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PM Rev. B-01-08, Change In Effective Date For Five “WW” Codes For Methotrexate

Program Memorandum

Department of Health and Human Services (DHHS)

Carriers

HEALTH CARE FINANCING ADMINISTRATION (HCFA)

PM Rev. B-01-08, Change In Effective Date For Five “WW” Codes For Methotrexate

Date: FEBRUARY 8, 2001

CHANGE REQUEST 1481

SUBJECT: Change In Effective Date For Five “WW” Codes For Methotrexate

The National Drug Codes (NDCs) codes were available when the oral anti-cancer drug benefit, covering methotrexate, became effective on January 1, 1994. However, Medicare did not assign WW codes to these particular NDC codes because at that time they were not high in utilization. When a claim was filed citing NDCs for methotrexate, the durable medical equipment regional carriers (DMERCs) processed the claim with a Not Otherwise Classified (NOC) code. However, recently, there has been such an increase in the utilization of these particular NDC drugs that it was felt that these drugs should have their own WW code for processing. According to Program Memorandum (PM) B-00-35, Change Request 1228, dated July 20, 2000, the effective date for these WW codes was October 1, 2000. Under normal circumstances, the claims coming into the DMERCs would not accept the NDC codes until October 1, 2000. In reality, the DMERCs have accepted these codes prior to October 1, 2000, but in the past have processed them with an NOC.

If a claim is received with a date of service prior to October 1, 2000, the DMERCs would accept the claim and process with an NOC. If the claim has a date of service after October 1, 2000, the claim would automatically process under the NDC/WW crosswalk. The effective date should be set back to January 1, 1994, so that any claims will automatically crosswalk to the correct WW code without any manual intervention. Manual interventions slow processing and may cause errors. Any claims that were not set within the acceptable timeframe for filing a Medicare claim will still hit the untimely filing edit.

The DMERCs will not retroactively reprocess any previously processed claims. The change will affect only new claims with dates of service prior to October 1, 2000.

The effective date for this PM is January 1, 1994.

The implementation date for this PM is July 1, 2001.

These instructions should be implemented within your current operating budget.

This PM may be discarded after January 1, 2002.

If you have any questions, contact Angie Costello at 410-786-1554 or acostello@hcfa.gov.

HCFA-Pub. 60B

 

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