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Policy Education Topics

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Ankle-Foot/Ankle-Knee-Foot Orthoses

Automatic External Defibrillators

Canes and Crutches

Continuous Passive Motion Devices

Dear Physician Letter - Not Policy Specified

Documentation Best Practices

External Breast Prostheses

External Infusion Pumps

Glucose Monitors and Supplies

Hospital Beds and Accessories

Immunosuppressive Drugs

Knee Orthoses

Lower Limb Orthoses

Lower Limb Prostheses

Manual Wheelchairs

National Coverage Determination Policy-Related Articles

Nebulizers

Negative Pressure Wound Therapy

Oral Anticancer Drugs

Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics)

Oral Appliances for Obstructive Sleep Apnea

Orthopedic Shoes

Osteogenesis Stimulators

Ostomy and Ostomy Supplies

Oxygen and Oxygen Equipment

Parenteral and Enteral

Pneumatic Compression Devices

Positive Airway Pressure Devices

Power Mobility Devices

Refractive Lenses

Spinal Orthoses

Suction Pumps

Support Surfaces

Surgical Dressings

Therapeutic Shoes for Persons with Diabetes

Tracheostomy Supplies

Transcutaneous Electrical Nerve Stimulators

Upper Limb Prostheses

Urological and Urological Supplies

Vacuum Erection Devices

Ventilators

Walkers

Ambulance Services
- Coverage of Rural Air Ambulance Services
- Claim Denials for Medically Unnecessary Ambulance Transports: Avoiding Reason Code 55B10
- Ambulance Transports Included in SNF Consolidated Billing
- Ambulance Transports Excluded from SNF Consolidated Billing
- Medical Necessity of Ambulance Services
- Responsibility of Providing a Properly Executed Physician Certification Statement/Certificate of Medically Necessity

Billing
- Proper Submission of Fee-For-Time Compensation Arrangements and Reciprocal Billing Arrangements
- CPT Code 15830: Excision, Excess Skin and Subcutaneous Tissue; Abdomen, Infraumbilical Panniculectomy
- Annual Wellness Visits ‑ Billing Tips for Physicians

Cardiac
- Reminder for Billing Cardiac Rehabilitation Session and Session Limitations

Chiropractic Services
- Chiropractic Maintenance Care
- Documentation to Support Spinal Manipulation for CPT Code 98942
- Limited Coverage for Services Ordered or Furnished By a Chiropractor
- Proper Billing for Acupuncture

Clinical Trials
- Clinical Trial Services and Modifiers Q0 and Q1

Coding and Edits (Including MUEs)
- Adjustment of Claims with Automated Medical Review Denials
- Site of Service Codes for Continuous Home Care and General Inpatient Care Level of Service
- Medically Unlikely Edits Billing and Processing
- Counseling to Prevent Tobacco Use
- National Coverage Determination 190.3 - Cytogenetic Testing: Discretionary Diagnoses

Diabetes Awareness
- Medicare Diabetes Prevention Program
- Diabetic Self-Management Tool for Billing
- Medical Nutrition Therapy Tool for Billing
- Frequently Asked Questions for Diabetes Self-Management Training and Medical Nutrition Therapy
- Related Diabetes Awareness Preventive Service Guide

Documentation
- Documentation Required for Home Visits
- Capable Recipients for the Advance Beneficiary Notice of Noncoverage
- Change Request 6698 (Revised): Signature Guidelines for Medical Review Purposes
- Cloned Documentation Could Result in Medicare Denials for Payment
- Missing or Illegible Signatures/Signature Requirements
- Hardcopy Order and Progress Note Signature Guidelines/Attestation Sample
- Submitting Electronic Medical Records
- Tips for Responding to a Hospice ADR
- Therapy Reassessment
- Skilled Nursing Facility Medicare Part A Benefit Quick Reference Fact Sheet
- Scribing Medical Record Documentation
- Assistant at Surgery Billing Documentation Reminder
- Primary Care Exception Guidelines

Drugs and Vaccines
- Providers Performing Facet Joint Injections (CPT Code 64476)
- Erythropoiesis Stimulating Agents: Clinical Indications and Coverage Criteria Overview
- Testosterone Pellet Dosage

Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)
- Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)

