction.                                                       
03/30/95........  16481-16486.....  ................  ORD-073-N         New and Pending Demonstration Project Proposals         ...........  ...........
                                                                         Submitted Pursuant to Section 1115(a) of the Social                            
                                                                         Security Act: January 1995.                                                    
--------------------------------------------------------------------------------------------------------------------------------------------------------
*GN--General Notice; PN--Proposed Notice; FN--Final Notice; P--Notice of Proposed Rulemaking (NPRM); F--Final Rule: FC--Final Rule with Comment Period; 
  CN--Correction Notice; SN--Suspension Notice; WN--Withdrawal Notice; NR--Notice of HCFA Ruling                                                        

[FR Doc. 95-18333 Filed 7-25-95; 8:45 am]
BILLING CODE 4120-01-P