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Posting Date: 09/13/2024
Credit Balance Reporting Reminder: Submissions for Quarter Ending 9/30/2024 Start Soon!
Credit Balance Reporting Reminder: Submissions for Quarter Ending 9/30/2024 Start Soon! CBR submissions can be submitted starting on 10/1/2024 and are due within 30 days to be considered timely. Remember, even if no monies are owed to Medicare [...]
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Posting Date: 10/26/2021
Introduction to Podiatry Services
Podiatry Billing Guide Introduction to Podiatry Services Foot Care Table of Contents Treatment of Subluxation of Foot Exclusions from Coverage Exceptions to Routine Foot Care Exclusion Systemic Conditions That Might Justify Coverage [...]
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Posting Date: 10/26/2022
Podiatry Local Coverage Determinations
Podiatry Billing Guide Podiatry Local Coverage Determinations Table of Contents LCD for Routine Foot Care and Debridement of Nails (L33636) LCD for Incision and Drainage (I & D) of Abscess of Skin, Subcutaneous and Accessory [...]
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Posting Date: 10/26/2022
Podiatry National Coverage Determinations
Podiatry Billing Guide Podiatry National Coverage Determinations The following are in reference to CMS IOM Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1. Part 1 Section 20.29 [...]
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Posting Date: 10/26/2022
Modifier Usage
Podiatry Billing Guide Modifier Usage 25 – Significant, Separately Identifiable E/M Service by the Same Physician on the Same Day of the Procedure or Other Service Medicare allows payment for an E/M service performed on the same [...]
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Posting Date: 10/26/2022
Podiatry Coding Tips
Podiatry Billing Guide Podiatry Coding Tips Coding Information Procedure codes may be subject to NCCI edits or OPPS packaging edits. Refer to CCI and OPPS requirements prior to billing Medicare. For services requiring a [...]
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Posting Date: 10/26/2022
Advance Beneficiary Notice of Noncoverage/National Correct Coding Initiative
Podiatry Billing Guide Advance Beneficiary Notice of Noncoverage/National Correct Coding Initiative ABN Services denied as not reasonable and medically necessary, under Section 1862(a) (1) of the Social Security Act, are subject to [...]
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Posting Date: 10/26/2021
Related Content
Related Content CMS IOM Publication 100-01, Medicare General Information, Eligibility and Entitlement, Chapter 5, Section 70.3 CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 290: Foot Care CMS [...]
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Posting Date: 10/26/2021
Biopsy to Prove Onychomycosis in Routine Foot Care
Biopsy to Prove Onychomycosis in Routine Foot Care National Government Services has been made aware of a situation where podiatrists have been approached by laboratories stating that they need to biopsy their patients to make sure they have [...]
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Posting Date: 09/16/2024
Third Quarter Top Ten EDI Part B Edits
Third Quarter Top Ten EDI Part B Edits Using data analysis we’ve updated the Top Ten EDI Edits for the third quarter. Visit Quarterly Top Ten EDI Part B Edits to view the edits and their description, and learn how you can quickly identify the [...]
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Posting Date: 09/16/2024
Third Quarter Top Ten EDI Institutional Edits
Third Quarter Top Ten EDI Institutional Edits Using data analysis, we’ve updated the Top Ten EDI Edits for the third quarter. Visit Quarterly Top Ten EDI Institutional Edits to view the edits and their description, and learn how you can [...]
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Posting Date: 01/02/2024
Medicare Part B Final Rule 2024
Medicare Part B Final Rule 2024 CMS announced finalized policy changes for Medicare payments under the PFS, and other Medicare Part B topics, effective on or after 1/1/2024. The CY 2024 PFS final rule is one of several final rules that [...]
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Posting Date: 11/07/2022
Who Can Bill for Diabetes Self-Management and Medical Nutrition Therapy?
Who Can Bill for Diabetes Self-Management and Medical Nutrition Therapy? Table of Contents Who Can Bill for Diabetes Self-Management and Medical Nutrition Therapy? Who Can Bill for DSMT Billable Codes for Diabetes Self-Management Training [...]
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Posting Date: 11/07/2022
Common Questions for Diabetes Self-Management Program Accreditation
Common Questions for Diabetes Self-Management Program Accreditation Does my organization need to be accredited to bill for DSMT services? Answer: Yes. In order to bill Medicare for DSMT services, your organization’s DSMT program must be [...]
