National Provider Identifier Registry

National Provider Identifier Registry The NPI Registry is free and enables providers to search provider National Plan & Provider Enumeration System information. All information produced by the NPI Registry is provided in accordance with [...]

National Uniform Claim Committee

National Uniform Claim Committee The NUCC is a voluntary organization that replaced the Uniform Claim Form Task Force in 1995.  The committee was created to develop a standardized data set for use by the noninstitutional health care [...]

Open Door Forums

Open Door Forums CMS conducts ODFs. The ODF addresses the concerns and issues of providers. Providers may participate via conference call and have the opportunity to express concerns and ask questions. For more information, including signing [...]

P.O. Box Mailing Addresses

P.O. Box Mailing Addresses For the P.O. Box mailing addresses, please visit the Contact Us page on our website. Reviewed 10/21/2024

Patient Protection and Affordable Care Act of 2010

Patient Protection and Affordable Care Act of 2010 ​​​For information related to the HIPAA Privacy and Security Rules, visit the Office for Civil Rights website. The Privacy and Security Rules are available for download, and you will find [...]

Physician Quality Payment Program

Physician Quality Payment Program The MACRA ended the SGR formula for clinician payment under the MPFS and established a quality payment incentive program, the QPP. This program provides clinicians with two ways to participate: through [...]

Provider Contact Center

Provider Contact Center For information about the Provider Contact Center, please visit the Contact Us page on our website.  Reviewed 10/21/2024

Provider Enrollment

Provider Enrollment The Provider Enrollment Customer Service Department has direct telephone lines available for provider enrollment inquiries. Toll-Free Provider Enrollment Numbers Please use the following toll-free provider enrollment [...]

Reconsideration (Second Level of Appeal)

Reconsideration (Second Level of Appeal) A written reconsideration request must be filed with a QIC within 180 days of receipt of the redetermination. When providers receive an unfavorable redetermination, providers shall follow the [...]

Recovery Audit Program

Recovery Audit Program The Recovery Audit Program’s mission is to identify and correct Medicare improper payments through the efficient detection and collection of overpayments made on claims of health care services provided to Medicare [...]

Redetermination (First Level of Appeal)

Redetermination (First Level of Appeal) A redetermination is an examination of a claim by National Government Services personnel who are different from the personnel who made the initial claim determination. The appellant (the provider filing [...]

U.S. Government Printing Office

U.S. Government Printing Office The GPO is responsible for the production and distribution of information products and services including the official publications of Congress, the White House and other federal agencies in digital and print [...]

Washington Publishing Company

Washington Publishing Company Washington Publishing Company, Inc. is a private company categorized under the commercial Printing and Newspaper Publishing Combined company that is an established health care IT and consulting company. WPC [...]

CMS-1500 Claim Form Completion Instructions

CMS-1500 Claim Form Completion Instructions Table of Contents General Information Claim Filing Instructions for Paper and Electronic Submission Regulations on Charging for Claim Form Completion Optical Character Recognition System [...]

55H2B

Avoiding/Correcting This Error Ensure the submitted documentation supports the beneficiary is confined to the home.  An individual shall be considered “confined to the home” (homebound) if the following two criteria are met: Criterion [...]

55H20

Avoiding/Correcting This Error This denial is based on review of a claim that was submitted as a demand bill. The charges on this claim are beneficiary liable. The beneficiary may be billed for these charges.

Submit an Initial Enrollment Application

Table of Contents Step 1: Determine You are in the Right Place Step 2: Complete the Medicare Application Step 3: Submit the Required Documentation Related Content [Return to Top] Step 1: Determine You are in the Right Place The [...]

Submit an Initial Enrollment Application

Table of Contents Step 1: Determine You are in the Right Place Step 2: Complete the Medicare Application Step 3: Submit the Required Documentation Related Content [Return to Top] Step 1: Determine You are in the Right Place The [...]

Submit an Initial Enrollment Application

Table of Contents Step 1: Determine You are in the Right Place Step 2: Complete the Medicare Application Step 3: Submit the Required Documentation Related Content [Return to Top] Step 1: Determine You are in the Right Place The [...]

View Existing Medicare ID (PTAN) in PECOS and Effective/End Dates for Reassignment

View Existing Medicare ID (PTAN) in PECOS and Effective/End Dates for Reassignment Important: If you recently submitted an application to request a PTAN, please verify the approval letter was received prior to submission of claims. Log [...]

