Medicaid and Medicare: Program issuances and coverage decisions; quarterly listing,

 
CONTENT

[Federal Register: December 23, 2005 (Volume 70, Number 246)]

[Notices]

[Page 76290-76313]

From the Federal Register Online via GPO Access [wais.access.gpo.gov]

[DOCID:fr23de05-81]

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-9033-N]

Medicare and Medicaid Programs; Quarterly Listing of Program Issuances--July Through September 2005

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Notice.

SUMMARY: This notice lists CMS manual instructions, substantive and interpretive regulations, and other Federal Register notices that were published from July 2005 through September 2005, relating to the Medicare and Medicaid programs. This notice provides information on national coverage determinations (NCDs) affecting specific medical and health care services under Medicare. Additionally, this notice identifies certain devices with investigational device exemption (IDE) numbers approved by the Food and Drug Administration (FDA) that potentially may be covered under Medicare. This notice also includes listings of all approval numbers from the Office of Management and Budget for collections of information in CMS regulations. Finally, this notice includes a list of Medicare-approved carotid stent facilities.

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, and to foster more open and transparent collaboration efforts, we are also including all Medicaid issuances and Medicare and Medicaid substantive and interpretive regulations (proposed and final) published during this 3-month time frame.

FOR FURTHER INFORMATION CONTACT: 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. (See Section III of this notice for how to obtain listed material.)

Questions concerning items in Addendum III may be addressed to Timothy Jennings, Office of Strategic Operations and Regulatory Affairs, Centers for Medicare & Medicaid Services, C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-2134.

Questions concerning Medicare NCDs in Addendum V may be addressed to Patricia Brocato-Simons, Office of Clinical Standards and Quality, Centers for Medicare & Medicaid Services, C1-09-06, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-0261.

Questions concerning FDA-approved Category B IDE numbers listed in Addendum VI may be addressed to John Manlove, Office of Clinical Standards and Quality, Centers for Medicare & Medicaid Services, C1-13- 04, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-6877.

Questions concerning approval numbers for collections of information in Addendum VII may be addressed to Bonnie Harkless, Office of Strategic Operations and Regulatory Affairs, Regulations Development and Issuances Group, Centers for Medicare & Medicaid Services, C5-14- 03, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-5666.

Questions concerning Medicare-approved carotid stent facilities may be addressed to Sarah J. McClain, Office of Clinical Standards and Quality, Centers for Medicare & Medicaid Services, C1-09-06, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-2994.

Questions concerning all other information may be addressed to Gwendolyn Johnson, Office of Strategic Operations and Regulatory Affairs, Regulations Development Group, Centers for Medicare & Medicaid Services, C5-14-03, 7500 Security Boulevard, Baltimore, MD 21244-1850, or you can call (410) 786-6954.

SUPPLEMENTARY INFORMATION:

  1. Program Issuances

    The Centers for Medicare & Medicaid Services (CMS) is responsible for administering the Medicare and Medicaid programs. These programs pay for health care and related services for 39 million Medicare beneficiaries and 35 million Medicaid recipients. Administration of the two programs involves (1) furnishing information to Medicare beneficiaries and Medicaid recipients, health care providers, and the public and (2) maintaining effective communications with regional offices, State governments, State Medicaid agencies, State survey agencies, various providers of health care, all Medicare contractors that process claims and pay bills, and others. To implement the various statutes on which the programs are based, we issue regulations under the authority granted to the Secretary of the Department of Health and Human Services under sections 1102, 1871, 1902, and related provisions of the Social Security Act (the Act). We also issue various manuals, memoranda, and statements necessary to administer the programs efficiently.

    Section 1871(c)(1) of the Act requires that we publish a list of all Medicare manual instructions, interpretive rules, statements of policy, and guidelines of general applicability not issued as regulations at least every 3 months in the Federal Register. 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, and to foster more open and transparent collaboration, we are continuing our practice of including Medicare substantive and interpretive regulations (proposed and final) published during the respective 3-month time frame.

  2. How To Use the Addenda

    This notice is organized so that a reader may review the subjects of manual issuances, memoranda, substantive and interpretive regulations, NCDs, and FDA-approved IDEs published during the subject quarter to determine whether any are of particular interest. We expect this notice to be used in concert with previously published notices. Those unfamiliar with a description of our Medicare manuals may wish to review Table I of our first three notices (53 FR 21730, 53 FR 36891, and 53 FR 50577) published in 1988, and the notice published March 31, 1993 (58 FR 16837). Those desiring information on the Medicare NCD Manual (NCDM, formerly the Medicare

    [[Page 76291]]

    Coverage Issues Manual (CIM)) may wish to review the August 21, 1989, publication (54 FR 34555). Those interested in the revised process used in making NCDs under the Medicare program may review the September 26, 2003, publication (68 FR 55634).

    To aid the reader, we have organized and divided this current listing into eight addenda:

    Addendum I lists the publication dates of the most recent quarterly listings of program issuances.

    Addendum II identifies previous Federal Register documents that contain a description of all previously published CMS Medicare and Medicaid manuals and memoranda.

    Addendum III lists a unique CMS transmittal number for each instruction in our manuals or Program Memoranda and its subject matter. A transmittal may consist of a single or multiple instruction(s). Often, it is necessary to use information in a transmittal in conjunction with information currently in the manuals.

    Addendum IV 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--

    [cir] Date published;

    [cir] Federal Register citation;

    [cir] Parts of the Code of Federal Regulations (CFR) that have changed (if applicable);

    [cir] Agency file code number; and

    [cir] Title of the regulation.

    Addendum V includes completed NCDs, or reconsiderations of completed NCDs, from the quarter covered by this notice. Completed decisions are identified by the section of the NCDM in which the decision appears, the title, the date the publication was issued, and the effective date of the decision.

    Addendum VI includes listings of the FDA-approved IDE categorizations, using the IDE numbers the FDA assigns. The listings are organized according to the categories to which the device numbers are assigned (that is, Category A or Category B), and identified by the IDE number.

    Addendum VII includes listings of all approval numbers from the Office of Management and Budget (OMB) for collections of information in CMS regulations in title 42; title 45, subchapter C; and title 20 of the CFR.

    Addendum VIII includes listings of Medicare-approved carotid stent facilities. All facilities listed meet CMS standards for performing carotid artery stenting for high risk patients.

  3. How To Obtain Listed Material

    1. Manuals

      Those wishing to subscribe to program manuals 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 Orders, 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. Additionally, most manuals are available at the following Internet address: http://cms.hhs.gov/manuals/default.asp.

    2. 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 given above. When ordering individual copies, it is necessary to cite either the date of publication or the volume number and page number.

      The Federal Register is also available on 24x microfiche and as an online database through GPO Access. The online database is updated by 6 a.m. each day the Federal Register is published. The database includes both text and graphics from Volume 59, Number 1 (January 2, 1994) forward. Free public access is available on a Wide Area Information Server (WAIS) through the Internet and via asynchronous dial-in. Internet users can access the database by using the World Wide Web; the Superintendent of Documents home page address is http://www.gpoaccess.gov/fr/index.html , by using local WAIS client software,

      or by telnet to swais.gpoaccess.gov, then log in as guest (no password required). Dial-in users should use communications software and modem to call (202) 512-1661; type swais, then log in as guest (no password required).

    3. Rulings

      We publish rulings on an infrequent basis. Interested individuals can obtain copies from the nearest CMS Regional Office or review them at the nearest regional depository library. We have, on occasion, published rulings in the Federal Register. Rulings, beginning with those released in 1995, are available online, through the CMS Home Page. The Internet address is http://cms.hhs.gov/rulings.

    4. CMS' Compact Disk-Read Only Memory (CD-ROM)

      Our laws, regulations, and manuals are also available on CD-ROM and 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 on the CD-ROM disk:

      Titles XI, XVIII, and XIX of the Act.

      CMS-related regulations.

      CMS manuals and monthly revisions.

      CMS program memoranda.

      The titles of the Compilation of the Social Security Laws are current as of January 1, 2003. (Updated titles of the Social Security Laws are available on the Internet at http://www.ssa.gov/OP_Home/ssact/comp-toc.htm. ) The remaining portions of CD-ROM are updated on a

      monthly basis.

      Because of complaints about the unreadability of the Appendices (Interpretive Guidelines) in the State Operations Manual (SOM), as of March 1995, we deleted these appendices from CD-ROM. We intend to re- visit this issue in the near future and, with the aid of newer technology, we may again be able to include the appendices on CD-ROM.

      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.

  4. How To Review Listed Material

    Transmittals or Program Memoranda can be reviewed at a local Federal Depository Library (FDL). Under the FDL program, government publications are sent to approximately 1,400 designated libraries throughout the United States. Some FDLs may have arrangements to transfer material to a local library not designated as an FDL. Contact any library to locate the nearest FDL.

    In addition, individuals may contact regional depository libraries that 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

    [[Page 76292]]

    sales outlets. Individuals may obtain information about the location of the nearest regional depository library from any library. For each CMS publication listed in Addendum III, CMS publication and transmittal numbers are shown. To help FDLs locate the materials, use the CMS publication and transmittal numbers. For example, to find the Medicare NCD publication titled ``Cochlear Implantation,'' use CMS--Pub. 100-03, Transmittal No. 42.

    (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: December 7, 2005. Jacquelyn Y. White, Director, Office of Strategic Operations and Regulatory Affairs.

    Addendum I

    This addendum lists the publication dates of the most recent quarterly listings of program issuances.

    June 27, 2003 (68 FR 38359) September 26, 2003 (68 FR 55618) December 24, 2003 (68 FR 74590) March 26, 2004 (69 FR 15837) June 25, 2004 (69 FR 35634) September 24, 2004 (69 FR 57312) December 30, 2004 (69 FR 78428) February 25, 2005 (70 FR 9338) June 24, 2005 (70 FR 36620) September 23, 2005 (70 FR 55863)

    Addendum II--Description of Manuals, Memoranda, and CMS 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 former CIM (now the NCDM) 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 [July through September 2005]

    Transmittal No.

    Manual/Subject/Publication No.

    Medicare General Information (CMS--Pub. 100-01)

    25

    Next Generation Desktop Testing Requirements Definitions Next Generation Desktop Maintainer Requirements 26

    Implement New Medicare Plan ID and Carrier Number for the Single Testing Contractor Shared System Testing Requirements for Maintainers, Beta Testers, and Contractors 27

    Provider Extract File 28

    Conforming Changes for Change Request 3648 to Pub. 100-01 Hospital Insurance (Part A) for Inpatient Hospital, Hospice, and Skilled Nursing Facility Services--A Brief Description Home Health Services Supplementary Medical Insurance (Part B)--A Brief Description Discrimination Prohibited Role of Part A Intermediaries Limitation on Physical Therapy, Occupational Therapy and Speech-Language Pathology Services Certification for Hospital Services Covered by the Supplementary Medical Insurance Program Content of the Physician's Certification Recertifications for Home Health Services Physician's Certification and Recertification for Outpatient Physical Therapy Occupational Therapy and Speech-Language Pathology Recertification Under Arrangements Term of Agreements Determining Payment for Services Furnished After Termination, Expiration, or Cancellation Home Health Agency Defined 29

    2005 Scheduled Release for October Updates to Software Programs and Pricing/Coding Files

    Medicare Benefit Policy (CMS--Pub. 100-02)

    37

    Conforming Changes for Change Request 3648 to Pub. 100-02 Medical and Other Health Services Furnished to Inpatients of Participating Hospitals Outpatient Hospital Services Distinguishing Outpatient Hospital Services Provided Outside the Hospital Coverage of Outpatient Therapeutic Services Medical and Other Health Services Furnished by Home Health Agencies Skilled Services Defined Speech-Language Pathology Physical Therapy, Speech-Language Pathology, and Occupational Therapy Furnished by the Skilled Nursing Facility or by Others Under Arrangements With the Facility and Under Its Supervision Inpatient Physical Therapy, Occupational Therapy, and Speech-Language Pathology Services Services Furnished Under Arrangements With Providers Supplementary Medical Insurance Provisions Services Not Provided Within United States

    Medicare National Coverage Determinations (CMS--Pub. 100-03)

    42

    Cochlear Implantation Cochlear Implantation (Effective April 4, 2005)

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    Medicare Claims Processing (CMS--Pub. 100-04)

    601

    Cochlear Implantation Billing Requirements for Expanded Coverage of Cochlear Implantation Intermediary Billing Procedures Applicable Bill Types Special Billing Requirements for Intermediaries Intermediary Payment Requirements Carrier Billing Procedures Healthcare Common Procedure Coding System 602

    Expansion of Various Alpha and Numeric Fields Within the Outpatient Prospective Payment System Outpatient Code Editor 603

    Modification to the Appeals Language on the Medicare Summary Notice; Full Replacement of Change Request 3808 Appeals Section Back of Medicare Summary Notice--Carriers and Intermediaries Carrier Spanish Medicare Summary Notices Back Intermediary Spanish Medicare Summary Notices Back 604