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Posting Date: 11/07/2022
Medical Nutrition Therapy Tool for Billing
Medical Nutrition Therapy Tool for Billing CMS considers DSMT and MNT complementary services. This means Medicare will cover both DSMT and MNT without decreasing either benefit as long as the referring physician determines that both are [...]
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Posting Date: 06/13/2022
Remote Physiological Monitoring and Cardiovascular Monitoring Service and Billing Information
Remote Physiological Monitoring and Cardiovascular Monitoring Service and Billing Information Table of Contents Remote Physiological Monitoring Services CPT Codes: 99091, 99453, 99454, 99457, 99458 Remote Physiological Monitoring [...]
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Posting Date: 09/17/2024
National Government Services Contractor Advisory Committee Meeting
National Government Services Contractor Advisory Committee Meeting There will be a multi-jurisdictional CAC meeting held on Thursday 10/17/2024 at 3:00-5:00 p.m. ET, 2:00-4:00 p.m. CT. Meeting details can be found on the National Government [...]
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Posting Date: 09/19/2024
Laboratory and Diagnostic Services: Documentation Responsibilities
Laboratory and Diagnostic Services: Documentation Responsibilities When National Government Services is conducting a pre-pay or post-pay review of claims and services, we may request additional documentation. The billing provider must obtain [...]
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Posting Date: 11/01/2021
Global Surgery
Global Surgery Table of Contents Definition of a Global Surgical Package Where can I find the postoperative periods for covered surgical procedures? What services are included in the global surgery payment? What services are not [...]
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Posting Date: 08/10/2023
Duplicate Claim Editing Information
Duplicate Claim Editing Information Part B Duplicate Claim Edit National Government Services implemented a Part B duplicate claim edit in our EDI front-end processing system for Part B providers. Providers are notified that a claim is a [...]
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Posting Date: 10/15/2021
Physician Dialysis Services
Physician Dialysis Services Table of Contents Physician Dialysis Services Monthly Capitation Payment Coding Claim Submission Tips Billing for a Partial Month Documentation Requirements Related Content [...]
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Posting Date: 11/23/2021
Oncology Care Model
Oncology Care Model Note: If you did not register for the CMS OCM during the open application and selection period, then you are not a part of this program. The names of those practices and payers participating in OCM can be found on the OCM [...]
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Posting Date: 11/29/2021
Spinraza (nusinersen) Billing
Spinraza (nusinersen) billing Spinraza (nusinersen) is a medication that was approved in December 2016 by the U.S. FDA for the treatment of all forms of SMA. HCPCS code J2326 - Inj, nusinersen, 0.1mg should be used to report Spinraza. [...]
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Posting Date: 02/22/2023
Chimeric Antigen Receptor (CAR) T-cell Therapy
Chimeric Antigen Receptor (CAR) T-cell Therapy Table of Contents NCD 110.24: Chimeric Antigen Receptor (CAR) T-cell therapy: Billing Instructions Overview Billing and coding CAR T-cell therapy for inpatient services Clinical [...]
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Posting Date: 09/19/2024
MLN Connects® Newsletter: September 19, 2024
MLN Connects® Newsletter: September 19, 2024 News Resources & Flexibilities to Assist with the Public Health Emergency in Louisiana Skilled Nursing Facilities: Report Your Expanded Ownership, Management, & Related Party Data [...]
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Posting Date: 09/19/2024
Billing Errors on 2024/2025 Influenza Season Claims
Billing Errors on 2024/2025 Influenza Season Claims The influenza season runs from August 1st of each year until July 31st the following year. Every influenza vaccine is assigned a new NDC each season. This season, some codes no longer have a [...]
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Posting Date: 01/19/2022
Learn About MDPP
Learn About MDPP The MDPP expanded model includes an evidence-based set of services aimed to help prevent the onset of type 2 diabetes among Medicare beneficiaries with an indication of prediabetes. MDPP services is available to eligible [...]
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Posting Date: 01/19/2022
Framework for Prevention and Goals
Framework for Prevention and Goals CMS along with the CDC provides a framework for diabetes prevention efforts. It brings together partners from the public and private sectors to prevent or delay type 2 diabetes. The MDPP is structured [...]
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Posting Date: 01/19/2022
Delivering a Lifestyle Change for Medicare Beneficiaries
Delivering a Lifestyle Change for Medicare Beneficiaries Providers play a vital role in beneficiary referrals. Although a referral is not required, a provider’s assessment during the AWV or the IPPE is strongly recommended by NGS. Providers [...]
