License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2009 American Medical Association (AMA). All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the AMA.

You, your employees and agents are authorized to use CPT only as contained in the following authorized materials including but not limited to CGS fee schedules, general communications, Medicare Bulletin, and related materials internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. Applications are available at the AMA website.

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The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

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POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

End User License Agreement

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Non-Routine Supplies on HH PPS Claims

Effective for HH PPS episodes beginning on or after January 1, 2008, non-routine supply severity levels are indicated on HH PPS claims through a code value in the 5th position of the HIPPS code. The 5th position of the HIPPS code can contain two sets of values. One set of codes (the letters S through X) indicate that supplies were provided. The second set of codes (the numbers 1 through 6) indicate the HHA is intentionally reporting that they did not provide supplies during the episode.

HHAs must ensure that if they are submitting a HIPPS code with a 5th position containing the letters S through X, the claim must also report a non-routine supply revenue with covered charges. This revenue code may be either revenue code 27x, excluding 274, or revenue code 623, consistent with the instructions for optional separate reporting of wound care supplies.

HCPCS code

Required only for revenue code 0274 (Prosthetic and Orthotic Devices). Enter this information when required into the "HCPC" field via direct data entry (DDE) on Fiscal Intermediary Standard System (FISS) page 02, which corresponds with form locator (FL) 44 on the CMS-1450 paper claim form.

Service units (required)

Units must be reported in both the TOT UNIT and COV UNIT fields on the FISS page 02. These fields correspond to form locator (FL) 46 on the CMS-1450 claim form. HHAs may choose to use a default "1" in each of these fields.

Charges (required)

When reporting 0623 and 027X, charge amounts for the two revenue codes must be separate and distinct. Charges are keyed into the "TOT CHARGE" field on FISS page 02, which corresponds to FL 47 on the CMS-1450 claim form.

Dates of Service (required)

The line item date of service must fall within the "FROM" and "TO" date of the claim. This information is entered into the "SERV DATE" field on FISS page 02, which corresponds to FL 45 on the CMS-1450 claim form.

Providers may use the first Medicare billable visit in the episode as the date of service submitted with non-routine or surgical dressing/wound care supplies.

Routine Versus Non-Routine Supplies

The Medicare Benefit Policy Manual (CMS Pub 100-02, Ch. 7, § 50.4.1) defines routine versus non-routine supplies. Use this definition to determine whether a supply item is non-routine and must be reported separately