Search Results - NGSMEDICARE

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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.

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

Posting Date: 01/03/2022

Respiratory Pathogen Panel Testing

Respiratory Pathogen Panel Testing N/A L39027 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39027 A58741 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=58741 A58890 [...]

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 [...]

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 [...]

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

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 [...]

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 [...]

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 [...]

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[...]

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 [...]

Posting Date: 04/19/2021

Percutaneous Coronary Intervention

Percutaneous Coronary Intervention heart, angina, intracoronary L33623 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33623 A56823 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=56823 92920, [...]

Posting Date: 10/02/2022

Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)

Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography) retinal, retinopathy, chorioretinitis, vitreous L33567 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33567 A56726 [...]

Posting Date: 07/27/2023

Nonvascular Extremity Ultrasound

Nonvascular Extremity Ultrasound clot, plantar fasciitis L33619 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33619 A56787 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=56787 76881, 76882

Posting Date: 10/02/2022

Nerve Conduction Studies and Electromyography

Nerve Conduction Studies and Electromyography electrodiagnostic, neurologic, EMG, NCS, neuromuscular, motor, needle L35098 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=35098 A57668 [...]

Posting Date: 02/14/2023

Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)

Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA) heart, calcium, congenital, bypass L33559 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=33559 A56737 [...]

Posting Date: 04/04/2023

Transcranial Magnetic Stimulation

Transcranial Magnetic Stimulation depression, major depressive disorder, magnetic field L33398 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=33398 A57528 https://www.cms.gov/medicare-coverage-database/view/article.aspx?artic[...]

Posting Date: 04/04/2023

Incision and Drainage (I & D) of Abscess of Skin, Subcutaneous and Accessory Structures

Incision and Drainage (I & D) of Abscess of Skin, Subcutaneous and Accessory Structures paronychia, skin, carbuncle, boil L33563 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33563 A56766 [...]

Posting Date: 01/06/2023

Genomic Sequence Analysis Panels in the Treatment of Hematolymphoid Diseases

Genomic Sequence Analysis Panels in the Treatment of Hematolymphoid Diseases N/A L37606 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=37606 A56793 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=56[...]

Posting Date: 10/31/2022

Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

Drugs and Biologicals, Coverage of, for Label and Off-Label Uses administration, compendia, FDA L33394 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=33394 A52855 [...]

Posting Date: 10/26/2022

Osteopathic Manipulative Treatment

Osteopathic Manipulative Treatment somatic, skeletal, dysfunction L33616 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33616 A56954 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=56954 A55318 [...]

Posting Date: 10/02/2022

Psychiatric Inpatient Hospitalization

Psychiatric Inpatient Hospitalization active treatment L33624 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33624 A56865 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=56865

Posting Date: 10/02/2022

Frequency of Hemodialysis

Frequency of Hemodialysis dialysis, kidney disease, end stage renal disease L37475 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=37475 A55672 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=55672 [...]

Posting Date: 08/10/2022

Prostate Rectal Spacers

Prostate Rectal Spacers N/A L37485 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=37485 A56539 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=56539 A58100 [...]

Posting Date: 04/19/2021

Multimarker Serum Tests Related to Ovarian Cancer Testing

Multimarker Serum Tests Related to Ovarian Cancer Testing N/A L38371 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=38371 A57020 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=57020 A58112 [...]

Posting Date: 04/19/2021

Varicose Veins of the Lower Extremity, Treatment of

Varicose Veins of the Lower Extremity, Treatment of telangiectasia, spider veins, cosmetic, ligation and stripping, Endovenous radiofrequency ablation, EFRA, laser ablation L33575 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdi[...]