CMS Pub. 100-04, ch. 32, § 310.1

Monitoring Furnished Before January 1, 2013

(Rev. 2743, Issued: 07-25-13, Effective: 07-01-01-13, Implementation, 08-26-13)

Prior to January 1, 2013, the applicable HCPCS code for Transesophageal Doppler cardiac

monitoring is:

HCPCS 76999 (billed with modifier -26) when performed in a hospital setting for ventilated

patients in the ICU or for operative patients with a need for intra-operative fluid optimization.

If globally billed using code 76999, it shall be returned as unprocessable to the provider using

a claim adjustment reason code (CARC) such as:

CARC 58: “Treatment was deemed by the payer to have been rendered in an

inappropriate or invalid place of service. Note: Refer to the 835 Healthcare Policy

Identification Segment (loop 2110 Service Payment Information REF), if present.”

HCPCS 76999 (billed with modifier -TC) shall be denied when performed in a hospital

setting for ventilated patients in the ICU or for operative patients with a need for intra-operative fluid optimization with a message such as:

CARC 58: “Treatment was deemed by the payer to have been rendered in an

inappropriate or invalid place of service. Note: Refer to the 835 Healthcare Policy

Identification Segment (loop 2110 Service Payment Information REF), if present.”

RARC M77: “Missing/incomplete/invalid place of service.”

MSN 17.9: “Medicare (Part A/Part B) pays for this service. The provider must bill the

correct Medicare contractor.” (English version) or “Este servicio es pagado por

Medicare (Parte A/Parte B). El proveedor debe enviar la facture al contratista de

Medicare correcto.”(Spanish version).

HCPCS 76999 (billed globally or with -26 or -TC) when performed in an ASC setting for

operative patients with a need for intra-operative fluid optimization, ultrasound diagnostic

procedures are covered when performed by an entity other than the ASC.