    Issued to a specific audience, not posted to Internet/Intranet due to Confidentiality of Instruction 605

    Frequency Instructions for Smoking and Tobacco- Use Cessation Counseling Services Remittance Advice Notices Medicare Summary Notices 606

    Medicare Program-Update to the Hospice Payment Rates, Hospice Cap, Hospice Wage Index, and the Hospice Pricer for FY 2005 Payment Rates 607

    Issued to a specific audience, not posted to Internet/Intranet due to Confidentiality of Instruction 608

    New Health Professional Shortage Area Modifier Zip Code Files Provider Education Claims Coding Requirements Services Eligible for Health Professional Shortage Area and Physician Scarcity Bonus Payments Post-payment Review Health Professional Shortage Area Incentive Payments for Physician Services Rendered in a Critical Access Hospital 609

    Remittance Advice Remark Code and Claim Adjustment Reason Code Update 610

    This Transmittal is rescinded and replaced by Transmittal 634 611

    Payment Methodology for Rehabilitation Services in Indian Health Service/Tribally Owned and/or Operated Hospitals and Hospital Based Facilities Services Paid Under the Physician Fee Schedule 612

    Abarelix for Treatment of Prostate Cancer 613

    New Healthcare Common Procedure Coding System Codes and Systems Edits for Supplies and Accessories for Ventricular Assist Devices-- Full Replacement of CR 3761 614

    Medicare Physician Fee Schedule Database 2006 File Layout 615

    Revision of Chapter 24, Electronic Data Interchange Support Requirements Electronic Data Interchange General Outreach Activities Carrier, Durable Medical Equipment Regional Carrier, and Fiscal Intermediary Analysis of Internal Information Systems Information Review of Provider Profiles Contact with New Providers Production and Distribution of Material to Increase Use of Electronic Data Interchange Electronic Data Interchange Enrollment New Enrollments and Maintenance of Existing Enrollments Submitter Number Release of Medicare Eligibility Data Network Service Vendor Agreement Electronic Data Interchange User Guidelines Directory of Billing Software Vendors and Clearinghouses Technical Requirements--Data, Media, and Telecommunications System Availability Media Telecommunications and Transmission Protocols Toll-Free Service Initial Editing Translators Required Electronic Data Interchange Formats General Health Insurance Portability and Accountability Act Electronic Data Interchange Requirements Continued Support of Pre-Health Insurance Portability and Accountability Act Electronic Data Interchange Formats National Council for Prescription Drug Program Claim Requirements Crossover Claim Requirements Direct Data Entry Screens Use of Imaging, External Key Shop, and In-House Keying for Entry of Transaction Data Submitted on Paper Electronic Funds Transfer Electronic Data Interchange Testing Requirements

    [[Page 76294]]

    Shared System and Common Working File Maintainers Internal Testing Requirements Carrier, Durable Medical Equipment Regional Carrier, and Intermediary Internal Testing Requirements Third-Party Certification Systems and Services Electronic Data Interchange Submitter/Receiver Testing by Carriers, Durable Medical Equipment Regional Carriers, and Fiscal Intermediaries Testing Accuracy Limitation on Testing of Multiple Providers That Use the Same Clearinghouse, Billing Service, or Vendor Software Carrier, Durable Medical Equipment Regional Carrier, and Fiscal Intermediary Submitter/ Receiver Testing With Legacy Formats During the Health Insurance Portability and Accountability Act Contingency Period Discontinuation of Use of Claim Legacy Formats following Successful Health Insurance Portability and Accountability Act Format Testing Electronic Data Interchange Receiver Testing by Carriers, Durable Medical Equipment Regional Carriers, and Intermediaries Changes in Provider's System or Vendor's Software, and Use of Additional Electronic Data Interchange Formats Support of Electronic Data Interchange Trading Partners User Guidelines Technical Assistance to Electronic Data Interchange Trading Partners Training Content and Frequency Prohibition Against Requiring Use of Proprietary Software or Direct Data Entry Free Claim Submission Software Remittance Advice Print Software Medicare Remit Easy Print Software for Carrier and Durable Medical Equipment Regional Carrier Provider Use Medicare Standard Fiscal Intermediary PC-Print Software Newsletters/Bulletin Board/Internet Publication of Electronic Data Interchange Information Provider Guidelines for Choosing a Vendor Determining Goals/Requirements Vendor Selection Negotiating With Vendors Electronic Data Interchange Edit Requirements Carrier, Durable Medical Equipment Regional Carrier, and Fiscal Intermediary X12 Edit Requirements Supplemental Fiscal Intermediary-Specific Shared System Edit Requirements Fiscal Intermediary Health Insurance and Portability Accountability Act Claim Level Implementation Guide Edits Supplemental Carrier/Durable Medical Equipment Regional Carrier-Specific Shared System Implementation Guide Edit Requirements Keyshop and Image Processing Carrier, Durable Medical Equipment Regional Carrier, or Fiscal Intermediary Data Security and Confidentiality Requirements Carrier, Durable Medical Equipment Regional Carrier, and Fiscal Intermediary Electronic Data Interchange Audit Trails Security-Related Requirements for Carrier, Durable Medical Equipment Regional Carrier, or Fiscal Intermediary Arrangements with Clearinghouses And Billing Services Mandatory Electronic Submission of Medicare Claims Small Providers and Full-Time Equivalent Employee Self-Assessments Exceptions Unusual Circumstance Waivers Unusual Circumstance Waivers Subject to Provider Self-Assessment Unusual Circumstance Waivers Subject to Medicare Contractor Approval Unusual Circumstance Waivers Subject to Contractor Evaluation and CMS Decision Electronic and Paper Claims Implications of Mandatory Electronic Submission Enforcement Provider Education 616

    Certified Registered Nurse Anesthetist Pass- Through Payments Anesthesia and Certified Registered Nurse Anesthetist Services in a Critical Access Hospitals Payment for Certified Registered Nurse Anesthetist Pass-Through Services Payment for Anesthesia Services by a Certified Registered Nurse Anesthetist (Method II Critical Access Hospital Only) 617

    Administration of Drugs and Biologicals in a Method II Critical Access Hospital Coding for Administering Drugs in a Method II Critical Access Hospital Coding for Low Osmolar Contrast Material 618

    Coding for the Administration of Other Drugs and Biologicals Clarification for Carriers and Durable Medical Equipment Regional Carriers About Correction and Recoupment of Previously Processed Claims 619

    Late IRF-PAI Data Submission Penalty Protocol Within the Inpatient Rehabilitation Facility Prospective Payment System Payment Adjustment for Late Transmission of Patient Assessment Data 620

    New Fiscal Intermediary (FI) Edit to Identify Potentially Excessive Medicare Payments Fiscal Intermediary Edits Affecting Multiple Bill Types Threshold Edit for Outpatient and Inpatient Part B Claims 621

    Locality Codes for Purchased Diagnostic Tests 622

    This Transmittal is rescinded and replaced by Transmittal 668 623

    Durable Medical Equipment Regional Carrier Only--Corrections to the Billing Indicator Field for Adjusted Claims 624

    This Transmittal is rescinded and replaced by Transmittal 686 625

    Competitive Acquisition Program for Part B Drugs--Coding, Testing, and Implementation 626

    Common Working File Expansion of Duplicate Claim Edit for Clinical Diagnostic Services 627

    New Low Osmolar Contrast Material (LOCM) HCPCS Codes/Payment Criteria/Payment Level

    [[Page 76295]]

    Low Osmolar Contrast Media (HCPCS Codes Q9945- Q9951) Payment Criteria/Payment Level 628

    Radiopharmaceutical Diagnostic Imaging Agents Codes Applicable to Positron Emission Tomography Scan Services Performed on or After January 28, 2005 Appropriate Common Procedure Terminology Codes Effective for Positron Emission Tomography Scan Services Performed on or After January 28, 2005 Tracer Codes Required for Positron Emission Tomography Scans 629

    Certificate of Medical Necessity Claim Edits Workload Reporting Durable Medical Equipment Regional Carrier Systems 630

    Medicare Part A Skilled Nursing Facility Prospective Payment System Pricer Update and Health Insurance Prospective Payment System Coding Update Effective January 1, 2006 Health Insurance Prospective Payment System Rate Code Skilled Nursing Facility Prospective Payment System Rate Components Decision Logic Used by the Pricer on Claims 631

    Claim Status Category Code and Claim Status Code Update 632

    Billing and Claims Processing Instructions for Claims Subject to Expedited Determinations Limitation of Liability Notification and Coordination With Quality Improvement Organizations Limitation on Liability--Overview Hospital Claims Subject to Hospital Issued Notices of Noncoverage Scope of Issuance of Hospital Issued Notices of Noncoverage General Responsibilities of Quality Improvement Organizations and Fiscal Intermediaries Related to Hospital Issued Notices of Noncoverage Billing and Claims Processing Requirements Related to Hospital Issued Notices of Noncoverage Skilled Nursing Facility, Home Health Agency, Hospice, and Comprehensive Outpatient Rehabilitation Facility Claims Subject to Expedited Determinations Scope of Issuance of Expedited Determination Notices General Responsibilities of Quality Improvement Organizations and Fiscal Intermediaries Related to Expedited Determinations Billing and Claims Processing Requirements Related to Expedited Determinations Coordination With the Quality Improvement Organization 633

    Guidelines for Payment of Vaccines (Pneumococcal Pneumonia Virus, Influenza Virus, and Hepatitis B Virus) and Their Administration Provided by Indian Health Service/Tribally-Owned and/or Operated Hospitals and Hospital Based Facilities Billing Requirements Bills Submitted to Fiscal Intermediaries Vaccines and Vaccine Administration 634

    Guidelines for Payment of Vaccines (Pneumococcal Pneumonia Virus, Influenza Virus, and Hepatitis B Virus) and Their Administration at Renal Dialysis Facilities Vaccines Furnished to End-Stage Renal Disease Patients Fiscal Intermediary Payment for Pneumococcal Pneumonia, Influenza Virus, and Hepatitis B Vaccine Bills Submitted by Hospices and Payment for Renal Dialysis Facilities 635

    Financial Liability for Services Subject to Home Health Consolidated Billing Home Health Prospective Payment System Consolidated Billing and Primary Home Health Agencies Home Health Prospective Payment System Consolidated Billing Beneficiary Notification and Payment Liability Under Home Health Consolidated Billing Responsibilities of Home Health Agencies Responsibilities of Providers/Suppliers of Services Subject to Consolidated Billing Responsibilities of Hospitals Discharging Medicare Beneficiaries to Home Health Care Home Health Consolidated Billing Edits in Medicare Systems Non-routine Supply Editing Therapy Editing Other Editing Related to Home Health Consolidated Billing Only Request for Anticipated Payment Received and Services Fall Within 60 Days After Request for Anticipated Payment Start Date No Request for Anticipated Payment Received and Therapy Services Rendered in the Home Health Insurance Eligibility Query to Determine Episode Status Other Editing and Changes for Home Health Prospective Payment System Episodes Coordination of Home Health Prospective Payment System Claims and Episodes With Inpatient Claim Types 636

    Instructions for Implementation of CMS Ruling 05-01; Presbyopia-Correcting Intraocular Lens 637

    Issued to a specific audience, not posted to Internet/Intranet due to Confidentiality of Instruction 638

    New Medicare Summary Notice Messages Adjustments Ajustes 639

    Cessation of Additional $50 Payment for New Technology Intraocular Lenses Ambulatory Surgical Center Services on Ambulatory Surgical Center List Payment for Intraocular Lens 640

    Medicare Part A Skilled Nursing Facility Prospective Payment System Pricer Update FY 2006 641

    October 2005 Quarterly Update to Skilled Nursing Facility Consolidated Billing 642

    New Waived Tests 643

    Nature and Effect of Assignment on Carrier Claims

    [[Page 76296]]

    644

    October 2005 Non-Outpatient Prospective Payment System Code Editor Specifications Version 21 645

    Issued to a specific audience, not posted to Internet/Intranet due to Confidentiality of Instruction 646

    Update to the Inpatient Provider Specific File and the Outpatient Provider Specific File to Retain Provider Information 647

    The Supplemental Security Income/Medicare Beneficiary Data for Fiscal Year 2004 for Inpatient Prospective Payment System Hospitals 648

    Issued to a specific audience, not posted to Internet/Intranet due to Confidentiality of Instruction 649

    Competitive Acquisition Program for Part B Drugs--Coding, Testing, and Implementation 650

    This Transmittal is rescinded and replaced by Transmittal 673 651

    Changes to the Laboratory National Coverage Determination Edit Software for October 2005 652

    This Transmittal is rescinded and replaced by Transmittal 661 653

    October 2005 Quarterly Average Sales Price Medicare Part B Drug Pricing File, Effective October 1, 2005 and Revisions to April 2005 and July 2005 Quarterly Average Sale Price Medicare Part B Drug Pricing File 654

