What is the requirements for diagnostic injections? Are two required?

Do we use the same billing guideline for 64550 and 20551?

Can the patient can have two diagnostic SIJI and then four therapeutic SIJI within a 12-month rolling period for a total of six per year?

There is a contrast shortage. Use may not be an option.

When billing for waste on a single use vial would you round units up or down for a half unit?

What is the proper way to submit professional physician claim with multiple NDC numbers for the same drug code?

J3357, Ustekinumab (Stelara) is listed on the Self-Administered Drug Exclusion List: Medical Policy Article A53021, and it says “acceptable”. Does this mean it is excluded or not?

When billing an unclassified drug code such as J3490, are the units of service on the claim always equal to one?

If using steroid during diagnostic is that when the 12-month clock start?

Does Medicare Part B make payment for the unused portion of a multi-dose vial of a drug/biological?

Is the GY modifier required on the drug code and the administration code for noncovered self-administered drugs?

What is the correct way to bill an unlisted drug or biological?

How do I bill a bilateral joint injection and HCPCS J1040 for two units?

Why is radiofrequency ablation (RFA) noncovered?

Is the shingles vaccine covered by Medicare?

Does the waste with the JW modifier appended always go on the second line regardless of the billed amount? For example, the billed amount for the waste is higher than the administered amount.

It does not make sense to use steroids during a diagnostic injection. Please explain.

What is the time period between a therapeutic injection and repeat diagnostic, if the therapeutic injection has not been performed for an extended period? At this point, does diagnostic need to be repeated?

Don't use G0260 only applies to POS 49? So, regardless of facility type, G0260 no longer needs to be used? And Is G0260 still fine to bill for an ASC or will they now just have 27096 for facility & should be billed with POS 24 and bill G0260 for our SIJI on the facility side?

Can sacroiliac joint injections be performed bilaterally?

We are in a group of eight physicians. What if the patient saw a different physician in clinic and a different physician is doing injection. Is that okay?

For patients who are already receiving treatment do they need to repeat diagnostic procedures under the new policy?

What should be done if patient does not want to continue conservative treatment?

If SIJ is injected on right and then determined to inject the left side in another session does that count as bilateral?

When does a pain scale or functional assessment need to be done?

We receive referrals for an injection with detailed chart notes, does our provider need to see and examine the patient again?

Do we use the KX modifier on facility charges for the ASC?

Will there be a minimal amount of time between SI joint steroid injections?

Can CRNAs perform these procedures?

Do all established drug HCPCS codes require the dosage amount in its description on the claim?

Can Medicare Part B providers who bill on the professional CMS-1500 claim form, and electronic equivalent, bill unclassified drug code C9399?

Are unclassified drug codes included in average sales price (ASP) files?

Prior Authorization: Hospital Outpatient Department and Exemption Process

Join us for this general webinar about Prior Authorization for certain Hospital Outpatient Department (OPD) services. This webinar will have a non-clinical focus with emphasis on general requirements as listed in the OPD Operational Guide.

CAH, FQHC and RHC Quarterly Top Claim Errors

Do you struggle with your claim denials, rejections and return to provider (RTP) claims? Do you want to be proactive in preventing unnecessary errors? Join us in a review of top claim errors for your provider type based on recent data analysis [...]

CLAIMS: During the patient check in process, may we have the patient check a box on a form at each visit stating they agree to allow us to bill Medicare and have that serve as the patient’s acceptance for our filing a claim?

CLAIMS: Why would my postoperative claims deny?

CLAIMS: How do I know if a HCPCS/CPT code is subject to MUE (medically unlikely edit)?

CLAIMS: Where are comments entered on the 837P electronic claim form?

CLAIMS: Medicare is the beneficiary's secondary payer and I am receiving denials when submitting using the CMS-1500 form. How can I resolve this?

CLAIMS: When submitting an ambulance claim, do the base and mileage codes need to have the same ZIP code for the same trip?

CLAIMS: I file all my Medicare claims electronically except for Medicare Secondary Payer (MSP) claims because I thought I had to attach the primary Explanation of Benefits (EOB). Is this the correct process?

CLAIMS: How do I prevent monthly End Stage Renal Disease claims from denying?

CLAIMS: What is the correct way to submit a beneficiary name on a claim?

CLAIMS: I am receiving inconsistent payments on claims billed for the same drug. How can I prevent this?

CLAIMS: How do I submit documentation for an additional development request (ADR)?

CLAIMS: On a screening Pap smear test claim, which pointer does my diagnosis code need to be in?

MLN Connects® Newsletter: July 15, 2025

MLN Connects® Newsletter: July 15, 2025 CMS Proposes Physician Payment Rule to Significantly Cut Spending Waste, Enhance Quality Measures, and Improve Chronic Disease Management for People with Medicare Posted 7/15/2025

[RESOLVED] NGSConnex and IVR Experiencing Outages

[RESOLVED] NGSConnex and IVR Experiencing Outages We were experiencing outages with our web portal, NGSConnex and the IVR System. Part B providers were unable to check claim status, appeal status or submit appeal and reopening requests via [...]

Modifier 22 Supporting Documentation for Part B claims

Modifier 22 Supporting Documentation for Part B claims The Centers for Medicare & Medicaid Services, Internet-Only-Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Section 40.2.10 Unusual Circumstances states: [...]

APPEALS: What is the appeal process?

APPEALS: How would one submit a paper appeal?

CAR-T: Will the Part A claim for CAR-T deny if it is submitted with the KX modifier?

CAR-T: What is the effective date for the requirement of the KX modifier for administration of CAR-T?

CAR-T: Is the KX modifier required for Part A and Part B claims?

CAR-T: Is Risk Evaluation and Mitigation Strategy (REMS) verified by the facility’s site name or address?

Home Health Top Claim Errors

Do you see the same rejections and return to providers over and over? Do you know how to correct the most common errors and more importantly how to avoid them in the future? In this session we’ll review the most common reason codes assigned to [...]

MEDICAL REVIEW: How do I sign up for the CMS and NGS Listserv messages?

MEDICAL REVIEW: I’m appealing my claim but received a letter to recoup funds from the TPE denial. What do I do about these letters?

MEDICAL REVIEW: My claim was reopened or adjusted by Medical Review. Does this impact the appeal window?

MEDICAL REVIEW: How do I change my address and which address exactly am I changing to ensure receipt of the MR letters and ADRs?