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Posting Date: 08/30/2022
Proper Billing of Surgical Comanagement (Modifiers 54 and 55)
Proper Billing of Surgical Comanagement (Modifiers 54 and 55) Table of Contents Proper Billing of Surgical Comanagement (Modifiers 54 and 55) Exceptions Date(s) of Service Care Provided in Different Payment Localities 55 Modifier [...]
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Posting Date: 03/29/2022
Critical Care Policy Clarification
Critical Care Policy Clarification The CMS implemented the new policy for critical care services as published in the Centers for Medicare & Medicaid Services Internet-Only Manual, Publication 100-04, Medicare Claims Processing Manual, [...]
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Posting Date: 02/01/2022
Critical Care Tip Sheet
Critical Care Tip Sheet Table of Contents Service and Medical Necessity The Following CMS Billing Consideration Guidelines Apply Provider Time Assessment and Documentation The Following CMS Billing Consideration Guidelines [...]
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Posting Date: 04/26/2022
Critical Care Services: CPT Codes 99291-99292
Critical Care Services: CPT Codes 99291-99292 Table of Contents Definition Context Providers Who May Perform Critical Care Services and Medical Necessity Palliative and Hospice Patients Full Attention of the Provider and Provider [...]
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Posting Date: 10/20/2017
Certification or Recertification of Medicare Covered Home Health Services
Certification or Recertification of Medicare Covered Home Health Services Billing HCPCS Codes G0180 and G0179 of Patient Eligibility for Medicare-covered Home Health Services under a Home Health Plan of Care Physician [...]
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Posting Date: 11/13/2020
Initial Episode Clarified for Home Health Face-to-Face Encounter
Initial Episode Clarified for Home Health Face-to-Face Encounter CMS requires a patient receiving HH services under the Medicare HH benefit have a FTF encounter with the certifying physician for the initial episode. CMS has clarified that this [...]
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Posting Date: 03/13/2023
Sacroiliac Joint Injections and Procedures
Sacroiliac Joint Injections and Procedures Table of Contents Sacroiliac Joint Injections and Procedures Diagnostic SIJI Diagnostic SIJI Limitations Therapeutic SIJI Therapeutic SIJI Limitations SIJ Denervation [...]
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Posting Date: 02/14/2024
Eligible Part B Physicians and Nonphysicians to Enroll as Ordering and Referring Only
Eligible Part B Physicians and Nonphysicians to Enroll as Ordering and Referring Only Physician and nonphysician practitioners who can enroll in Medicare solely to order or refer: Doctors of medicine or osteopathy Doctors of dental surgery [...]
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Posting Date: 02/02/2021
Approval or Denial
Approval or Denial Approval Once your application is approved, you will receive an emailed, faxed or mailed Medicare letter with PTAN. Review this letter to ensure that everything is accurate and if you have any questions, please contact the [...]
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Posting Date: 02/01/2021
Acknowledgement Email
Acknowledgement Email Upon receipt of your application submission, the contact person (identified on application) will receive an email confirmation from: CustomerService-DoNotReply@cms.hhs.gov containing the PECOS web tracking number. [...]
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Posting Date: 08/21/2018
Approved Pending Regional Office Review
Approved Pending Regional Office Review For ambulatory surgical centers (ASCs) and portable x-ray suppliers (PXRS): When credentialing, you will receive an approved pending regional office review status in PECOS. National Government [...]
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Posting Date: 11/15/2021
Acknowledgement Email
Acknowledgement Email Upon receipt of your application submission, the contact person (identified on application) will receive an email confirmation from: NGS-PE-Communications@elevancehealth.com containing the NGS case number for tracking [...]
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Posting Date: 02/02/2021
Approval or Denial
Approval or Denial Approval Once your application is approved, you will receive an email containing a Medicare letter with PTAN. Review this letter to ensure that everything is accurate and if you have any questions, please contact the [...]
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Posting Date: 10/03/2024
Local Coverage Determination Open Meeting
Local Coverage Determination Open Meeting National Government Services is hosting a Proposed Local Coverage Determination Open Meeting on 10/24/2024. Details are available by accessing the Local Coverage Determination Open Meeting [...]
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Posting Date: 10/03/2024
Claim Denials During Hospice Elections Liability Reminder
Claim Denials During Hospice Elections Liability Reminder When a Medicare beneficiary elects hospice benefits, the hospice is required to provide all items and services needed for the hospice treatment and palliative care associated with it in [...]
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Posting Date: 10/03/2024
MLN Connects® Newsletter: October 3, 2024
MLN Connects® Newsletter: October 3, 2024 News HHS Releases Final Guidance for Second Cycle of Historic Medicare Drug Price Negotiation Program Resources & Flexibilities to Assist with the Public Health Emergency in Florida, [...]
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Posting Date: 10/04/2024
HCPCS 75580 Returning to Provider With Reason Code 32402
Part A claims being billed with HCPCS 75580 are receiving reason code 32402 when billed with the cardiology revenue code (048X) and cannot process for payment. CMS has determined that claims should be allowed to process when HCPCS 75580 is [...]
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Posting Date: 10/04/2024
Accountable Care Organization Realizing Equity, Access, and Community Health Model Claims Adjusted in Error
Accountable Care Organization Realizing Equity, Access, and Community Health Model Claims Adjusted in Error CMS informed NGS of an issue that occurred on 7/26/2024 impacting some claims from 2021 – 2024 related to the ACO REACH Model. CMS [...]
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Posting Date: 10/04/2024
Botulinum Toxins
Botulinum Toxins Botox, Myobloc, Dysport,Xeomin, spasticity, chemodenervation L33646 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33646 A52848 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=5284[...]
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