    Services Not Provided Within the United States Services Received by Medicare Beneficiaries Outside the United States Source of Part B Claims Appeals of Denied Charges for Physicians and Ambulance Services in Connection With Foreign Hospitalization Services Rendered in Nonparticipating Providers Coverage Requirements for Emergency Hospital Services in Foreign Countries Services Furnished in a Foreign Hospital Nearest to Beneficiary's U.S. Residence Coverage of Physician and Ambulance Services Furnished Outside U.S. Payment by the Railroad Retirement Beneficiaries for Services Furnished in Canada to Qualified Railroad Retirement Beneficiaries Foreign Religious Nonmedical Health Care Facility Claims Elections to Bill for Services Rendered at Nonparticipating Hospitals Processing Claims Appeals on Claims for Emergency and Foreign Services Payment for Services from Foreign Hospitals Full Denial--Foreign Claim--Beneficiary Filed 655

    This Transmittal is rescinded and replaced by Transmittal 663 656

    Full Replacement of Change Request 3607, Payment Edits in Applicable States For Durable Medical Equipment Prosthetics, Orthotics & Supplies Provider Billing for Prosthetics and Orthotic Services 657

    Quarterly Update to Correct Coding Initiative Edits, Version V11.3, Effective October 1, 2005 658

    Billing for Devices Under the Hospital Outpatient Prospective Payment System Billing for Devices Under the Outpatient Prospective Payment System Requirements that Hospitals Report Device Codes on Claims on Which They Report Specified Procedures Edits for Claims on Which Specified Procedures Are To Be Reported With Device Codes 659

    Instructions for Downloading the Medicare Zip Code File 660

    This Transmittal is rescinded and replaced by Transmittal 664 661

    This Transmittal is rescinded and replaced by Transmittal 672 662

    This Transmittal is rescinded and replaced by Transmittal 691 663

    Update To The Hospice Payment Rates, Hospice Cap, Hospice Wage Index, and the Hospice Pricer for Fiscal Year 2006 664

    This Transmittal is rescinded and replaced by Transmittal 683 665

    October Quarterly Update for 2005 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Fees Schedule 666

    Updates to the Coordination of Benefits Contractor Detailed Error Report File Layout Consolidation of the Claims Crossover Process Coordination of Benefits Agreement Detailed Error Notification Process 667

    Home Care and Domiciliary Care Visits (Codes 99321-99350) 668

    Enforcement of Hospital Inpatient Bundling: Carrier Denial of Ambulance Claims During an Inpatient Stay Hospital Inpatient Bundling General Coverage and Payment Policies Common Working File Editing of Ambulance Claims for Inpatients Intermediary Guidelines Provider/Intermediary Bill Processing Guidelines Effective April 1, 2002, as a Result of Fee Schedule Implementation 669

    Schedule for Completing the Calendar Year 2006 Fee Updates and the Participating Physician Enrollment Procedures 670

    Realignment of States and Medicare Claims Processing Workload From Durable Medical Equipment Regional Carrier Regions A, B, C, and D to the Durable Medical Equipment Major Ambulatory Jurisdictions A, B, C and D 671

    Updated Manual Instructions for the Medicare Claims Processing Manual, Regarding Smoking and Tobacco-Use Cessation Counseling Services Healthcare Common Procedure Coding System and Diagnosis Coding Carrier Billing Requirements Fiscal Intermediary Billing Requirements Medicare Summary Notices 672

    October Update to the 2005 Medicare Physician Fee Schedule Database 673

    Manual Update on Medical Nutrition Therapy Services--Manualization Medicare Nutrition Therapy Services General Conditions and Limitations on Coverage Referrals for Medicare Nutrition Therapy Services Dietitians and Nutritionists Performing Medicare Nutrition Therapy Services

    [[Page 76297]]

    Payment for Medicare Nutrition Therapy Services General Claims Processing Information Common Working File Edits 674

    This Transmittal is rescinded and replaced by Transmittal 692 675

    Changes to Appeals of Claims Decisions: Redeterminations and Reconsiderations (Implementation Date October 1, 2005) Workload Data Analysis Program Managing Appeals Workloads Standard Operating Procedures Execution of Workload Prioritization Workload Priorities 676

    2006 Healthcare Common Procedure Coding System Annual Update Reminder 677

    This Transmittal is rescinded and replaced by 687 678

    This Transmittal is rescinded and replaced by 688 679

    Medicare Redetermination Notice and Effect of the Redetermination Medicare Redetermination Notice (for partly or fully unfavorable redeterminations) Medicare Redetermination Notice (for fully favorable redeterminations) Effect of the Redetermination 680

    Inpatient Rehabilitation Facility Annual Update: Prospective Payment System Pricer Changes for FY 2006 681

    Guidelines For Payment of Vaccines (Pneumococcal Pneumonia Virus, Influenza Virus, And Hepatitis B Virus) and Their Administration Provided by Indian Health Services/Tribally-Owned and/or Operated Hospitals and Hospital Based Facilities Billing Requirements Bills Submitted to Fiscal Intermediaries Vaccines and Vaccine Administration 682

    Issued to a specific audience, not posted to Internet/Intranet due to Confidentiality of Instruction 683

    October 2005 Outpatient Prospective Payment System Code Editor Specifications Version 684

    Correction to Chapter 17, Section 80.2.3, MSN/ ANSI X12 Denial Messages for Anti-Emetic Drugs 685

    Discontinuation of the Skilled Nursing Facility Healthcare Common Procedure Coding System Help File and Notification to Fiscal Intermediaries and Providers of the Redesigned Skilled Nursing Facility Consolidated Billing Annual Update File Posted on CMS Web site Services Included in Part A Prospective Payment System Payment Not Billable Separately by the Skilled Nursing Facility Services Beyond the Scope of the Part A Skilled Nursing Facility Benefit Billing for Medical and Other Health Services General Payment Rules and Application of Part B Deductible and Coinsurance 686

    Common Working File Unsolicited Response Adjustments for Certain Claims Denied Due to an Open Medicare Secondary Payer Group Health Plan Record Where the Group Health Plan Record Was Subsequently Deleted 687

    Appeals of Claims Decisions: Redeterminations and Reconsiderations (Implementation Dates for Fiscal Intermediary Initial Determination Issued On or After May 1, 2005 and Carrier Initial Determinations Issued on or After January 1, 2006) Filing a Request for Redetermination Appeal Rights for Dismissals Dismissal Letters Model Dismissal Notices Reconsideration--The Second Level of Appeal Filing a Request for a Reconsideration Time Limit for Filing a Request for a Reconsideration Contractor Responsibilities--General Qualified Independent Contractor Case File Development Qualified Independent Contractor Case File Preparation Forwarding Qualified Independent Contractor Case Files Qualified Independent Contractor Jurisdictions Tracking Cases Effectuation of Reconsiderations 688

    Appeals of Claims Decisions: Redeterminations and Reconsiderations (Implementation Dates for All Requests for Redetermination Received by Fiscal Intermediary on or After May 1, 2005, and All Requests for Redetermination Received by Carriers on or After January 1, 2006) Redetermination--The First Level of Appeal The Redetermination The Redetermination Decision Dismissals Vacating a Dismissal 689

    One Time Update to the National Council Prescription Drug Programs Companion Document Regarding Crossover Claims to Medicaid 690

    Fiscal Year (FY) 2006 Payment for Services Furnished in Ambulatory Surgical Centers 691

    October 2005 Update of the Hospital Outpatient Prospective Payment System 692

    Fiscal Year 2006 Inpatient Prospective Payment System and Long Term Care Hospital Changes 693

    Updates to the Inpatient Rehabilitation Facility and Skilled Nursing Facility Provider Specific File and Changes in Inpatient Rehabilitation Facility Prospective Payment System for FY 2006 Provider-Specific File Case-Mix Groups Facility Level Adjustments Area Wage Adjustment

    [[Page 76298]]

    Rural Adjustment Outlier Teaching Status Adjustment Full Time Equivalent Resident Cap Inpatient Rehabilitation Facility Prospective Payment System Pricer Software 694

    Update to the Healthcare Provider Taxonomy Codes Version 5.1

    Medicare Secondary Payer (CMS--Pub. 100-05)

    31

    Full Replacement of Change Request 3770, Expanding the Number of Source Identifiers for Common Working File Medicare Secondary Payer Records Change Request 3770 Is Rescinded Definition of Medicare Secondary Payer/Common Working File Terms Medicare Secondary Payer Delete Transaction Identification of Reimbursement Advisory Committee Created Group Health Plan Records 32

    Exception for Small Employers in Multi-Employer Group Health Plans Overview and General Responsibilities Introduction to the Coordination of Benefits Contractor Scope of the Coordination of Benefit Contractor in Relation to Contractors Contractors Claim Referrals to the Coordination of Benefit Contractors IRS/SSA/CMS Data Match Coordination of Benefit Contractors Discontinues Dissemination of the Right of Recovery Letters to Contractors Exception for Small Employers in Multi-Employer Group Health Plans Purpose Background Specific Information 33

    Working Aged Exception for Small Employers in Multi-Employer Group Health Plans 34

    Manualization: Long-Standing Medicare Secondary Payer Policy in Chapter 1 of the Medicare Secondary Payer Internet Only Manual General Provisions Working Aged End-Stage Renal Disease Workers' Compensation No-Fault Insurance Liability Insurance Conditional Primary Medicare Benefits When Conditional Primary Medicare Benefits May Be Paid When a Group Health Plan Is a Primary Payer to Medicare When Conditional Primary Medicare Benefits May Not Be Paid When a Group Health Plan Is a Primary Payer to Medicare When Medicare Secondary Payer Benefits Are Payable and Not Payable Multiple Insurers Definitions Crediting Deductible for Non-Inpatient Psychiatric Services Clarification of Current Employment Status for Specific Groups Actions Resulting From Group Health Plan or Large Group Health Plan Nonconformance Federal Government's Right to Sue and Collect Double Damages 35

    Updates to the Group Health Plan Identification and Recovery Processes General IRS/SSA/CMS Data Match (Data Match) Group Health Plan Identified Cases Non-Data Match Group Health Plan Identified Cases Other Sources of Recovery Actions Group Health Plan Acknowledges Specific Debt (42 CFR 411.25) Recovery When a State Medicaid Agency Has Also Requested a Refund From the Group Health Plan Identification of Group Health Plan Mistaken Primary Payments Via the Recovery Management and Accounting System Progression of Recovery Management Accounting System Group Health Plan Lead Identification Progression of Recovery Management Accounting System History Search Contractor Recovery Case Files (Audit Trails) Group Health Plan Letters (Used for Recovery Management Accounting System/Healthcare Integrated General Ledger Accounting System (ReMAS/HIGLAS) When the Only Debtor Interfaced to Healthcare Integrated General Ledger Accounting System Is the Employer) Employer Group Health Plan Letter Important Information for Employers Insurer Group Health Plan Letter (Used for Recovery Management Accounting System/ Healthcare Integrated General Ledger Accounting System When the Only Debtor Interfaced to Healthcare Integrated General Ledger Accounting System Is the Employer) Accountability Worksheet (Not Applicable to Recovery Management Accounting System/ Healthcare Integrated General Ledger Accounting System Users) Summary Data Sheet (Not Applicable to ReMAS/ HIGLAS Users) Field Description on the Medicare Secondary Payer Summary Data Sheet Payment Record Summary (Used with ReMAS/HIGLAS Users but in a Modified Format)

    [[Page 76299]]

    Courtesy Copy of All Medicare Secondary Payer Group Health Plan-Based Recovery Demand Packages to the Employer's Insurer/Third Party Administrator Insurer/Third Party Administrator Courtesy Copy Letter Recovery Management Accounting System Error Reports Mistaken Group Health Plan Primary Payments Mistaken Primary Payment Activities and Record Layouts Contractor Actions Upon Receipt of the Data Match Cycle Tape or Other Notice of Non-Data Match Group Health Plan Mistaken Payments (for Contractor Not on ReMAS/HIGLAS for GHP Recovery) and Actions to Take for Those Contractors Using Recovery Management Accounting System/Health Integrated General Ledger Accounting System Group Health Plan Functions Coordination of Benefits Contractor Responsibility to Obtain Missing Medicare Secondary Payer Information Time Limitations for Group Health Plan Recoveries Actual Notice Contractor History Search Aggregate Claims for Recovery Documentation of Debt Recovery Attempt Audit Trails Summary of Medicare Reimbursement Claim Facsimiles for Each Claim Mistakenly Paid IRS/SSA/CMS Mistaken Payment Recovery Tracking System Inpatient, Skilled Nursing Facility, and Religious Non-Medicare Health Care Outpatient Mistaken Payment Report Record Layout Home Health Agency Mistaken Payment Record Layout Communication Receive in Response to Recovery Actions 36

    Update to the Healthcare Provider Taxonomy Codes Version 5.1

    Medicare Financial Management (CMS--Pub. 100-06)

    71

    Notice of New Interest Rate for Medicare Overpayments and Underpayments 72

    Claims Accounts Receivable Update Intermediary Claims Accounts Receivable Financial Reporting for Intermediary Claims Accounts Receivable 73

