A 90-minute webconference to provide members with the CMS Outlook for 2006 regarding quality improvement and clinical standards and to unveil the new password-protected Learning Network website. Invited speakers include: Barry Straube, M.D., Director & Chief Clinical Officer, Office of Clinical Standards and Quality, CMS; Trent Haywood, M.D., Deputy Chief Clinical Officer, Office of Clinical Standards and Quality, CMS; and Jean Moody-Williams, R.N., M.P.P., Director, Division of Quality, Evaluation and Health Outcomes, CMS.
PILOT MEDICAID HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) CODE REQUEST PROCESS
| Network Point of Contact: Jeffery Thompson, M.D. M.P.H., Chief Medical Officer and Director of the Division of Medical Management, Washington State Medicaid |
Purpose The Pilot Medicaid Code Request Process provides State Medicaid Agencies with a mechanism for requesting new Healthcare Common Procedure Coding System (HCPCS) codes or modifications to the existing HCPCS Code Set that is similar to the standard HCPCS code request process, but which is designed specifically for Medicaid programs. States should only request new HCPCS codes through this process after first determining that current codes are not adequate to meet Medicaid program operating needs.
National Code Request Process The HCPCS Level II Code Set contains alpha-numeric codes used to identify items not included in the American Medical Association’s Current Procedural Terminology (CPT-4) codes. The Centers for Medicare & Medicaid Services (CMS) makes decisions pertaining to additions, deletions, and revisions to the HCPCS Code Set, with input from the private insurance sector, Medicare program staff, and Medicaid program staff. Public requests for modifications to the existing HCPCS Level II Code Set must be submitted by following the procedures outlined at www.cms.hhs.gov/medicare/hcpcs.
Pilot Medicaid Code Request Process This pilot process is the new mechanism States should use to request modifications to the HCPCS Level II Code Set that are needed to satisfy national Medicaid program operating needs. Under this process, the State Medicaid Agency must submit its request to the Center for Medicaid and State Operations (CMSO) following the Medicaid application format. A subgroup of the internal CMS HCPCS Workgroup, consisting of CMSO program staff and State Medicaid Agency representatives to the CMS HCPCS Workgroup, initially reviews the request. If clarification is needed, the requester will be contacted and provided the opportunity to make changes to its request, or to supply additional information. If a preliminary decision is made by the subgroup that a national Medicaid program operating need exists, the request will be submitted to the CMS HCPCS Workgroup for discussion at a regularly scheduled meeting. Requests for coding changes that do not represent a national Medicaid program operating need will not be forwarded to the Workgroup, and the requester will be notified by CMSO staff, and provided an explanation.
