J1




Posted 3/4/2011
 
Palmetto to Review Aranesp and Avastin
The Palmetto GBA J1 Part A Medical Review department will be performing a service specific probe review for HCPCS code J0881, Injection, Darbepoetin Alfa (non-end-stage renal disease (non-ESRD) use). This probe is based on a data analysis that demonstrates high utilization of this code and documented issues in the J1 region. A sample of 100 claims will be selected from the former Wisconsin Physician Services (WPS) location. 

If you receive an Additional Development Request (ADR), please return the requested documentation with a copy of the ADR to the J1 Part A Medical Review department address within 30 days of the date listed on the ADR. Use the J1 Part A ADR Cover Sheet and view instructions (PDF, 51 KB) on the Palmetto GBA J1 Part A Web site. 

If you received multiple requests for records and will be responding with records at the same time, please use the ADR Separator Sheet (PDF, 85 KB). For more requirements, view the article Filing Requirements for Providers Responding to Additional Documentation Requests (ADR) on the Palmetto GBA J1 Part A Web site. 

When sending in documentation to the ADR request, please include:

  • Submit physician's orders that are signed, dated and legible
  • Documentation of administration for the dates of service in question
  • Physician progress notes
  • Hemoglobin and hematocrit levels
  • Any other documentation to support the HCPCS code billed
  • Submit all documentation pertaining to the Erythropoietin Stimulating Agents (ESA) L27571
        
The Palmetto GBA J1 Part A Medical Review department will be performing a service specific probe review for HCPCS code J9035, Bevacizumab. This probe review is based on a data analysis that demonstrates high utilization of this code and documented issues in the J1 region. A sample of 100 claims will be selected from the former Wisconsin Physician Services (WPS) region. 

If you receive an Additional Development Request (ADR), please return the requested documentation with a copy of the ADR to the J1 Part A Medical Review department address within 30 days of the date listed on the ADR. Use the J1 Part A ADR Cover Sheet and view instructions (PDF, 51 KB) on the Palmetto GBA J1 Part A Web site.

If you received multiple requests for records and will be responding with records at the same time, please use the ADR Separator Sheet (PDF, 85 KB). For more requirements, view the article Filing Requirements for Providers Responding to Additional Documentation Requests (ADR) on the Palmetto GBA J1 Part A Web site.

Posted 2-21-2011

J1 Part B LCDs Revised

Share with your staff - The following J1 Part B Local Coverage
Determinations (LCDs) have been revised: Cytogenetic Studies L28251,
Injection of Spinal Canal L28270, MOHS Micrographic (MMS) Surgery L28278,
Oncotype DX Test – Breast Cancer Prognosis L28287 and Psychotherapy
Services L28294.

http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/8E5K3M0853?opendocument 

MACS




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