    This Transmittal is rescinded and replaced by Transmittal 75 74

    Discovery Code Indication for Recovery Audit Contractor (RAC) Non-MSP Identified Overpayments 75

    New Thresholds for 2nd Demand Letter for Physicians/Suppliers Part B Overpayment Demand Letters to Physicians/ Suppliers 76

    Development of New Report to Capture Benefits, Improvement and Protection Act and Medicare Prescription Drug, Improvement, and Modernization Act Appeals Data Monthly Statistical Report on Intermediary and Carrier Part A and Part B Appeals Activity Form Redeterminations Qualified Independent Contractor Reconsiderations Administrative Law Judge Results Department Appeals Board Effectuations Clerical Error Reopenings Validation of Reports 77

    Non-Medicare Secondary Payer Debt Referral and Debt Collection Improvement Act of 1996 Activities Background Cross Servicing Treasury Offset Program Definition of Delinquent Debt Referral Requirements Exemptions to Referral Debt to be Referred Delinquent Non-Medicare Secondary Payer Fiscal Intermediary Debt, Including Debt on the Provider Overpayment Reporting System Delinquent Non-Medicare Secondary Payer Medicare Carrier Debt, Including Debt on the Physician/Supplier Overpayment Reporting System Delinquent Non-Medicare Secondary Payer Debt Previously Ineligible for Referral Debt Collection Improvement Act Language/Intent to Refer Letter Response to ``Intent to Refer'' Letter Provider Overpayment Reporting System Updates Physician/Supplier Overpayment Reporting System Updates Cross Servicing Collection Efforts Actions Subsequent to Debt Collection System Input Transmission of Debt Update to Debt Collection System After Transmission Financial Reporting for Debt Referred Financial Reporting for Non-Medicare Secondary Payer Debt

    [[Page 76300]]

    78

    Coordination of Benefits Agreement Process for Contractor Financial Staff Notification

    Medicare State Operations Manual (CMS--Pub. 100-07)

    09

    Revision of Appendix P and Certain Exhibits of the State Operations Manual 10

    Revisions--Appendix J--Interpretive Guidelines Intermediate Care Facilities With Mental Retardation 11

    Revised Chapter 2--``The Certification Process,'' Sections 2180E thru 2200F, and Appendix B--``Interpretive Guidelines: Home Health Agencies''

    Medicare Program Integrity (CMS--Pub. 100-08)

    115

    Program Integrity Manual Revision Affiliated Contractor/Full Program Safeguard Contractor Communication With the Comprehensive Error Rate Testing Contractor Overview of the Comprehensive Error Rate Testing Process Providing Sample Information to the Comprehensive Error Rate Testing Contractor Providing Review Information to the Comprehensive Error Rate Testing Contractor Providing Feedback Information to the Comprehensive Error Rate Testing Contractor Disputing/Disagreeing With a Comprehensive Error Rate Testing Decision Handling Overpayments and Underpayments Resulting From the Comprehensive Error Rate Testing Findings Handling Appeals Resulting From Comprehensive Error Rate Testing Initiated Denials Tracking Overpayments Tracking Appeals Potential Fraud Full Program Safeguard Contractor Requirements Involving Comprehensive Error Rate Testing Information Dissemination Full Program Safeguard Contractor Error Rate Reduction Plan Contacting Non-Responders Late Documentation Received by the Comprehensive Error Rate Testing Contractor Voluntary Refunds Local Coverage Determination/National Coverage Determination Comprehensive Error Rate Testing Review Contractor Review Guidelines 116

    Revise the Fiscal Intermediary Shared System to Allow Reporting of Data for the Comprehensive Error Rate Testing Program Resolution File at a Line Level 117

    Revise the Medicare Contractor System and the VIPS Medicare System To Allow Update of the Comprehensive Error Rate Testing Program Resolution File Within Five Business Days of a Comprehensive Error Rate Testing Request 118

    Various Benefit Integrity Clarifications Goal of Medical Review Program Overpayment Procedures Disposition of the Suspension The Medicare Fraud Program Program Safeguard Contractor and Medicare Contractor Benefit Integrity Unit Organizational Requirements Training for Law Enforcement Organizations Procedural Requirements Requests for Information From Outside Organizations Sharing Fraud Referrals Between the Office of Inspector General and the Department of Justice Complaint Screening Investigations Conducting Investigations Disposition of Cases Reversed Denials by Administrative Law Judges on Open Cases Types of Fraud Alerts Coordination Investigation, Case, and Suspension Entries Update Requirements for Cases Closing Investigations Deleting Investigations, Cases, or Suspensions Access Harkin Grantees or Senior Medicare Patrol-- Complaint Tracking System Harkin Grantees or Senior Medicare Patrol Project Description Harkin Grantees Tracking System Instructions System Access to Metaframe and Data Collection Data Dissemination/Aggregate Report Referral of Cases to the Office of the Inspector General/Office of Investigations Immediate Advisements to the Office of Inspector General/Office of Investigations Denial of Payments for Cases Referred to and Accepted by Office of Inspector General/Office of Investigations Take Administrative Action on Cases Referred to and Refused by Office of Inspector General / Office of Investigations Referral to State Agencies or Other Organizations Referral to Quality Improvement Organizations

    [[Page 76301]]

    Referral Process to CMS Referrals to Office of Inspector General Breaches of Assignment Agreement by Physician or Other Supplier Annual Deceased-Beneficiary Postpayment Review Vulnerability Report 119

    Issued to a specific audience, not posted to Internet/Intranet due to Confidentiality of Instruction 120

    Correction to Change Request (CR) 3222: Local Medical Review Policy/Local Coverage Determination Medicare Summary Notice Message Revision Denials Notices 121

    This Transmittal is rescinded and replaced by Transmittal 124 122

    Medical Review Collection Number Requirements Overview of Prepayment and Postpayment Review for Medical Review Purposes 123

    Chapter 3, Medicare Modernization Act Section 935 Verifying Potential Errors and Setting Priorities Determining Whether the Problem Is Widespread or Provider Specific Overpayment Procedures ``Probe'' Reviews 124

    Evidence of Medical Necessity: Wheelchair and Power Operated Vehicle Claims 125

    Medical Review Additional Documentation Requests Additional Documentation Requests During Prepayment or Postpayment Medical Review

    Medicare Contractor Beneficiary and Provider Communications (CMS--Pub. 100-09)

    12

    Next Generation Desktop Testing Requirements 13

    Provider Contact Centers Training Program Guidelines for Telephone Service Staff Development and Training

    Medicare Managed Care (CMS--Pub. 100-16)

    66

    Beneficiary Enrollment and Disenrollment Requirements for Medicare Advantage Plans Changes in Requirements for Periodic Surveys of Current and Former Enrollees, and in the CMS Method for Calculating Interest on Overpayment and Underpayments to Health Maintenance Organizations, Comprehensive Medical Plans and Health Care Prepayment Plans 67

    Initial Publication of Chapter 1--General Provisions Introduction Definitions Types of Medical Assistance Plans Cost Sharing in Enrollment--Related Costs 68

    Revisions to Chapter 12, ``Effect of Change of Ownership,'' and Chapter 14, ``Contract Determination and Appeals'' Effect of Change of Ownership What Constitutes a Change of Ownership Address for Sending Notifications to CMS When a Novation Agreement Is Required Acceptable Novation Agreements Contract Determination Notice Postponement of the Contract Determination's Effective Date Reconsiderations Time Frames for Filing a Reconsideration Request Parties to the Hearing Conduct and Record of a Hearing Reopening of Contract Reconsidered Determination or Decision of a Hearing Officer or the Administrator 69

    Beneficiary Enrollment and Disenrollment Requirements for Medicare Advantage Plans 70

    Deletion of MCM Chapter 19--The Enrollment and Payment User's Guide, and Chapter 20--Managed Care and Medical Assistance Business Requirements 71

    Changes in Manual Instructions for Benefits and Beneficiary Protections Basic Rules Types of Benefits Availability and Structure of Plans CMS Review and Approval of M+C Benefit-- rewritten and relocated to Sec. 20 Requirements Relating to Medicare Conditions of Participation--renumbered as Sec. 4.10.7 Provider Networks--renumbered as new Sec. 10.8 and parts of the old Sec. 20, ``Original Medicare Covered Benefits'' CMS Approval of Proposed Plan MA Benefits--old 10.7 revised and located here General Guidelines on Benefit Approval Screening Mammography, Influenza Vaccine, and Pneumococcal Vaccine Inpatient Hospital Rehabilitation Service Value-Added Items and Services Prescription Drug Discount Programs

    [[Page 76302]]

    Waiting Periods and Exclusions That Are Not Present in Original Medicare Annual Beneficiary Out-of-Pocket Cap Drug Benefits Drugs That Are Covered Under Original Medicare Mid-Year Benefit Enhancements Multi-Year Benefits Return to Home Skilled Nursing Facility Guidance on Acceptable Cost-Sharing and Deductibles Homemaker Services Caregiver Resource Services Electronic Monitoring Dentures Chiropractic Services Cash Beauty Parlor Transportation Safety Items Travel for Transplants Meals Basic Benefits Cost-sharing Rules for Medical Assistance Regional Plans Supplemental Benefits and Mandatory Supplemental and Optional Supplemental Basic Versus Supplemental Benefits The Annual Deductible General Rule Accessing Plan Contracting Providers Enrollee Information and Disclosure Definitions Factors That Influence Service Area Approval The ``County Integrity Rule'' General Rule Employer Plans Basic Rule Medicare Benefits Secondary to Group Health Plans and Large Group Health Plans Medicare Secondary Payer Rules and State Laws Discrimination Against Beneficiaries Prohibited Disclosure Requirements at Enrollment (and Annually Thereafter) Information Pertaining to a Medical Assistance Organization Changing Their Rules or Provider Network Other Information That Is Disclosable Upon Request Access and Availability Rules for Coordinated Care Plans Emergency and Urgently Needed Services Post-Stabilization Care Services General Description Private Fee-for-Service Plan Terms and Conditions of Participation Provider Types--Direct Contracting, Deemed Contracting, Non-Contracting Access to Services Payments and Balance Billing Advance Notice of Coverage Prompt Payment Requirements Original Medicare vs. Estimated Payment Amounts Table Summarizing Private Fee-for-Service Plan Provider Types and Rules 72

    Changes in Manual Instructions for Intermediate Sanctions Types of Intermediate Sanctions General Basis for Imposing Intermediate Sanctions on Medical Assistance Organizations Imposing Sanctions for Specific Medical Assistance Contract Violations Civil Monetary Penalties for Medical Assistance Organizations That Improperly Terminate the Medical Assistance Contract CMS Process for Suspending Marketing, Enrollment, and Payment Contract Termination by CMS

    Medicare Business Partners Systems Security (CMS--Pub. 100-17)

    00

    None

    Demonstrations (CMS--Pub. 100-19)

    26

    This Transmittal is rescinded and replaced by Transmittal 27 27

    The Medicare Chronic Care Improvement, ``Medicare Health Support,'' Program 28

    The Medicare Care Management for High Cost Beneficiaries Demonstration

    [[Page 76303]]

    One-Time Notification (CMS--Pub. 100-20)

    161

    Kansas Blue Cross Blue Shield Carrier Numbering Issue 162

    Instructions for Fiscal Intermediary Standard System and Multi-Carrier System Healthcare Integrated General Ledger Accounting System Changes 163

    Qualified Independent Contractor Jurisdictions 164

    Medicare HIPAA Electronic Claims Report--Third Reporting Timeframe Extension 165

    Issued to a specific audience, not posted to Internet/Intranet due to Confidentiality of Instruction 166

    This Transmittal is rescinded and replaced by Transmittal 173 167

    Issued to a specific audience, not posted to Internet/Intranet due to Sensitivity of Instruction 168

    Shared System Maintainer Hours for Resolution of Problems Detected During Health Insurance Portability and Accountability Act Transaction January 2006 Release Testing 169

    Analysis of Systems Improvements to Streamline POS Code Set Updates 170

    Updates to the Coordination of Benefits Agreement Insurance File for Use in the National Claims Crossover Program 171

    Preliminary system updates in preparation for ending the Medicare contingency plan in October 2005 172

    Issued to a specific audience, not posted to Internet/Intranet due to Confidentiality of Instruction 173

    Overnight Oximetry Testing 174

    Fiscal Intermediary Shared System Modification 175

    Common Working File Calculation of Next Eligible Date for Preventive Services 176

    Change of the CareFirst Part A Plan to Highmark in the State of Maryland and Washington, DC 177

    Termination of Existing Crossover Agreements as Trading Partners Transition to the National Coordination of Benefits Agreement Program 178

    Issued to a specific audience, not posted to Internet/Intranet due to Confidentiality of Instruction 179

    Calculation of the Interim Payment of Indirect Medical Education Through the Inpatient Prospective Payment Pricer for Hospitals That Received an Increase to Their Full-Time Equivalent Resident Cap Under Section 422 of the Medicare Modernization Act, P.L. 108-173 180

    Issued to a specific audience, not posted to Internet/Intranet due to Confidentiality of Instruction 181