Evaluation and Management
- CMS Evaluation and Management Services Guide
- Critical Care Services: CPT Codes 99291-99292
- Definition of New Patient for Billing Evaluation and Management Services
- Evaluation & Management Documentation Training Tool
- Evaluation and Management Frequently Asked Questions
- Evaluation and Management Services: 1995 Documentation Guidelines
- Evaluation and Management Services: 1997 Documentation Guidelines
- Low Vision Services
- Nonphysician Practitioners: Evaluation and Management Services
- Prolonged Services: Face-to-Face
- Prolonged Services: Non-Face-to-Face
- Prolonged Services: Comparative Differences of Face-to-Face/Non Face-to-Face CPT Codes
- Time-Based Evaluation and Management Services
- Tip Sheet: Proper Use of Modifier 25
- General E/M Information
- Documentation
- History Prior to 12/31/2020
- Examination Prior to 12/31/2020
- Medical Decision Making Prior to 12/31/2020
- Admission and Discharge Services
- Split/Shared and Incident To Services
- Observation Services
- Consultations
- Time-Based Services Prior to 12/31/2020
- Prolonged Services On or After 1/1/2021
- Chronic Care Management
- Critical Care Services
- IPPE and AWV
- Provider Specialty
- Teaching Environment E/M Services
- Scribes
- Fee-For-Time Compensation Arrangements
- New vs. Established Patients
- Emergency Department
- Separately Identifiable Service
- Global Period Services
- Behavioral Health Services
- Transitional Care Management
- Smoking Cessation
- Advanced Care Planning
- Modifiers
- Urgent Care
- Preoperative Clearance
- Time-Based Services On or After 1/1/2021
- Prolonged Services Prior to 12/31/2020
- Medical Decision Making On or After 1/1/2021
- History On or After 1/1/2021
- Examination On or After 1/1/2021

Global Surgery
- Global Surgery

Hospice Benefit

Psychiatric Services

Home Health Benefit
- Initial Episode Clarified for Home Health Face-to-Face Encounter

Incident To Services
- Incident to Quick Reference Chart
- “Incident to” Services
- Incident to Job Aid for Place of Service Office
- Incident to Office Guidelines

IPPE and AWV
- The Annual Wellness Visit

Laboratory Services
- Medicare Coverage for Zika Virus Testing

Mental Health Awareness
- Behavioral Health Integration Services
- Mental Health Services
- Mental Health Billing Guide

Modifiers
- Anesthesia Modifiers
- Correct Usage of Modifier 79 for Multiple Procedures
- Modifier 25
- Modifier 52
- Clarification for Billing Services on Fingers and Toes Using Modifiers F1-F9, FA, TI-T9 and TA vs. Modifier 50
- Modifier 90 (Reference to Outside Laboratory)
- Modifier 51
- Modifier 33
- Modifier 59 and the Subset Modifiers XE, XP, XS, XU - Specific Modifiers for Distinct Procedural Services
- Proper Billing of Surgical Comanagement (Modifiers 54 and 55)
- Assistants at Surgery at Teaching Hospitals

Opioid Epidemic in America
- Opioid Epidemic Newsletters
- Resources and Related Information
- Opioid Treatment Program

Osteopathic

Organ Transplant
- Medicare Coverage for Living Organ Transplant Donors

Outpatient Observation Services
- Outpatient Observation Services: Reporting Time Correctly

Outpatient Therapy Functional Reporting
- Outpatient Therapy Functional Reporting

Radiology Services
- Nonphysician Practitioner Scope of Practice for Radiology Services Within Illinois, Minnesota and Wisconsin

RuralServ
- NGS RuralServ
- NGS RuralServ
- NGS RuralServ
- NGS RuralServ
- NGS RuralServ
- NGS RuralServ

Social Determinants of Health
- Social Determinants of Health – House Calls
- Social Determinants of Health – Environmental Influences
- Social Determinants of Health – New AMA Coding Guidelines

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This site area provides additional policy-related resources for DMEPOS billed to the Jurisdiction B DME MAC.

Access all LCDs and PAs from the Medical Policy Center
Additional billing resources can be accessed from the Claim Submission Articles and Modifier Tips sections of our website

This site area gives you access to additional policy-related articles.

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