Original Medicare First Level of Appeal Tips Sheet for Medicare Providers

Original Medicare First Level of Appeal Tips Sheet for Medicare Providers If you disagree with Medicare’s claim determination, you may appeal. However, please follow these important tips before you submit a first level of appeal [...]

New York State Ambulance Services in Rural Areas (for JK providers only)

New York State Ambulance Services in Rural Areas NYS has unique requirements for the payment of paramedic intercept services when an ambulance company can provide only BLS services. Paramedic intercept services can be approved in counties and [...]

PECOS Starter Guide

PECOS Starter Guide Follow the steps outlined below to assist you and your staff with the PECOS processes. Table of Contents New/Initial Enrollee Revalidation Return for Corrections Change of Information Submit Pending Application [...]

General Information

General Information Original Medicare does not normally cover routine vision services, such as eyeglasses and eye exams. Medicare may cover some vision costs if associated with other covered expenses (that is, Medicare may cover some vision [...]

Provider Qualifications

Provider Qualifications Definition Ophthalmologist An ophthalmologist is a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) who has completed medical school and an ophthalmology residency that specialized in eye and [...]

Local Coverage Determinations

Local Coverage Determinations Table of Contents Cataract Extraction LCD L33558 Corneal Pachymetry LCD L33630 Coding Guidelines Ophthalmic Biometry for Intraocular Lens Power Calculation LCD L33621 A-Scan Ultrasound Ophthalmic [...]

National Coverage Determinations

National Coverage Determinations Table of Contents Hydrophilic Contact Lens for Corneal Bandage Photodynamic Therapy Ocular Photodynamic Therapy Photosensitive Drugs Verteporfin Hydrophilic Contact Lenses Scleral Shell Intraocular [...]

Limitation of Liability (Advance Beneficiary Notice)

Limitation of Liability (Advance Beneficiary Notice) Services denied as not reasonable and medically necessary, under Section 1862(a) (1) of the Social Security Act, are subject to the Limitation of Liability (ABN) provision. The ABN is a [...]

Glaucoma Screening ‒ Preventive Services Coverage

Glaucoma Screening ‒ Preventive Services Coverage Medicare provides coverage of an annual glaucoma screening for beneficiaries in at least one of the following high-risk groups: Individuals with diabetes mellitus; Individuals with a family [...]

Related Content

Related Content CMS IOM Publication 100-01, Medicare General Information, Eligibility and Entitlement Manual, Chapter 5, Section 70.5 CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 15 Includes the [...]

Micro-invasive Glaucoma Surgery Update

Micro-invasive Glaucoma Surgery Update The MIGS LCD, L37244, and Billing and Coding Article, A56588, will not become final and therefore have been removed from the Medicare Coverage Database. Accordingly, at this time there will be no change [...]

Comprehensive Error Rate Testing Program

PECOS Starter Guide

PECOS Starter Guide Follow the steps outlined below to assist you and your staff with the PECOS processes. New/Initial Enrollee Revalidation Return for Corrections Change of Information Submit Pending Application Add a New [...]

Understanding Authorized Official and Delegated Official Roles

Table of Contents Understanding Authorized Official and Delegated Official Roles Medicare Enrollment Records CMS Identity and Access Management System [Return to Top] Understanding Authorized Official and Delegated Official Roles [...]

National Government Services Medicare Part B Care Management Services September Series

National Government Services Medicare Part B Care Management Services September Series According to the CDC, six in ten adults in the U.S. have a chronic disease and four in ten adults have two or more. As your Medicare Contractor for [...]

MLN Connects® Newsletter: September 12, 2024

MLN Connects® Newsletter: September 12, 2024 News COVID-19: Updated Vaccines for 2024–2025 Season Rural Emergency Hospital Provisions, Conversion Process, & Conditions of Participation: Revised Guidance CMS Roundup (September 6, 2024) [...]

Portable X-Ray Pricing Update

Portable X-ray pricing fees for CY 2024 will have new fees in production by 9/6/2024.

Check Appeal Status

Check Appeal Status Table of Contents Check Appeal Status Check Status of Requests Submitted in NGSConnex Check Status of Requests Not Submitted in NGSConnex [Return to Top] Check Appeal Status Click the Appeals button from the [...]

Provider Qualifications

Podiatry Billing Guide  Provider Qualifications A doctor of podiatric medicine is a physician, but only with respect to those functions which he/she is legally authorized to perform in the State in which he/she performs them. The [...]

Billing for FQHC MAO Plan Supplemental Payment (PPS Providers)

Billing for FQHC MAO Plan Supplemental Payment (PPS Providers) Medicare will provide supplemental payments to FQHCs that contract with MAOs to cover the difference, between the payment received from the MAO and the payment to which the FQHC [...]