    National Modifier and Condition Code To Be Used To Identify Disaster Disaster Related Claims

    Addendum IV.--Regulation Documents Published in the Federal Register [July through September 2005]

    FR Vol. Publication date

    70 page CFR parts affected

    File code

    Title of regulation number

    July 6, 2005..................... 39022 414................. CMS-3125-IFC

    Medicare Program; Competitive Acquisition of Outpatient Drugs and Biologicals Under Part B. July 8, 2005..................... 39514 .................... CMS-1288-N

    Medicare Program; Meeting of the Advisory Panel on Ambulatory Payment Classification (APC) Groups--August 17, 18, and 19, 2005. July 12, 2005.................... 40039 .................... CMS-2212-N

    Medicaid Program; Meeting of the Medicaid Commission--July 27, 2005. July 14, 2005.................... 40788 484................. CMS-1301-P

    Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2006. July 14, 2005.................... 40709 .................... CMS-1288-CN

    Medicare Program; Meeting of the Advisory Panel on Ambulatory Payment Classification (APC) Groups--August 17, 18, and 19, 2005; Correction. July 22, 2005.................... 42331 .................... CMS-3142-FN

    Medicare Program; Evaluation Criteria and Standards for Quality Improvement Program Contracts. July 22, 2005.................... 42330 .................... CMS-1315-N

    Medicare Program; August 22, 2005, Meeting of Practicing Physicians Advisory Council and Request for Nominations. July 22, 2005.................... 42329 .................... CMS-3153-N

    Medicare Program; Meeting of the Medicare Coverage Advisory Committee--October 6, 2005. July 22, 2005.................... 42328 .................... CMS-4093-N

    Medicare Program; Request for Nominations for the Advisory Panel on Medicare Education. July 22, 2005.................... 42327 .................... CMS-3158-N

    Medicare Program; Request for Nominations for Members for the Medicare Coverage Advisory Committee. July 22, 2005.................... 42276 146................. CMS-4094-F3

    Amendment to the Interim Final Regulation for Mental Health Parity. July 25, 2005.................... 42674 419 and 485......... CMS-1501-P

    Medicare Program; Proposed Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2006 Payment Rates. August 4, 2005................... 45130 418................. CMS-1286-F

    Medicare Program; Hospice Wage Index for Fiscal Year 2006.

    [[Page 76304]]

    August 4, 2005................... 45026 409, 411, 424, and CMS-1282-F

    Medicare Program; 489.

    Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2006. August 4, 2005................... 44930 .................... CMS-2220-N

    Medicare Program; Meeting of the Medicaid Commission--August 17- 18, 2005. August 4, 2005................... 44879 402................. CMS-6019-P

    Medicare Program; Revised Civil Money Penalties, Assessments, Exclusions, and Related Appeals Procedures. August 8, 2005................... 45764 405, 410, 411, 413, CMS-1502-P

    Medicare Program; 414, and 426.

    Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2006. August 12, 2005.................. 47278 405, 412, 413, 415, CMS-1500-F

    Medicare Program; 419, 422, and 485.

    Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2006 Rates. August 15, 2005.................. 47880 412................. CMS-1290-F

    Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for FY 2006. August 15, 2005.................. 47759 483................. CMS-3198-P

    Medicare and Medicaid Programs; Condition of Participation: Immunization Standard for Long Term Care Facilities. August 26, 2005.................. 50940 410................. CMS-3017-IFC

    Medicare Program; Conditions for Payment of Power Mobility Devices, including Power Wheelchairs and Power-Operated Vehicles. August 26, 2005.................. 50680 419 and 485......... CMS-1501-CN

    Medicare Program; Proposed Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2006 Payment Rates; Correction. August 26, 2005.................. 50375 .................... CMS-4111-N

    Medicare Program; Meeting of the Advisory Panel on Medicare Education, September 27, 2005. August 26, 2005.................. 50374 .................... CMS-1330-N

    Medicare Program; Town Hall Meeting on the Medicare Provider Feedback Group (MPFG)-- September 12, 2005. August 26, 2005.................. 50373 .................... CMS-4106-PN

    Medicare Program; Changes in Medicare Advantage Deeming Authority. August 26, 2005.................. 50372 .................... CMS-1309-NC

    Medicare and Medicaid Programs; Announcement of an Application From a Hospital Requesting Waiver for Organ Procurement Service Area. August 26, 2005.................. 50358 .................... CMS-2209-N

    Medicaid Program; Fiscal Disproportionate Share Hospital Allotments and Disproportionate Share Hospital Institutions for Mental Disease Limits. August 26, 2005.................. 50358 .................... CMS-1486-N

    Medicare Program; Announcement of New Members of the Advisory Panel on Ambulatory Payment Classification (APC) Groups. August 26, 2005.................. 50262 447 and 455......... CMS-2198-P

    Medicaid Program; Disproportionate Share Hospital Payments. August 26, 2005.................. 50214 433................. CMS-2210-IFC

    Medicaid Program; State Allotments for Payment of Medicare Part B Premiums for Qualifying Individuals: Federal Fiscal Year 2005. August 26, 2005.................. 50214 405................. CMS-4064-IFC3

    Medicare Program; Changes to the Medicare Claims Appeal Procedures: Correcting Amendment to a Correcting Amendment. August 30, 2005.................. 51321 410................. CMS-6024-P

    Medicare Program; Prior Determination for Certain Items and Services. September 1, 2005................ 52105 .................... CMS-1308-NC

    Medicare Program; Withdrawal of Ambulance Fee Schedule Issued in Accordance With Federal District Court Order in Lifestar Ambulance v. United States, No. 4:02- CV-127-1 (M.D. Ga., Jan. 16, 2003)-- Medicare Covered Ambulance Services. September 1, 2005................ 52056 405, 410, 411, 413, CMS-1502-CN

    Medicare Program; 414, and 426.

    Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2006; Correction. September 1, 2005................ 52023 422................. CMS-4069-F3

    Medicare Program; Establishment of the Medicare Advantage Program; Correcting Amendment; Partial Stay of Effectiveness. September 1, 2005................ 52019 403................. CMS-4063-F

    Medicare Program; Medicare Prescription Drug Discount Card; Revision of Marketing Rules for Endorsed Drug Card Sponsors. September 6, 2005................ 52930 414................. CMS-1325-IFC2

    Medicare Program; Competitive Acquisition of Outpatient Drugs and Biologicals Under Part B: Interpretation and Correction.

    [[Page 76305]]

    September 16, 2005............... 54751 .................... CMS-5017-N

    Medicare Program; Medicare Health Care Quality (MHCQ) Demonstration Programs. September 23, 2005............... 55905 .................... CMS-3159-N

    Medicare Program; Meeting of the Medicare Coverage Advisory Committee--November 29, 2005. September 23, 2005............... 55903 .................... CMS-1269-N5

    Medicare Program; Emergency Medical Treatment and Labor Act (EMTALA) Technical Advisory Group (TAG) Meeting--October 26, 2005 Through October 28, 2005. September 23, 2005............... 55897 .................... CMS-8027-N

    Medicare Program; Medicare Part B Monthly Actuarial Rates, Premium Rate, and Annual Deductible for Calendar Year 2006. September 23, 2005............... 55896 .................... CMS-8025-N

    Medicare Program; Part A Premium for Calendar Year 2006 for the Uninsured Aged and for Certain Disabled Individuals Who Have Exhausted Other Entitlement. September 23, 2005............... 55887 .................... CMS-1307-GNC

    Medicare Program; Criteria and Standards for Evaluating Intermediary, Carrier, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Regional Carrier Performance During Fiscal Year 2006. September 23, 2005............... 55885 .................... CMS-8026-N

    Medicare Program; Inpatient Hospital Deductible and Hospital and Extended Care Services Coinsurance Amounts for Calendar Year 2006. September 23, 2005............... 55863 .................... CMS-9032-N

    Medicare and Medicaid Programs; Quarterly Listing of Program Issuances-April Through June 2005. September 23, 2005............... 55862 .................... CMS-2227-PN

    Medicare and Medicaid Programs; Application by the Accreditation Commission of Healthcare for Deeming Authority for Home Health Agencies. September 23, 2005............... 55812 447 and 455......... CMS-2198-CN

    Medicaid Program; Disproportionate Share Hospital Payments. September 29, 2005............... 56901 .................... CMS-2230-FN

    State Children's Health Insurance Program (SCHIP); Redistribution of Unexpended SCHIP Funds From the Appropriation for Fiscal Year 2002. September 30, 2005............... 57376 505................. CMS-1320-P

    Medicare Program; Health care Infrastructure Improvement Program; Forgiveness of Indebtness. September 30, 2005............... 57368 505................. CMS-1287-IFC

    Medicare Program; Health Care Infrastructure Improvement Program; Selection Criteria of Loan Program for Qualifying Hospitals Engaged in Cancer- Related Health Care. September 30, 2005............... 57300 .................... CMS-1307-CN

    Medicare Program; Criteria and Standards for Evaluating Intermediary, Carrier, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Regional Carrier Performance During Fiscal Year 2006; Correction Notice. September 30, 2005............... 57297 .................... CMS-3144-NC

    Medicare Program; Calendar Year 2005 Review of Appropriateness of Payment Amounts for New Technology Intraocular Lenses (NTIOLs) Furnished by Ambulatory Surgical Centers (ASCs). September 30, 2005............... 57296 .................... CMS-1269-N6

    Medicare Program; Emergency Medical Treatment and Labor Act (EMTALA) Technical Advisory Group (TAG): Announcement of a New Member. September 30, 2005............... 57174 418................. CMS-1286-CN

    Medicare Program; Hospice Wage Index for Fiscal Year 2006. September 30, 2005............... 57166 412................. CMS-1290-CN

    Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for FY 2006; Correction. September 30, 2005............... 57164 411 and 424......... CMS-1282-CN

    Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Correction. September 30, 2005............... 57161 405, 412, 413, 415, CMS-1500-CN

    Medicare Program; 419, 422, and 485.

    Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2006 Rates; Correction.

    Addendum V--National Coverage Determinations

    [July Through September 2005]

    A national coverage determination (NCD) is a determination by the Secretary with respect to whether or not a particular item or service is covered nationally under Title XVIII of the Social Security Act, but does not include a determination of what code, if any, is assigned to a particular item or service covered under this title, or determination with respect to the amount of payment made for a particular item or service so covered. We include below all of the NCDs that were issued during the quarter covered by this notice. The entries below include information concerning completed decisions

    [[Page 76306]]

    as well as sections on program and decision memoranda, which also announce pending decisions or, in some cases, explain why it was not appropriate to issue an NCD. We identify completed decisions by the section of the NCDM in which the decision appears, the title, the date the publication was issued, and the effective date of the decision. Information on completed decisions as well as pending decisions has also been posted on the CMS Web site at http://cms.hhs.gov/coverage .

    National Coverage Determinations

    [July Through September 2005]

    There were no new NCDs posted during this time period.

    Addendum VI--FDA-Approved Category B IDEs

    [July Through September 2005]

    Under the Food, Drug, and Cosmetic Act (21 U.S.C. 360c) devices fall into one of three classes. To assist CMS under this categorization process, the FDA assigns one of two categories to each FDA-approved IDE. Category A refers to experimental IDEs, and Category B refers to non-experimental IDEs. To obtain more information about the classes or categories, please refer to the Federal Register notice published on April 21, 1997 (62 FR 19328).

    The following list includes all Category B IDEs approved by FDA during the second quarter, July through September 2005.