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Posting Date: 01/19/2022
Receiving CDC Recognition and Medicare Enrollment
Receiving CDC Recognition and Medicare Enrollment Organizations who wish to furnish MDPP services to beneficiaries and bill Medicare for those services must enroll in Medicare as an MDPP supplier. To become a Medicare-enrolled MDPP supplier, [...]
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Posting Date: 01/19/2022
MDPP Codes and Payment Amounts 2023
MDPP Codes and Payment Amounts 2023 HCPCS G-codes are used when submitting claims to bill Medicare for payment. MDPP HCPCS G-codes may be used only one time per eligible beneficiary (except for G9890 and G9891). The initial session (G9873) [...]
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Posting Date: 02/06/2024
MDPP Codes and Payment Amounts 2024
MDPP Codes and Payment Amounts 2024 Medicare pays up to 22 visits billed with codes G9886 and G9887, combined, in a 12-month period: Months 1–6: one in-person/distance learning visit every week (up to 16) Months 7–12: one [...]
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Posting Date: 01/19/2022
MDPP Billing Information
MDPP Billing Information In addition to the usual information that needs to be completed to file a claim for a Medicare Part B service to your MAC, you will need to complete the following items of the CMS-1500 form or electronic equivalent [...]
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Posting Date: 01/19/2022
Contact Information and Resources
Contact Information and Resources Inquiry Type Examples Help Desk Contact Information Process of MDPP CDC Recognition Credential via CDC, check status of application for CDC recognition or submitting [...]
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Posting Date: 11/15/2021
Prevent Revalidation Processing Delays
Prevent Revalidation Processing Delays When National Government Services receives a revalidation application, we often determine additional information is needed to process the application. In those cases, a request for additional information [...]
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Posting Date: 08/01/2024
Medicare University
Medicare University National Government Services offers a variety of teleconferences, webinars and face-to-face educational sessions on Medicare-related topics including rules and regulations throughout the year. Medicare University (MU), our [...]
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Posting Date: 09/10/2024
Expected Timeframes for Therapy Services
Expected Timeframes for Therapy Services CMS and CPT guidelines for provider time spent and documented on therapy services may vary, depending on the definition of the service and the context in which it is performed. Therapy services [...]
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Posting Date: 06/22/2022
Standard Companion Guide Trading Partner Information
Standard Companion Guide Trading Partner Information Instructions Related to the X12 277 Health Care Claim Request for Additional Information Version 6020 Companion Guide Version Number: 6.0 Revised: October 2019 Preface Companion Guides [...]
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Posting Date: 04/20/2022
Standard Companion Guide Trading Partner Information
Standard Companion Guide Trading Partner Information Instructions Related to the X12 278 and 275 Prior Authorization Transactions Companion Guide Version Number: 1.0 Created: April, 2022 Preface Companion Guides (CG) may contain two types of [...]
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Posting Date: 06/15/2022
Creating a 276 Claim Status Request in PC-ACE
Creating a 276 Claim Status Request in PC-ACE Claim Status Request Files must be prepared and transmitted using communication software. Select INST or PROF from the PC-ACE Claims Processing System main menu. Select List Claims [...]
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Posting Date: 12/19/2016
PC-ACE for Institutional Users: Importing and Reading the 999 and 277CA Files
PC-ACE: Importing and Reading the 999 and 277CA Files In order for PC-ACE to read 999 or 277CA files, they must be saved into the proper sub-folder within the WINPCACE folder. 277CA files go within the Stat1500 (Part B) sub-folder or the [...]
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Posting Date: 03/28/2022
PC-ACE Quick Reference Guide: Medicare Secondary Payer
PC-ACE Quick Reference Guide: Medicare Secondary Payer The following are Medicare A (Institutional) instructions for entering line item and claim information into PC-ACE when Medicare is the secondary payer. Situations where Medicare is the [...]
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Posting Date: 11/19/2018
View and Print ERA in PC-ACE
View and Print ERA in PC-ACE PC-ACE offers the ability to translate an ERA to either view and/or print for both institutional and professional ERAs after they have been downloaded. ERAs viewed/printed in PC-ACE provides the same data that is [...]
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Posting Date: 09/26/2024
MLN Connects® Newsletter: September 26, 2024
MLN Connects® Newsletter: September 26, 2024 News CMS Roundup (September 20, 2024) Cardiovascular Disease: Talk with Your Patients about Screening Claims, Pricers, & Codes Cardiology CPT Code 75580: Issue with Claims Returned to [...]