Connecticut

Connecticut Member Name Professional Title Association Business Name/Address Email Fitzgerald, Elizabeth Audit and Education Specialist Hartford Healthcare 181 Patricia Genova Drive Newington, CT [...]

General Information

General Information Certain diagnostic services provided by an IDTF are considered for Medicare payment when medically necessary. A referring/treating provider must order all covered services. The treating physician or nonphysician [...]

Performance Standards

Performance Standards If providers are credentialing as an IDTF, then the performance standards shall be reviewed thoroughly before submitting a Medicare application. Refer to the IDTF Performance Standards and Attachment 2 beginning on page [...]

Interpreting Physicians and Personnel (Technicians) Who Perform Tests

IDTF Billing Guide Interpreting Physicians and Personnel (Technicians) Who Perform Tests An IDTF may be either a mobile or stationary/fixed facility. Portable/Mobile Facility There are two types of mobile IDTFs. Each are large [...]

Supervising Physicians

Supervising Physicians Supervision means the imaging is done under the physician’s overall control and direction and the licensed supervising physician is directly overseeing and ensuring the quality of medical care. An IDTF must have one or [...]

Code Level Supervision

Code Level Supervision The supervision level required for diagnostic services is assigned by CMS. A list of diagnostic procedures and the supervision level required for each service is available in the CMS Medicare Physician Fee Schedule [...]

Lung Cancer Screening

Lung Cancer Screening Early detection by screening is an important strategy for patients with a high risk for lung cancer. The LDCT is an additional preventive service benefit under the Medicare program. CMS established NCD for lung cancer [...]

Claim Guidelines

Claim Guidelines The name and NPI of the referring/ordering provider must be in Items 17 and 17b of the CMS-1500 claim form or the EMC equivalent. An IDTF shall not be allowed to bill for any CPT or HCPCS codes that are solely therapeutic. [...]

Electronic Funds Transfer

EFT allows for claim payments to be electronically transferred to your bank in place of a hard copy check mailed to the facility. Medicare payments due a provider or supplier of services may be sent to a bank (or similar financial institution) [...]

Electronic Funds Transfer Form and Instructions

Table of Contents Electronic Funds Transfer Form and Instructions Submitting the EFT Form CMS-588 EFT Completion Tips for Sole Proprietors, Sole Owners, Clinic/Groups, Organizations, Providers and Suppliers [Return to Top] Electronic [...]

Frequently Asked Questions Have Been Reviewed and Updated

Frequently Asked Questions Have Been Reviewed and Updated We’ve reviewed and updated our educational FAQs. Visit our Help and FAQs page located within the Education section of our website. Topics available are: ASCA Appeals CAR T-cell [...]

9/18/2024 Part B POE Advisory Group Meeting

9/18/2024 Part B POE Advisory Group Meeting Meeting Minutes Meeting Time: 10:00 a.m.‒12:00 p.m. ET Member Attendees: Elizabeth Aldrich, Dawson Ballard, Doris Barnes, Aurelia Barraco, Sheila Bembeneck, Madelon Berger, Todd Bergstrom, Louise [...]

Notification of the 2025 Dollar Amount in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge Hearing or Federal District Court Review

Notification of the 2025 Dollar Amount in Controversy Required to Sustain Appeal Rights for an Administrative Law Judge Hearing or Federal District Court Review The amount that must remain in controversy for ALJ hearing requests filed on or [...]

MLN Connects® Newsletter: October 24, 2024

MLN Connects® Newsletter: October 24, 2024 News CMS Roundup (October 18, 2024) Rural Health Clinic & Federally Qualified Health Center: Final CY 2024 Payment Policies Claims, Pricers, & Codes Home Health Consolidated [...]

PECOS Correct and Resubmit Application Instructions

PECOS Correct and Resubmit Application Instructions Login to PECOS and select the following: My Associates View Enrollment for applicable enrollment under Existing Associates Correct and Resubmit for applicable [...]

Supporting Documentation Information

Supporting documentation with the submission of an application is very important. The paper CMS-855A identifies applicable information under section 17. Here’s a list when applicable for initial enrollment, change of information or [...]

