Medicare Transmittal 956 CR 5124 May 19, 2006. NOPR Billing Instruction Clarification Physician Offices/IDTF use QR Modifier Hospitals use QR and V70.7 MLM CMS Educational Article MM5124 Published May 31, 2006. CMS Effective: January 28, 2005 NOPR Opened May 8, 2006
CMS Effective: January 28, 2005
NOPR Opened May 8, 2006
NOPR Patients DOS Effective: May 8, 2006
Implemented by Medicare Contractors:
June 19th 2006
Noridian & Empire QR modifier system errors corrected!
No Waiting Period
Hold claims until all data entered into the Registry
Providers Bill Medicare
Claim Form & Codes
UB/1450 Claim Form
1500 Claim Form
Modifier Use by Providers to Identify NOPR Claims
Use only with procedure, not necessary with the radiopharmaceutical billed on the same DOS as the procedure.
V70.7 Use in the Second Diagnosis Position FL 68
From Current CMS policy CR 3741
A 72-year-old woman with diffuse large cell non-Hodgkin's lymphoma is undergoing chemotherapy with R-CHOP. PET/CT (skull-base to mid thigh) is requested after the second cycle of treatment for monitoring of therapy.
A 67-year-old man has a history of glioblastoma multiforme of left parietal lobe treated with surgery, radiation therapy, and temazolamide. Follow-up MRI demonstrates a new 8 mm focus of contrast enhancement adjacent to the original tumor bed. Brain PET is requested for restaging, to distinguish recurrent tumor for radiation necrosis.
A 68-year-old woman has newly diagnosed dermatomyositis and progressive weight loss. CT of the chest, abdomen, and pelvis demonstrated no evidence of malignancy. Whole-body PET/CT is requested to detect an occult malignancy as the cause of her paraneoplastic syndrome.
Managed Medicare Plans – Medicare Advantage