Medicare Reimbursement Requirements

from the July 2003 issue

The ICAVL is aware of published Local Medical Review Policies for the states listed within the chart below. Payment policies exist for the majority of these states similar to the following:

A vascular diagnostic study may be personally performed by a physician or a technologist. Consequently, the physician performing and/or interpreting the study must be capable of demonstrating documented training through recent residency training or post-graduate CME and experience, and maintain that documentation for postpayment review. The accuracy of non-invasive vascular diagnostic studies depends on the knowledge, skill and experience of the technologist and physician performing and interpreting the study. By (specified date), all non-invasive vascular diagnostic studies, when performed by a technologist, must be performed by a technologist who has demonstrated competency in ultrasound by receiving one of the following credentials in vascular ultrasound technology: Registered Vascular Specialist (RVS); Registered Vascular Technologist (RVT). The RVS and RVT credentials are provided by the following nationally recognized organizations: RVT by the American Registry of Diagnostic Medical Sonographers (ARDMS); and, RVS by Cardiovascular Credentialing International (CCI). Alternately, by (specified date), such studies must be performed in a facility or vascular laboratory accredited by one of the following nationally recognized accreditation organizations: Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL) and the American College of Radiology (ACR) Vascular Ultrasound Accreditation Program. If a vascular laboratory or facility is accredited, the technologists performing non-invasive vascular studies in that laboratory are considered to have demonstrated competency in vascular ultrasound. Effective (specified date), documentation of either the RVT or facility accreditation will be required each January prior to billing electronically for that new year and with any and all submitted paper claims.

STATE	MEDICARE CARRIER	POLICY #	EFFECTIVE DATE
ALABAMA	Blue Cross Blue Shield of Alabama	B00-19	9/1/2000
ALASKA	Noridian Mutual Insurance Company	89-019-R1a	Recommendation - 5/1/00
ARKANSAS	Arkansas Medicare Services	AC-02-055	NEW 1/1/2005
ARIZONA	Noridian Mutual Insurance Company	89-019-R1a	Recommendation - 5/1/00
COLORADO	Noridian Mutual Insurance Company	2000.05	Recommendation - 5/1/00
DELAWARE	Trailblazer Health Enterprises, LLC	U-4.6	2/4/2000
HAWAII	Noridian Mutual Insurance Company	89-019-R1a	Recommendation - 5/1/00
IDAHO	CIGNA Healthcare Medicare Administration	2003-04	1/1/2004 DRAFT
ILLINOIS	Wisconsin Physicians Service	M95 053R5	1/1/1998
IOWA	Noridian Mutual Insurance Company	n/a	7/1/1998
KANSAS/ WESTERN MO	Blue Cross Blue Shield of Kansas	n/a	1/1/1997
LOUISIANA	Blue Cross Blue Shield of Arkansas - Louisiana Territory	LA-00-003	1/1/1997
MARYLAND	Trailblazer Health Enterprises, LLC	U-4.6	2/4/2000
MICHIGAN	Wisconsin Physicians Service	CV-033	6/1/2002
MINNESOTA	Wisconsin Physicians Service	CV-033	6/1/2002
MISSISSIPPI	Cahaba Government Benefit Administrators	OTH-9726	1/1/1998
MISSOURI	Missouri Medicare Services	AC-02-055	NEW 1/1/2005
NEBRASKA	Blue Cross Blue Shield of Kansas	n/a	7/1/1998
NEVADA	Noridian Mutual Insurance Company	2000.05	Recommendation - 5/1/00
NEW JERSEY	Empire Medicare Services	MNB-NJ-99-5	1/1/1999
NEW MEXICO	Oklahoma/New Mexico Medicare Services	AC-02-055	NEW 1/1/2005
NEW YORK (upstate)	HealthNow NY, Inc.	VS001E05	1/1/1999
NEW YORK	Empire Medicare Services	VS001E01	1/1/1999
NORTH CAROLINA	CIGNA Healthcare Medicare Administration	2000-008	1/1/2002
NORTH DAKOTA	Noridian Mutual Insurance Company	2000.05	Recommendation - 5/1/00
OHIO	Palmetto GBA	96-0026-L	1/1/1999
OKLAHOMA	Oklahoma/New Mexico Medicare Services	AC-02-055	NEW 1/1/2005
OREGON	Noridian Mutual Insurance Company	89-019-R1a	Recommendation - 5/1/00
PENNSYLVANIA	HGS Administrators	M-40D	1/1/1999
SOUTH CAROLINA	Palmetto GBA	96-0026-L	1/1/1999
SOUTH DAKOTA	Noridian Mutual Insurance Company	2000.05	Recommendation - 5/1/00
TENNESSEE	CIGNA Medicare	96-07-04	NEW 1/1/2004
TEXAS	Trailblazer Health Enterprises, LLC	U-4.6	2/4/2000
VIRGINIA	Trailblazer Health Enterprises, LLC	M-16.3	2/1/1998
WASHINGTON, DC	Trailblazer Health Enterprises, LLC	U-4.6	2/4/2000
WASHINGTON	Noridian Mutual Insurance Company	2000.05	Recommendation - 5/1/00
WEST VIRGINIA	Palmetto GBA	96-0026-L	1/1/1999
WISCONSIN	Wisconsin Physicians Service	CV-033	6/1/2002
WYOMING	Noridian Mutual Insurance Company	2000.05	Recommendation - 5/1/00

The ICAVL website contains a full listing of this information, along with direct links to the publication of these policies on the respective carriers' websites.

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