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Posting Date: 09/16/2020
Appeal Status <7>
Appeal Status <7> When Appeal Status is selected, the IVR will request and collect the following information: NPI PTAN TIN HICN or MBI Refer to the Phonetic Alphabet for assistance with speaking alpha characters [...]
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Posting Date: 11/08/2023
Determine Beneficiary Responsibility on an MSP Claim
Table of Contents Determine Beneficiary Responsibility on an MSP Claim Step 1: Review the Remittance Advice Step 2: Assess the Beneficiary’s Responsibility The MSP Patient Responsibility Formula: The Beneficiary’s Responsibility on [...]
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Posting Date: 11/09/2023
MLN Connects® Newsletter: November 9, 2023
MLN Connects® Newsletter: November 9, 2023 News CMS Roundup (Nov 3, 2023) Marriage and Family Therapists & Mental Health Counselors: Enroll in Medicare Now American Indians or Alaska Natives: Help Your Patients Achieve Optimal [...]
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Posting Date: 05/03/2022
Vein Ablation and Related Services
General Documentation Requirements for Vein Ablation and Related Services Checklist of prior authorization request (PAR) information to include: Doppler ultrasound results Documentation stating presence or absence of DVT (deep vein [...]
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Posting Date: 03/17/2016
Electrical Stimulation Therapy: Important Coverage and Documentation Reminders
Electrical Stimulation Therapy: Important Coverage and Documentation Reminders Table of Contents CPT/HCPCS: 97032 Coverage and Documentation Provider Actions Related Content [Return to Top] CPT/HCPCS: 97032 National Government [...]
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Posting Date: 02/26/2016
Documentation Reminder: Psychiatry and Psychology Services
Documentation Reminder: Psychiatry and Psychology Services Table of Contents Documentation Reminder: Psychiatry and Psychology Services Submitting Documentation Provider Actions Related Content [Return to Top] Documentation [...]
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Posting Date: 05/03/2022
Botulinum Toxin Injections
General Documentation Requirements for Botulinum Toxin Injections Prior authorization is only required when one of the required Botulinum Toxin codes (J0585, J0586, J0587, or J0588) is used in conjunction with one of the required CPT injection [...]
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Posting Date: 11/09/2023
Processing Issue Botulinum Toxin Claims Returned to Provider with 5PRIA
Part A claims that have been submitted with Botulinum J codes (J0585, J0586, J0587, J0588) have incorrectly RTP with reason code 5PRIA.
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Posting Date: 08/04/2022
Medicare Part B Coverage and Billing Guidance for Breast Ultrasound
Medicare Part B Coverage and Billing Guidance for Breast Ultrasound Breast ultrasound uses sound waves to produce pictures of the inside of the breast and can show changes that are more difficult to see on a mammogram. Breast ultrasound is not [...]
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Posting Date: 04/27/2023
KX Modifier on Outpatient Physical Therapy, Occupational Therapy or Speech Language Pathology Claims
KX Modifier on Outpatient Physical Therapy, Occupational Therapy or Speech Language Pathology Claims Reminders Providers report KX modifier on a claim line(s) to confirm the medical records contain specific required documentation that meets [...]
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Posting Date: 03/29/2023
LCD, Billing and Coding Article Updates for March and April 2023
LCD, Billing and Coding Article Updates for March and April 2023 Pain Management (L33622) Effective 3/19/2023 The LCD has been revised to remove all references to sacroiliac joint injections. Please refer to LCD L39455 Sacroiliac Joint [...]
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Posting Date: 06/29/2023
National Government Services Proposed LCDs for Comment (6/22/2023-8/5/2023) - Update
National Government Services Proposed LCDs for Comment (6/22/2023-8/5/2023) - Update The proposed LCDs listed below are being presented for comment for the Jurisdiction 6 and Jurisdiction K MACs. The formal comment period extends from [...]
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Posting Date: 10/05/2023
National Government Services Proposed LCDs for Comment
National Government Services Proposed LCDs for Comment The proposed LCDs listed below are being presented for comment for the Jurisdiction 6 and Jurisdiction K MACs. The formal comment period extends from 10/5/2023–11/18/2023. These proposed [...]
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Posting Date: 04/07/2022
Panniculectomy Best Practices
Panniculectomy Best Practices Table of Contents Panniculectomy, Excision of Excess Skin and Subcutaneous Tissue (including Lipectomy) and Related Services Coverage Documentation Requirements Best practice/documentation [...]
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Posting Date: 05/03/2022
Botulinum Toxin Best Practices
Botulinum Toxin Best Practices Table of Contents Botulinum Toxin Injections Coverage Documentation Requirements Best Practice/Documentation Feedback/Tips and Help Related Content [Return to Top] Botulinum Toxin [...]
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Posting Date: 10/29/2021
Implantation of Spinal Neurostimulator
Implantation of Spinal Neurostimulator Table of Contents Implantation of Spinal Neurostimulator Coverage Documentation Requirements Best Practice/Documentation Feedback/Tips Related Content [Return to Top] Implantation of [...]
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Posting Date: 06/14/2023
Facet Joint Interventions for Pain Management Best Practices
Facet Joint Interventions for Pain Management Best Practices Table of Contents Indications and/or Medical Necessity Coverage Documentation Requirements Diagnostic Facet Joint Injections (IA or MBB) Therapeutic Facet Joint Injection [...]
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Posting Date: 10/05/2023
Cardiovascular Nuclear Medicine
Cardiovascular Nuclear Medicine cardiac scan, stress test, heart, coronary, ejection, perfusion, blood pool L33560 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=33560 A56743 [...]
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Posting Date: 10/05/2023
Epidural Steroid Injections for Pain Management
Epidural Steroid Injections for Pain Management spine, pain, transforaminal, sacral, steroid, spinal L39036 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39036 A58745 [...]
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Posting Date: 09/30/2021
Visual Fields Testing
Visual Fields Testing eyes, ophthalmology, vision L33574 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=33574 A56551 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=56551 92081, 92082, 92083
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