    IDE/Category

    G040204 G050005 G050016 G050028 G050035 G050036 G050041 G050044 G050069 G050072 G050082 G050086 G050103 G050107 G050108 G050112 G050113 G050114 G050117 G050119 G050120 G050122 G050123 G050125 G050127 G050129 G050130 G050132 G050133 G050134 G050135 G050136 G050141 G050144 G050145 G050146 G050147 G050148 G050149 G050153 G050155 G050158 G050160 G050161 G050163 G050165 G050166 G050170 G050172 G050174 G050177 G050178 G050180 G050181 G050182 G050183

    Addendum VII--Approval Numbers for Collections of Information

    Below we list all approval numbers for collections of information in the referenced sections of CMS regulations in Title 42; Title 45, Subchapter C; and Title 20 of the Code of Federal Regulations, which have been approved by the Office of Management and Budget:

    OMB Control Numbers

    [Approved CFR Sections in Title 42, Title 45, and Title 20 (Note: Sections in Title 45 are preceded by ``45 CFR,'' and sections in Title 20 are preceded by ``20 CFR'')]

    OMB number

    Approved CFR sections

    0938-0008.................... 414.40, 424.32, 424.44 0938-0022.................... 413.20, 413.24, 413.106 0938-0023.................... 424.103 0938-0025.................... 406.28, 407.27 0938-0027.................... 486.100-486.110 0938-0033.................... 405.807 0938-0035.................... 407.40 0938-0037.................... 413.20, 413.24 0938-0041.................... 408.6, 408.22 0938-0042.................... 410.40, 424.124 0938-0045.................... 405.711 0938-0046.................... 405.2133 0938-0050.................... 413.20, 413.24 0938-0062.................... 431.151, 435.1009, 440.220, 440.250, 442.1, 442.10-442.16, 442.30, 442.40, 442.42, 442.100-442.119, 483.400- 483.480, 488.332, 488.400, 498.3-498.5 0938-0065.................... 485.701-485.729 0938-0074.................... 491.1-491.11 0938-0080.................... 406.7, 406.13 0938-0086.................... 420.200-420.206, 455.100-455.106 0938-0101.................... 430.30 0938-0102.................... 413.20, 413.24 0938-0107.................... 413.20, 413.24 0938-0146.................... 431.800-431.865 0938-0147.................... 431.800-431.865 0938-0151.................... 493.1357, 493.1363, 493.1405, 493.1406, 493.1411, 493.1417, 493.1423, 493.1443, 493.1449, 493.1455, 493.1461, 493.1462, 493.1469, 493.1483, 493.1489, 493.1491 0938-0155.................... 405.2470 0938-0170.................... 493.1269-493.1285 0938-0193.................... 430.10-430.20, 440.167 0938-0202.................... 413.17, 413.20 0938-0214.................... 411.25, 489.2, 489.20 0938-0236.................... 413.20, 413.24 0938-0242.................... 442.30, 488.26 0938-0245.................... 407.10, 407.11

    [[Page 76307]]

    0938-0246.................... 431.800-431.865 0938-0251.................... 406.7 0938-0266.................... 416.41, 416.47, 416.48, 416.43 0938-0267.................... 410.65, 485.56, 485.58, 485.60, 485.64, 485.66 0938-0269.................... 412.116, 412.632, 413.64, 413.350, 484.245 0938-0270.................... 405.376 0938-0272.................... 440.180, 441.300-441.305 0938-0273.................... 485.701-485.729 0938-0279.................... 424.5 0938-0287.................... 447.31 0938-0296.................... 413.170, 413.184 0938-0301.................... 413.20, 413.24 0938-0302.................... 418.22, 418.24, 418.28, 418.56, 418.58, 418.70, 418.74, 418.83, 418.96, 418.100 0938-0313.................... 489.11, 489.20 0938-0328.................... 482.12, 482.13, 482.21, 482.22, 482.27, 482.30, 482.41, 482.43, 482.45, 482.53, 482.56, 482.57, 482.60, 482.61, 482.62, 485.618, 485.631 0938-0334.................... 491.9, 491.10 0938-0338.................... 486.104, 486.106, 486.110 0938-0354.................... 441.60 0938-0355.................... 442.30, 488.26 0938-0357.................... 409.40-409.50, 410.36, 410.170, 411.4- 411.15, 421.100, 424.22, 484.18, 489.21 0938-0358.................... 412.20-412.30 0938-0359.................... 412.40-412.52 0938-0360.................... 488.60 0938-0365.................... 484.10, 484.11, 484.12, 484.14, 484.16, 484.18, 484.20, 484.36, 484.48, 484.52 0938-0372.................... 414.330 0938-0378.................... 482.60-482.62 0938-0379.................... 442.30, 488.26 0938-0382.................... 442.30, 488.26 0938-0386.................... 405.2100-405.2171 0938-0391.................... 488.18, 488.26, 488.28 0938-0426.................... 476.104, 476.105, 476.116, 476.134 0938-0429.................... 447.53 0938-0443.................... 473.18, 473.34, 473.36, 473.42 0938-0444.................... 1004.40, 1004.50, 1004.60, 1004.70 0938-0445.................... 412.44, 412.46, 431.630, 456.654, 466.71, 466.73, 466.74, 466.78 0938-0447.................... 405.2133 0938-0448.................... 405.2133, 45 CFR 5, 5b; 20 CFR Parts 401, 422 Subpart E 0938-0449 440.180, 441.300- 441.310 0938-0454.................... 424.20 0938-0456.................... 412.105 0938-0463.................... 413.20, 413.24, 413.106 0938-0467.................... 431.17, 431.306, 435.910, 435.920, 435.940-435.960 0938-0469.................... 417.126, 422.502, 422.516 0938-0470.................... 417.143, 417.800-417.840, 422.6 0938-0477.................... 412.92 0938-0484.................... 424.123 0938-0501.................... 406.15 0938-0502.................... 433.138 0938-0512.................... 486.304, 486.306, 486.307 0938-0526.................... 475.102, 475.103, 475.104, 475.105, 475.106 0938-0534.................... 410.38, 424.5 0938-0544.................... 493.1-493.2001 0938-0564.................... 411.32 0938-0565.................... 411.20-411.206 0938-0566.................... 411.404, 411.406, 411.408 0938-0573.................... 412.230, 412.256 0938-0578.................... 447.534 0938-0581.................... 493.1-493.2001 0938-0599.................... 493.1-493.2001 0938-0600.................... 405.371, 405.378, 413.20 0938-0610.................... 484.10, 489.102 0938-0612.................... 493.801, 493.803, 493.1232, 493.1233, 493.1234, 493.1235, 493.1236, 493.1239, 493.1241, 493.1242, 493.1249, 493.1251, 493, 1252, 493.1253, 493.1254, 493.1255, 493.1256, 493.1261, 493.1262, 493.1263, 493.1269, 493.1273, 493.1274, 493.1278, 493.1283, 493.1289, 493.1291, 493.1299 0938-0618.................... 433.68, 433.74, 447.272 0938-0653.................... 493.1771, 493.1773, 493.1777 0938-0657.................... 405.2110, 405.2112 0938-0658.................... 405.2110, 405.2112

    [[Page 76308]]

    0938-0659.................... 456.700, 456.705, 456.709, 456.711, 456.712 0938-0667.................... 482.12, 488.18, 489.20, 489.24 0938-0679.................... 410.38 0938-0685.................... 410.32, 410.71, 413.17, 424.57, 424.73, 424.80, 440.30, 484.12 0938-0686.................... 493.551-493.557 0938-0688.................... 486.304, 486.306, 486.307, 486.310, 486.316, 486.318, 486.325 0938-0691.................... 412.106 0938-0692.................... 466.78, 489.20, 489.27 0938-0701.................... 422.152 0938-0702.................... 45 CFR 146.111, 146.115, 146.117, 146.150, 146.152, 146.160, 146.180 0938-0703.................... 45 CFR 148.120, 148.124, 148.126, 148.128 0938-0713.................... 441.16, 489.66, 489.67 0938-0714.................... 411.370-411.389 0938-0717.................... 424.57 0938-0721.................... 410.33 0938-0723.................... 421.300-421.318 0938-0730.................... 405.410, 405.430, 405.435, 405.440, 405.445, 405.455, 410.61, 415.110, 424.24 0938-0732.................... 417.126, 417.470 0938-0734.................... 45 CFR 5b 0938-0739.................... 413.337, 413.343, 424.32, 483.20 0938-0742.................... 422.300-422.312 0938-0749.................... 424.57 0938-0753.................... 422.000-422.700 0938-0754.................... 441.151, 441.152 0938-0758.................... 413.20, 413.24 0938-0760.................... 484 Subpart E, 484.55, 484.205, 484.245, 484.250 0938-0761.................... 484.11, 484.20 0938-0763.................... 422.1-422.10, 422.50-422.80, 422.100- 422.132, 422.300-422.312, 422.400- 422.404, 422.560-422.622 0938-0770.................... 410.2 0938-0778.................... 422.64, 422.111 0938-0779.................... 417.126, 417.470, 422.64, 422.210 0938-0781.................... 411.404-411.406, 484.10 0938-0786.................... 438.352, 438.360, 438.362, 438.364 0938-0783.................... 422.66, 422.562, 422.564, 422.568, 422.570, 422.572, 422.582, 422.584, 422.586, 422.590, 422.594, 422.602, 422.612, 422.618, 422.619, 422.620, 422.622 0938-0787.................... 406.28, 407.27 0938-0790.................... 460.12, 460.22, 460.26, 460.30, 460.32, 460.52, 460.60, 460.70, 460.71, 460.72, 460.74, 460.80, 460.82, 460.98, 460.100, 460.102, 460.104, 460.106, 460.110, 460.112, 460.116, 460.118, 460.120, 460.122, 460.124, 460.132, 460.152, 460.154, 460.156, 460.160, 460.164, 460.168, 460.172, 460.190, 460.196, 460.200, 460.202, 460.204, 460.208, 460.210 0938-0792.................... 491.8, 491.11 0938-0798.................... 413.24, 413.65, 419.42 0938-0802.................... 419.43 0938-0818.................... 410.141, 410.142, 410.143, 410.144, 410.145, 410.146, 414.63 0938-0829.................... 422.568 0938-0832.................... Parts 489 and 491 0938-0833.................... 483.350-483.376 0938-0841.................... 431.636, 457.50, 457.60, 457.70, 457.340, 457.350, 457.431, 457.440, 457.525, 457.560, 457.570, 457.740, 457.750, 457.810, 457.940, 457.945, 457.965, 457.985, 457.1005, 457.1015, 457.1180 0938-0842.................... 412.23, 412.604, 412.606, 412.608, 412.610, 412.614, 412.618, 412.626, 413.64 0938-0846.................... 411.352-411.361 0938-0857.................... Part 419 0938-0860.................... 413.65, 419.42 0938-0866.................... 45 CFR Part 162 0938-0872.................... 413.337, 483.20, 0938-0873.................... 422.152 0938-0874.................... 45 CFR Parts 160 and 162 0938-0878.................... Part 422 Subpart F & G 0938-0883.................... 45 CFR Parts 160 and 164 0938-0884.................... 405.940 0938-0887.................... 45 CFR 148.316, 148.318, 148.320 0938-0897.................... 412.22, 412.533 0938-0907.................... 412.230, 412.304, 413.65 0938-0910.................... 422.620, 422.624, 422.626 0938-0911.................... 426.400, 426.500 0938-0916.................... 483.16

    [[Page 76309]]

    0938-0920.................... 438.6, 438.8, 438.10, 438.12, 438.50, 438.56, 438.102, 438.114, 438.202, 438.206, 438.207, 438.240, 438.242, 438.402, 438.404, 438.406, 438.408, 438.410, 438.414, 438.416, 438.710, 438.722, 438.724, 438.810 0938-0921.................... 414.804 0938-0931.................... 45 CFR Part 142.408, 162.408, and 162.406 0938-0933.................... 438.50 0938-0934.................... 403.766 0938-0936.................... 423 0938-0940.................... 484 and 488 0938-0944.................... 422.250, 422.252, 422.254, 422.256, 422.258, 422.262, 422.264, 422.266, 422.270, 422.300, 422.304, 422.306, 422.308, 422.310, 422.312, 422.314, 422.316, 422.318, 422.320, 422.322, 422.324, 423.251, 423.258, 423.265, 423.272, 423.279, 423.286, 423.293, 423.301, 423.308, 423.315, 423.322, 423.329, 423.336, 423.343, 423.346, 423.350 0938-0950.................... 405.910 0938-0951.................... 423.48 0938-0953.................... 405.1200 and 405.1202 0938-0954.................... 414.906, 414.908, 414.914, 414.916 0938-0957.................... Part 423 Subpart R

    Addendum VIII--Medicare-Approved Carotid Stent Facilities [July Through September 2005]

    On March 17, 2005, we issued our decision memorandum on carotid artery stenting. We determined that carotid artery stenting with embolic protection is reasonable and necessary only if performed in facilities that have been determined to be competent in performing the evaluation, procedure, and follow-up necessary to ensure optimal patient outcomes. We have created a list of minimum standards for facilities modeled in part on professional society statements on competency. All facilities must at least meet our standards in order to receive coverage for carotid artery stenting for high risk patients.

