CMS Pub. 100-04, ch. 6, § 110.4.1

Barring any delay in the Medicare Physician Fee Schedule, CMS will provide the new

code files to CWF by November 1. Should this date change, CWF will be notified

through the appropriate mechanism. All future updates will be submitted via a Recurring

Update Notification form. These Recurring Update Notifications also describe how the

changes will be implemented.

CWF will be provided with 4 coding files (Physician Services, Professional Component

of Physician Services to be Submitted with the 26 Modifier, Ambulance, and Therapy)

that are effective based on dates of service January 1 through December 31 for that year.

New files shall be provided for each calendar year. Quarterly updates to the four files

will continue as usual.

A/B MACs (B)/DME MACs must continue to respond to rejects and unsolicited

responses received from CWF per current methodology.

A/B MACs (B)/DME MACs must reopen and reprocess any claims brought to their

attention for services that prior to this update were mistakenly considered to be subject to

consolidated billing and therefore, not separately payable. A/B MACs (B)/DME MACs

need not search claims history to identify these claims.

Prior to January 1 of each year, new codes files will be posted to the CMS Web site at.

https://www.cms.gov/Medicare/Billing/SNFConsolidatedBilling/. Should this date

change, A/B MACs (B)/DME MACs will be notified through the appropriate mechanism.

Coding changes throughout the year may also be made as necessary through a quarterly

update process.

As soon as the new code files are posted to the CMS Web site, through their Web sites

and list serves, A/B MACs (B)/DME MACs must notify physician, non-physician

practitioners, and suppliers of the availability of the files.