How do we report unilateral vs. bilateral injections?

Have the payable diagnoses for IVIG and Rituximab changed? I don’t see all of the previously payable diagnoses in the applicable drug local coverage determinations (LCDs) and articles.

When did this go into effect?

Does anti-inflammatory steroid as named in the diagnostic injection mean an injected NSAID or corticosteroid?

If a SIJI is performed and a biological agent is added to the injected will the injection still be covered?

Can SIJIs be performed under sedation? How about monitored anesthesia care (MAC)? Is “twilight” allowed?

Are the radiofrequency ablations allowed now until 3/20/2023, or are already noncovered?

Can chemotherapy be split into two doses on two different dates of service if the patient was unable to complete a full dose in one day? For example, the patient's port was not functioning properly.

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

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

Principal Care Management

Principal Care Management PCM is a model of care focused on patients with a single, high-risk chronic condition expected to last 6 months to 1 year or until the patient’s death and designed to improve health outcomes and reduce complications. [...]

IMPORTANT: Action Required for SNF Due Date of 8/1/2025

IMPORTANT: Action Required for SNF Due Date of 8/1/2025 For those SNFs that have not yet submitted their Form CMS-855A revalidation application or, as applicable, SNF Attachment, this is an important reminder that you must do so by [...]

Interactive Voice Response System Changes Coming Soon

Interactive Voice Response System Changes Coming Soon We’re making changes to our IVR system soon. You’ll still dial the same number, but you’ll hear a new voice. If the IVR doesn't recognize your voice, we recommend you switch to touch tone. [...]

LCD and Billing and Coding Articles Updates

LCD and Billing and Coding Articles Updates Local Coverage Determinations Drugs and Biologicals, Coverage of, for Label and Off-Label Uses (L33394) This LCD was released to Final on 5/29/2025 and will be effective 7/13/2025. The Indications [...]

Chiropractic Billing and Documentation

During this webinar, we will discuss chiropractic coverage, coding guidelines and the importance of documentation in order to support billing for these services.

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 [...]

Preventive Services: Screening for STIs/HIBC to Prevent STIs, Hepatitis B, Hepatitis C Virus and HIV including HIV PrEP

This webinar is the latest in a series of Medicare preventive services webinars. During this session, we’ll review the Medicare coverage, coding and billing guidelines for screening for sexually transmitted infections (STIs)/high intensity [...]

LCD NCD: What are Medical Policy Articles?

LCD NCD: Does NGS offer any other LCD resources?

LCD NCD: How can I view and comment on proposed LCDs?

LCD NCD: How do I find LCDs?

LCD NCD: Can I request a change be made to a current LCD?

LCD NCD: How do I find out if an LCD or medical coverage policy has changed in my jurisdiction?

LCD NCD: How do I search for an LCD if I do not know the LCD number?

LCD NCD: What are the differences between LCDs and NCDs?

PC-ACE: Why am I receiving security rights error/issue when installing PC-ACE?

PC-ACE: How do I correct a web browser error when downloading or making changes to the software?

PC-ACE: How do I determine the version of PC-ACE I am using?

PC-ACE: How often is the PC-ACE software upgraded?

PC-ACE: Is there a resource I can use to assist me with Medicare Secondary Payer (MSP) claims when using PC-ACE?

PC-ACE: Where can I find out more about the PC-ACE free billing software?

EDI: How can I tell if I am set up for electronic billing?

EDI: Is the 277CA returned for each test submission?

EDI: I heard that 5010 requires a physical address in box 33 and P.O. boxes are no longer accepted. Is this true?

EDI: What PTAN should I enter on the EDI enrollment forms if the provider is a member of a group?

EDI: Will you reject claims where the group number and policy number are the same values?

EDI: Will you reject claims with a P.O. Box in the billing provider address?

EDI: How do I restore a remit file?

EDI: How long are Electronic Remittance Advices (ERAs) available in my mailbox?

EDI: What information do I need to have available when calling for Electronic Data Interchange (EDI) assistance?

EDI: I received a payer acknowledgement/acceptance report from my clearinghouse. Does this mean you accepted my claims?

EDI: After I receive a 277CA will I receive anything else?

EDI: Where in the 277 CA file can we find the rejection message that provides the detailed rejection reason description?

EDI: What provider address should I include on the EDI enrollment forms?

EDI: When is a provider authorization form required?

EDI: I received my application back with errors on my Provider Authorization Form. Can I correct it or will I have to complete an entirely new application and authorization form?

EDI: I am receiving the following Claim Status Code and EIC code on my 277CA. What do these codes mean?

EDI: What is an Approved Entity?

EDI: I am receiving the following CSC and EIC code on my 277CA. How do I make the correction?

EDI: I am missing an Electronic Remittance Advice (ERA). How do I order a duplicate?

EDI: What is a Network Service Vendor (NSV)?

EDI: What Entity Name should I enter on the EDI Enrollment Agreement form?

REMITTANCE: How long will I receive paper remittances once I sign up for the electronic remittance advice?

REMITTANCE: Do I need special computer software to use the electronic remittance advice?

REMITTANCE: If I have a computer problem while trying to download my electronic remittance advice, can I have it reposted to download again?

REMITTANCE: Can I post the electronic remittance advice information into my accounts receivable system?

MEDICAL REVIEW: How do I request an appeal on a claim reviewed by the Medical Review Department?

MEDICAL REVIEW: How can I use NGSConnex to respond to Medical Review additional documentation requests?

MEDICAL REVIEW: What mailing address does NGS use to send Medical Review additional documentation requests (ADRs) to providers?