CMS will be making some changes to the Medicare realtime eligibility response next weekend. This does not effect DDE responses (HIQA, HIQH,etc).
1. The Medicare preventive data will be removed from the response. It will only be returned if a HCPCS code is specifically requested. So if you’re trying to find out if the beneficiary is eligible for a mammogram, you will need to request one of the mammography HCPCS codes. They will also be showing more detailed financial info on each service including whether or not the deductible and/or coinsurance is waived for that service. I’ve include the screening tests below with the appropriate codes.
- Annual Depression Screening includes code G0444.
- Annual Wellness Visit (AWV) includes codes G0438 and G0439.
- Cardiovascular Disease Screening (CARD) includes codes 80061, 82465, 83718, and 84478.
- Colorectal Cancer Screening (COLO) includes codes G0104, G0105, G0106, G0120 and G0121.
- Diabetes Screening Tests (DIAB) includes codes 82947, 82950, and 82951.
- Fecal Occult Blood Test (FOBT) includes codes G0328 and 82270.
- Glaucoma Screening (GLAU) includes codes G0117 and G0118.
Intensive Behavioral Counseling for Obesity includes code G0447.
- Intensive Behavioral Therapy (IBT) for Cardiovascular Disease (CVD) includes code G0446.
- Initial Preventive Physical Examination (IPPE) includes codes G0402, G0403, G0404, and G0405.
- Pneumococcal Vaccine (PPV) includes codes 90669, 90670 and 90732.
- Prostate Cancer Screening (PROS) includes codes G0102 and G0103.
- Screening and High Intensive Behavioral Counseling (HIBC) to prevent STIs includes code G0445.
- Screening Mammography (MAMM) includes codes G0202 and 77057.
- Screening Pap Test (PAPT) includes codes Q0091, P3000, G0123, G0143, G0144, G0145, G0147, and G0148.
- Screening Pelvic Exam (PCBE) includes code G0101.
- Ultrasound Screening for Abdominal Aortic Aneurysm (AAA) includes code G0389
2. The response will now show the individual hospice periods instead of lumping them into one large period. You will be able to see the beginning and ending date for each period.