IDEAS Study Medicare Claim Denials – Please Let Us Know!- 5.30.2016

TO: IDEAS Study PET imaging facility administrators (please forward as needed to coders and billers)

The IDEAS Study is aware that a number of Medicare Administrative Contractors (MACs) and Medicare Advantage plans are denying claims for amyloid PET scans performed under the IDEAS Study Coverage with Evidence Development (CED) program. We are working closely with the Centers for Medicare & Medicaid Services (CMS) to resolve these problems as quickly as possible.

If your facility receives denials of IDEAS Study claims, please inform us via IDEAS-Study@acr.org . In order for us to assist you with any denial, we need to review a de-identified copy of the submitted claim form (electronic or paper copy with all PHI redacted) and a de-identified copy of the Explanation of Benefits (EOB) showing the reason for the denial. These documents should be sent to IDEAS-Study@acr.org. The IDEAS-Study claims consultant will review and be in touch with the person indicated on the e-mail submission.

Additionally, to assist with billing, we also created sample Medicare claims and a site billing checklist available on the IDEAS website at: http://www.ideas-study.org/forms/.

SPECIAL NOTICE FOR IDTF SITES ONLY (does NOT apply to Hospitals or Physician offices)

If your PET facility is an Independent Diagnostic Testing Facility (IDTF), please verify that your facility has notified your Medicare Administrative Contractor via the CMS-855B Form listing all the CPT and HCPCS level II codes used for the IDEAS Study. A list of all the potential IDEAS Study CPT/HCPCS codes as of 5-16-2016 are CPT 78811, 78814, A9586 and A9599. Check back in June as we anticipate two new HCPCS codes to be added and these would need to be submitted on an updated CMS-855B prior to performing and billing those new codes.

For your information, it is a requirement that all CPT/HCPCS codes/procedures that an IDTF intends to perform when enrolling with the CMS-855B are listed. If an IDTF that is already enrolled wants to perform additional CPT and HCPCS code tests that were not originally specified on its CMS-855B and that are for procedure types and supervision levels similar to its previously allowed codes, the contractor shall have the IDTF amend its CMS-855B to add the additional codes and equipment listing (if necessary). A new site visit is not required. However, if the enrolled IDTF will be performing CPT or HCPCS codes for different types of procedures, or with different supervisions levels, a new site visit is required. Claims submitted with procedure codes not reported on the CMS-855B form and reviewed by the contractor will be denied.

The IDEAS Study Operations Team

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