Anesthesia Billing Modifiers

Anesthesia Billing Modifiers Table of Contents Physician Anesthesia Modifiers Qualified Nonphysician Anesthetist Modifiers Monitored Anesthesia Care (MAC) MAC Deep Complex Complicated Teaching Physicians Anesthesia Furnished in [...]

Anesthesia

Anesthesia General Anesthesia Information Anesthesia is the administration of a drug or gas to induce partial or complete loss of consciousness. Services involving administration of anesthesia should be reported by the use of the CPT [...]

Concurrent, Medical Direction and Supervision

Concurrent, Medical Direction and Supervision Table of Contents Concurrent Medically Directed Procedures Medical Direction and Temporary Relief Medical Directed Rate Medically Supervised Related Content [Return to Top] [...]

Group/Member Practice Responsibilities

Group/Member Practice Responsibilities Table of Contents Members of a Group More than One Teaching Physician Related Content [Return to Top] Members of a Group If anesthesiologists are in a group practice, one physician member may [...]

Local Coverage Determinations

Local Coverage Determinations General An LCD is a decision by Medicare, whether to cover, and under what circumstances to cover, a particular item or service in our jurisdiction in accordance with Section 1862(a) (1) (A) of the Social [...]

Moderate (Conscious) Sedation

Moderate (Conscious) Sedation Moderate sedation codes 99143‒99150 were deleted and replaced with codes 99151‒99157 in 2017. 99151‒99157: Are not used to report administration of medications for pain control, minimal sedation, deep sedation, [...]

National Coverage Determinations

National Coverage Determinations General Medicare coverage is limited to items and services that are reasonable and necessary for the diagnosis or treatment of an illness or injury (and within the scope of a Medicare benefit category). NCDs [...]

Teaching Anesthesiology Services

Teaching Anesthesiology Services Table of Contents Teaching Anesthesiology Services Anesthesia Services and Teaching CRNA Physician Personally Performed and Personally Performed with CRNA and AA Related Content [Return to Top] [...]

Resources and References

Resources and References Anesthesia Guidelines and Regulations CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 12 Section 50 CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 10 CMS [...]

Anesthesia Billing Codes

Anesthesia Billing Codes Table of Contents Anesthesia Not Otherwise Classified Codes Add-On Codes for Anesthesia Related Content [Return to Top] Anesthesia Body Area CPT Codes Head 00100‒00222 [...]

Daily Management and Pain Management

Daily Management and Pain Management Table of Contents Daily Management of Continuous Pain Control Techniques Pain Management Consultations Postoperative Pain Control Procedures [Return to Top] Daily Management of Continuous [...]

Monitoring Anesthesia Services

Monitoring Anesthesia Services Monitored Anesthesia Monitored anesthesia care involves intraoperative monitoring by a physician or qualified individual under the medical direction of a physician or of the patient’s vital physiological signs [...]

Payment and Reimbursement

Payment and Reimbursement Table of Contents Anesthesia Claim Billing Instructions Multiple Anesthesia Procedures Multiple CRNAs Same Procedure Payment at Personally Performed Rate Payment at Medically Directed Rate Payment at [...]

Provider Qualifications

Provider Qualifications Table of Contents General State Licensing Physician – Anesthesiologist (Specialty 05) Medical and Surgical Services Performed with Anesthesia by an Anesthesiologist Qualified Nonphysician Anesthetists [...]

National Government Services Guide for New Providers

National Government Services Guide for New Providers

National Government Services Guide for New Providers

National Government Services Guide for New Providers

A/B DME MAC Collaborative Lower Limb Orthoses Webinar

A/B DME MAC Collaborative Lower Limb Orthoses Webinar This is your opportunity to hear directly from the Medicare contractors regarding Medicare’s criteria necessary for the coverage of lower limb orthoses. Representatives from all four DME [...]

Cervical Fusion with Disc Removal Best Practices

Cervical Fusion with Disc Removal Best Practices Table of Contents Introduction Coverage General Documentation Requirements Medical Necessity Criteria for Each Indication Limitations and Exceptions to Conservative Therapy [Return to [...]

Home Health Billing

Avoiding Reason Code 38200

CR 9189 Transmittal 602: Medical Review of Home Health Services

Contractor Advisory Committee

Assist National Government Services in the Development of Local Coverage Determinations Background CMS released Change Request 10901 and the companion MLN® Matters MM10901: Local Coverage Determinations (LCDs) article to expand the parameters [...]