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Posting Date: 02/02/2021
Who May File an Appeal
Who May File an Appeal Table of Contents Who May File an Appeal Appointment of Representative When Is an Appointment Not Necessary? Who May Be a Representative How to Make and Revoke an Appointment Required Elements When to Submit the [...]
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Posting Date: 02/02/2021
Submit an Appeal Electronically with NGSConnex
Submit an Appeal Electronically with NGSConnex Table of Contents Submit an Appeal Electronically with NGSConnex Step 1: Access NGSConnex Step 2: Submit an Electronic Appeal and Attach Documentation Step 3: Attach Documentation [...]
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Posting Date: 08/11/2021
Get Help Submitting an Appeal Hard Copy
Get Help Submitting an Appeal Hard Copy Table of Contents Get Help Submitting an Appeal Hard Copy Step 1: Complete the Appeals Request Form Helpful Tips: [Return to Top] Get Help Submitting an Appeal Hard Copy All levels of appeals [...]
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Posting Date: 02/24/2022
Reopenings for Minor Errors and Omissions
Reopenings for Minor Errors and Omissions Table of Contents Reopenings for Minor Errors and Omissions Reopening Facts What is a Clerical Error? Clerical Error and Omission Reopening Request Request a Reopening - NGSConnex Request a Reopening - [...]
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Posting Date: 02/02/2021
What Documents are Needed
What Documents are Needed Table of Contents What Documents are Needed Supporting Medical Records Ambulance Ambulatory Surgery, Operating Room, Lithotripsy and Preadmission Testing Cardiac Rehabilitation Clinic and Therapeutic [...]
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Posting Date: 03/23/2015
Medicare Provider & Supplier Search
Medicare Provider & Supplier Search Search the CMS Website Find a doctor Find a supplier Search the National Government Services Website Medicare Participating Physicians Directory
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Posting Date: 12/19/2016
Social Security Administration Resources
Social Security Administration Resources Common Issues Handled by the Social Security Administration The following Medicare-related issues are the responsibility of the Social Security Administration (SSA) and should be handled by your local [...]
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Posting Date: 10/07/2010
Social Security Administration
Social Security Administration All Medicare/Social Security-related questions are handled by the closest Social Security office in each Congressional district for each state. The following describe reasons to contact the SSA regarding [...]
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Posting Date: 04/26/2023
Tobacco Cessation Counseling Doesn’t Have To Be Lengthy or Intimidating
Tobacco Cessation Counseling Doesn’t Have To Be Lengthy or Intimidating Did you know that tobacco cessation counseling is a covered Medicare service? Brief tobacco counseling provides substantial health benefits while producing cost savings. [...]
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Posting Date: 11/06/2023
Common Definitions for Claim Submission Types
Common Definitions for Claim Submission Types Appeals An appeal is an independent review of the initial or revised determination. Proceeding with an appeal is the responsibility of the provider. Overall there are five levels of appeal the [...]
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Posting Date: 10/10/2022
The Great American Smokeout is Coming!
The Great American Smokeout is Coming! As a health care professional who provides care to patients with Medicare, you can help protect the health of your patients by encouraging them to take advantage of Medicare-covered preventive services, [...]
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Posting Date: 01/26/2015
State Health Insurance Assistance Program
State Health Insurance Assistance Program The State Health Insurance Assistance Program (SHIP) is a national program available in all states that offers free and unbiased one-on-one counseling and assistance to People with Medicare and [...]
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Posting Date: 06/04/2020
Beneficiary Contact Center
Beneficiary Contact Center People with Medicare have a single Medicare point-of-contact at: 1-800-MEDICARE 1-800-633-4227 TTY/TDD: 1-877-486-2048 1-800-MEDICARE connects you to a seamless network of customer service entities that [...]
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Posting Date: 11/08/2023
Set Up an Extended Repayment Schedule
If repaying an overpayment would constitute a “hardship” on the provider, a request for an ERS should be submitted immediately. While you may request an ERS at any time during the debt-collection process, timely submission of a valid request [...]
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Posting Date: 11/08/2023
Set Up an Extended Repayment Schedule
If repaying an overpayment would constitute a “hardship” on the provider, a request for an ERS should be submitted immediately. While you may request an ERS at any time during the debt-collection process, timely submission of a valid request [...]
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Posting Date: 11/08/2023
Provider Enrollment: Reminder for Open Enrollment and Participation Agreement
Provider Enrollment: Reminder for Open Enrollment and Participation Agreement The 2024 Annual Participation Open Enrollment Period is approaching for another year. While this is an important time (from mid-November to December 31) for [...]
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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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Posting Date: 04/19/2021
Visual Electrophysiology Testing
Visual Electrophysiology Testing N/A L36831 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=36831 A57060 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=57060 A55475 [...]
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Posting Date: 06/01/2023
Urodynamics
Urodynamics cystometrogram, uroflowmetry, urethral pressure profile, sphincter electromyogram, sphincter electromyogram, incontinence, voiding dysfunction L33576 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33576 A57455 [...]
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Posting Date: 10/12/2022
Transthoracic Echocardiography (TTE)
Transthoracic Echocardiography (TTE) cardiac, doppler, stress, cardovascular, myocardial, heart, contrast L33577 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33577 A56781 [...]
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Posting Date: 10/02/2022
Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) OCT, eyes, cornea, glaucoma L34380 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=34380 A56537 https://www.cms.gov/medicare-coverage-database/view/article.aspx?artic[...]
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Posting Date: 07/13/2023
Peripheral Nerve Blocks
Peripheral Nerve Blocks N/A L36850 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=36850 A57452 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=57452 A55421 [...]
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