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Posting Date: 10/08/2021
Bone Mass Measurements
Preventive Services Guide Bone Mass Measurements Table of Contents Bone Mass Measurements Risk Factors Coverage Guidelines and Frequency Limits Coverage Criteria HCPCS/CPT Coding HCPCS/CPT Codes ICD-10 Codes Diagnosis [...]
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Posting Date: 09/26/2024
Know Your Provider Enrollment Revalidation Due Date Today and Protect Your Bottom Line
Know Your Provider Enrollment Revalidation Due Date Today and Protect Your Bottom Line Attention: Provider Enrollment and Credentialing Departments Revalidate before your due date to avoid a “Stay of Enrollment” or claim rejections which may [...]
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Posting Date: 09/26/2024
Know Your Provider Enrollment Revalidation Due Date Today and Protect Your Bottom Line
Know Your Provider Enrollment Revalidation Due Date Today and Protect Your Bottom Line Attention: Provider Enrollment and Credentialing Departments Revalidate before your due date to avoid a “Stay of Enrollment” or claim rejections which may [...]
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Posting Date: 10/06/2021
Hepatitis B Virus Screening
Preventive Services Guide Hepatitis B Virus Screening Hepatitis B is a virus that can damage the liver, it is spread through contact with infected blood or body fluids and can be transmitted through sex with an infected person or by sharing [...]
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Posting Date: 10/06/2021
Screening for Sexually Transmitted Infections and HIBC to Prevent STIs
Preventive Services Guide Screening for Sexually Transmitted Infections and HIBC to Prevent STIs Table of Contents Screening for Sexually Transmitted Infections Coverage Criteria High/Increased Risk Factors Frequency Limits [...]
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Posting Date: 09/27/2024
LCD and Article Updates for September/October 2024
LCD and Article Updates for September/October 2024 A58152 Billing and Coding: Computed Tomography Cerebral Perfusion Analysis (CTP) The following ICD-10-CM diagnosis codes were added to Group 1- ICD-10-CM Codes That Support Medical necessity [...]
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Posting Date: 10/08/2021
Cardiovascular Disease Screening Tests
Preventive Services Guide Cardiovascular Disease Screening Tests Cardiovascular disease generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina) or stroke. Table of [...]
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Posting Date: 10/06/2021
Counseling to Prevent Tobacco Use
Preventive Services Guide Counseling to Prevent Tobacco Use Smoking is the leading preventable cause of disease, disability and death in the United States. It harms nearly every organ in the body and causes about one in every five deaths. [...]
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Posting Date: 11/10/2021
Depression Screening
Preventive Services Guide Depression Screening Also Known as Screening for Depression in Adults Coverage Criteria Covered annually At least 11 months must have passed since last depression screening G0444: Annual depression [...]
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Posting Date: 10/06/2021
Glaucoma Screening
Preventive Services Guide Glaucoma Screening Glaucoma is a group of eye diseases in which damage to the optic nerve results in loss of eyesight. Medicare beneficiaries over the age of 60 have an increased risk of developing glaucoma. CMS has [...]
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Posting Date: 10/06/2021
Hepatitis C Virus Screening
Preventive Services Guide Hepatitis C Virus Screening Hepatitis C is a virus that can damage the liver; it is transmitted through infected blood or body fluids. The most common way people get infected is by sharing needles used to inject [...]
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Posting Date: 10/08/2021
Human Immunodeficiency Virus Screening
Preventive Services Guide Human Immunodeficiency Virus Screening HIV attacks cells that help the body fight infection making a person vulnerable to other infections. Nearly 1.2 million Americans are now living with HIV infection and about [...]
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Posting Date: 10/11/2021
Intensive Behavioral Therapy for Cardiovascular Disease
Preventive Services Guide Intensive Behavioral Therapy for Cardiovascular Disease CVD generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain or stroke. CMS has determined [...]
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Posting Date: 10/11/2021
Intensive Behavioral Therapy for Obesity
Preventive Services Guide Intensive Behavioral Therapy for Obesity In 2003, the United States Preventive Services Task Force found good evidence that BMI “is reliable and valid for identifying adults at increased risk for mortality and [...]
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Posting Date: 11/07/2022
Medical Nutrition Therapy
Preventive Services Guide Medical Nutrition Therapy MNT is a dietary intervention that is used to prevent or treat health conditions that are caused by or made worse by unhealthy eating habits. Table of Contents Eligibility Criteria [...]
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