Denials for HCPCS G2211

NCCI editing for HCPCS G2211 code was updated on 12/05/2024 to require HCPCS G0463 as the primary code for G2211 add-on code. This has resulted in denials of claims for the add-code G2211 when billed with CPTs 99202-99205 and 99211-99215. [...]

Top J6 Part B Claim Errors are Available

Top J6 Part B Claim Errors are Available We conduct a comprehensive data analysis on a quarterly basis to update and disseminate the latest insights on the most common claim errors. This initiative provides: Claim Error Reason Code [...]

Coverage Criteria and Frequency Limits

Coverage Criteria and Frequency Limits Table of Contents Counseling to Prevent Tobacco Use Diagnosis Coding Cost Sharing Reimbursement Nonparticipating Providers Related Content [Return to Top] Counseling to Prevent Tobacco Use [...]

Counseling to Prevent Tobacco Use and Tobacco Related Diseases Job Aid

April 2025 EDI Front End Quarterly Release

April 2025 EDI Front End Quarterly Release Please be advised that while the Centers for Medicare & Medicaid Services mandated release for April 2025 was installed the weekend of 4/6/2025, the code set updates included with this release [...]

April 2025 EDI Front End Quarterly Release

April 2025 EDI Front End Quarterly Release Please be advised that while the Centers for Medicare & Medicaid Services mandated release for April 2025 was installed the weekend of 4/6/2025, the code set updates included with this release [...]

Social Security Income Ratios

Social Security Income Ratios The federal fiscal year 2023 SSI ratios for IPPS hospitals, IRF and LTCH were posted on the CMS website. IPPS IRF LTCH NGS will update the latest published 2023 SSI ratios in the Provider Specific File of [...]

55B31

Avoiding/Correcting This Error Review coverage guidelines and patient records to determine if all appropriate documentation was sent for review that may have supported medical necessity.  When you receive an ADR from National Government [...]

59132

Avoiding/Correcting This Error RHCs should not bill codes G0108 or G0109. Related Content CMS Internet-Only Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 9, Section 70.5 - Diabetes Self-Management Training (DSMT) [...]

Standard Companion Guide Trading Partner Information

Standard Companion Guide Trading Partner Information Instructions Related to the X12 275 Claims Attachment Version 6020 and HL7 Consolidated Clinical Document Architecture R2.1 Companion Guide Version Number: 8.0 Revised: April 2025 Preface [...]

U5233

Avoiding/Correcting This Error Verify the admission date, from, and through dates on the claim and compare the dates to the HMO entitlement dates. Verify the admission date, from, and through dates on the claim and compare the dates to the [...]

U5233

Avoiding/Correcting This Error Verify the admission date, from, and through dates on the claim and compare the dates to the HMO entitlement dates. Verify the admission date, from, and through dates on the claim and compare the dates to the [...]

U5220

Avoiding/Correcting This Error Verify the MBI and date(s) of service. If services were provided prior to the date the beneficiary was entitled to Medicare, no further action is necessary. Otherwise, correct and resubmit.

34293

Avoiding/Correcting This Error Review your beneficiary’s enrollment in a Medicare HMO/MAO prior to providing services. A beneficiary may drop MAO coverage; review the CWF, IVR, NGSConnex, or HETS to identify a termination date for the MAO [...]

U538Q

Avoiding/Correcting This Error Medicare does not pay for medical items/services furnished to an alien beneficiary who was not lawfully present in the United States on the date of service that the items/services were furnished. Related Content [...]

U5200

Avoiding/Correcting This Error Part of the eligibility verification process should include ensuring the dates of service fall within the Medicare entitlement period. Use the FISS/DDE Provider Online System or NGSConnex to verify [...]

C7010

Avoiding/Correcting This Error If services are unrelated to hospice stay, resubmit with condition code 07 (treatment of nonterminal illness for hospice patient). Verify hospice enrollment prior to claim submission by reviewing the CWF, the [...]

3/13/2025 Part B POE Advisory Group Meeting

3/13/2025 Part B POE Advisory Group Meeting Meeting Minutes Meeting Time: 10:00 a.m.‒12:00 p.m. ET Member Attendees: Doris Barnes, Aurelia Barraco, Brenda Bedard, Sheila Bembeneck, Madelon Berger, Todd Bergstrom, Kimberly Bischel, Mollie [...]

Meeting Minutes

Meeting Minutes Jurisdiction 6 and Jurisdiction K Combined Meeting 3/13/2025 Meeting 12/12/2024 Meeting 9/18/2024 Meeting 6/12/2024 Meeting

39929

Avoiding/Correcting This Error Verify the line level rejection information to determine the rejection for each of the lines of the claim in question. Resubmit as appropriate. Line level reason code(s) appear on the right view of claim page two [...]

