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Posting Date: 10/13/2022
Pathology Interpretation Services
Pathology Interpretation Services National Government Services has noted that there is some confusion and questions regarding the billing of professional components on some laboratory services. There is a certain subset of CPT codes for which [...]
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Posting Date: 10/12/2022
Clarification on the Proper Reporting of Radiation Treatment CPT Code 77427
Clarification on the Proper Reporting of Radiation Treatment CPT Code 77427 National Government Services would like to advise providers that bill CPT code 77427, Radiation treatment management, five treatments, of the proper way to report this [...]
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Posting Date: 08/16/2022
Background/Overview
Background/Overview Effective for dates of service on and after 1/1/2020, CMS pays OTPs, through weekly bundled payments, to deliver OUD treatment services to Medicare beneficiaries. OTP is a Medicare Part B benefit that provides coverage for [...]
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Posting Date: 08/16/2022
Coding and Billing for OTP Services
Coding and Billing for OTP Services Table of Contents Coding and Billing for OTP Services Coding for OTP Weekly Bundles New for 2024 HCPCS Code G0137 Separate Add-on Codes Frequency of Use and Billing Billing Cycles [Return [...]
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Posting Date: 08/16/2022
Payment Rates
Payment Rates Medicare-enrolled OTPs are paid flat dollar payment rates for the codes describing the OTP bundled services (HCPCS codes G2067 through G2080, and G2215 to G2216). Payment rates are based on the OTP provider’s geographic location. [...]
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Posting Date: 08/16/2022
Claim Submission Instructions
Claim Submission Instructions Use the instructions on the Billing/Payment section of the CMS Opioid Treatment Program (OTP) web pages. Reviewed 9/3/2024
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Posting Date: 08/16/2022
Billing and Payment for Dual Eligible Beneficiaries
Billing and Payment for Dual Eligible Beneficiaries A person who is eligible for both Medicare and Medicaid at the same time is “dually eligible”. Medicare is the primary payer for OTP services delivered to dually eligible beneficiaries. [...]
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Posting Date: 10/13/2022
Billing Cardiac Rehabilitation Session and Session Limitations
Billing Cardiac Rehabilitation Session and Session Limitations CR sessions are limited to a maximum of two one-hour sessions per day for up to 36 sessions up to 36 weeks with the option of an additional 36 sessions over an extended [...]
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Posting Date: 10/14/2022
Cardiac Rehabilitation and Intensive Cardiac Rehabilitation
Cardiac Rehabilitation and Intensive Cardiac Rehabilitation Medicare Part B pays for CR and ICR programs and related items/services. Specific criteria must be met by the Medicare beneficiary, the cardiac rehabilitation program itself, the [...]
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Posting Date: 10/14/2022
Pulmonary Rehabilitation
Pulmonary Rehabilitation Effective 1/1/2010, Medicare Part B pays for PR if specific criteria are met by the Medicare beneficiary, the PR program itself, the setting in which it is administered and the physician administering the program, as [...]
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Posting Date: 10/14/2022
Related Content
Related Content Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, Chapter 32, Cardiac Rehabilitation (CR) Programs, Intensive Cardiac Rehabilitation (ICR), [...]
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Posting Date: 09/05/2024
KidneyIntelX and KidneyIntelX.dkd Testing
KidneyIntelX and KidneyIntelX.dkd Testing L39726 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39726 A59595 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=59595 A59758 [...]
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Posting Date: 09/05/2024
Non-Invasive Fractional Flow Reserve (FFR) for Stable Ischemic Heart Disease
Non-Invasive Fractional Flow Reserve (FFR) for Stable Ischemic Heart Disease L39075 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39075 A58814 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=58814 [...]
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Posting Date: 10/26/2023
HHH - Promo 4
Banner saying "NGS RuralServ - Changing the way we deliver education to you." /web/ngs/ruralserv?selectedArticleId=1987743&
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Posting Date: 09/05/2024
MLN Connects® Newsletter: September 5, 2024
MLN Connects® Newsletter: September 5, 2024 News Osteogenesis Stimulators: Prior Authorization Requirements Suspended Hospice Benefit: Expanding Prepayment Review in 4 States Skilled Nursing Facility Advance Beneficiary Notice: Revised [...]
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Posting Date: 09/06/2024
LCD and Article Updates for August/September 2024
LCD and Article Updates for August/September 2024 Local Coverage Determinations Facet Joint Interventions for Pain Management L35936 Effective 8/1/2024 - Updated "Coverage Indications, Limitations and/or Medical Necessity" with the [...]
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Posting Date: 04/21/2023
Telligen QIN-QIO Hosting Chronic Kidney Disease Topics with National Kidney Foundation
Telligen QIN-QIO Hosting Chronic Kidney Disease Topics with National Kidney Foundation Chronic kidney disease (CKD) affects more than 1 in 7 U.S. adults—an estimated 37 million Americans. For Americans with diabetes or high blood pressure—the [...]
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Posting Date: 09/09/2024
Common Working File (CWF) Host Dark Days for October 2024 Release
Common Working File Host Dark Days for October 2024 Release For the upcoming October 2024 Release: For Production, CWF will be observing the Gray Day on Thursday, 10/3/2024, and Dark Days starting Friday, 10/4/2024 through Sunday, 10/6/2024 [...]
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