MLN Connects® Newsletter: May 22, 2025

MLN Connects® Newsletter: May 22, 2025 News Discarded Drugs: Get Updated Lists Medicare Provider Payment & Utilization Public Use Files: Annual Update Medicare Fee-for-Service Geographic Variation Public Use Files & Interactive [...]

The 2025 Spring Part B Virtual Conference Begins in One Week!

The 2025 Spring Part B Virtual Conference Begins in One Week! The 2025 Spring Part B Virtual Conference begins in one week! This is your last chance to register and join us on June 3–5, 2025! Don’t miss out on this must-attend event!   [...]

MLN Connects® Newsletter: May 22, 2025

MLN Connects® Newsletter: May 22, 2025 Departments of Labor, Health and Human Services, Treasury Announce Move to Strengthen Healthcare Price Transparency Trump administration issues request for information, guidance to expand access to real [...]

Medically Unlikely Edits

Claim ADRs

Claim Additional Development Requests Types include: Origins Facts Identification NOC and unlisted codes. Modifiers: AS, 22, 52, 53, 62, 66, 80, 81, 82. PWK initiated and records are not [...]

CMS Medically Unlikely Edits

Medically Unlikely Edits and Related Billing Clarifications

Medically Unlikely Edits and Related Billing Clarifications An MUE is the maximum number of UOS allowable under most circumstances for a single HCPCS/CPT code billed by a provider for a particular date of service for a single beneficiary. [...]

Medical Review Targeted Probe and Educate ADRs

Medical Review Targeted Probe and Educate Additional Development Requests Origins Facts Identification CMS’ TPE program is provider specific education that will focus on improving issues without allowing other [...]

General Information

General Information National Government Services or other CMS contractors may need to request additional information for Medicare claims to assess compliance with Medicare rules. These requests are ADRs. An ADR is a notification/letter [...]

Related Resources

Related Resources MLN® Educational Tool: How to Use the Medicare National Correct Coding Initiative (NCCI) Tools Medicare National Correct Coding Initiative (NCCI) Edits Medicare NCCI Medically Unlikely Edits (MUEs) National Correct [...]

The National Correct Coding Initiative Lookup Tool

The National Correct Coding Initiative Lookup Tool The National Correct Coding Initiative Lookup Tool is designed to help providers identify when certain codes are subject to the automated code pair edits. Search for coding pairs by entering a [...]

Ways to Respond to ADRs

Ways to Respond to ADRs When you are ready to submit, refer to the ADR for the specific submission methods available. NGS offers multiple ways for providers to submit their documentation in response to an ADR. CMS audit contractors notate in [...]

Relocation of the Medically Unlikely Edit Webpage Information

Relocation of the Medically Unlikely Edit Webpage Information National Government Services would like to inform you of an important change regarding the placement of the MUE section on our website. The MUE information has been relocated and is [...]

National Correct Coding Initiative and Medically Unlikely Edits

Quarterly Version Update Changes

Quarterly Version Update Changes CMS posts changes to each of its NCCI PTP published edit files on a quarterly basis. This includes additions, deletions and modifier indicator quarterly changes to PTP column one/column two correct coding edits [...]

Procedure to Procedure Edits

Procedure to Procedure Edits The NCCI contains one table of edits for physicians/practitioners and one table of edits for outpatient hospital services. Hospital PTP edits apply to types of bills subject to the outpatient code editor for the [...]

Add-on Codes

Add-on Codes Add-on codes are specific types of HCPCS/CPT codes intended to describe services that can only be reported in conjunction with a primary procedure. They represent additional work performed during the primary procedure and [...]

Smoking Cessation Tools and Resources - You Can Help Your Patients Quit Tobacco Use

Smoking Cessation Tools and Resources - You Can Help Your Patients Quit Tobacco Use Smokefree.gov Centers for Disease Control and Prevention: Tips from Former Smokers campaign Centers for Disease Control and Prevention: Office on Smoking [...]

Medicare Physician Fee Schedule Database

Medicare offers several tools to help providers bill their services. Many questions you have can be answered by learning how to access and use the Medicare Physician Fee Schedule Database. We hope you'll join us for an overview of this database.

Steps to Claim Corrections

This webinar includes the top continuous errors we find at National Government Services with claim submissions. Join us to learn how to correct your claims. We will also include an interactive segment on the different claim scenarios that cause [...]