    Effective Date--July 7, 2005

    Antelope Valley Hospital, 1600 West Avenue J, Lancaster, CA 93534

    Medicare Provider 050056 Baptist St. Anthony's Hospital, 1600 Wallace Boulevard, Amarillo, TX 79106

    Medicare Provider 450231

    Dayton Heart Hospital, 707 S. Edwin Moses Boulevard, Dayton, OH 45408

    Medicare Provider 360253

    Duke Health Raleigh Hospital, 3400 Wake Forest Road, Raleigh, NC 27609

    Medicare Provider 340073

    East Pasco Medical Center, 7050 Gall Boulevard, Zephyrhills, FL 33541-1399

    Medicare Provider 100046

    FirstHealth Moore Regional Hospital, 1555 Memorial Drive, P.O. Box 3000 Pinehurst, NC 28374

    Medicare Provider 340115

    The George Washington University Hospital, 900 23rd Street, NW., Washington, DC 20037

    Medicare Provider 090001

    Heart Hospital of Lafayette, 1105 Kaliste Saloom Road, Lafayette, LA 70508

    Medicare Provider 190263

    Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287- 1629

    Medicare Provider 210009

    Kingman Regional Medical Center, 3269 Stockton Hill Road, Kingman, AZ 86401

    Medicare Provider 030055

    Lafayette General Medical Center, 1214 Coolidge Street, P.O. Box 52009, Lafayette, LA 70505

    Medicare Provider 190002

    Manatee Memorial Hospital and Health Systems, 206 2nd Street East, Bradenton, FL 34208

    Medicare Provider 100035

    Mercy Health System, 1000 Mineral Point Avenue, P.O. Box 5003, Janesville, WI 53547-5003

    Medicare Provider 520066

    The Methodist Hospital, 6565 Fannin Street, Houston, TX 77030

    Medicare Provider 450358

    Mohawk Valley Vascular Center of Faxton, St. Luke's Healthcare, 1656 Champlain Avenue, Utica, NY 13502

    Medicare Provider 330044

    Northwest Medical Center, 2801 North State Road 7, Margate, FL 33063-9002

    Medicare Provider 100189

    Oakwood Hospital and Medical Center, 18101 Oakwood Boulevard, P.O. Box 2500, Dearborn, MI 48123-2500

    Medicare Provider 230020

    Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903

    Medicare Provider 041007

    Scripps Green Hospital, 10666 North Torrey Pines Road, La Jolla, CA 92037-9100

    Medicare Provider 050424

    St. Cloud Hospital, 1406 Sixth Avenue North, St. Cloud, MN 56303- 1901

    Medicare Provider 240036

    St. Joseph's Regional Medical Center, 703 Main Street, Paterson, NJ 07530

    Medicare Provider 310019

    St. Luke's Hospital, 5901 Monclova Road, Maumee, OH 43537-1899

    Medicare Provider 360090

    St. Vincent Hospital, 835 S. Van Buren Street, P.O. Box 13508, Green Bay, WI 54307-3508

    Medicare Provider 520075

    St. Vincent's Medical Center, 1800 Barrs Street, Jacksonville, FL 32204

    Medicare Provider 100040

    Stormont-Vail HealthCare, 1500 S.W. 10th Avenue, Topeka, KS 66604- 1353

    Medicare Provider 170086

    Tomball Regional Hospital, 605 Holderrieth Street, Tomball, TX 77375

    Medicare Provider 450670

    Trinity Mother Frances Health System, 800 E. Dawson, Tyler, TX 75701

    Medicare Provider 450102

    Effective Date--July 15, 2005

    Allen Memorial Hospital, 1825 Logan Avenue, Waterloo, IA 50703-1999

    Medicare Provider 160110

    Alta Bates Summit Medical Center, Alta Bates Campus, 2450 Ashby Avenue Berkley, CA 94705

    Medicare Provider 050305

    Alta Bates Summit Medical Center, Summit Campus, 350 Hawthorne Avenue, Oakland, CA 94609

    Medicare Provider 050043

    Banner Baywood Heart Hospital, 6750 East Baywood Avenue, Mesa, AZ 85206

    Medicare Provider 030105

    Battle Creek Health System, 300 North Avenue, Battle Creek, MI 49016

    [[Page 76310]]

    Medicare Provider 230075

    Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215

    Medicare Provider 220086

    BryanLGH Medical Center, 1600 South 48th Street, Lincoln, NE 68506- 1299

    Medicare Provider 280003

    Deborah Heart & Lung Center, 200 Trenton Road, Browns Mills, NJ 08015

    Medicare Provider 310031

    Erie County Medical Center Corporation, 462 Grinder Street, Buffalo, NY 14215

    Medicare Provider 330219

    Fairview Southdale Hospital, 6401 France Avenue, Edina, MN 55435

    Medicare Provider 240078

    Gratiot Medical Center, 300 East Warwick Drive, Alma, MI 48801-1096

    Medicare Provider 230030

    Harbor Hospital, 3001 South Hanover Street, Baltimore, MD 21225-1290

    Medicare Provider 210034

    Holmes Regional Medical Center, 1350 South Hickory Street, Melbourne, FL 32901

    Medicare Provider 100019

    Holy Cross Hospital, 4725 North Federal Highway, Fort Lauderdale, FL 33308

    Medicare Provider 100073

    Marion General Hospital, 1000 McKinley Park Drive, Marion, OH 43301

    Medicare Provider 360011

    Mease Countryside Hospital, 3231 McMullen Booth Road, Safety Harbor, FL 34695

    Medicare Provider 100265

    Mercy General Hospital, 4001 J Street, P.O. Box 19245, Sacramento, CA 95819-9990

    Medicare Provider 050017

    OU Medical Center, 1200 Everett Drive, Oklahoma City, OK 73104

    Medicare Provider 370093

    Pennsylvania Hospital of the University of Pennsylvania Health System, 800 Spruce Street, Philadelphia, PA 19071-6192

    Medicare Provider 390226

    Provena Mercy Medical Center, 1325 North Highland Avenue, Aurora, IL 60506

    Medicare Provider 140174

    Reading Hospital and Medical Center, P.O. Box 16052, Reading, PA 19612-6052

    Medicare Provider 390044

    Regional Medical Center of Hopkins County, 900 Hospital Drive, Madisonville, KY 42431

    Medicare Provider 180093

    Sacred Heart Medical Center, 101 West 8th Avenue, P.O. Box 2555, Spokane, WA 99220-2555

    Medicare Provider 500054

    Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA 92103

    Medicare Provider 050077

    Sisters of Charity Providence Hospitals, 2435 Forest Drive, Columbia, SC 29204

    Medicare Provider 420026

    Tucson Medical Center, 5301 East Grant Road, Tucson, AZ 85712

    Medicare Provider 030006

    UCLA Medical Center, 10833 Le Conte Avenue, Los Angeles, CA 90095- 1730

    Medicare Provider 050262

    University of Colorado Hospital, 4200 East 9th Avenue, Denver, CO 80262

    Medicare Provider 060024

    Effective Date--July 20, 2005

    Christus St. Patrick Hospital, 524 South Ryan Street, Lake Charles, LA 70601

    Medicare Provider 190027

    Condell Medical Center, 801 South Milwaukee Avenue, Libertyville, IL 60048

    Medicare Provider 140202

    Florida Hospital Ormond Memorial, 875 Sterthaus Avenue, Ormond Beach, FL 32174

    Medicare Provider 100169

    Lakewood Hospital, 14519 Detroit Avenue, Lakewood, OH 44107

    Medicare Provider 360212

    Loma Linda University Medical Center, 11234 Anderson Street, P.O. Box 2000, Loma Linda, CA 92354

    Medicare Provider 050327

    Miami Valley Hospital, Medical Imaging, One Wyoming Street, Dayton, OH 45409-2793

    Medicare Provider 360051

    National Park Medical Center, 1910 Malvern Avenue, Hot Springs, AR 71901

    Medicare Provider 040078

    Newark Beth Israel Medical Center, 201 Lyons Avenue, Newark, NJ 07112

    Medicare Provider 310002

    Salina Regional Health Center, P.O. Box 5080, Salina, KS 67402-5080

    Medicare Provider 170012

    Scott and White Memorial Hospital and Scott, Sherwood and Brindley Foundation, 2401 South 31st Street, Temple, TX 76508

    Medicare Provider 450054

    Sentra Norfolk General Hospital, 600 Gersham Drive, Norfolk, VA 23507

    Medicare Provider 490007

    Spartanburg Regional Medical Center, 101 East Wood Street, Spartanburg, SC 29303

    Medicare Provider 420007

    St. Francis Hospital, 3237 South 16th Street, Milwaukee, WI 53215- 4592

    Medicare Provider 520078

    St. Vincent Indianapolis Hospital, 2001 West 86th Street, Indianapolis, IN 46260

    Medicare Provider 150084

    Tulsa Regional Medical Center, 744 West 9th, Tulsa, OK 74127

    Medicare Provider 370078

    University Hospital, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210

    Medicare Provider 330241

    UT Southwestern University Hospitals--Zale Lipshy, 5151 Harry Hines Boulevard, Dallas, TX 75390

    Medicare Provider 450766

    UT Southwestern University Hospitals--St. Paul, 5909 Harry Hines Boulevard, Dallas, TX 75390

    Medicare Provider 450044

    Effective Date--July 22, 2005

    Forrest General Hospital, 6051 Highway 49, Hattiesburg, MS 39401- 7243

    Medicare Provider 250078

    Hamilton Medical Center, P.O. Box 1168, Dalton, GA 30722-1168

    Medicare Provider 110001

    Heritage Valley Health System, The Medical Center, 100 Dutch Ridge Road, Beaver, PA 15009-9700

    Medicare Provider 390036

    Northeast Georgia Medical Center, 743 Spring Street, Gainesville, GA 30501

    Medicare Provider 110029

    Wishard Health Services, 1001 West Tenth Street, Indianapolis, IN 46202

    Medicare Provider 150024

    Effective Date--July 27, 2005

    East Texas Medical Center Athens, 2000 South Palestine, Athens, TX 75751

    Medicare Provider 450389

    Glendale Adventist Medical Center, 1509 Wilson Terrace, Glendale, CA 91206

    Medicare Provider 050239

    Lahey Clinic Medical Center, Inc., 41 Mall Road, Burlington, MA 01805

    Medicare Provider 220171

    Saint Joseph Hospital, One Saint Joseph Drive, Lexington, KY 40504

    Medicare Provider 180010

    St. Mary's Medical Center, 2900 First Avenue, Huntington, WV 25702

    Medicare Provider 510007

    Yakima Regional Medical and Cardiac Center, 110 South 9th Avenue, Yakima, WA 98902

    Medicare Provider 500012

    Effective Date--August 1, 2005

    Alegent Health Bergan Mercy Medical Center, 7500 Mercy Rd., Omaha, NE 68124-9832

    Medicare Provider 280060

    Bon Secours DePaul Medical Center, 150 Kingsley Ln., Norfolk, VA 23505

    Medicare Provider 490011

    Hendrick Medical Center, 1900 Pine St., Abilene, TX 79601-2316

    Medicare Provider 450229

    Nebraska Heart Hospital, 7500 S. 91st St., Lincoln, NE 68526

    [[Page 76311]]

    Medicare Provider 280128

    Singing River Hospital System, 3109 Bienville Blvd., Ocean Springs, MS 39564

    Medicare Provider 250040

    St. Peter's Hospital,315 South Manning Blvd., Albany, NY 12208

    Medicare Provider 330057

    University of California San Francisco Medical Center, 500 Parnassus Ave., San Francisco, CA 94143-0296

    Medicare Provider 050454

    Effective Date--August 4, 2005

    Bowling Green Warren County Community Hospital Corp. d/b/a The Medical Center, 250 Park Street, P.O. Box 90010, Bowling Green, KY 42102-9010

    Medicare Provider 180013

    Carson-Tahoe Hospital, 775 Fleischmann Way, P.O. Box 2168, Carson City, NV 89702-2168

    Medicare Provider 290010

    Heart Hospital of Austin, 3801 N. Lamar Boulevard, Austin, TX 78756

    Medicare Provider 450824

    Indiana Heart Hospital, 8040 Clearvista Parkway, Suite 200, Indianapolis, IN 46256

    Medicare Provider 150154

    JFK Medical Center, 5301 South Congress Avenue, Atlantis, FL 33462

    Medicare Provider 100080

    Sierra Vista Regional Medical Center, 1010 Murray Avenue, San Luis Obispo, CA 93405

    Medicare Provider 050506

    St. Joseph Hospital, 1100 West Stewart Drive, P.O. Box 5600 Orange, CA 92863-5600

    Medicare Provider 050069

    St. Luke's Cornwall Hospital, 70 Dubois Street, Newburgh, NY 12550

    Medicare Provider 330264

    UCI Medical Center, 101 The City Drive South, Orange, CA 92868

    Medicare Provider 050348

    Effective Date--August 8, 2005

    Lynchburg General Hospital, 1920 Atherholt Road, Lynchburg, VA 24501-1104

    Medicare Provider 490021

    Mercy Hospitals Bakersfield, 2215 Truxtun Avenue, P.O. Box 119, Bakersfield, CA 93302

    Medicare Provider 050295

    Virginia Regional Medical Center, 901 Ninth Street North, Virginia, MN 55792

    Medicare Provider 240084

    Effective Date--August 9, 2005

    Columbia Hospital, 2201 45th Street, West Palm Beach, FL 33407

    Medicare Provider 100234

    Fairview Hospital, 14519 Detroit Avenue, Fairview, OH 44107

    Medicare Provider 360077

    Forum Health-Northside Medical Center, Cardiovascular Administration, 500 Gypsy Lane, Youngstown, OH 44501

    Medicare Provider 360141

    Mercy Hospital, 144 State Street, Portland, ME 04101

    Medicare Provider 020008

    New Hanover Regional Medical Center, 2131 South 17th Street, P.O. Box 9000, Wilmington, NC 28402-9000

