TrailBlazer Part B Update

The April 2007 through June 2007 “Top Denial/Reject Reasons for Radiation Therapy” article is now available on the Radiation Therapy Web page. Click here.

The April 2007 through June 2007 “Top Denial/Reject Reasons for Chemotherapy” article is now available on the Chemotherapy Web page. Click here.

Billing Reminder
Radiation Treatment Management Services:
77427© Radiation tx management, x 5
77435© Sbrt management

Historically, TrailBlazer has required the above codes be reported with a quantity billed amount to reflect the number of radiation treatments that were managed. This reporting mechanism allowed us to meet CMS’ requirement that billing entities must indicate on each claim the number of fractions for which payment is sought.

Due to the implementation of the Medically Unlikely Edit (MUE), which is affected by the quantity billed amounts, TrailBlazer has changed the reporting requirements for these codes. A notice was posted on our Web site, dated May 23, 2007, which indicated that effective July 2, 2007, providers should report these services as follows:

• Each radiation therapy management service should be billed on a separate detail line.
• The date of service should be the beginning date for each set of five treatments delivered for code 77427.
• The date of service should be the beginning date of the treatments delivered for code 77435.
• Payment will only be made after the fifth treatment has been delivered or for the last three or four fractions at the end of the treatment course for code 77427.
• Payment will only be made after the last treatment has been delivered for code 77435.
• Indicate “0010” in the quantity billed field for claims billed electronically.
• Indicate “1” in Item 24g for claims billed on the CMS-1500 paper claim form.
• Indicate each treatment date within the comment field for claims billed electronically (this bullet was omitted from the August 9, 2007, listserv message in error).
• When reporting on the CMS-1500 paper claim form, an attachment indicating each treatment date should be attached.

Claims reported for these services on or after July 2, 2007, will deny based on the MUE, unless reported as indicated above. Reference Medicare Part B Newsletter No. 07-072, dated July 11, 2007, page 16.

Provider Enrollment Status Inquiry
Providers can now track their Part B provider enrollment applications from the TrailBlazer website. Applications go through a 15-day review process. The contact person listed on the application will receive a notice containing the tracking number. This number will be required in order to use the online tracking tool.

To utilize this new tool, go to the Self-Service Option listed on the top right side of the website. Click here.