39934

Avoiding/Correcting This Error Review each line level denial reason code(s). Follow the steps provided in that line level reason code narrative. Line level reason code(s) appear on the right view of claim page two (MAP171D). In order to access [...]

39934

Avoiding/Correcting This Error Review each line level denial reason code(s). Follow the steps provided in that line level reason code narrative. Line level reason code(s) appear on the right view of claim page two (MAP171D). In order to access [...]

38312

Avoiding/Correcting This Error If appropriate, correct and resubmit a new claim.   To prevent this error on future claims: Ensure you have received all charges from all departments and that no claim has been submitted for the same DOS [...]

38200

Avoiding/Correcting This Error Always verify the status of a submitted claim before submitting another claim. Verify claim status using the IVR system, FISS/DDE or the NGSConnex online portal. Per CMS mandate, PCC representatives are not [...]

C7010

Avoiding/Correcting This Error If services are unrelated to hospice stay, resubmit with condition code 07 (treatment of nonterminal illness for hospice patient). Verify hospice enrollment prior to claim submission by reviewing the CWF, the [...]

U5210

Avoiding/Correcting This Error Each beneficiary should be screened for eligibility. Part of the eligibility verification process should include ensuring the dates of service fall within the Medicare entitlement period. Use the IVR system, the [...]

U5210

Avoiding/Correcting This Error Each beneficiary should be screened for eligibility. Part of the eligibility verification process should include ensuring the dates of service fall within the Medicare entitlement period. Use the FISS Provider [...]

39929

Avoiding/Correcting This Error Verify the line level rejection information to determine the rejection for each of the lines of the claim in question. Resubmit as appropriate. Line level reason code(s) appear on the right view of claim page two [...]

38312

Avoiding/Correcting This Error If appropriate, correct and resubmit a new claim.   To prevent this error on future claims: Ensure you have received all charges from all departments and that no claim has been submitted for the same DOS [...]

38031

Avoiding/Correcting This Error If appropriate, correct and resubmit a new claim. To prevent this error on future claims, ensure you have received all charges from all departments and that no claim has been submitted for the same DOS and [...]

W7113

Avoiding/Correcting This Error Prevent future similar errors by checking the I/OCE and ICD-10 official guidelines prior to claim submission. Verify the diagnosis codes reported; correct and resubmit. Related Content The I/OCE Quarterly [...]

34963

Avoiding/Correcting This Error Verify billing and, if appropriate correct and return the claim. Online providers should press PF9 to restore the claim. Related Content New Fiscal Intermediary Shared System Consistency Edit to Validate [...]

32078

Avoiding/Correcting This Error Ensure the appropriate revenue code(s) and HCPCS/CPT code(s) are reported on the claim and each claim line contains the correct service date. Verify the information billed and PF9 to resubmit. Related [...]

W7072

Avoiding/Correcting This Error Verify billing and, if appropriate, correct and resubmit the claim for payment. Related Content Centers for Medicare & Medicaid Services Internet-Only Manual Publication 100-04, Medicare Claims Processing [...]

W7089

Avoiding/Correcting This Error Payment for a FQHC encounter requires a medically necessary face-to-face visit. Each FQHC specific payment code (G0466-G0470) must have a corresponding service line with a HCPCS code that describes the qualifying [...]

32404

Verify HCPCS code using the FISS Inquiries HCPCS file (option 14). Allowable HCPCS codes will be displayed based on DOS. Avoiding/Correcting This Error Use the claims correction option to report the appropriate HCPCS/CPT code and resubmit the [...]

32402

Avoiding/Correcting This Error Verify HCPCS code using the FISS DDE Inquiries HCPCS file (option 14) to determine the allowable revenue codes based upon the date of service. Verify billing and, if appropriate, correct the claim using the [...]

N5052

Avoiding/Correcting This Error The beneficiary’s name listed on the claim has to be an exact match to what is posted on CWF. Be sure that any special characters (including apostrophes, dashes, commas) and suffixes (Jr., Sr., III) that are [...]

32243

Avoiding/Correcting This Error Review the claim and either update the charges or remove the line containing zero or blank charges. Return the claim for processing. 

W7089

Avoiding/Correcting This Error Payment for a FQHC encounter requires a medically necessary face-to-face visit. Each FQHC specific payment code (G0466-G0470) must have a corresponding service line with a HCPCS code that describes the qualifying [...]