    Medicare Provider 340141

    Sharp Grossmont Hospital, P.O. Box 158, La Mesa, CA 91944-0158

    Medicare Provider 050026

    Torrance Memorial Medical Center, 3330 Lomita Boulevard, Torrance, CA 90505-5073

    Medicare Provider 050351

    Effective Date--August 16, 2005

    Englewood Hospital and Medical Center, 350 Engle Street, Englewood, NJ 07631

    Medicare Provider 310045

    Mobile Infirmary Medical Center, Five Mobile Infirmary Circle, Mobile, AL 36607

    Medicare Provider 010113

    Ocean Medical Center, 425 Jack Martin Boulevard, Brick, NJ 08724

    Medicare Provider 310052

    OSF St. Joseph Medical Center, 200 East Washington Street, Bloomington, IL 61701

    Medicare Provider 140162

    St. Luke's Medical Center, LP, 1800 East Van Buren Street, Phoenix, AZ 85006

    Medicare Provider 030037

    Effective Date--August 19, 2005

    Inova Alexandria Hospital, 4320 Seminary Road, Alexandria, VA 22304

    Medicare Provider 490040

    Inova Fairfax Hospital, Inova Fairfax Hospital for Children and Inova Heart and Vascular Institute, 3300 Gallows Road, Falls Church, VA 22042-3300

    Medicare Provider 490063

    Milford Hospital, 300 Seaside Avenue, P.O. Box 3015, Milford, CT 06460-0815

    Medicare Provider 070019

    Our Lady of the Lakes Regional Medical Center, 5000 Hennessy Boulevard, Baton Rouge, LA 70808

    Medicare Provider 190064

    Summit Hospital, 17000 Medical Center Drive, Baton Rouge, LA 70816

    Medicare Provider 190202

    University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0060

    Medicare Provider 230046

    Effective Date--August 22, 2005

    Baptist Hospital of Miami, 8900 North Kendall Drive, Miami, FL 33176

    Medicare Provider 100008

    Camden-Clark Memorial Hospital, 800 Garfield Avenue, P.O. Box 718, Parkersburg, WV 26102

    Medicare Provider 510058

    HCA Dauterive Hospital, 600 North Lewis Avenue, New Iberia, LA 70563

    Medicare Provider 190003

    Kadlec Medical Center, 888 Swift Boulevard, Richland, WA 99352

    Medicare Provider 500058

    Lancaster Community Hospital, 43830 10th Street West, Lancaster, CA 93534

    Medicare Provider 050204

    Mercy Hospital, 4050 Coon Rapids Boulevard, Coon Rapids, MN 55433

    Medicare Provider 240115

    Montefiore Medical Center, 111 East 210th Street, New York, NY 10467

    Medicare Provider 330059

    Morristown Memorial Hospital, 100 Madison Avenue, Morristown, NJ 07962-1956

    Medicare Provider 310015

    Palmetto Health Richland, 5 Richland Medical Park Drive, Columbia, SC 29203-6897

    Medicare Provider 420018

    Saint Elizabeth Regional Medical Center, 555 South 70th Street, Lincoln, NE 68510

    Medicare Provider 280020

    Springhill Medical Center, 3710 Dauphine Street, Mobile, AL 36608

    Medicare Provider 010144

    Unity Hospital, 550 Osborne Road, Fridley, MN 55432

    Medicare Provider 240132

    Wilson Memorial Regional Medical Center, 33-57 Harrison Street, Johnson City, NY 13790

    Medicare Provider 330394

    Effective Date--August 23, 2005

    Jackson Madison County General Hospital, 708 West Forest Avenue, Jackson, TN 38301-3956

    Medicare Provider 044002

    Leesburg Regional Medical Center, 600 E. Dixie Avenue, Leesburg, FL 34748

    Medicare Provider 100084

    Meriter Hospitals, Inc., 202 South Park Street, Madison, WI 53715

    Medicare Provider 520089

    Poplar Bluff Regional Medical Center, 2620 North Westwood Boulevard, Poplar Bluff, MO 63901

    Medicare Provider 260119

    Saint Francis Hospital, 241 North Road, Poughkeepsie, NY 12601-1399

    Medicare Provider 330067

    The Western Pennsylvania Hospital, 4800 Friendship Avenue, Pittsburg, PA 15224

    Medicare Provider 390090

    Effective Date--August 24, 2005 Halifax Medical Center, 303 N. Clyde Morris

    [[Page 76312]]

    Boulevard, Daytona Beach, FL 32114

    Medicare Provider 100017

    Jackson Hospital, 1725 Pine Street, Montgomery, AL 36106-1117

    Medicare Provider 010024

    Marietta Memorial Hospital, 401 Matthew Street, Marietta, OH 45750

    Medicare Provider 360147

    Meadowcrest Hospital, 2500 Belle Chasse Highway, Gretna, LA 70056

    Medicare Provider 190152

    Medical Center Hospital, P.O. Box 7239, Odessa, TX 79760-7239

    Medicare Provider 450132

    REX Healthcare, 4420 Lake Boone Trail, Raleigh, NC 27607

    Medicare Provider 340114

    St. John's Mercy Medical Center, 615 South New Ballas Road, St. Louis, MO 63141

    Medicare Provider 260020

    Effective Date--August 26, 2005

    Candler Hospital, 5353 Reynolds Street, Savannah, GA 31405

    Medicare Provider 110024

    CHRISTUS Santa Rosa, 333 North Santa Rosa Street, San Antonio, TX 78207-3198

    Medicare Provider 450237

    Durham Regional Hospital, 3643 North Roxboro Road, Durham, NC 27704

    Medicare Provider 344155

    Hillcrest Medical Center, 1120 South Utica Avenue, Tulsa, OK 74104

    Medicare Provider 370001

    Houston Northwest Medical Center, 710 FM 1960 West, Houston, TX 77090

    Medicare Provider 450638

    Mercy Hospital, 3663 South Miami Avenue, Miami, FL 33133

    Medicare Provider 100061

    Saint Barnabas Medical Center, Old Short Hills Road, Livingston, NJ 07039

    Medicare Provider 310076

    Effective Date--August 31, 2005

    Columbia St. Mary's Hospital Milwaukee, Inc., 2323 North Lake Drive, Milwaukee, WI 53211

    Medicare Provider 520051

    Franklin Square Hospital Center, 9000 Franklin Square Drive, Baltimore, MD 21237-9986

    Medicare Provider 210015

    The Griffin Hospital, 130 Division Street, Derby, CT 06418

    Medicare Provider 070031

    Gwinnett Medical Center, 1000 Medical Center Boulevard, Lawrenceville, GA 30045

    Medicare Provider 110087

    Louis A. Weiss Memorial Hospital, 4646 North Marine Drive, Chicago, IL 60640

    Medicare Provider 140082

    The North Shore Medical Center, 81 Highland Avenue, Salem, MA 01970

    Medicare Provider 220006

    South Pointe Hospital, 20000 Harvard Road, Warrensville Hts., OH 44122

    Medicare Provider 360144

    Southwest Medical Center--Lafayette, 2810 Ambassador Caffery, Lafayette, LA 70506

    Medicare Provider 190205

    St. Mary's Hospital Ozaukee, Inc., 13111 North Port Washington Road, Mequon, WI 53097

    Medicare Provider 520027

    St. Tammany Parish Hospital, 1202 South Tyler Street, Covington, LA 70433

    Medicare Provider 190045

    Trinity Medical Center Terrace Park, 4500 Utica Ridge Road, Bettendorf, IA 52722

    Medicare Provider 160104

    UAMS Medical Center, 4301 West Markham, Little Rock, AK 72205-7199

    Medicare Provider 040016

    Valley Baptist Medical Center--Harlingen, P.O. Drawer 2588, 2101 Pease Street, Harlingen, TX 78551

    Medicare Provider 450033

    Effective Date--September 6, 2005

    Carilion Roanoke Memorial Hospital, 1906 Belleview Avenue, Roanoke, VA 24014

    Medicare Provider 490024

    Midland Memorial Hospital, 2200 West Illinois Avenue, Midland, TX 79701-6499

    Medicare Provider 450133

    Provena Saint Joseph Medical Center, 333 North Madison Street, Joliet, IL 60435-6595

    Medicare Provider 140007

    Salinas Valley Memorial Healthcare System, 450 E. Romie Lane, Salinas, CA 93901

    Medicare Provider 050334

    UHHS Geauga Regional Hospital, 13207 Ravenna Road, Chardon, OH 44024

    Medicare Provider 360192

    Effective Date--September 8, 2005

    Howard Regional Health System, 3500 South Lafountain Street, P.O. Box 9011, Kokomo, IN 46904-9011

    Medicare Provider 150007

    Luther Hospital, 1221 Whipple Street, P.O. Box 4105, Eau Claire, WI 54702-4105

    Medicare Provider 520070

    Our Lady of Fatima Hospital, 200 High Service Avenue, No. Providence, RI 02904

    Medicare Provider 041005

    Pitt County Memorial Hospital, Inc., P.O. Box 6028, Greenville, NC 27835-6028

    Medicare Provider 340040

    Effective Date--September 12, 2005

    Baylor All Saints Medical Center, 1400 Eighth Avenue, Fort Worth, TX 76104

    Medicare Provider 450137

    St. Vincent's Hospital, Staten Island, 355 Bard Avenue, Staten Island, NY 10310

    Medicare Provider 330028

    SUNY Stony Brook University Hospital, Nicolls Road, Stony Brook, NY 11794

    Medicare Provider 330393

    The Washington Hospital, 155 Wilson Avenue, Washington, PA 15301

    Medicare Provider 390042

    Effective Date--September 15, 2005

    Abilene Regional Medical Center, 6250 Highway 83/84, Abilene, TX 79606

    Medicare Provider 450558

    Bon Secours Cottage Health Services, 468 Cadieux Road, Grosse Pointe, MI 48230

    Medicare Provider 230089

    HealthOne/HCA Rose Medical Center, 4567 E. 9th Avenue, Denver, CO 80220

    Medicare Provider 060032

    Providence Health Center, 6901 Medical Parkway, Waco, TX 76712

    Medicare Provider 450042

    St. Edward Mercy Medical Center, 7301 Rogers Avenue, P.O. Box 17000, Fort Smith, AR 72917-7000

    Medicare Provider 040062

    St. Joseph's Hospital, 3001 W. Dr. M.L. King Jr. Boulevard, Tampa, FL 33607

    Medicare Provider 100075

    Effective Date--September 22, 2005

    Baylor University Medical Center, Department of Radiology, 3500 Gaston Avenue, Dallas, TX 75246

    Medicare Provider 450021

    Delray Medical Center, 5352 Linton Boulevard, Delray Beach, FL 33484

    Medicare Provider 100258

    Desert Springs Hospital, 2075 East Flamingo Road, Las Vegas, NV 89119

    Medicare Provider 290022

    Ellis Hospital, 1101 Nott Street, Schenectady, NY 12308

    Medicare Provider 330153

    Ingham Regional Medical Center, 401 West Greenlawn Avenue, Lansing, MI 48910

    Medicare Provider 230167

    St. Joseph's Hospital, 11705 Mercy Boulevard, Savannah, GA 31419

    Medicare Provider 110043

    Mercy Hospital of Pittsburgh, 1400 Locust Street, Pittsburgh, PA 15219-5166

    Medicare Provider 390028

    The Pottsville Hospital and Warne Clinic, 420 South Jackson Street, Pottsville, PA 17901

    Medicare Provider 390030

    Southwest Mississippi Regional Medical Center, 215 Marion Avenue, McComb, MS 39648

    Medicare Provider 250097

    Sparks Regional Medical Center, 1311 South

    [[Page 76313]]

    I Street, P.O. Box 17006, Fort Smith, AR 72917-7006

    Medicare Provider 040055

    Tampa General Hospital, 2 Columbia Drive, Tampa, FL 33606

    Medicare Provider 100128

    Wesley Medical Center, 550 N. Hillside, Wichita, KS 67214

    Medicare Provider 170123

    Effective Date--September 28, 2005

    Advocate Illinois Masonic Medical Center, 836 W. Wellington Avenue, Chicago, IL 60657-5193

    Medicare Provider 140182

    East Texas Medical Center-Tyler, 1000 South Beckham, Tyler, TX 75701

    Medicare Provider 450083

    Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219

    Medicare Provider 330914

    Mesa General Hospital, 515 North Mesa Drive, Mesa, AZ 85201

    Medicare Provider 030017

    Opelousas General Health System, 539 E. Prudhomme Street, P.O. Box 1389, Opelousas, LA 70570

    Medicare Provider 190017

    Southern Ohio Medical Center, 1895 27th Street, Portsmouth, OH 45662

    Medicare Provider 360008

    St. Joseph Hospital, 2901 Squalicum Parkway, Bellingham, WA 98264

    Medicare Provider 500030

    St. Lukes Hospital, 801 Ostrum Street, Bethlehem, PA 18015

    Medicare Provider 390049

    WakeMed Health and Hospitals, 3000 New Bern Avenue, Raleigh, NC 27610

    Medicare Provider 340069

    Yale-New Haven Hospital, 20 York Street, New Haven, CT 06504,

    Medicare Provider 070022

    [FR Doc. 05-24023 Filed 12-22-05; 8:45 am]

    BILLING CODE 4120-01-U